Rough night as a new RN in ICU please HELP!

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Specializes in ICU.

Hi all,

Last night I had a DKA/ ETOH Pancreatitis patient. Both new onset in the ICU. His pH was 7.14-7.16 all night, I cant even count on both hands the amps of Bicarb I pushed. All his electrolyes were out of balance, mainly calcium which was in the 6.2-6.7 range. Well, he also developed acute renal failure and we started him on CVVHD.

This morning at 6am he went into SVT in the 180's and sustained even after 6 and 12 of Adenosine, Cardioversion X 3. He was given a cardizem bolus and started on a drip which brought his rate to 140's. He was also started on Neo for systolic of 80's. And so, I left at 0930 this morning feeling like a complete failure.

Can anyone help me through this? I know that being that acidotic and with basically all his systems failing he wont possibly still be alive when I come back on Thursday.. So, if anyone has any advice, it would be great. Thanks.

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Specializes in MICU/SICU.

Seems to me like he was awfully sick when you picked him up, and that you did everything in your power to do. Sadly, some things are just out of our hands. :cry:

I'm a new RN in the ICU too, and I feel your stress! Hang in there!

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Specializes in MICU/SICU.

Where do you feel that you "failed", in treating this patient, with all the illnesses you detailed - any one of which (eTOH withdrawal, DKA, Pancreatitis) can be fatal on it's own, let alone cocktailed together...you treated him, where's the failure? keep your chin up - you did lots!

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Specializes in Critical care, neuroscience, telemetry,.

Hell, you didn't fail. That guy was a metabolic nightmare. My guess is that with the CVVHD and correction of his DKA that he will probably live to be admitted another time.

Good nursing care doesn't necessarily correlate with the overall condition of the patient at shift change. Bluntly put: Do all the right things and some patients will die anyway. The corollary to this is that sometimes we screw up royally and the patient emerges unscathed and actually a little better. Damned if I understand it.

Some gentle, heartfelt advice here: Please don't do like I did and spend the first 10 years of your nursing career thinking that every negative outcome is your fault. You may have to own a few along the way - most of us do - but, by and large, the outcome depends on the patient. The patient you took care of has no doubt been drinking for a long time and no amount of nursing care (or, I suspect, medicine) is going to reverse the damage and make him whole. That he had a pulse when you left him is testament alone to your nursing skills as there are probably folks who wouldn't have realized how sick he was or wouldn't have acted so aggressively. The fact that you were there two hours after shift change indicates that you worked your tail off to save his **** poor protoplasm and actually suceeded. Kudos to you. :yeah:

Enjoy your day off and keep us posted.

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Specializes in SICU, MICU, CICU, NeuroICU.

You did everything except fail. As a patient advocate, the best thing you did was keep the patient alive (which happens to be the most important). Don't think you failed. You did everything in your power to help the patient and that's what nurses do.

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Specializes in SICU, L&D, MCC, Tele.

You sound like you did great--that was a heavy pt. Every new nurse feels the way you do--when I was a new new on the way home in the morning I would thank god I didn't kill anyone and on the way in I would pray everyone was still alive!!! Now I really like having the type of pt you had--I feel challenged. I remember the first time I ever push cardizem--although i was concerned for the pt--I was amazed --watching their heart stop for a few seconds (my pt converted on cardizem alone). Your pt was very unstable--and you sound like you performed well!!:yeah:

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Specializes in ICU/Critical Care.

I think you did what you could. I've only been in SICU for a little over a year now and some nights are cake and others are night. Last week I had a shift from hell, one patient who was post-extubation was hypoxic and in respiratory distress, the other was hypotensive. All at the same time. The patient in respiratory distress ended up on bipap for most of the night until the docs finally decided to reintubate at 6am. My other patient was fine after a bolus and some albumin. I think you did a great job. Don't feel like a failure. Nursing is a 24hr/day job.

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Specializes in Critical Care.

Some (hopeful) humor:

From the great novel The House of God: "The patient is the one with the disease."

Meaning sometimes they live because of what we do, and sometimes they live in spite of what we do.

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Specializes in Critical Care.

I agree with all the other posters, he abused his body, and doctors and nurses have to try and fix him. It is very frustrating sometimes. You did a great job!

Sometimes I am oh so happy to just tiptoe out of my shift with my patient hanging by a thread after doing everything possible.

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