student nurse and older woman with end-stage CHF - page 2
Well I want to tell you a little story about a friend of mine from nursing school ... she had a patient, an older woman with end-stage CHF, I believe, who was on complete fluid restrictions. Well,... Read More
Jul 18, '04Occupation: Still deciding - practicum in NICU, interviewing for ICU Joined: Jun '04; Posts: 8Thanks, Bluesky and everyone else for the validation. I learned so much from that one experience. She was 98 with no family and was brought in from a nursing home after an MI. She came in on a Tuesday, I was there Wednesday and Friday. I volunteered to take care of her because she was irritating the nurses on staff (they were calling her "their screamer"). When I arrived they were moving her from a room near the nurses station to one at the end of the hall.
She was scared. She had one friend visit who was giving her water with a pink spongey. She was diagnosed with heart failure and pneumonia, and was on IV antibiotics (although, judging by the sound of her lungs and the fill and clear pattern, I think it was really CHF). She was NPO because they were worried about aspiration. She was screaming for water. I didn't really expect her to be there on Friday, since the docs had been clear with her friend that it wouldn't be long. I asked the nurse why she wasn't in hospice. She thought it was an issue of filling beds (this was a med surg unit). I asked the doc the same question and he said that, if she was still here by Saturday, they'd move her.
When I returned on Friday, she was very uncomfortable and fighting. She was still NPO, off the atibiotics with no IV fluids. A nurse assistant was very upset about her, and I decided to work hard at making this day the best it could be for her. The first thing we did was get her a soft care mattress. Next, I challenged the NPO and they ordered a swallow test. She passed that (and to show her spunk, she was so irritated by the repeated test that she finally yelled at the speech therapist "I'm dying, I'm an old lady, leave me alone!"). We got her some pureed food for lunch and, after questioning the lack of IV fluids the doc ordered an IV. He said to give her whatever she wanted.
So the rest of the day was spent holding her hand, feeding her, giving her sips of water and generally trying to make her comfortable. She passed away on Saturday.
This experience was profound for me. It was the first time I had considered hospice as an option for my nursing career. It also became clear to me that I could not do med surg. Those nurses are amazing in their ability to multi-task, but it was clear that they were overwhelmed and it would eat me alive to have a patient like that one be one of six I was expected to care for.
And as Bluesky has been so wonderful to point out to me in my moments (hours, days) of self doubt, this is what nursing is all about. Not to mention Mom and Nurse's wonderful reinforcement. I've made some great friends in nursing school.
It's good to hear nurses with so much experience reinforcing that the patient advocate is a huge part of what we are, and it's good to believe that my altruism is not ignorance but might be workable in my future as a nurse.
I start adult ICU training at the end of August. I'd appreciate it if you'd all remember me in your prayers -
Jul 18, '04Occupation: Nurse Practitioner Specialty: Acute rehab/geriatrics/cardiac rehab ; From: US ; Joined: Nov '03; Posts: 647; Likes: 128GR8FUL - Thanks for sharing ....You'll make a wonderful ICU nurse... Oh and by the way...welcome to allnurses!!