Hi, I need some expert advise. First, I am 50yrs old, and have been a nurse for only 21/2 years, with almost all of that in ICU/MSU. Ok, I had a 63 y/o woman as a patient the other night. She came to us because she was getting a CT scan and respiratory arrested. They did not intubate her at the time, just brought her back with a sternal rub and CPAP. For me she was A/O x 3, good sats on the CPAP. BP was in the 80's sys when I came on shift, but the previous nurse said she just gave her dilaudid. The woman seemed ill, but not critical. Chest xray showed endstage fibrosis in her lungs. She had the barrel chest going on. Anyway, her pressure did not recover enough for me, so I called the doc, and we bolused her with NSS. I put her in slight Trendelnberg. BP came up to high 80's with a MAP of 60. I felt a little better. Toward morning, her K came back at 6.4. Again I called the doc, and got K exulate ordered. By the time I left at 7am, the K exulalte hadn't arrived, but I made sure the new nurse new to watch for it. Well, I come in the next night and ask where this paitent was, and they said she died about 9 in the morning!! I guess her breathing got worse,so they finally tubed her, and when the nurse was trying to find pulses with the doppler, she bradyied down to asysole! They tried everything, but never got her back into a rythym of any kind. I felt so bad. It left me wondering if I missed something. Everyone assured me I did all I was supposed to, it just happened. What could have happened?
As I read all these good responses, I agree with most of them, I can't help but tell you that sometimes these things just happen. Even though she was a fairly young patient, you said yourself that she was end stage pulm fibrosis. With that in mind, and the fact that she was in respiratory distress,,, even if you all managed to save her life that day, it would have been a matter of days or weeks before she would have died anyway.
She was a very sick patient, and when you have multiple serious medical problems like these, they tend to make everything worse. The lungs damaged the heart, the bad circulation from the heart damaged the kidneys, the damaged kidneys messed up the electrolytes, the messed up electrolytes probably stopped the heart.
But,, you did your job,, you might have been able to get that kayexelate in faster, but would that have worked? I don't know, she sounded pretty sick to me. As long as you diligently call the doctor with updated progress reports, and follow his orders,, you did your job. Don't feel bad,, these things happen in ICU.
Specializes in Not too many areas I haven't dipped into.
I think we have all walked out at the end of the shift beating ourselves up and blaming ourselves...nit picking every thing we did when it really isn't appropriate. We do the best we can with what we have to work with and as long as you did your best and the doctors were doing their best, unfortunately, some people just don't make it.
Yeah, there could have been other interventions...yeah, maybe something could have been done differently....but I think you can say this about every case...even the ones that turn out positively!
((HUGS)))
You have chosen a hard profession and I applaud you for posting and putting yourself out there in such a vulnerable position.
Were ABGs drawn? If she was already at a K of 6.4 and became acidotic, her K could quickly become life-threatening. I agree with those who said that something faster than kayexalate should have been ordered--insulin + D50. Calcium doesn't drop potassium level, it helps to prevent the arrhythmias caused by hyperkalemia.
GooeyRN, ADN, BSN, CNA, LPN, RN
1,553 Posts
Not your fault.