Too little too late

Nurses General Nursing

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Hi everyone! I am in need of some encouragement here. I've only been a nurse for about a year and so I feel stupid like I missed something and can't forgive myself. On my first night working this week, I had an older adult female (patient A) 61y.o. that was assigned to me. The day shift nurse told me that the patient was somewhat confused at times (alert to person and place most of the time but couldn't tell you the date), and that she could walk to the bedside commode with assistance, but that she was a big lady and really needed persuading to get her out of bed instead of using the bedpan like she prefers. She had a colon resection the day before and did have SCDs and TEDs on. Upon entering the room at the beginning of the night, the lady demanded (not asked) that she have some Ativan because she was feeling very anxious, so, after assisted her up to the BSC and back to bed, I gave her 1mg to help her anxiety. Anyways, as the night progressed, the lady tossed and turned in bed, and tried to get up a few times unassisted so I put her bed alarm on and continued to check on her frequently throughout the night (at least one to two times an hour). I checked her vitals around 0400 and I had a little difficulty obtaining her bp, but that's no surprise because our vital machines malfunction frequently (old pieces of crap), so I got her vitals manually and didn't note anything unusual for her. I gave her bath around 0600, and checked on her again around 0650 She made it fine until the end of my shift and after I had passed off report at 0700 and got ready to leave, a nurse tech went to go check on her and do the morning vitals and found patient A unresponsive and blue. After calling a code, we tried to resuscitate her and managed to long enough to get her down to ICU where they put her on a vent. When they did a CT scan they found that she is severely brain damaged due to hypoxia and her family decided to remove life support. Now, it's been three days since this event and I keep replaying events in my mind over and over, trying to figure out what I missed. I had just thought that the lady's agitation was related to possible sun-downers or that she had reacted strangely to the Ativan. Now maybe I think she was in distress and I didn't even notice. I feel so stupid and inadequate. The doctors said that they think that she may have had a PE and said that there was not much I would have been able to do anyways, but I still feel terrible. The family came up to our floor and thanked us for trying our hardest to save her. I just keep thinking wouldh've/couldh've/shouldh've and it's hard for me to let it go. :crying2: Now I'm scared to go back to work for fear that I'll miss something again.

Specializes in Tele, Med-Surg, MICU.

Don't beat yourself up. I'm assuming that here SpO2 was fine, which is one of the first things you check with increased confusion. It sounds like you provided excellent care.

In the ICU, patients do die suddenly of PE's, often with few s/s... their heart, SpO2, and respirations are constantly monitored and they just suddenly code, and many times there is nothing that can be done.

Take away from this the importance of DVT prophylaxis, the heparin, lovenox, SCD's, and getting patients out of bed, into a chair, ambulating them. It's all theoretical and just another task until you witness the worse case scenario.

Specializes in hopeful ER/Surg.

Thank you all so much- I learn a lot from reading these!

Edited...reread.

Meg, she was not in any cardiovascular or respiratory distress when you assessed her before and after so you did everything right. My question is, when you bathe her did she expressed that something didn't feel right or her behavior seemed unusual besides demanding the Ativan? Nobody is perfect and nursing is a source of constant learning. Like you, I beat myself up whenever I think about the should'ves. That means that you do have great compassion for your patients and you take your job as a nurse seriously. Most importantly, you care.

"The hallmark of a good nurse", I suppose?

Please don't say this, I beg of you. We are taking care of human lives so we darn better take our jobs seriously!

I agree with the advice given, but watch out posting things like this, if her family decides to sue for some reason, they will look on social websites for information and any doubt on your part that is expressed can be used against.

Specializes in Ambulatory Care, Case Manager.
"The hallmark of a good nurse", I suppose?

Please don't say this, I beg of you. We are taking care of human lives so we darn better take our jobs seriously!

I say this, because there are some nurses who don't take their jobs seriously. I was paired up with some of those type of nurses when I did my clinicals. There are nurses who unfortunately just don't care about their patients.

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