Warning Signs

leslie :-D · Aug 30, 2008

What are some warning signs you see before a pt goes south on you? (other than change in VS, respiratory issues/lung sounds, mottling, etc)

sometimes you'll care for a seemingly dying pt, only to see them rally again...

eating, wounds miraculously healing, color restored, ms sharp, etc.

and then they die.

those signs always kill me (as well as the pt):chuckle

leslie

BelleKat, BSN, RN · Aug 30, 2008

Sometimes they tell you. BELIEVE THEM!!

I've had pts say,"I feel like something bad is going to happen.... or I don't feel like I'm going to make it". Something like that. Watch them closely.

Bumashes, MSN, APRN, NP · Aug 30, 2008

Ummm, some other signs to watch for would be anxiety and anxiousness. Change in level of consciousness. Maybe they start talking out of their heads or get disoriented easily all of a sudden. Change in skin temp (either hot OR cold.) They may have crappy urine output, especially on post-surgical patients, like

I'm sure others with more experience than me will write in with some good ones.

Jo Dirt · Aug 30, 2008

Mottling of the lower extremities, pooling of blood on backs of legs and buttocks are dead give-a-ways.

Dixielee, BSN, RN · Aug 30, 2008

Sometimes they tell you. BELIEVE THEM!!
I've had pts say,"I feel like something bad is going to happen.... or I don't feel like I'm going to make it". Something like that. Watch them closely.

Yep, that is a big one! Never blow it off and tell them they are going to be "just fine". Investigate further and watch them like a hawk. 9 times out of ten, they are right and there is nothing you can do to stop it.

I had one guy, 42 year old who came in by EMS for chest pain, no pain at present, good spirits, vitals rock stable. He has just gotten onto the ER cot and EMS was rolling out of the room. The patient calmly said, "Bye bye guys", (we assumed he meant to the EMS folks), then slumped over, was in v-fib and we never even got a trace of a rhythm back. So, he really did mean, "Bye Bye".

Rnandsoccermom · Aug 30, 2008

Ummm, some other signs to watch for would be anxiety and anxiousness. Change in level of consciousness. Maybe they start talking out of their heads or get disoriented easily all of a sudden. Change in skin temp (either hot OR cold.) They may have crappy urine output, especially on post-surgical patients, like
I'm sure others with more experience than me will write in with some good ones.

I second all of these. Also would like to add restlessness, SOB and sweating for no apparent reason.

nerdtonurse?, BSN, RN · Aug 30, 2008

I second (or third or whatever) the "getting better enough to die" things....like suddenly improved BP, HR, respirations, suddenly more A/O than they have been in a long time, etc. Someone says, "Mom's more at herself than she's been in years" -- look out.

One thing I notice is the "coolin' and poolin'" in my folks with resp/cardiac/renal failure. When that cold gets from the feet up to their abdomen, you're going to be calling the cadaver transporter soon.

I've also seen a lot of head thrown back, mouth breathing from resp. pts.

In alzheimer's, I see a lot of reaching and grabbing motions. Maybe it's an echo to that earliest motor behavior an infant has...don't know.

But the most telling one for me is when people start "seeing" their dead spouse, dead parents, etc. Don't know whether they are seeing the person's spirit or if it's the pt's brain trying to comfort their soul by showing them "movies" of their deceased loved ones, but when they start saying, "my husband's standing at the foot of the bed, he wants me to go with him...." in a pt that's been A/O -- they're getting ready to go.

FroggyMama · Aug 31, 2008

But the most telling one for me is when people start "seeing" their dead spouse, dead parents, etc. Don't know whether they are seeing the person's spirit or if it's the pt's brain trying to comfort their soul by showing them "movies" of their deceased loved ones, but when they start saying, "my husband's standing at the foot of the bed, he wants me to go with him...." in a pt that's been A/O -- they're getting ready to go.

This is a big one. When 90-somethings start talking to "Mama" or "Daddy", you better watch out! And if they say, "I just want to die!", believe them.

Pepper The Cat, BSN, RN · Aug 31, 2008

This may sound weird - but I just a really bad vibe off the person. I also get a real urgent need to check on them, even if I've seen them 10 mintues before.

icyounurse, BSN, RN · Aug 31, 2008

Yep, that is a big one! Never blow it off and tell them they are going to be "just fine". Investigate further and watch them like a hawk. 9 times out of ten, they are right and there is nothing you can do to stop it.
I had one guy, 42 year old who came in by EMS for chest pain, no pain at present, good spirits, vitals rock stable. He has just gotten onto the ER cot and EMS was rolling out of the room. The patient calmly said, "Bye bye guys", (we assumed he meant to the EMS folks), then slumped over, was in v-fib and we never even got a trace of a rhythm back. So, he really did mean, "Bye Bye".

Yeah that is always something to take REALLY seriously when a patient tells you they are going to die, even if they look fine.

When I was a new nurse, we had this guy come into ICU. He was young, alert and oriented, vitals fine, diagnosis PE. It looked as though it was resolving. He was very pleasant and joking with us about football teams and such. And he said he just felt like he was going to die and the feeling wouldnt go away and wanted us to promise he wouldnt die.

About 2 hours later out of nowhere his head turned dark purple from the shoulders up and of course he went unresponsive, O2 sat 50's..............

We coded immediately and he didnt make it.Massive pulmonary emboli. the nurse who cared for him was devastated. It was pretty spooky.

Jo Dirt · Aug 31, 2008

This is a big one. When 90-somethings start talking to "Mama" or "Daddy", you better watch out! And if they say, "I just want to die!", believe them.

A couple of hours before my 83 year old father-in-law (permanently) lost consciousness from a head injury from a fall, he was yelling "Mommy! Georgie!" (Mommy had been gone 20 yrs., George was his brother who was deceased).

Since he had been suffering from dementia for some time I didn't really think a lot of it, but I do know that was the first time I heard him yell out for his mother and brother like that. He died in hospice a few days later.