When everything could go wrong...it did

[blessedmomma247]

I have been in this field for almost 11yrs now...10yrs as an aide and barely over a year as a nurse. I a lot of hands on experience when an older client is in their final hours. You name it, I have seen it. Today..tops them all and I just need to vent!!

Well, this morning, I arrived at work and during report, it was noted that one of my clients was now on comfort cares and that my client was pretty much non-responsive. After report, I did my walking rounds. (This is my routine, my facility does not have a policy on walking rounds. But I learned a very important lesson at one place, when I found a pt that had passed during the night and apparently gone unnoticed...) During my walking rounds, I also do several simple dressing changes and quick assessments. My client that was on comfort care was my first priority and I knew immediatly that my client wasnt going to make it thru my shift. I obtained a quick set of vitals and make sure my client was comfortable. I started my med pass and going thru my morning routine ect. At first, with the exception of my client on comfort cares, it was a pretty routine morning. Then I had a fall.... An aide was walking by a client's room, and noticed feet sticking out from the side of the bed and went to investigate and discovered the client on the floor. The aide ran and got me and when I walked in the room, my stomach hit the floor. Here was my 95lb little tiny client laying on the floor, bleeding from the head and trying to get up. Long story short...a good size lac on the side of the head and x-rays were still pending on the right hip when I left. Thankfully, the lac only needed steri strips but the client's right side of the face was already bruising..and even though the client denied any pain during ROM of the hip..I requested an x-ray anyway...just to be sure.

After I made sure my client okay, doc notified and family notified (thank goodness for cordless phones..I wasnt stuck at the desk!!!), I did a quick check on my comfort care client. I then noticed that the client's lungs were starting to fill up and I really did not want to suction my client at this point, the less invasive the better. Sooo, I called Hospice and got an order for Atropine plus an increase of the PRN pain med and requested a hold on all meds except for comfort...pain, fever, O2, anxiety..etc... and then I medicated my client. I then resumed my med pass and was able to finish it 45mins late. Not to bad considering. I sat down at the desk to work on some MD orders and charting. I was only there for about 10 mins when an aide came up to me and said that they found another client on the floor. :eek: Seriously???? So, I got up and went to exam the client who fell this time. Thankfully, there were no apparent injuries. BUT, since the client was found on the floor, and the client isnt able to tell me if they hit their head or not, I had to start Neuro's. So now I have two post falls w/ Neuro's and a client who most likely wont make it to the end of my shift and its only 10:30 am. Needless to say, my noon med pass was also behind schedule. And one of my AAOx3 clients blew a gasket because I was 45mins late with their meds. Well to them I was...I still had 15mins legally to give my client their med. So I had to note the client's behavior, give a a PRN and call the family... So now, most of my clients are returning from lunch and I am catching them as they go by to give them their meds. One of my clients stated they didnt feel very well, c/o dizziness, headache, nausa...so I grabbed a quick set of vitals and they were WNL...denied pain but kept saying they just didnt feel right.(Thinking stroke..but not sure) I hate it when they say that because its never good and you have no idea how to make them feel better. This client is AAOx3 as well and it bothered me that something was wrong yet didnt know what. I asked an aide to help my client into bed. As soon as my med pass was done...a whole 20mins later..I went to go check on my client and would you know...my client passed!!! So here I am trying to figure out what in the world just happen because this client was literally just talking to me and now was gone!! This client was going home next week!! As I am hanging up the phone with the family, one of my aides came up and told me that the client on comfort cares "didnt look right". So I march my way down the hall and as I walked into the room, I noticed how my client was breathing and I knew it was just a matter of minutes. There was no family around, so I pulled the curtain and sat down in the chair next to the bed and held the client's hand and prayed with them until it was over. During that time, it didnt matter to me if I was behind on my paperwork or not, if another client was upset because I was with them at that same moment. The only thing that matter was that someone was with this client at that particular moment. It was so moving and peaceful.

So despite that by 2pm, I had two falls and two deaths, I didnt feel overwhelmed. I felt like the nurse that I worked so hard to be. All of my clients...all 29 of them...recieved the best care I could give them today, but I was very glad to see the on coming nurse!!

[nurse12b]

Now that is a day that I would not want again... Did they find out what happened to the one pt?

[RescueNinja]

Yikes! Glad you came out smiling!! Kudos to you for caring enough to make your palliative client's last few moments on earth special.

[momandstudent]

Thank you for the dedication that you put forth today (which, by the sounds of it, would be an everyday occurance for you). I am so sorry that you had so much to deal with today but you were a very important part to many patients today. Thank you for being a great nurse and may you find peaceful days ahead-you deserve it!

[arabianeyez83]

The pt that was talking to you then a few minutes later died, you guys didnt code him or anything? Was he DNR?

[GaLara]

You sound like an amazing nurse. I'm just starting Nursing school this fall and I hope to have the composure in a crisis that you seem to!

[kool-aide, RN]

That sounds like a VERY eventful day at work! I don't know about you, but I kinda like it when my shift is a little hectic. It makes the time fly by and in a situation like that, it would make me feel great knowing I did everything I could to help my patients. Just curious, what part of the country are you located? I have never heard anyone say "clients" in a healthcare setting. Sounds like that shift was your sink-or-swim moment; congrats on swimming!

[Forever Sunshine, ASN, RN]

If I was your on-coming nurse please call me in early.

No nurse should have to go through all of that in one shift. Did you at least have a supervisor to help you?

[wooh, BSN, RN]

Wow, I've had busy days, and while I have had 2 patients fall during a shift, I've never had more than one patient die on me in a shift!

I applaud you on keeping it together!

[carolmaccas66, BSN, RN]

You are an absolute legend.

It was great you spent time with your dying patient. I know a nurse who did this with a client who passed away after 30 minutes or so, and she actually got told off for spending too much time with this poor little old lady who had no family, & was terrified of dying on her own.

My friend resigned the next day. So much for compassion from nurses!

I hope next time you tell your shift coordinator how hard you work.

[blessedmomma247]

The pt who died suddenly was a full code, but at my facility if the client is found not breathing, no heartbeat and has clearly passed...we do not start the code. Its still a grey area for me bc I am new to this place and I am not used to that..a full code means you start CPR when you find a client that way..I have done CPR on a client who had clearly passed..the client was cold and gray. But nope, charge nurse said the client was a full code..so we started and didnt stop until EMS arrived and looked as us like we were nuts for trying to raise the dead. As far as my client yesterday, it was that person spoke to me, the aide assisted them to bed and they closed their eyes and that was it. I am not sure what happen but since they had a fall in the last six months, I had to call the corner office and they had to remove my client. Not sure if they will do an autopsy, think that is up to the family. I think my client had a massive stroke; that is why my client was there in the first place after suffering a stroke in May.

As far as calling my pts "clients", it was just pounded in head in nursing school and I quess I cant let it go. And as far as help yesterday..well on the weekend, we do not have a nurse manager or supervisor. I do have a RN who is on call and there 4 other LPNs in the building at the same time. I did call the on call nurse only to let her know of the incidents and to make sure I had done everything paperwork wise. I have learned that 99% of the time, its you and you alone. Thank God I had an awesome team of aides...we work great together!!

[Sparrowhawk]

Good job...good way to keep your head and keep cool. You get a big gold star..or you SHOULD!!!