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!!
. 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. 
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!!!