So have you ever had the worst possible night or day at work and you just could not believe any of the things that were going on? This was me the other night at work. First, let me give you some background. It was my weekend to work. I got to work on a Friday night and got 4 patients, which is really good because normally I have 6. One of my patients was a little old lady, who had fallen at her assisted living facility. All her scans were normal and they decided not to do surgery. Her blood pressure had dropped super low that morning so the day shift nurse had given her albumin twice. The day nurse and I were talking trying to see if she was even stable enough to stay on our floor. (S/n 9/10 if your patient is plummeting fast you will either have to call a rapid response team or a code blue and send them to step down or ICU depending on the situation.) The night tech was doing her rounds and got a blood pressure of 60 over something and asked me had her blood pressure been that low. So I immediately went to check the trends. (You will find that some patients blood pressure run low and always run low or run high and always run high so it’s really important to check the trends on your patients. Their normal could be different from the average person's normal blood pressure) So I checked and her normal blood pressure was not that low. This called for me to check her blood pressure manually. Now keep this in mind guys, don’t lose that skill because access to an automatic blood pressure machine is so easy. As a matter of fact, make sure you keep up with all your skills once you leave the skills lab in school. So I can honestly say I’m pretty good at manual blood pressures but this lady’s blood pressure was so faint. Seriously, I couldn’t hear anything and, of course, the cardiologist was in the room waiting on the correct pressure. I tried two more times before going to get a colleague to help because the blood pressure I got was so low like 68/40 and I didn’t want to be wrong especially in this particular situation. She rechecked it for me and got 66/42, so I wasn’t that far off. As I’m going back to tell the doctor my results I see he’s on the phone and waited until he was done to go back. He went on to tell me that the patient's power of attorney went ahead and made her a DNR (do not resuscitate) because basically, her heart was giving out. The doctor ordered for me to start her on fluids and give her another dose of albumin. He went ahead put the order for her to be a DNR and we had an okay night. She was still talking to me, her blood pressure had gone up some, and she was still stable. Before I got off, I went to see her, tell her bye and that I would see her tonight. She said the cutest thing, "See you later alligator." Of course, I replied with, "after while crocodile. "
Fast forward to Saturday night as I got to work excited to see my lady, the day nurse basically tells me everything started declining around noon. They had taken her off fluids, inserted a Foley catheter, and made her complete comfort care with oral care every 4 hours. My heart literally fell to my feet. This same lady who was talking, laughing, and playing around with me just the night before was now barely hanging on to life! I literally wanted to cry. I went in to see her and she was gasping but still breathing. I could tell she could still hear us because she squeezed my hand a little. I told her I was back and I would be in and out checking on her. So after that, I went got my other patients squared away. As soon as I sat down to chart around 10:30/11:00, I hear my charge nurse calling out for some help. One of his confused patients kept trying to get out of the bed. Usually, when patients are confused we turn the bed alarm on and attach a tab monitor. My charge nurse was already in the room trying to get the guy to lie back down because neither of us wanted him to fall. I walk in the room to ask him to lie back down and baby it popped off. He starts punching my charge nurse, pinching me and starts trying to spit on us and I’m just like WOW WTF. (Secretly I wanted to walk out of the room) So we ended up calling for more back up. There were only 3 nurses and the tech and all of us were in there trying to get him calmed down. My charge left to get an order for restraints and Haldol so this man wouldn't try to cause any harm to himself or others. Once you start working, or if you’re already working, you will see confused patients. With these types of patients, you have to remember they are not thinking clearly, but don’t let that open you or others to be harmed in the process. They find the strength of Thor and this can seriously harm you so always always always be careful. We finally get him calm and taken care of so I sit down. Not even a minute later telemetry called. The telemetry technician tells me that she thinks this is the final party for my lady and her heart rate is in the 30s. I got up to go in her room to check her out so she wouldn't be alone in her last minutes. I won’t give y’all the exact details of her final departure so I’ll move on to what happened next!
So there’s me being the scared, sensitive young nurse that I am peeping around the corner to let my charge nurses know my patient has passed. He’s, however, still charting on the events that happened with his patient, Mike Tyson. I took this time to go to the bathroom to cry. Guys, I know it seems idiotic that I cried over someone I barely knew, but the spirit she possessed was just wonderful and I mean, come on, she was my first patient to die. I DESERVED TO CRY! So I did lol.
By the time I got back, he was ready with all my paperwork. First, I had to call the doctor to let her know the patient had expired. She asked what was going on with the patient before her departure, code status and said she would send the ER doctor to do the death note. Step one.......done! Step two notify the family! As I stated before she was old, and a DNR so they knew her time was coming. I found out and confirmed the funeral home they wanted her to be sent to and other details. Step 2.......we through! Step 3 call the coroner! Guys, I have never ever, ever dealt with a coroner before except that one time when my grandfather passed and all they did was come pick up the body. So I call the coroner and she asks a lot of questions like: the patient's past medical history, the chief complaint about being admitted to the hospital, cause of death, whether the patient had been seen by the family, history about her admission date, etc. Again.......I've never dealt with this so I’m like scanning the chart trying to find the answers to her questions. Eventually, she was satisfied with the answers, said it was okay to release the body to the funeral home and she would go by there to see her. Step 3 look at me....almost done! I’m corny I know I like to rhyme. So moving on to the next step....step 4 was to call LOPA. This stands for the Louisiana Organ Procurement Agency. Working in different states you will have to call different agencies so just inquire about who to call in case death occurs on your shift. I called LOPA and they asked what happened to the patient and if the patient was infected with any type of diseases when they died in order to do an assessment on their organs. This is to see if the organs can be procured and used to benefit someone else. Being that my patient was 91 she was ruled out due to age and the conversation was very short. Finally, I had to wait on the guy from the funeral home to come to get the body. I don’t know about you guys, but I never knew that funeral homes had answering services like the doctors. It was about an hour and 30 minutes before the funeral home came to get her and I helped the guy zip her up in the body bag. I was obviously sad but I still had about 3 hours at work.
Just as soon as the room was released and cleaned, there was a request for the room from the ER. So I ended the night with an admission. Guys, I absolutely despise getting an admit between 4 and 5 because doing the initial admit assessment takes up so much time when you have to get ready to pass 5 and 6 o'clock medications. That is why time management is so important. The way I address this is by going pass my meds before I accept my report on my new patient. This patient is already in the ER holding area and most of the time is stable and sleeping. Now if this were a patient who needed immediate care that the ER couldn't provide I, of course, would not leave them in the ER. So I passed meds early to give my patients a little more time to sleep before day shift comes and they really appreciate it. I always say "you don't come to the hospital to get sleep" lol. Then I called to get the report from the ER nurse. My patient got upstairs at about 4:45 and since everything else was already done I was able to get the admit assessment done quickly. It always helps when the patient has been in one of our facilities before because the past medical and surgical history just flows into the new assessment! My new patient was a very nice man and was a good way to end my crazy night.
Have you guys ever dealt with the death of a patient? Have you ever had to deal with a patient that was extremely hard to calm down? If so tell me about it in the comments!
The Klassic Nurse 💋
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