~Sigh~ Nothing like an unexpected death....

9 ...to shake a new nurse's self confidence. I watched my patient die before my eyes tonight. 89yo LOL, DNR, admitted for CP, totally alert and oriented. 2 hours after admission, suddenly says she "can't breathe". Desatting, despite increasing O2 flow rate until she is on NRB flush. By the time the RRT showed up, she's already satting in the 30s, HR in the 20s. It was so sudden and fast, we should all be so lucky. I think she threw a PE.

It was her time to go, and I did everything right, but still.....I question myself. What could I have done differently? Did I wait too long to get help? Did I miss something that I should have noticed? My head knows I did a good job, but my stomach is in a knot and I keep doubting myself.

The CNA was awesome. She stayed with the pt. the whole time, while I went and got meds, made phone calls, grabbed masks. She left before I had a chance to thank her. :redpinkhe
Bless you, we all get patients like that it sounds like you did everything you could unfortunately some patients just die. It's natural to reflect on an unexpected incident and that's something that makes you a good nurse, if you didn't question yourself that would be a worry. I used to find it helpful to talk to someone else who was present, maybe a senior who can run through things with you.

Quote from Virgo_RN...to shake a new nurse's self confidence. I watched my patient die before my eyes tonight. 89yo LOL, DNR, admitted for CP, totally alert and oriented. 2 hours after admission, suddenly says she "can't breathe". Desatting, despite increasing O2 flow rate until she is on NRB flush. By the time the RRT showed up, she's already satting in the 30s, HR in the 20s. It was so sudden and fast, we should all be so lucky. I think she threw a PE. It was her time to go, and I did everything right, but still.....I question myself. What could I have done differently? Did I wait too long to get help? Did I miss something that I should have noticed? My head knows I did a good job, but my stomach is in a knot and I keep doubting myself. The CNA was awesome. She stayed with the pt. the whole time, while I went and got meds, made phone calls, grabbed masks. She left before I had a chance to thank her. :redpinkhe

Quote from GoLytelyThe patient was 89 yrs. old. At 89, death should never be unexpected.

Sounds like you did things right - especially considering the fact that your CNA was with the patient the whole time, that's a nice comfort for the patient during her final hours.

It sounds like you did all you could do. I agree, reflecting on what you may have been able to do differently is a part of being a nurse and the reason why even if you've been in the field since the dawn of time you are still learning. It's only natural to second guess yourself with an unexpected death. But, she was 89 y/o, she was a DNR, so you and your CNA did what you could to make her comfortable and ease her suffering while honoring her wishes. Obviously this is something that she and her family had thought about, hence the DNR. So, yeah, learn from it, but it sounds like what you'll be learning is that you did everything you could do under the circumstances and the hard part is going to be emotionally moving on. It sounds like you had a great CNA; be sure to thank them, too often their role is underappreciated by nurses/doctors and I'm sure that you taking the time to thank them will help them as well; they might well be second-guessing if they missed anything also.Just my additional :If she did indeed throw a clot, there's probably not much that could have been done regardless. I work with oncology patients all of the time now, which was a huge adjustment for me at first b/c of the increased number of deaths that I had to learn to deal with. I've come to appreciate being a part of the end-of-life care of patients and after I learned to view it as an honor almost to be one of the caregivers to help ease patients through that transition to whatever lies beyond this life in as compassionate a way as is possible. I'm not very religious, but I do believe in a higher power, and truly believe that sometimes he/she intervenes to make sure that certain caregivers are given certain patients b/c of their ability to provide exactly the kind of care that patient needs right at the end. :heartbeat

I don't have much to say except that how you are feeling is completely and totally understandable. I wasn't there but I'm still pretty darn sure that there wasn't anything else you could have done.

you are a nurse......not god......you just can't fix everyone. know you did all you could and leave it at that. god sometimes has other plans.

I guess by "unexpected", I just meant that she didn't appear to be someone on death's door when I admitted her. I've admitted pt.s that I didn't expect to make it through the night, but not only did they do so, but lived long enough to be discharged back home. I must have been expecting it to a certain degree, though, because when I saw that she was a DNR, I remember thinking "Oh, good." and getting that card signed and put in the chart right away.I will have to check in with the CNA. She did such a good job, and I hope she's okay. I don't know how many of these situations she's been a part of.

Quote from Virgo_RNI will have to check in with the CNA. She did such a good job, and I hope she's okay. I don't know how many of these situations she's been a part of.

A few years ago, my 80 year old Aunt with well controlled CHF, woke her husband (my Uncle) up at 6am and said "I'M Dying". he quick dialled 911 but she was dead by the time he hung up. My guess is some kind of rapid onset pulmonary edema. Even tho she was 80, everyone was taken by surprise. But not a bad way to go, actually.Sudden deaths happen. She was lucky to have you at her side at the end.:heartbeat

Thank you for posting, it helps EVERYone when we share our experiences and personal thoughts/insightyeah:

Ok, so this may be a stupid question. Forgive me, I am new and have not experienced a patient's death.But, if the patient was a DNR, why did you call rapid response? Is this just a standard protocol in your facility? What would they have done considering the patient's DNR status?