[chalenegirl]

i have been an Rn for 6 months now at a very busy medical floor.

my patient (mr. B) was discovered by me. VS absent at 0635am. code blue called, i started compressions...but after 40 mins - pt died.

pt was a 44 year old male, in with a necrotic toe on the rght foot. the r foot had 2 toe amputations already, and many ulcers. hx of DM, and chronic back pain, smoker. pt looked well, did his own dressing, walked to eat at the nearby hospitals, had a daughter.
at 2200, his last BS was 13.3, gave 10 units of humalin N. pt was fine.
throughout the night. At 0100, pt was up to the bathroom (i collectd 5 bottles of urine), talking and voiced no concerns. at 0200, i Gave him his standing and prn meds as per his request (very high dosages of ms contin, percocets and demerol - pt's rx for last 6 years). i asked him if he wanted me to wake him up at 6am for his meds tonight (last night he wanted to sleep in), he said no, he wanted to sleep, he spoke abotu how it's so hard for him to sleep b/c of the pain in his back.
throughout night pt changed positions while sleeping, said hi to the RN covering me for my break at 0300, he was breathing at 0535!
i was at the bed next to him, at 0555 - changing the bag, flushing his lines, repositions, checking his BS, measuring the foley output, resp assessment. i was with this other pt for 40 mins. as i was leaving the room, i peaked at mr. B and he was dead.

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i feel like ****. i feel like i should have woken him up. i don't know how to cope with this. i am feeling this utter guilt, and sadness....grief for the family and for myself. i'm a good RN, i don' tknow what happened. i did everything i was supposed to do, i did my hourly checks. he was breathing. it was so unexpected. the whole team said it was unexpected. he was a nice man, who showed me a picture of his daughter on his computer, he sad "this is what i'm going home to". he's going to be a coroner's case, i'm hopign to find out what happened to him as well.

i keep on going over what might have happened or what i would have done to cause this, but i don't know.
his vitals were stable. afebrile. blood sugars were ok. inslin was given - what if i gave the wrong type of insulin?? but it was given at 2200, and he was fine at 0200. so that can't be it. what if the pain meds did something?? but he was on that rx for 6 years! he was well enough to produce 5 full urine bottle containers at 0100....i dont know. he was young, he should'n't have died.
everyone on the team said i did the right thing, i did the best i could. i doubt myself. everyone said the first code is the hardest, but this is really bothering me. how do you get over this? what can i do? pls give me some advice.

sighs. feeling very lost right now .

[NavyJim58]

Chalenegirl, the first thing is to try and not blame yourself. Sounds like you were doing your job and this was not your fault. I can relate as this post brings back thoughts of the first patient I lost:

fourty year old alcoholic "walks" into the ER complaining of bleeding from the rectum......3 hours later he is dead......the doc can't stop the bleeding.....I can't get a line in him......goes from bad to worse and he expires.....I felt the same guilt.....how can a guy walk into our ER and then die and we can't save him......I beat myself up for weeks :frustrated: ......don't do it.......its not your fault.....

[TomB]

It's very hard, chalenegirl. It happens. Unfortunately you will get used to it. Because of insurance, etc., only the sickest of the sick get admitted to the hospital. The acuity is very high. It sounds like you did everything right. Don'r beat yourself up.

[ENARN2006]

Just a reminder --- Your charting should ALWAYS be defensive. You should have had nurses notes written for everytime you checked him (& every other patient). I work in the ER and write 'notes' on my patients EVERY hour - no matter if they are there for a broken finger or something non-life threatening - some people say that the more notes you have, the more it opens you up to being torn apart by a lawyer... whatever. I know what I write, I know my assessments were correct, and I'm a strong enough nurse to know that things happen out of our control sometimes - despite our best efforts.

Death is an unfortunate (or fortunate, depends how you look at it) part of this field...

[sierra_lpn]

If your facility offers counseling, now would be a good time to take advantage of those services.

Good Luck.

[HONEY22]

Hi i am sorry to hear the news
it must be so awful for u,i cant imagine what it must be like to deal with someone who died while you where there, dont let it get to thats life that why we nurses do what we do, to make there lives comftable as much as we can before they pass on,
dont blame yourself if u did all u could then thats ok, if you did something wrong that killed him with those medications,then thats a diffrent thing and your mangement would of dealt with it, its a hard one to call as i am sue you are a good nurse girl
if you want to deal with it there are causes that deal with those sort of things death etc.
Signed Honey