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Fluids & Electrolytes
DURING INITIAL ROUNDS, I introduced myself to Mr. H. He was eating breakfast and said he'd rested comfortably during the night. His I.V. site was infiltrated, so I restarted his peripheral venous access, completed my assessment, and administered his prescribed I.V. antibiotic and morning medications. A few minutes later, I heard a voice calling out frantically, "Help me! Please, I can't breathe!" It was Mr. H. As I entered his room, I found him diaphoretic and sitting upright in the bed.
Mr. H had end-stage chronic obstructive pulmonary disease and at age 56, he was slowly dying. As Mr. H's anxiety increased, I called the respiratory therapist to administer a nebulizer treatment and sat down beside him. I took his hand in mine, made him look me in the eyes, and said to him, "Breathe with me." As I began to take slow breaths in through my nose and out through my mouth, I said, "Pursed lip breathing." I continued to breathe, slowly and deliberately, maintaining eye contact. "Relax, just breathe," I whispered. Mr. H followed my lead and began to slow his breathing. The respiratory therapist arrived and administered a nebulizer treatment. Relaxing back on the bed after a few minutes, Mr. H loosened his tight grip on my hand and closed his eyes. "I'm OK now." As I left the room, I looked back and reminded him, "Call if you need anything." He managed a little smile and said that he would.
Later that day, as I walked past his room on my way to check on another patient, Mr. H motioned for me to come in. He said that he wanted to introduce me to his daughter. "This is my nurse, Gail," he said to the attractive young woman sitting by his bed. "She held my hand," he added. Smiling broadly, she offered her hand and said, "It's nice to meet you. Daddy told me about what happened this morning. Thank you for taking care of him."
"You're welcome," I replied. "I'll be back to check on you a little later, Mr. H. Enjoy your visit with your daughter."
As I left his room, it occurred to me that even though I'd restarted his I.V. quickly, provided his medications in a timely manner, and performed my assessment efficiently, Mr. H chose to mention to his daughter only that I held his hand.
As busy nurses, with the complex requirements of the job and demands for our time, it's easy to forget that the patient's priorities might not be our priorities. Mr. H reminded me that, at times, the most important nursing care we provide may be just to be present with them.
Mr. H was hospitalized several more times during his last year. Each time he was hospitalized his clinical status deteriorated, finally requiring several days of endotracheal intubation and mechanical ventilation in the ICU. On that admission, Mr. H requested do-not-resuscitate (DNR) status during a discussion with his healthcare provider. When I arrived for work that morning, one of the nurses told me that Mr. H had just passed away. She asked me to notify his daughter. Even though his death was expected, it would be difficult to make that call. Briefly rehearsing what I'd say, I punched in the numbers. When his daughter answered, I identified myself. "This is Gail," I said. "I'm a nurse at the hospital." She responded, "Daddy passed away, didn't he?"
"Yes. Peacefully," I said. "I am so sorry for your loss." I added, "We met about a year ago, but I don't imagine that you'd remember me after all this time."
"Oh, yes," she said. "I do remember you, Gail. You held his hand."
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