The air we breathe
I'm on my Cardio placement and am treating a lady who was initially admitted into hospital feeling unwell and SOB on a background of metastatic lung cancer. She also initially presented with HTN, tachycardia, diarrhoea, sepsis and acute neutopaenia, furthermore she just recently completed her 5th cycle of chemo. Long time smoker. Last Tuesday she was requiring 4l O2 saturating at about 93% via a HM at rest, we are constantly trying to wean her down. During any type of transfer or global mvt her sats plummet. She is basically really unwell. I have been treating her since last Tuesday and RX has consisted of positioning, ACBT's, UL/LL ex's and trying to get her mobile (SOOB and basic transfers from SOEB to commode). She finds it extremely tiring and exhasuting just standing so ambulating has been a challenge.
So on Thursday I had big plans to try and take a few steps with her WZF or at least trying for a SOEB and transfer. However no go, pt refused Rx because too exhausted. About 30 mins later I see her on her commode returning from her shower with her nurse, so I thought I will quickly perform a treatment and at least transfer her from her commode to bed. Mission accomplished but was quickly kicked out by the nurse who still had to clean her up, so Rx half complete.
20 mins later I returned to complete my Rx, then after putting the sat monitor on I was shocked to see her sats hovering around 50%, and tacycradic. I quickly changed fingers to make sure, and it still read the same. I then asked the pt how she felt and said she felt exhausted. I then went into automatic pilot and put the Hudson Mask straight on, pumped up the O2 to approx 4l vis HM, re-positioned her so she was sitting upright in bed and monitored her sats, they thankfully started climbing steadily back up to towards 70%. I then grabbed her nurse to monitor, she said she would look after her. I then promptly relayed the story to my supervisor.
In retrospect and after talking to my supervisor it is so important to relay important information to other health staff, eg to ensure they give O2 for my pt when transferring, and keep on monitoring her vital signs. I also need to make sure I complete all my treatments there and then. In reflection communication is so important with all health personnel for best pt focussed outcomes. If anyone should have any other input in how they might have done things differently then I would like to hear. By the way the pt is now doing fine, currently on RA at rest and saturating above 90%.
posted by Christian @ 2:08 PM
4 Comments:
I agree about the communication and how vital it is between nurses physio and doctors. The nurses Can be a great help and inform us of recent events that sometimes are not recorded in the notes. They too benefit from knowing our thoughts on the patient ans issues we may have. Good communication will will therefore save both proffessions time and avoid simple errors and make our Rx better and more focussed. Keep up the good work Kahuna.
Hi Christian, sounds like a scary incident you had there. Well, the most extreme desaturation case on my previous cardio placement was at 70% and my patient was absolutely symptom free without O2 while walking. She continued happily down the corridor while my heart was thumping for her and requesting her to take a break with a calm and straight face.(Was walking her to the toilet where the nurse was waiting for her to assist her bath). Guess you did the right thing but sometimes if the patient does get such symptoms/signs quickly, we can actually work with the nurse as part of your assessment/treatment such as transfers which typically require sit to stand and form part of their routine(t/f to commode for bath). Saves time and effort on the patient. Also the nurse personally see what transfers or mobility the patient is capable of and take note from your input. And monitor her stas closely which you did.
Hi all
How can this information best be communicated?
Regards
John
Guess one of the ways where the whole team could get to know this issue would be to document clearly in the case notes with an asterisk to allow action to be taken or at least an awareness on this patient's presentation. Cos sometimes informing the nurse in charge or supervisor is not enough as they/we may not be around when the patient shows such signs and symptoms. A clear documentation should help.
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