A patient on my team was a fresh hip replacement post-op from the afternoon and it was now the evening. He was running a bit of a low BP (80/50) He hadn't voided post-op yet and had >900ml in his bladder, we decided to catheterize him. Before catheterizing he stated that he was feeling "fainty", he was lying flat in bed at this time. I inserted that catheter which he was a bit anxious about and I coached him on deep breaths through the procedure. After insertion he was saying he still felt pretty fainty and he looked pale, shallow resps (denied SOB), was closing his eyes and his jaw was chattering quite severely (At first glance I thought he was seizuring b/c of his jaw jittering but he responded to my questions appropriately, so alert & conscious). I took his BP again and it was till low around 85/55. I gave a cool clothe for his forehead. His HOB was at only about 20 degrees but in hindsight I guess I should have lowered it all the way, but than again his resps were pretty shallow b/c he was feeling unwell. Dressing was dry & intact. This was one of those times that I wasn't sure how serious this behavior or S&S were. I'm still new to the orthopeadic/surg area and I wasn't sure if maybe these kind of episodes are sometimes seen with fresh post-ops (maybe after effects of anesthetic? hemodynamic status a bit irregular after being under the stress of surg?) Also some more info you may be wondering: he was receiving IV morphine q1h, which I knew may be contributing to the low BP as well...
This was around the time of shift change and the head nurse on the team was not overly concerned about the low BP or fainty feeling complaints. But I thought it seemed like a pretty abnormal episode, anyway it's still bugging me so I'm asking you nurses too!
What do you think was causing the intense jaw chattering? Do you think this what they call a vaso-vagal type of episode? If this was your patient what would have done differently or what would be your first thoughts/interventions?
Thanks for your input!! I learn a lot by others thoughts and suggestions, helps me to think reflect on my actions for the future.
-uncertain nursing student.