Another wierd bad thing

  1. Hi all,
    Yesterday, I was in charge on our high-risk ob floor. A post-partum patient who had a c-section the day previous came back from the postpartum floor. Apparently, after having been up and about, foley out, been to the nursery to see baby, etc. the patient started complaining at about 1545 of blurry vision. She was a mild preeclamptic who had had a c-section under general anesthesia. Labs were drawn and were normal. She then said that she couldn't see colors, then lost vision altogether. They took her down for CT which was normal. (This pt is 17 yrs old). Then she came over to L&D. Neurology came up, said her pupils were reactive, did all kinds of bedside neuro exam. I got IV going, drew labs, tox screen, (neg), and she was thrashing around and mumbling incoherently. We put her in four-point restraints, at which time she calmed a little bit. Then the neuro guy said her pupils weren't reactive anymore. Her pulse was fluctuating from 60's to 100's up to 200 at one point. Pressure 170/95.
    Now she's in the unit intubated and the neuro says maybe she had a stroke of the hippocampus and the pons, or maybe it's atypical preeclampsia, or maybe who knows. Nobody knows what's wrong with this chick. The family, of course, is hysterical.
    Anybody heard of anything like this??? Everyone here is baffled. MRI showed diffuse infarcts as far as I could find out.
    It was the wierdest thing I think I've ever seen.
    Lisa
    •  
  2. 18 Comments

  3. by   finallyRN
    Lisa-
    Sorry to hear of your patient. Sorry I have no info to share but am curious if anyone else has seen this.
  4. by   canoehead
    Wow, was it a stroke r/t high BP? How terrible for the family, and for nurses too. I hate it when someone is sick and no one knows what to do.
  5. by   SmilingBluEyes
    Man oh man, every OB nurse's worst nightmare....sounds like she stroked out to me....why.....eclampsia or a previous underlying condition as-yet undiagnosed, I dont 'know. I hope to Heaven she recovers. How frightening. Pls post us as to how she is doing. I am sorry I have no useful contribution to make here!
  6. by   rdhdnrs
    She died last night. Still no diagnosis. I'll let you all know if I find anything out.
  7. by   SmilingBluEyes
    OMG I am so sorry to hear this. So sorry. What a sad end for her family, friends, and you , the staff that cared for her. I am truly sad to hear of this.
  8. by   OBNURSEHEATHER
    I'm so sorry Lisa. It's not too often we lose someone, especially a mom, in OB. It's always such a shock.

    So tragic for her family.

    Heather
  9. by   L&D.RN
    Wow, how scarey...let us know if you find out what happened. LB
  10. by   finallyRN
    How scary- I'm so sorry. It is so hard to loose a mom. the poor infant and family. Please let us know if you find anything else.
  11. by   andrewsgranny
    OMG I was reading this post and never expected to hear this girl died. I am so sorry. What a shame. Pls. keep us informed.
  12. by   obtnt
    As a previous PIH'er and C/S X3, I know now why the nurses (who I thought were being silly and old fashioned) would not let me up oob until day 3!!!! I was so mad, I thought that because my bp was down almost to a normal reading I could go to the NICU to see my baby and do anything because I was delivered!!! It just goes to show you how serious PIH is and it has serious and mysterious symptoms and consequences!!! Keep those pts at rest for at least three days and be diligently observant to any unusual sx because anything can happen as we can sadly see here. Also, we had a pt with PIH who had seizures with a bp of 120/88 but you have to remember her "normal" was 90/60!!
  13. by   BBnurse34
    Thank you for reminding us that there can be traumatic situations in a well looking OB patient. We had a healthy laboring woman code. She was walking and collapsed. She was coded as a crash section was performed to save the baby. It was an amniotic embolism.
  14. by   Nighshft
    I am so sorry at the result, It does sound like she stroked out. We always maintain the Mgso4 for 24 hrs post delivery - they can seize up to 2 weeks postdelivery
    A good point was made -- we should ALWAYs know a pt's usual BP - 120/80 is high for a pt whose USUAL bp is 90/50

close