whats wrong with this patient?

  1. I had a very sick patient yesterday and can't figure out what was going on anyone have any ideas?

    This was a 30 year old G2 P2 post pardum mom, delivery went fine except that she bleed a little after delivery but was stabilized without the use of meds.

    7 am - patient calls for pain meds: I gave her 2 T3 noticed her IV was dry with blood half way up the tubing, D/C IV. Assessed she was firm and down 1-2, small - moderate vag flow, Bowl sounds were slightly hypo but not bad. Vitals were T - 98.7 P- 83 BP- 100/70.

    10am - I go in to check her fundus again and it was still firm and down 1-2, only this time I notice she is getting a bit distended with gas and she admits mild discomfort from gas, I gave her kondramul and made her walk in the hall

    12 pm - patient reports voiding without trouble vitals still fine but her abdomen is more distended with air. I made her walk in the hall again and gave her colase.

    1:30 pm - she is even more distended and now rates her pain at 6/10 from gas. I called the doctor who said to give her kondrmul and colase, I told the doc I had done this and she told me to give her a 2-4-6 enema (which is what I wanted to do)

    2:00 pm enema done patient in BR reports passing gas and liquid stool. I thought I had fixed her.

    3:00 pm - every time I went to check on her she had been in the BR now her abdomen is grossly distended and tempanic, she reports she has had 4 bouts of liquid stool. And says that the day before previous to delivery she hadn't been hungry and was sick to her stomach. Bowl sounds more hypo but still present x 4 T 94.7 (I checked it 4 times tempanicly, orally and axially) BP 90/40 P 87. H&H was 14/39, WBC's 18. I put in a call to the doctor; get orders for warming blanket stat CBC and cath UA.

    4:00 pm - lab calls WBC's 26, H&H 15/42, while I am strait cathing for the UA I get 1000 CC out and stopped because I didn't have a container to catch the rest. She is very lethargic and looking kinda pale. While I'm cathing her they call a Code blue in the nursery so I know I am now without help. Temp is still 94.

    4:30 pm -UA comes back normal - call the doctor who says " I don't think she has an infection but give her 3g Unisom Q6
    5:00 pm start the IV get antibiotic going temp still 94 but patients color looks better and she is awake and talking.

    6:00 I put a Foley in and got 500 right away so I left it in, the poor girl was incontinent with a large amount of clear liquid stool. Temp is still 94.7, her mother tells me she had diariah for 3 days before delivery and had a hard time eating, the patient is now complaining of reflux. Stomach is still distended with air

    7:00 pm I call the doctor again and report what I have done and that her temp is still 94. The doctor doesn't know what's wrong and I tell her I had suspected a bowl obstruction but couldn't figure out the temp. Doctor doesn't think it's a bowl obstruction but just says to watch her for the night.

    9:20 pm I finally finished my charts and left.

    My best guess is that she had some kind of obstruction but I can't explain the temp and the two seem to be related so I'm stumped.

    Any idea's?
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    About Dayray

    Joined: Nov '01; Posts: 720; Likes: 185
    RN in L&D


  3. by   Sleepyeyes
    She needs ab ct scan to r/o bowel obstruction???

    Just guessing here....keep us posted?

    ((((prayers for pt))))
  4. by   SusanRN2004
    I am just a student, I am just wondering....do you nurses ever call back to check on patients on your day off? I would wonder what happened to some patients.

    If you work two or three days in a row, do you usually have the same patients. (If they are still there)

    I am sorry if I sidetracked this post. I am just curious about what is wrong with the woman, and we may never know!
  5. by   kewlnurse
    Send the stool for c-diff, o&p, get a flat plate, get blood, sputum cx, how are her lungs? any change in mentation? You can go spetic an drop your temp.
  6. by   JMP
    Signs of sepsis

    elevated OR below normal temp

    High wbc count OR low wbc

    elevated resp rate

    tachy ( elevated HR)

    low BP
  7. by   Dayray
    I just called and asked about her. They did a CT scan and guess what they found........ Bowl obstruction and Kewlnurse you were right she is also septic and thats what was causeing the low temp.
    She has an NG and they got her temp to 96.8

    Thanks for the responses.
  8. by   Spazzy Nurse
    Very interesting! Sounds like she maybe had this obstruction for a while, since she was having diarrhea for a few days before she had her baby? Poor Mom!

    Glad it happened while she was still inpt. rather than at home when she was trying to adjust to having a new baby around!
  9. by   Sleepyeyes
    Thanks, dayray for the update. And thanks, Kewl, I'll remember that.... Low Temp = septic....

    Can I ask, though, why is it that the docs always order the blood cultures X2 only if someone has an intractable fever of >101??
  10. by   kewlnurse
    Originally posted by Sleepyeyes

    Can I ask, though, why is it that the docs always order the blood cultures X2 only if someone has an intractable fever of >101??
    Cuz we know more than them :roll