Mystery symptoms on hip pt.

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Specializes in Postpartum.

UPDATE 7/28 I have had a few days off. Day after this post, I go in to find my pt. up in a chair, talking to friends, lucid and cheerful; helped back to bed, a lot of pain, but only tylenol. Still, her wound is still weeping serous and dressing soaks out in 2 hrs. Still has a foley but UOP good. Anyway I go back tomorrow. First I spoke with a nurse friend and was suprised to learn she is still there.

SHE HAD TO GO BACK TO THE OR FOR AND I&D OF HIP, NO ANESTHETIC CEPT A SPINAL AND HAD HEMOVAC PLACED. So, the upshot is she is not draining more than 5 ccs in the drain a shift, cultures of the hip are pending again, and she was SO MUCH pain that night the MD was called and because she is on coumadin tx and has allergies to IBU, the only thing they could come up with was neurontin. Guess it worked well for her. Cant wait to see what tomorrow brings.

Okay everyone is stumped on this lady. Lets try and figure it out without me breaking any HIPPA's

Elderly

Hx. CHF, aneurism (which left her very slightly off)

broke R hip, came in and had ORIF

oriented and talkative at admit and up to day after

Meds: pca dilaudid, removed day two Heparin GTT removed day three, on Coumadin. Multiple bruises even on her pubic area. Has had three or four units of PRBC's. Percocet, removed day four, Onadestron schedule twice daily, PRN Vicodin .5-1 Q6, Lorazepam po or iv .25 Q4 only. Daily meds include Potassium and antibiotics, prevacid, doc, senna and Lasix.

Now, the pca, percs, some phenergren were all d/c'd because the pt began to have altered loc. She also panics and has a sense of doom and hyperventilates, thus the lorazepam. Often the pt is diaphoretic and states she is hot.

She is a COMPLETELY different woman then when I first saw her.

The wound is stapled and well approximated but weeps so much serous fluid that the dressing must be changed Q2H. She obviously has much pain when turning.

During the day she becomes a bit more lucid but is unable to get up with PT more than sitting up. When she is "sundowning" or whatever is happening at the eve/noc period, she is practically having to be restrained as she is so confused she doesnt even realize she has a broken hip.

Yesterday when I took her over she had had only lorazepam X2 and TYLENOL for pain. UGGGH. This is because she denies pain when you ask her and because her son did not want her to be so loopy as it scared him.

She was becoming more and more disoriented and anxious. I and the NTL consulted everything and did vitals.. O2 sats normal, temp normal, bp normal WBC normal, blood cultures and wound culture growing NOTHING. Gave her lorazepam X1 and her vicodin, .5 X2. She only got worse. LUO on shift (250)

Our thoughts - Pain, sundowning and ARF?? Other theories were sepis but the signs are not pointing that way. Small stroke, but grips equal, no noted drooping.

She had to have Narcan X2 for sedation and guess what, she snapped out of it a lot, but that was after 10 doses of percocet the day and night before. However yesterday she had had no meds all day and still became very agitated and disoriented.

SO, what more can we do? If its been tried I will let you know. If we find out what happened, I will let you know. :uhoh3:

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my experience has observed the elderly having s/p anesthesia confusion and agitation for sev'l days after surgery.

ativan is also known for paradoxical agitation.

and finally, pain can make someone nuts.

something to consider.

leslie

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Specializes in Postpartum.

Yup, pain and ativan were my first thoughts. Getting the pain controlled in an elderly with her tendency to snow is the tough part.

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Yup, pain and ativan were my first thoughts. Getting the pain controlled in an elderly with her tendency to snow is the tough part.

i have received positive feedback to vicodin.

it provides good pain relief and doesn't snow them.

leslie

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Specializes in ER,OR, MedSurg, OccuMed,ICU.

Have they done a UA? UTI's can really mess with people. Just a thought.

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Specializes in Community, OB, Nursery.

UTI was my first thought too.

Pain or anesthesia of any sort can make anyone wacko, regardless of age.

Also, once I had a guy with about the same sx...and it was thyroid storm, and he had a hx of hypothyroidism.

Tricky, tricky.

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Specializes in SICU, EMS, Home Health, School Nursing.

Ah the dreaded ICU psychosis strikes again!! I had a pt like that a few months ago she was s/p abdominal surgery and she went crazy?!? They had her in the ICU just so that we could monitor her more closely...she ended up getting out of bed and falling once we transfered her to step-down. One of the docs I talked to said that sometimes Ativan and pain meds can make the psychosis worse in some of the people, but then on the other hand, pain and lack of sleep also makes it worse. Try to keep her on a schedule...lights on during the day and lights off at night and try to limit waking her at night. Maybe a sleep aide for at night would help too.

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Specializes in NICU.

I had a patient that acted this way once. Crazy for days. They finally got a good 8 hours of sleep and woke up a different person. It's amazing what a little sleep will do for someone.

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Specializes in Trauma ICU, MICU/SICU.

I agree with the vicodin advice. Don't know if I'd go with a sleeper, assuming she's elderly, don't recall seeing her age.

How about some Haldol at night so she can be less nuts and sleep. She seems typical elderly patient in the hospital. You also said she had a small stroke, was that while in hospital for the hip?

You said Sats are normal, are they trending down? Tachy? Febrile?

Hope she gets better fast!

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Specializes in ortho/neuro/general surgery.

I agree with the previous posts. How about slapping tele on her and doing an EKG and a head CT?

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Okay everyone is stumped on this lady. Lets try and figure it out without me breaking any HIPPA's

Elderly

Hx. CHF, aneurism (which left her very slightly off)

broke R hip, came in and had ORIF

oriented and talkative at admit and up to day after

Meds: pca dilaudid, removed day two Heparin GTT removed day three, on Coumadin. Multiple bruises even on her pubic area. Has had three or four units of PRBC's. Percocet, removed day four, Onadestron schedule twice daily, PRN Vicodin .5-1 Q6, Lorazepam po or iv .25 Q4 only. Daily meds include Potassium and antibiotics, prevacid, doc, senna and Lasix.

Now, the pca, percs, some phenergren were all d/c'd because the pt began to have altered loc. She also panics and has a sense of doom and hyperventilates, thus the lorazepam. Often the pt is diaphoretic and states she is hot.

She is a COMPLETELY different woman then when I first saw her.

The wound is stapled and well approximated but weeps so much serous fluid that the dressing must be changed Q2H. She obviously has much pain when turning.

During the day she becomes a bit more lucid but is unable to get up with PT more than sitting up. When she is "sundowning" or whatever is happening at the eve/noc period, she is practically having to be restrained as she is so confused she doesnt even realize she has a broken hip.

Yesterday when I took her over she had had only lorazepam X2 and TYLENOL for pain. UGGGH. This is because she denies pain when you ask her and because her son did not want her to be so loopy as it scared him.

She was becoming more and more disoriented and anxious. I and the NTL consulted everything and did vitals.. O2 sats normal, temp normal, bp normal WBC normal, blood cultures and wound culture growing NOTHING. Gave her lorazepam X1 and her vicodin, .5 X2. She only got worse. LUO on shift (250)

Our thoughts - Pain, sundowning and ARF?? Other theories were sepis but the signs are not pointing that way. Small stroke, but grips equal, no noted drooping.

She had to have Narcan X2 for sedation and guess what, she snapped out of it a lot, but that was after 10 doses of percocet the day and night before. However yesterday she had had no meds all day and still became very agitated and disoriented.

SO, what more can we do? If its been tried I will let you know. If we find out what happened, I will let you know. :uhoh3:

can you get a bladder scan?? or check for urinary retention, post-void residuals... lots of patients with surgical hips aren't able to urinate after surgery... also, could be uti... or if not those, is she well-anticoagulated?? There might be possibility of DVT and PE...

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Specializes in Peds, ER/Trauma.

I agree with some of the other posts- she needs a UA & head CT.....

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