Tuesday, November 2, 2010

In which I am mistaken for a Stepdown nurse...

So I had this patient.... Came into ER with headache and nausea, and BP 200s/100s. 33 weeks pregnant. Stat C Section for pre-eclampsia. I took care of her her first night on the floor. Her SBP was still on the higher side (140s), but coming from Tele that's really nothing to write home about. Baby was in NICU. Mom was recovering fairly well. Sort of. Turns out she developed HELLP syndrome and her blood counts were not pretty. Still, she was pretty stable and seemed to be doing okay.

Then I had her the second night. Apparently during Day and Eve shifts, her kidneys started failing. Her urine output was scant, and she was starting to get a bit swollen. They gave a small dose of IV lasix (20mg) but no luck. By my shift, we were during hourly urine outputs (ugh) and labs q6 hrs. Lungs were starting to get a little diminished, and the slightest bit coarse. She was on nasal cannula and continuous pulse ox, with frequent vitals. Honestly, it was kind of refreshing getting some of what I was used to.

Until I realize that I was not dealing with Med/Surg doctors.

I text-paged the doc to let her know that urine outputs for the various hours was very low (totaling about 70mL for the entire shift) and mentioned the lung sounds. Asked if maybe we try a larger dose of lasix or something (would be the first course of action on tele, since it can sometimes prevent renal failure from worsening). The doc said they'd decided she had Acute Tubular Necrosis and that we should encourage PO fluids and keep the IV running.

Yes, doctor. We should keep pumping fluids into someone who is not processing them or excreting them. That sounds like a great idea. Fast forward to change of shift when we have to cut off her ring to prevent it from impairing circulation in her very swollen hands.

When I came back the third night, I was incredibly relieved to hear she'd been transferred to ICU (apparently there were no available SDU or Tele beds) and set up to start hemodialysis.

She finally recovered enough to get back to the mom/baby floor, and with any luck should be going home this morning. :)

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