Case review

Disclaimer: The below situation is based on my understanding of the case and not necessarily to be right, any discussion and comments are welcome.

13/2/2022

I want to discuss a case with a critical life condition that properly leads to death. 

Patient A/85y (Female) is admitted due to fluid overload, SOB with a past history of ESRF on HD therapy. She is first noted with desaturation, and properly with a chest infection diagnosed by CXR, CXR showed a large area of hazziness and increasing. The doctor prescribed Bipap for ventilation support due to T2RF (not for increasing O2).

Patient A is able to keep saturation without BiPAP support for a few days before entering the life-threatening condition.

She was on neuro obs Q4H because the doctor is concerned about the risk of a sudden decrease in her conscious level leading to respiratory failure with standby BiPaP. I was in a PA shift at that moment, she was clinically stable for the whole P shift and stable for the first round of vital signs taken at 7am. However, for the second round of vital signs, she noted BP dropped from SBP 130mmhg to around 88mmhg, I immediately called MO for fluid replacement, NS 250ml FR x 2 was given with poor outcome. The doctor then diagnosed it as a septic shock and discuss DNACPR and not for intubation with her family. 

At the moment, the Patient was confused and not in a coma state, leading to a misconception that the condition is relatively stable. However, due to low blood pressure despite fluid replacement and the increasing haziness of the chest, the doctor still opts for comfort care.

每次記錄這些case我就想起了我對當護士的熱情。雖然在內科病房工作是很辛苦，但也很有挑戰性的，也更加展現了我的不足。

21/2/2022

後記：都過了一個星期的時間了，婆婆septic的問題似乎是治好了，血壓也回復到正常水平了。

附加資料

Septic Shock Nursing (Sepsis) Treatment, Pathophysiology, Symptoms Distributive