A patient came in through the PACU for pre-op care for a simple procedure. The patient was in and out of the OR quickly and returned to PACU for post-op care. Kim Wolfgang, RN had taken care of this patient during the pre-op phase and received this patient post-operatively.
Upon arrival to PACU, the patient was extremely agitated and disoriented. Kim knew from having taken care of him shortly before that this behavior was completely opposite from his baseline. However, it can be normal for patients to be disoriented after undergoing anesthesia. Kim was very patient with the gentleman and continued with his post-op care while he continued to escalate his behavior. At this point, Kim decided to invite the patient's family to the bedside to help reorient the patient and hopefully assist him to relax and become more comfortable. Having the family at the bedside seemed to work for a little while, but the patient's behavior continued to escalate.
At this point, the anesthesiologist had been in to see the patient and cleared the patient for discharge to the floor. However, Kim could tell that something was wrong. Until this point, it had been near impossible to obtain an accurate blood pressure due to the patient's level of agitation and inability to remain still during the reading. The blood pressure readings were all abnormally high and getting worse. Then out of the blue the patient spiked a high fever.
Kim knew that the patient needed to be reevaluated and that something was seriously wrong. Kim was persistent in drawing the attention of both the anesthesiologist and surgeon to the changes in the patient’s condition and soon had both physicians and the OR staff at the patient's bedside. Multiple tests were ordered and performed and the patient was sent to the ICU for further monitoring. If it hadn't been for Kim's attentiveness to the patient's condition, her advocacy for the patient and her persistence to get things done, the outcome may have been much different for this patient.