Case Study #6: Sepsis
Day 1: Medical Ward
Place: Medical/Surgical Floor
“You must be George Thomas?”
“I am, and you must be the waitress that I’ve been waiting for. I asked for a two-egg omelette and fried tomatoes and black coffee. Service is so bad here. Even my driver here can’t get a drink.”
“All right then, Mr. Thomas. You are in the hospital, you have a serious infection, and your driver here, Glen, is the hospital porter. I am going to be the nurse caring for you. My name is Greta.”
“Right, right. I remember now. That Dr. Jim was always telling me that. You must think I am a crazy old man.”
“No, Mr. Thomas. Sometimes infections do strange things to our thinking.”
“Greta, can you help me push Mr. Thomas into his room?” Glen asks.
“Sure thing, Glen. Mr. Thomas, hands off the rails. I don’t want to catch your finger on the door frame as we go through.”
Glen and Greta get the stretcher into George’s room, and with a little help, George is able to slide from the stretcher onto the bed.
“Oh, this bed is so much more comfortable. Why was I on that thing?”
Glen leans down and quietly looks around like he is sharing a secret. “That is the Emergency Room stretcher. It’s designed so it’s easy to move and transport, but it’s really made to be uncomfortable so people don’t stay long in the Emergency.”
George nods his head. “Makes sense to me. That’s the way I would have designed it.”
“Had your fun, Glen? Let’s not make Mr. Thomas more confused,” Greta reprimands, hiding a smile. “Mr. Thomas, Glen is pulling your leg.”
“I knew that. Just checking to see if you did.”
Glen moves the stretcher out of the room. “I’ll drop the charting off at the desk.”
“Yes, that would be perfect,” says Greta. “Thank you.” She then turns her attention to the patient. “Mr. Thomas, I’m going to pull the side rails up here to keep you safe. Here is a call button. If you need anything, press it, and I will come and help you. I want you to stay in bed until Physio can help us. I’ll be back in a few minutes to take your blood pressure and complete your admission to this floor.”
“Got it. Stay in bed, push button for help, you’ll be back.” George nods.
Greta smiles and leaves the room.
|Day: 1||Pulse Rate||Blood Pressure||Respiratory Rate||Temperature||O2 Saturation|
“Mr. Thomas, I have a small lunch tray for you.”
Greta enters the room and sees the bed empty, and a small pool of blood on the sheet with the IV device hanging on the side rail.
“Confound it. Where did he go?” Greta looks down and sees small drops of blood on the floor and notes that the trail leads to the bathroom.
Moving quickly to the bathroom, she opens the door to find George on the floor under the sink to the left of the toilet.
“George, George, are you ok?”
“I think so. Who waxed the floor and made it slippery? This is an accident waiting to happen!”
“Yes, do you hurt anywhere?”
“My hip hurts.”
“Ok, stay right where you are.” Greta leans across George and pulls the nurse assist cord.
“What do you think I have been doing for the last while?”
A few seconds later, Addy comes in and opens the bathroom door wider. “Oh my, you really do need help, Greta.”
“Yes, Mr. Thomas slipped here and says his hip hurts. I wonder if the physiotherapist is around and can help us move him in a manner that won’t further injure his hip.”
“If you’re ok, I will find the physio and another to help,” Addy says.
“Yeah, I believe we’re ok,” responds Greta.
A few minutes later, Addy returns to the bathroom with Dorothy, a physiotherapist.
“Greta, Tim will be joining us shortly to help move him. He’s gone to get one of the stretchers that go almost to the floor, as he thinks if his hip hurts he will be going for X-rays.”
“Good thinking. Are you our new physio?”
“Yes, name is Dorothy. Quite the pickle you have here, eh?”
“That’s one way of describing it. How can we get Mr. Thomas out of the bathroom?”
“Well,” considers Dorothy, “if he can lift his shoulders a bit, we can wrap a lift sheet around his upper body, then pull on the sheet and slide him out from under the sink.”
Addy grabs a lift sheet out of the cupboard just outside of the room and assists Dorothy with lifting Mr. Thomas’s shoulders while Greta wraps the sheet around his upper body.
Dorothy leans down and grabs one end of the sheet and holds onto the sink with the other hand. Greta imitates her and uses the wall for balance.
“Addy, can you just lift Mr. Thomas’s heels off the floor, and we will slide him little by little out the door where it will be easier to look after him,” Dorothy says.
All three work together to slide George out through the bathroom door and into the middle of his private room.
“Ow, my hip really hurts.”
“Addy, can you take his vital signs? Dorothy, can you help me assess his hip?” Greta says.
Addy leaves the room to grab the vital sign machine.
Dorothy kneels down beside George and pulls his legs slightly to straighten them.
“Ok, it looks like his left leg is slightly shortened, and look how it turns out a bit more than the right. He may have fractured his hip or maybe this is the way he has always been. Not sure. Needs an X-ray.”
“Right. Once we have him on the stretcher, I will contact Dr. Pierce who is covering today and let him know,” Greta says.
Addy takes George’s vital signs to find not much of a difference.
Tim finally arrives with the stretcher and lowers it down to about six inches off the floor.
The three nurses, with the physiotherapist coordinating the lift, move George off the floor and onto the stretcher.
“Thought I would get a nice bed. Back to Emergency I go?” asks George.
“No, Mr. Thomas. Just this stretcher until we can X-ray your hip,” Tim says.
“Ok,” Greta says. “Can someone help me bring the stretcher out to the nursing station? I want to keep an eye on him until I contact Dr. Pierce and get the X-ray completed.”
Addy and Tim laugh. “Sure thing,” Tim says.
Greta contacts Dr. Pierce and explains the whole situation. Dr. Pierce agrees that a left hip X-ray is warranted. He also asks Greta to restart the IV.
“Greta, X-ray called,” reports Addy. “They can take Mr. Thomas now. Should I send for a porter?”
“Yes, he is good to go with a porter.”
“Gurpreet, this is Mr. George Thomas, from med/surg, fell this morning in the bathroom, suspected hip fracture.”
“Ok, follow me into Room 2 and we can get started.”
“Not sure if you remember me, Mr. Thomas. I was the one that took your chest picture when you were in Emergency.”
“Oh, yeah, I remember you. I asked for a discount on the picture.”
Gurpreet smiles. “Not quite, Mr. Thomas. Not that type of picture. Ok, we are going to help you shuffle over to this X-ray table.”
The porter and Gurpreet get George onto the X-ray table, and they position him for the X-ray. Gurpreet places a cassette under George’s hip, and then positions the camera. Double checking the distance and the aperture settings, she steps back behind the lead shield and presses the button. Gurpreet repeats the process three more times to get views of George’s hip from all directions possible.
At the scanner she reviews the images and makes some adjustments to the brightness of the last image. She thinks to herself, All look good. Don’t see any fractures. Gurpreet then releases the images into George’s health record.