gut feelings..

Placement: Cardio (gen surg)
I was given a patient to see with a supervisor in a HDU ward. Patient is a 90 y.o male who has undergone a cholesystomy. He has COPD which reduces his tolerance for ambulation, he then developed pneumonia and has to be admited to HDU. His obs are really unstable (low BP and sats) and has increased secretion which can be heard with his breathing. He was given a BiPAP. I was asked to decide how to treat this patient. I decided to sit him up over the edge of the bed and if he copes well, get him to stand up and sits him on a high back chair. I talked it through my supervisor and we decided to go ahead with it. Transferring the patient was challenging enough as he has many attachment and that took awhile. When patient was sitting over the edge of the bed, his sats was coping well but because of his upright positioning, we had to detach him from the BP monitor. We managed to get him to stand up and transfered him to a high back chair. He sat there while i do my ACBT cycle. He looked really unwell (but then again, he's always dyspneic), my gut feelings told me to check his BP and my supervisor told the nurse to assist with that, his BP at that point was ~80/50 (can't remember exactly but low enough for a code blue). We decided to quickly put him back onto the bed with the leg rest tilted up. His BP quickly stabilised. From this experience, I have learn that we have to constantly monitor unstable patients from all aspects (and cannot be dependent on O2 sats only). When monitoring is not available, always opt on the save side and follow our gut feelings.