Whilst recently on a geriatric placement I was asked to assess a 90yr old lady who was admitted 1/52 post fall. She has fractured a small part of her greater trochanter, had originally been sent home by her GP however was not able to cope with the pain and as such was admitted to this secondary hospital for rehab. On initial assessment it was found that the patient had decreased exercise tolerance with SOBOE and reduced dynamic standing balance. She was also very anxious and displaying signs of expressive aphasia, which was contributing alot to her anxiety. Discussion with her daughter revealed that the expressive aphasia had developed about a month ago and had been written off as a hiccup in the aging process by her GP, the patient also had a very limited exercise tolerance and rarely walked further than within her home. The daughter mentioned that her anxiety was most likely being caused by being surrounded by so many people when she was used to being by herself so much.
The second session was conducted at 8-30 am the next day and her obs had not yet been taken. The session was carried out in her room so as not to overwhelm her and finished off by walking her to the dining room. Although she continued to feel SOB she was able to walk further than the day before with no other adverse signs throughout the walk. At this stage the doctors were planning a CT to investigate the expressive aphasia.
On return to prac after the weekend I was informed that on the sunday the patient had been transferred to RPH and then had died. This information was extremely shocking as the patient had only been admitted for a small fracture. My supervisor was also shocked and apparantly the patient had simply collapsed while being transferred on sunday, after that we have no information on what happened. The disturbing thing about this patient was how unexpected her death was and how suddenly it happened. This was also the first time a patient of mine has died. Even though my treatment was unlikely to have influenced what happened, you still can't help but wonder if there was something else you should have picked up. It was also a really important warning that no matter who the patient is, you can't just assume that their case will be completely straightforward.
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Great post Cassie and so true! i've always tended to look at their presenting problem as the main problema and after reading your post i can see how that could be detrimental to my patient! i think its good to know as much about your patient as possible. however i dont think that the obs that day would have told you anything before you ambulated your patient. if there had been anything suspect in the obs, they would have told you, been done more frequently than they were obsiously doing them and the patient would have reported feeling more unwell than the day before. unfortunately for some reason some patients can rapidly decline for no apparent reason - i dont think you did anything which contributed to this patient passing away.
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