Carl Shapiro - GRQ - Medical Case 4 PDF

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Download Carl Shapiro - GRQ - Medical Case 4 PDF

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Medical Case 4: Carl Shapiro Guided Reflection Questions 1. How did the scenario make you feel? - It made me feel that nurses are heroes and are always supposed to be both reactive and proactive to help patients and achieve goals

2. What could have been the causes of Carl Shapiro’s ventricular fibrillation? -Carl Shapiro’s ventricular fibrillation could has been caused by the elevated levels of troponin and CK-MB which are both cardiac markers that are indicative of a potential myocardial injury. The injury would lead to the ST segment being elevated which may have led to the ventricular fibrillation. He could be predisposed due to uncontrolled BP, smoking, and family history too. 3. When performing CPR for Carl Shapiro, what are quality indicators you are performing resuscitation correctly? -Quality indicators that you are performing resuscitation correctly are seeing a minimal rise in the chest and if the patient begins has return of spontaneous respiration. Unfortunately, we can only physically see if the lungs are being inflated. We cannot see if the chest compressions are circulating blood through the body. - Important safety aspects to follow during defibrillation are to first check to see if the patient has a pulse. Then you want to ensure that the shock pads are placed in the correct spots and adhere to the chest properly. If the patient is hairy, you must shave the hair first. Following the prompts closely is vital. When the AED is checking the heart rhythm, nothing can be touching the patient. It’s important to verbally announce to clear the patient and anything touching the

patient and announce when a shock is going to be delivered, and yet again, clear the patient. After approximately four rounds of compressions and breaths, a pulse should be reassessed 4. Discuss safety aspects during defibrillation. - Do Not touch the Victim while the AED is analyzing - Do not use Cellular Phone or radio within 6 feet of AED -DO NOT defibrillate someone around flammable materials such as gasoline or free flowing oxygen.

5. If Carl Shapiro would have had return of spontaneous circulation (ROSC), what would your next interventions be? -If Carl had decided to go to the clinic instead of the ED and went into ventricular fibrillation there, my nursing care and interventions would have been different in that setting by assigning roles to those around me; one individual would call 911, one would retrieve the defibrillator, one would assist with breaths and if allowed, another team member to be on backup for compressions if I were to get tired while giving compressions.

6. What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format. Carl Shapiro is a 54-year-old male who travels frequently. He was seen in the Emergency Department at 1:30 p.m. for complaints of chest pain, diaphoresis, and shortness of breath. He was treated in the Emergency Department with aspirin and two doses of sublingual nitroglycerin. Chest pain improved with nitroglycerin administration. IV infusion of normal saline was started in the Emergency Department and is running at 25 mL/hour. Ordered lab values are pending. Provider wants to be called as soon as the labs are available. Patient is receiving oxygen at 4 L/min with SpO2 values at 97%. Chest pain was last rated as a “0” following second nitroglycerin dose and nitroglycerine patch 0.4 mg. He has been admitted to the Telemetry Unit. He had CXR done, which showed he MI and patient coded while on the tele unit. Patient was chocked and had 2 rounds of CPR before regaining consciousness. Patient now stable, on 4l of

02 via N/C, and continuous Ecg monitoring. Patient on continuous spo2 monitoring and to obtain labs Q 8 hours.

7. If Carl Shapiro’s family members had been present at the bedside during the arrest, describe what you could have done to support them during this crisis. -If Carl Shapiro’s family members had been present at the bedside during the arrest, measures that should be taken to support them during the crisis are allowing them to stay during the process but ensuring they are not in the way of the resuscitation team, (if staffing allows) assign one member to remain with the family during the process, provide an explanation of the events, assist with remaining calm and then taking them to a quiet area afterwards and addressing any questions or concerns they may have.

8. What would you do differently if you were to repeat this scenario? How would your patient care change? -

I would not do anything any differently, everything went well with the code team....