Carl Shapiro Reflection PDF

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Medical Case 4: Carl Shapiro Guided Reflection Questions 1. How did the scenario make you feel? The scenario had me uneasy because I actually wasn’t sure if something was going to go south, so I was trying to get my assessment and orders completed. After I saw my score I did feel more confident in what I knew and did. 2. What could have been the causes of Carl Shapiro’s ventricular fibrillation? He had a heart attack so the myocardial tissue is injured. That is my only guess at this time. 3. When performing CPR for Carl Shapiro, what are quality indicators you are performing resuscitation correctly? If you feel like you need to be coded yourself after performing CPR, that is probably an indication you performed it well. Jokes aside, if you feel for a pulse while someone is doing compressions you should feel for a pulse indicating quality compressions. A good place to feel for this is the femoral artery in the groin area. Radial is not recommended. Chest recoil is important to feel for and watch in your team mates while they are doing compressions. 4. Discuss safety aspects during defibrillation. Stand clear, stand clear and then follow the prompts on the monitor. 5. If Carl Shapiro would have had return of spontaneous circulation (ROSC), what would your next interventions be? CPR was successful, anticipate tons of orders that are possibly over your head, go get your charge nurse to assist you even if she has been pulled away. He will need frequent assessment and continuous ecg monitoring. Anticipate multiple cardiac drips and parameters for notifying providers. He will definitely be getting an EKG. Someone should notify family if they have not already been and last but not least someone may need to discuss his wishes going forward and educate him on what has happened to him. 6. What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format. I would probably recommend a bedside report with the oncoming nurse. To start I would introduce the patient: This is Carl Shapiro, 54 year old admitted from the ED where he was treated for chest pain with 2x nitro po and then a transdermal patch and aspirin. He came to us in stable condition. Had no complaints of chest pain, was alert and oriented x4. During assessment he went into ventricular fibrillation, pulse was checked and cpr was initiated. After two rounds of cpr and one shock delivery we had a ROSC. He is alert and we are now receiving orders for his continuance of care. His family has been contacted and are on their way. He has two 18 gauge IV sites one in each AC with NS infusing at 25 ml/hr. My recommendation is that you continue to monitor and watch for labs that are pending to be reported to the cardiologist who is on the unit.

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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. I would have kindly asked them to step out of the room, walked with them and then explained to them we were administering CPR and have not given any medications at this time. I would explain to them kindly that the code team needs room to work and that I will update them as often as possible. I would provide tissues and show them a comfortable area to sit, wait. 8. What would you do differently if you were to repeat this scenario? How would your patient care change? I would have done a more focused cardiac assessment first, then gotten the labs and chest xray then proceded with the rest of the full assessment.

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