Medical Case 04 Carl Shapiro DA PDF

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VSIM. Medical Case #4. Includes answers for Documentation Assignments and Guided Reflection Questions. ...

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Medical Case 4: Carl Shapiro Documentation Assignments 1. Document Carl Shapiro’s cardiac rhythms that occurred in the scenario. a. Normal Sinus b. Ventricular Fibrillation 2. Document the changes in Carl Shapiro’s vital signs throughout the scenario. a. First set of vitals: 124/74 bp, 98% SpO2, 99F, 88bpm, 12 RR b. Second Set of Vitals: no pulse, no breathing, EKG shows V Fib c. Third set of vitals: 80bpm- irregular, patient is breathing again, 97% SpO2 3. Identify and document key nursing diagnoses for Carl Shapiro. a. Decreased cardiac output d/t altered electrical conduction 4. Referring to your feedback log, document the assessment findings and nursing care you provided. a. I first got a whole set of vital signs and auscultated the heart b. I asked the patient about his pain and past and current medical history c. I took him to get a chest X ray d. I got a venous blood sample and sent it to lab e. When the patient stopped breathing, I checked his carotid pulse and called the code team f. I began CPR and had the AED attached g. I cleared the patient before shocking h. I continued CPR on a 30:2 ratio

Medical Case 4: Carl Shapiro Guided Reflection Questions 1. How did the scenario make you feel? a. Actually, I felt like I knew what I was doing. When I say on the continuous EKG that he was in V Fib, I knew which interventions I needed to do next and in which order. 2. What could have been the causes of Carl Shapiro’s ventricular fibrillation? a. This could have been related to the fact that he had just sustained his first MI and was in recovery. 3. When performing CPR for Carl Shapiro, what are quality indicators you are performing resuscitation correctly? a. The EKG will project a better rhythm – different from V Fib. There will be a faint pulse 4. Discuss safety aspects during defibrillation. © Wolters Kluwer Health | Lippincott Williams & Wilkins

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a. Making sure that the pads are placed correctly on the patient and making sure no one is touching the patient before shocking the patient. If Carl Shapiro would have had return of spontaneous circulation (ROSC), what would your next interventions be? a. Make sure oxygenation is 94% or higher, place ET and confirm placement b. Keep SBP over 90 mmhg by giving IVF bolus and a vasopressor c. Get a 12 lead EKG What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format. a. S: Pt arrive in the ED with chest pain that was alleviated by NTG. Was admitted to tele and had recurrent chest pain and V Fib without a pulse. Pt was then coded; CPR and a defibrillator were used. Pt is now stable b. B: Patient smokes ½ a pack of cigarettes a day and had a history of high blood pressure c. A: After code, patient was breathing and had an irregular pulse of 80 bpm d. R: Post Cardiac Arrest Care 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. a. Per Saint Lukes: We could give the family a choice to either watch in the corner so that they are able to see that we did everything in our power to resuscitate their loved one in the event that we do not succeed, they would feel better having seen the extent we went to help them out. If they did not want to stay, someone could walk them to the waiting room and wait with them. What would you do differently if you were to repeat this scenario? How would your patient care change? a. One thing I would do different is I would check the patient’s carotid pulse instead of his radial pulse after noticing he was in V Fib.

© Wolters Kluwer Health | Lippincott Williams & Wilkins

© Wolters Kluwer Health | Lippincott Williams & Wilkins...