Overdose Case Study Week 3 SPR21 PDF

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CASE STUDY: DRUG OVERDOSE SCENARIO You are on duty in the emergency department (ED) when a "code blue" is called. As the code nurse, you grab the crash cart and run to the code, which is in the employee lounge of the operating room. On the couch, you find a nurse, Z.H., unconscious, dusky, and barely breathing. 1. What immediate assessment of Z.H. do you need to perform? Access patient airway, ABC protocol 2. What intervention has the greatest priority? a. Obtaining a STAT toxicology screen b. Connecting her to the portable ECG monitor c. Establishing an IV line with 0.9% normal saline d. Supporting respirations by manually ventilating her 3. What assessment finding would lead you to suspect an opioid overdose is the reason for Z.H.'s condition? a. Hypertension b. Fever and tachycardia c. Constricted pupils and bradypnea d. Diaphoresis and cool, clammy skin Z.H.'s respiratory rate is 8 and shallow. The respiratory therapist intubates her and continues to ventilate her manually. You attach ECG leads to her chest and find Z.H. is in sinus bradycardia, with a ventricular rate of 44 and ST segment depression. 4. What is most likely the cause? Cardiac arrest CASE STUDY PROGRESS Z.H. is given an ampule of 50mL D50W, 1mg naloxone (Narcan), and 0.5mg atropine IV push. Her respirations improve slightly, and her pulse increases to 56 beats/min. She is transported to the ED. 5. Describe the purpose of administering the combination of D50W, atropine, and naloxone. Reverse overdose and hydration 6. What treatment will Z.H. require in the ED? Ensuring airway management while intubated and oxygen administration Assessing oxygenation status and circulation (i.e. pulse ox, respirations, pulse, blood pressure) Obtaining blood lab values and ABGs Monitoring ECG for any dysrhythmias

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CASE STUDY: DRUG OVERDOSE 7. Within 30 minutes of receiving the naloxone, Z.H. is starting to respond. Why do you need to continue to observe her closely? Select all that apply. a. Z.H. may develop pulmonary edema after receiving naloxone. b. A common adverse effect of naloxone is the onset of atrial fibrillation. c. The duration of action of the drugs taken may exceed that of naloxone. d. The risk of developing diabetic ketoacidosis is high after receiving naloxone and D50W. e. Rapidly reversing the effects of the drug overdose will cause a rebound decline in level of consciousness. 8. The physician orders an additional 0.6mg naloxone IV STAT. The vial in the accompanying illustration is available. How many milliliters will Z.H. receive? 0.6mL

9. What information do you need to obtain from Z.H.? how much of the drug that she took, what drug she took, when she took it, other medications that she has taken, allergies 10. In response to your questions, Z.H. tells you that she took fentanyl and that she has been using fentanyl she has taken from the hospital "periodically" for the past several months. How does the Health Insurance Portability and Accountability Act (HIPAA) apply given that Z.H. is a nurse? you should report to your supervisor. 11. What is a chemically impaired nurse? A nurse that is unable to provide competent care to patients due to being under the influence of drugs. One of Z.H.'s colleagues calls on the phone to ask how she is. You convey that you cannot talk about Z.H. with her; however, she goes on to tell you that she thought something was wrong with Z.H. because her behavior had been so erratic, but "I had no idea it was drugs. I didn't think Z.H. would ever do anything like that!" What are the visible signs of a chemically impaired nurse? symptoms of a substance-abusing nurse include shakiness/tremors; fatigue; slurred speech; alcohol on breath or frequent use of mints, gum and mouthwash; diaphoresis; unsteady gait; runny nose; frequent mood changes; weight gain or loss; frequent nausea, vomiting and diarrhea; constricted/dilated pupils and change in personal grooming 12. State four problems associated with impaired nurses who are practicing.

Copyright © 2016 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved

CASE STUDY: DRUG OVERDOSE Patient safety - may not be as quick to realize and report a change in a patient's status Patient's medications - patients may not be getting necessary pain medications Make medication / procedure errors Improper documentation

13. Z.H. asks what is going to happen to her career. What are the regulatory issues related to impaired nurses that will guide your response? Nurse is placed on leave while an investigation is conducted. HR leaders are required to report the abuse to the board of nursing. 14. She then asks you to call a friend to come stay with her. What information would you give her friend over the phone? Consent needs to be given from z.h for the nurse to talk to the patients friend before any details can be given. 15. The friend asks you what is wrong. How do you respond? If consent is given you could say.. Z.h is in the hospital being treated for an overdose.

Copyright © 2016 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved...