Comprehensive Nursing - Carl Shapiro v Sim Reflection

Medical Case 4: Carl Shapiro Guided Reflection Questions 1. How did the scenario make you feel? This scenario made me nervous when the patient lost consciousness. There was that feeling where I was frozen and didn’t know what to do, but I remembered about code blue and I took control of the situation after the emergency. It was really relieving when the patient gained consciousness again. 2. What could have been the causes of Carl Shapiro’s ventricular fibrillation? According to the diagnostics lab value, the patient’s troponin and CM-KB levels were elevated and these two lab values indicate manifestations of acute myocardial infarction. 3. When performing CPR for Carl Shapiro, what are quality indicators you are performing resuscitation correctly? Some signs of providing resuscitation correctly include delivering compressions and respirations using the 30:2 ratio. Two breaths should be given every 30 chest compressions. Make sure to allow chest recoil and always look if the chest is rising and falling when giving respirations. Elbows must be straight during compressions, no bending. Open the airway for patient. 4. Discuss safety aspects during defibrillation. Patient must not be touched when AED is analyzing the heart rhythm. When about to administer shock, stand clear from patient and do not touch anything. Any accessories that contain metal must be removed. 5. If Carl Shapiro would have had return of spontaneous circulation (ROSC), what would your next interventions be? Immediately assess pulse, airway and provide appropriate ventilation. Assess EKG machine for heart rhythm. Administer medications such as amiodarone or epinephrine if needed. 6. What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format. S – the patient is undergoing ventricular fibrillation when tending care. He became unconscious and code blue was called. CPR and AED shock are given. B – patient is a 54-year-old male who was delivered in the emergency department after experiencing chest pain, diaphoresis, and shortness of breath. He was treated in the ED with aspirin and two doses of sublingual nitroglycerin. A – After providing CPR and AED shock, the patient regained consciousness and resumed breathing erratically. Vital signs are HR 80, BP 110/66, RR 7, SpO2 97, Temp 99 F (37 C), and has ventricular premature beats. He is currently on 4L oxygen via nasal cannula. R – Monitor cardiac activity and provide adequate oxygen. 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 can imagine how stressing it must be for them to see Mr. Shapiro lose consciousness due to ventricular fibrillation. However, I would first explain to them that such occurrence happens when the heart is not in a healthy condition, especially when displaying sign and symptoms of acute myocardial infarction. Then, I will say that we’ll do everything we can to help her regain consciousness once more. I will advise them to remain calm while me and the other medical personnel do our interventions. After Mr. Shapiro becomes stable, I will educate the family about what and why it happened. 8. What would you do differently if you were to repeat this scenario? How would your patient care change? If I had the chance, I would ask the patient how he is feeling and if he needs any pain medications.