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Carl Shapiro Vsim

  1. Document Carl Shapiro’s cardiac rhythms that occurred in the scenario.

Acute MI, v-fib

  1. Document the changes in Carl Shapiro’s vital signs throughout the scenario.

Vitals were stable throughout entire sim.

  1. Identify and document key nursing diagnoses for Carl Shapiro.

Decreased Cardiac Output
related to:
changes in the frequency of heart rhythm.

  1. Referring to your feedback log, document the assessment findings and nursing care you provided.

Pt arrived at ER with Acute MI. Upon assessment He was A/O Xs3, IV in RAC running at 25mL/hr

Heart sounds were normal with pulses at 80BPM, Resps were even/unlabored about 12 breaths per minute, Pt has no complaints of pain, and stated he was walking when he had a sharp pain in his chest. Troponin and d-dimer elevated. Upon assessment pt stated he did not feel well and stopped breathing, Code team was activated, and CPR started. AED activated and shock was needed, CPR continued until Pt started breathing on his own. Code team and Dr arrived to take over.

GUIDED REFLECTION

  1. How did the scenario make you feel? Well things seemed to be going well until he tanked on me. I mean where did that come from???
  2. What could have been the causes of Carl Shapiro’s ventricular fibrillation? Heart muscle disease, narrowed coronary arteries, and heart attack are all conditions that can lead to ventricular fibrillation
  3. When performing CPR for Carl Shapiro, what are quality indicators you are performing resuscitation correctly? If the patient is hooked to a monitor, effective CPR will generate a waveform on the arterial pressure line that can be monitored for effective compressions. Return of respirations is a great indicator of successful CPR.
  4. Discuss safety aspects during defibrillation. It is important to check the patient for a pulse before using a defibrillator, CPR should be discontinued while defibrillator is in shock or analysis mode. “Clear” should be called at least twice before shocking.
  5. If Carl Shapiro would have had return of spontaneous circulation (ROSC), what would your next interventions be? Make certain patient has proper oxygen and is constantly monitored with SpO2 monitor. Monitor vitals. Prepare to draw additional labs and contact the DR.
  1. What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format. Patient went into V-Fib. CPR and defibrillation were used to resuscitate him. CPR was successful. Pt has a hx of obesity and smoking. Troponin and CK-MB were elevated from labs drawn in the ED. Constant vitals need to be taken and pt monitored for pain level. Continue plan of care and follow up with DR for additional orders.
  1. 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 used therapeutic communication and escorted them to the waiting area. I would also make certain that they were informed of the patient’s status frequently.
  1. What would you do differently if you were to repeat this scenario? How would your patient care change? Now that I know where all the assessment and code buttons are, my response would be a little quicker. In being more aware of where all the options are, I could provide more quality CPR.
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