NUR 305 Guided Reflection: Medical
Case of Carl Shapiro Analysis
Guided Reflection Questions for Medical Case 4: Carl Shapiro
Opening Phase
How did the scenario make you feel?
• This scenario was a lot more stressful than the other ones we have done for me. Even
though I knew the patient was going to have a cardiac issue, but I panicked when the
patient coded. I was delayed on CPR and administered medication when it wasn’t
necessary. I got a 0% the first round I did the simulation which caused me to really
evaluate my thought process with this patient.
Scenario Analysis Questions*
PCC What could have been the causes of Carl Shapiro’s ventricular fibrillation?
• The patient’s v-fib could have been caused by his PMH which included hypertension,
obesity, and family history. The patient also smoked half a pack of cigarettes per day. His
CK-MB (20 ng/mL) and Troponin-T (2.2 ng/mL) were elevated.
EBP When performing CPR for Carl Shapiro, what are quality indicators you are performing
resuscitation correctly?
• You want to make sure you perform compressions to an adequate depth and speed and
allow the chest to recoil fully. It is also good to ensure chest is rising when rescue
breaths are given
S If Carl Shapiro would have had return of spontaneous circulation (ROSC), what would
your next interventions be?
• I would monitor his oxygenation and ventilation. Although he is hooked up to a 3 lead
EKG, if the provider needs more information, a 12 lead may be able to give more
information. I would recommend getting another set of labs. I would monitor BP and
treat hypotension if it occurs.
PCC What key elements would you include in the handoff report for this patient? Consider
the SBAR (situation, background, assessment, recommendation) format.
• S – The patient went into cardiac arrest when getting treated for chest pain. The patient
became unresponsive, and a code was called. We shocked the patient and cpr was
performed. The patient began breathing again.
• B – Patient is a 54-year-old male who came into the emergency room for chest pain
which he describes as an elephant sitting on his chest. Patient smokes half a pack a day
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, and has HTN.
• A – After patient was breathing again, VS were as followed: T 99 F, HR 81, BP 116/69, RR
6, O2 97% on 10L with a nonrebreather.
• R – I recommend close cardiac monitoring due to v-fib and respiratory monitoring as his
respirations are still very low.
Concluding Questions
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.
© Wolters Kluwer Health | Lippincott Williams & Wilkins
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, • I would first have them step aside or leave the room so that the code team
can resuscitate the patient and I would very briefly explain what is about to
occur. After the patient is revived, I would take the time to debrief with the
family and answer any questions they may have. I would also see if a social
worker could stop by the patient’s room to provide them with the emotional
support they need.
What would you do differently if you were to repeat this scenario? How would
your patient care change?
• If I were to do this scenario again, I would try to treat the v-fib more rapidly. I
also learned that giving medication to someone in v-fib will not benefit, so it is
better to not administer the medication
* The Scenario Analysis Questions are correlated to the Quality and Safety Education
for Nurses (QSEN) competencies: Patient-Centered Care (PCC), Teamwork and
Collaboration (T&C), Evidence-Based Practice (EBP), Quality Improvement (QI), Safety
(S), and Informatics (I). Find more information at: http://qsen.org/
Case of Carl Shapiro Analysis
Guided Reflection Questions for Medical Case 4: Carl Shapiro
Opening Phase
How did the scenario make you feel?
• This scenario was a lot more stressful than the other ones we have done for me. Even
though I knew the patient was going to have a cardiac issue, but I panicked when the
patient coded. I was delayed on CPR and administered medication when it wasn’t
necessary. I got a 0% the first round I did the simulation which caused me to really
evaluate my thought process with this patient.
Scenario Analysis Questions*
PCC What could have been the causes of Carl Shapiro’s ventricular fibrillation?
• The patient’s v-fib could have been caused by his PMH which included hypertension,
obesity, and family history. The patient also smoked half a pack of cigarettes per day. His
CK-MB (20 ng/mL) and Troponin-T (2.2 ng/mL) were elevated.
EBP When performing CPR for Carl Shapiro, what are quality indicators you are performing
resuscitation correctly?
• You want to make sure you perform compressions to an adequate depth and speed and
allow the chest to recoil fully. It is also good to ensure chest is rising when rescue
breaths are given
S If Carl Shapiro would have had return of spontaneous circulation (ROSC), what would
your next interventions be?
• I would monitor his oxygenation and ventilation. Although he is hooked up to a 3 lead
EKG, if the provider needs more information, a 12 lead may be able to give more
information. I would recommend getting another set of labs. I would monitor BP and
treat hypotension if it occurs.
PCC What key elements would you include in the handoff report for this patient? Consider
the SBAR (situation, background, assessment, recommendation) format.
• S – The patient went into cardiac arrest when getting treated for chest pain. The patient
became unresponsive, and a code was called. We shocked the patient and cpr was
performed. The patient began breathing again.
• B – Patient is a 54-year-old male who came into the emergency room for chest pain
which he describes as an elephant sitting on his chest. Patient smokes half a pack a day
messages.downloaded_by
, and has HTN.
• A – After patient was breathing again, VS were as followed: T 99 F, HR 81, BP 116/69, RR
6, O2 97% on 10L with a nonrebreather.
• R – I recommend close cardiac monitoring due to v-fib and respiratory monitoring as his
respirations are still very low.
Concluding Questions
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.
© Wolters Kluwer Health | Lippincott Williams & Wilkins
messages.downloaded_by
, • I would first have them step aside or leave the room so that the code team
can resuscitate the patient and I would very briefly explain what is about to
occur. After the patient is revived, I would take the time to debrief with the
family and answer any questions they may have. I would also see if a social
worker could stop by the patient’s room to provide them with the emotional
support they need.
What would you do differently if you were to repeat this scenario? How would
your patient care change?
• If I were to do this scenario again, I would try to treat the v-fib more rapidly. I
also learned that giving medication to someone in v-fib will not benefit, so it is
better to not administer the medication
* The Scenario Analysis Questions are correlated to the Quality and Safety Education
for Nurses (QSEN) competencies: Patient-Centered Care (PCC), Teamwork and
Collaboration (T&C), Evidence-Based Practice (EBP), Quality Improvement (QI), Safety
(S), and Informatics (I). Find more information at: http://qsen.org/
