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NUR 409 – Clinical Simulation Case Studies
Case Study 141
You are on duty in the emergency department (ED) when a “code blue” is called overhead. 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, cyanotic, and barely
breathing. Her respirations are 8 breaths per minute and shallow. She is intubated and an IV line
is started with 0.9% normal saline. You attach ECG leads to her chest and find the following:
1. What is your interpretation of Z.H.'s rhythm?
● Bradycardia
Z.H. is given an ampule of 50 mL D50W, 0.4 mg naloxone (Narcan), and 0.5 mg atropine IV
push. Her respirations improve slightly and pulse increases to 56 beats/min. She is transported to
the ED.
2. Describe the purpose of administering the combination of D50W, atropine, and naloxone
(Narcan).
● Patients that come into the ED with an unknown reason for a decreased LOC must be
considered for the potential of being exposed or ingested a drug or chemical with toxic
effects.
● D50W: glucose to counteract any hypoglycemia caused DM or by any drugs ingested
● Atropine: an anticholinergic that helps reverse effects with bradycardia
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NUR 409 – Clinical Simulation Case Studies
● Naloxone (Narcan): works as an opioid antidote and helps reverse opioid induced
respiratory depression; given as a preemptive treatment due to the possibility of an opioid
overdose
3. What treatment will Z.H. require in the ED?
● A – Airway – monitor for airway patency and hypoxemia
● B – Breathing – monitor RR, breathing pattern and for pulmonary edema; mechanical
ventilation
● C – Circulation – Monitor any changes to level of consciousness & EKG, monitor IV
access
● D – Disability – Monitor blood glucose levels for any signs of hypoglycemia
● Obtaining any information on what patient was exposed to or ingested that brought her to
ED
4. Within 30 minutes of receiving the naloxone (Narcan), Z.H. is starting to respond. You need
to continue to observe her closely because: (Select all that apply.)
a. multiple doses of naloxone (Narcan) increase Z.H.'s risk of developing pulmonary
edema.
b. adverse effects of naloxone (Narcan) are atrial fibrillation and ventricular
dysrhythmias.
c. the opioid effect associated with drug overdose might return after naloxone (Narcan) is
metabolized.
NUR 409 – Clinical Simulation Case Studies
Case Study 141
You are on duty in the emergency department (ED) when a “code blue” is called overhead. 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, cyanotic, and barely
breathing. Her respirations are 8 breaths per minute and shallow. She is intubated and an IV line
is started with 0.9% normal saline. You attach ECG leads to her chest and find the following:
1. What is your interpretation of Z.H.'s rhythm?
● Bradycardia
Z.H. is given an ampule of 50 mL D50W, 0.4 mg naloxone (Narcan), and 0.5 mg atropine IV
push. Her respirations improve slightly and pulse increases to 56 beats/min. She is transported to
the ED.
2. Describe the purpose of administering the combination of D50W, atropine, and naloxone
(Narcan).
● Patients that come into the ED with an unknown reason for a decreased LOC must be
considered for the potential of being exposed or ingested a drug or chemical with toxic
effects.
● D50W: glucose to counteract any hypoglycemia caused DM or by any drugs ingested
● Atropine: an anticholinergic that helps reverse effects with bradycardia
, 2
NUR 409 – Clinical Simulation Case Studies
● Naloxone (Narcan): works as an opioid antidote and helps reverse opioid induced
respiratory depression; given as a preemptive treatment due to the possibility of an opioid
overdose
3. What treatment will Z.H. require in the ED?
● A – Airway – monitor for airway patency and hypoxemia
● B – Breathing – monitor RR, breathing pattern and for pulmonary edema; mechanical
ventilation
● C – Circulation – Monitor any changes to level of consciousness & EKG, monitor IV
access
● D – Disability – Monitor blood glucose levels for any signs of hypoglycemia
● Obtaining any information on what patient was exposed to or ingested that brought her to
ED
4. Within 30 minutes of receiving the naloxone (Narcan), Z.H. is starting to respond. You need
to continue to observe her closely because: (Select all that apply.)
a. multiple doses of naloxone (Narcan) increase Z.H.'s risk of developing pulmonary
edema.
b. adverse effects of naloxone (Narcan) are atrial fibrillation and ventricular
dysrhythmias.
c. the opioid effect associated with drug overdose might return after naloxone (Narcan) is
metabolized.
