1
Post-op Pain Management: Cardiac Arrest
Melissa Reynolds
Mt. San Jacinto Menifee
NURS 234
Professor Cortes
April 21, 2020
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Post-op Pain Management: Cardiac Arrest
Sheila Dalton, 52 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of
emphasis)
1. Gas Exchange
2. Acid-Base Balance
3. Fluid and Electrolyte Balance
4. Clinical Judgment
5. Patient Education
6. Communication
7. Collaboration
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Post-op Pain Management: Cardiac Arrest
History of Present Problem:
Sheila Dalton is a 52-year-old woman who has a history of chronic low back pain and COPD. She
had a posterior spinal fusion of L4-S1 earlier today. Her pain is currently controlled at 2/10 and
increases with movement. She was started on a hydromorphone patient-controlled analgesia (PCA)
with IV bolus dose that is 0.2 mg and a continuous rate of 0.2 mg/hour.
The nurse reported that her nausea has improved after receiving ondansetron IV four hours ago.
She was having increased pain despite using the PCA every 10 minutes. Her pain has decreased
from 6/10 to 2/10 since the PCA bolus was increased from 0.1 mg to 0.2 mg of hydromorphone IV
one hour ago.
What data from the history is RELEVANT and has clinical
significance to the nurse?
RELEVANT Data from Clinical Significance:
History:
1. Chronic low back pain 1. Herniated disks, most often occurring between the fourth and fifth lumbar
2. COPD vertebrae and can lead to chronic low back pain.
3. Spinal Fusion of L4-S1 2. COPD patients may already have decreased perfusion due to
today hypoxia and hypercapnia.
4. Pain increases with 3. Spinal fusion is commonly performed on patients with herniated
movement disks to stabilize the vertebrae. Spinal anesthesia may lead to
5. Pain increased despite use cardiac arrest.
of PCA 4. This is expected after a spinal fusion but with further investigation
could indicate other conditions.
5. Pain was increasing even with the PCA and pt’s hydromorphone
was increased.
Your shift continues…
Thirty minutes later she is feeling more nauseated, and you administer ondansetron 4 mg
IV push prn. Five minutes later she puts the call light on again. You are not able to respond
immediately because you are helping your other patient get on the commode. Little do you
know that Sheila is going to depend on your ability to THINK LIKE A NURSE and
clinically reason to save her life. When you arrive in her room you observe the following…
Patient Care Begins:
Current Assessment:
GENERAL Lethargic, unresponsive, ashen pale in color
APPEARANCE:
RESP: Minimal spontaneous respiratory effort present. When you arrive at the bedside
you observe that her mouth is full of liquid emesis with chunks of undigested
food that is drooling out the side of her mouth
CARDIAC: Unable to palpate the radial pulse, you go straight to the carotid pulse on the
neck and note a weak pulse with 2 palpable beats in 5 seconds.
Calculate pulse rate: 24/minute
NEURO: Unresponsive, does not arouse or awaken to vigorous physical stimuli
GI: Not assessed
Post-op Pain Management: Cardiac Arrest
Melissa Reynolds
Mt. San Jacinto Menifee
NURS 234
Professor Cortes
April 21, 2020
,2
Post-op Pain Management: Cardiac Arrest
Sheila Dalton, 52 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of
emphasis)
1. Gas Exchange
2. Acid-Base Balance
3. Fluid and Electrolyte Balance
4. Clinical Judgment
5. Patient Education
6. Communication
7. Collaboration
, 3
Post-op Pain Management: Cardiac Arrest
History of Present Problem:
Sheila Dalton is a 52-year-old woman who has a history of chronic low back pain and COPD. She
had a posterior spinal fusion of L4-S1 earlier today. Her pain is currently controlled at 2/10 and
increases with movement. She was started on a hydromorphone patient-controlled analgesia (PCA)
with IV bolus dose that is 0.2 mg and a continuous rate of 0.2 mg/hour.
The nurse reported that her nausea has improved after receiving ondansetron IV four hours ago.
She was having increased pain despite using the PCA every 10 minutes. Her pain has decreased
from 6/10 to 2/10 since the PCA bolus was increased from 0.1 mg to 0.2 mg of hydromorphone IV
one hour ago.
What data from the history is RELEVANT and has clinical
significance to the nurse?
RELEVANT Data from Clinical Significance:
History:
1. Chronic low back pain 1. Herniated disks, most often occurring between the fourth and fifth lumbar
2. COPD vertebrae and can lead to chronic low back pain.
3. Spinal Fusion of L4-S1 2. COPD patients may already have decreased perfusion due to
today hypoxia and hypercapnia.
4. Pain increases with 3. Spinal fusion is commonly performed on patients with herniated
movement disks to stabilize the vertebrae. Spinal anesthesia may lead to
5. Pain increased despite use cardiac arrest.
of PCA 4. This is expected after a spinal fusion but with further investigation
could indicate other conditions.
5. Pain was increasing even with the PCA and pt’s hydromorphone
was increased.
Your shift continues…
Thirty minutes later she is feeling more nauseated, and you administer ondansetron 4 mg
IV push prn. Five minutes later she puts the call light on again. You are not able to respond
immediately because you are helping your other patient get on the commode. Little do you
know that Sheila is going to depend on your ability to THINK LIKE A NURSE and
clinically reason to save her life. When you arrive in her room you observe the following…
Patient Care Begins:
Current Assessment:
GENERAL Lethargic, unresponsive, ashen pale in color
APPEARANCE:
RESP: Minimal spontaneous respiratory effort present. When you arrive at the bedside
you observe that her mouth is full of liquid emesis with chunks of undigested
food that is drooling out the side of her mouth
CARDIAC: Unable to palpate the radial pulse, you go straight to the carotid pulse on the
neck and note a weak pulse with 2 palpable beats in 5 seconds.
Calculate pulse rate: 24/minute
NEURO: Unresponsive, does not arouse or awaken to vigorous physical stimuli
GI: Not assessed
