Exam (elaborations) NURS 267 Med-Surg Carl Shapiro Feedback Log & Score Acute Myocardial Infarction

Exam (elaborations) NURS 267 Med-Surg Carl Shapiro Feedback Log & Score Acute Myocardial Infarction Feedback Log & Score — Carl Shapiro Apr 13, 2020 9:00 PM Date of Completion Apr 13, 2020 9:00 PM Carl Shapiro Age: 54 years Diagnosis: Acute Myocardial Infarction Score 0 0 0 100%          Feedback Log 0:00 You arrived at the patient's side. 0:00 You introduced yourself. 0:10 You washed your hands. To maintain patient safety, it is important to wash your hands as soon as you enter the room. 1:10 Patient status - ECG: Sinus rhythm with an anterior myocardial infarction. Heart rate: 82. Pulse: Present. Blood pressure: 121/72 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 98%. Temp: 99 F (37 C)  This study source was downloaded by from CourseH on :23:50 GMT -05:00 This study resource was shared via CourseH 4/13/2020 Feedback Log & Score — Carl Shapiro Apr 13, 2020 9:00 PM 1:24 You identified the patient. To maintain patient safety, it is important that you quickly identify the patient. 1:32 You looked for normal breathing. He is breathing at 12 breaths per minute. The chest is moving normally on both sides. 2:01 You attached the pulse oximeter. It is a good idea to monitor the saturation and pulse here. This will allow you to reassess the patient continuously. 2:10 Patient status - ECG: Sinus rhythm with an anterior myocardial infarction. Heart rate: 81. Pulse: Present. Blood pressure: 125/75 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 98%. Temp: 99 F (37 C) 2:16 You measured the blood pressure at 124/74 mm Hg. It is appropriate to monitor the patient by measuring the blood pressure. 2:42 You checked the temperature at the mouth. The temperature was 99 F (37 C). 3:03 You attached a 3-lead ECG. It is correct to attach the monitor to the patient. 3:10 Patient status - ECG: Sinus rhythm with an anterior myocardial infarction. Heart rate: 81. Pulse: Present. Blood pressure: 121/73 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 98%. Temp: 99 F (37 C) 3:15 You assessed the patient's IV. The site had no redness, swelling, infiltration, bleeding, or drainage. The dressing was dry and intact. This is correct. Assessing any IVs the patient has is always important. 3:45 You asked the patient if he had any pain. He replied: 'No, I don't have any pain.' 3:49 You asked the patient if he could describe his pain. He replied: 'It felt like an elephant sat on my chest.' 3:54 You asked the patient where the pain was located. He replied: 'It was in my chest.' 3:57 You asked the patient if the pain went anywhere. He replied: 'Not right now, but it kind of went down my right arm when it was there.' 4:03 You asked the patient how long he had pain for. He replied: 'I don't have any pain.' 4:08 You asked the patient how he felt. He replied: 'Pretty good. Can I get out of here?' 4:10 Patient status - ECG: Sinus rhythm with an anterior myocardial infarction. Heart rate: 81. Pulse: Present. Blood pressure: 121/73 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 98%. Temp: 99 F (37 C) 4:12 You asked the patient when the symptoms started. He replied: 'About 3 hours ago, I suddenly got some pain in my chest' This is an important question to ask as the duration of symptoms determines management options. 4:16 You asked the patient if he had any difficulty in breathing. He replied: 'No. Not anymore.'              This study source was downloaded by from CourseH on :23:50 GMT -05:00 This study resource was shared via CourseH 4/13/2020 Feedback Log & Score — Carl Shapiro Apr 13, 2020 9:00 PM 4:22 You asked the patient if he felt better. He replied: 'Yes, actually. I don't have any pain anymore.' 4:29 You provided patient education. This is correct. It is important to use every opportunity to provide patient education. 5:10 Patient status - ECG: Sinus rhythm with an anterior myocardial infarction. Heart rate: 81. Pulse: Present. Blood pressure: 124/74 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 98%. Temp: 99 F (37 C) 5:25 You listened to the lungs of the patient. The breath sounds are normal. 5:46 You listened to the heart of the patient. There were only normal heart sounds. 6:07 You took a venous blood sample. This is reasonable. 6:10 Patient status - ECG: Sinus rhythm with an anterior myocardial infarction. Heart rate: 81. Pulse: Present. Blood pressure: 122/72 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 98%. Temp: 99 F (37 C) 6:29 You requested a chest x-ray. This was correct. 7:10 Patient status - ECG: Sinus rhythm with an anterior myocardial infarction. Heart rate: 81. Pulse: Present. Blood pressure: 125/75 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 98%. Temp: 99 F (37 C) 7:45 You phoned the provider in order to discuss the patient. 8:10 Patient status - ECG: Sinus rhythm with an anterior myocardial infarction. Heart rate: 81. Pulse: Present. Blood pressure: 122/73 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 98%. Temp: 99 F (37 C) 8:44 The patient developed ventricular fibrillation. 8:44 Patient status - ECG: Ventricular fibrillation. Heart rate: --. Pulse: Absent. Blood pressure: - mm Hg. Respiration: 0. Conscious state: Unconscious. SpO2: --. Temp: 99 F (37 C) 8:44 You activated the code team. It was correct to activate the code team at this point. 8:57 You started CPR at a ratio of 30:2, starting with chest compressions. It was correct to perform high-quality CPR at this point to minimize hands-off time while preparing the defibrillator. 8:57 You placed a backboard under the patient. It is reasonable to place a backboard under the patient as long as interruptions in CPR can be avoided. 8:59 You attached the defibrillator pads. It is correct to prepare for defibrillation here. 9:13 You turned the defibrillator on. 9:18 You warned your colleague to stand clear. 9:18 You stopped CPR.             This study source was downloaded by from CourseH on :23:50 GMT -05:00 This study resource was shared via CourseH 4/13/2020 Feedback Log & Score — Carl Shapiro Apr 13, 2020 9:00 PM 9:23 The AED gave a 'Shock needed' message. 9:34 You delivered a shock with the AED. Defibrillation was the correct action here. You did it! The patient was successfully defibrillated. 9:34 Patient status - ECG: Sinus rhythm with an anterior myocardial infarction. There are ventricular premature beats. Heart rate: 79. Pulse: Absent. Blood pressure: - mm Hg. Respiration: 0. Conscious state: Unconscious. SpO2: --. Temp: 99 F (37 C) 9:43 You resumed CPR at a ratio of 30:2, starting with chest compressions. It was correct to perform high-quality CPR here. CPR might be required to make the heart start circulating blood again. 9:44 The patient obtained return of spontaneous circulation (ROSC). 9:44 Patient status - ECG: Sinus rhythm with an anterior myocardial infarction. There are ventricular premature beats. Heart rate: 79. Pulse: Weak. Blood pressure: 67/40 mm Hg. Respiration: 0. Conscious state: Unconscious. SpO2: 96%. Temp: 99 F (37 C) 9:59 Patient status - ECG: Sinus rhythm with an anterior myocardial infarction. There are ventricular premature beats. Heart rate: 79. Pulse: Present. Blood pressure: 97/58 mm Hg. Respiration: 0. Conscious state: Somnolent. SpO2: 97%. Temp: 99 F (37 C) 10:26 You stopped CPR. 10:34 The patient started breathing spontaneously again. 10:34 Patient status - ECG: Sinus rhythm with an anterior myocardial infarction. There are ventricular premature beats. Heart rate: 81. Pulse: Present. Blood pressure: 114/68 mm Hg. Respiration: 7. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C) 10:39 You assisted the code team and eventually performed a patient handoff. You managed to perform CPR most of the time it was recommended. Highquality CPR includes compressing hard and fast, allowing complete recoil after each compression, reducing hands-off time by minimizing interruptions in compressions, switching providers every 2 minutes, and avoiding excessive ventilation. The most common dysrhythmia in patients with cardiac arrest is ventricular fibrillation (VF), which is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. A common cause of VF is acute myocardial infarction (MI). Patients in VF should receive CPR if a defibrillator is not immediately available. When performing CPR, push hard and fast, allow complete chest recoil, and minimize interruptions. Reassess the rhythm and attempt defibrillation every 2 minutes, or after five cycles of 30:2 compressions to ventilations. Immediately after each shock, resume CPR, beginning with chest compressions. When the code team arrives, the primary nurse should remain by the patient's bedside to assist the code team and communicate patient history. You got 100%      