Summary MS2 Nursing Clinical, Week 1 VSIM; V-Sim Carl Shapiro Documentation and Guided Reflection.

Medical Case 4: Carl Shapiro Documentation Assignments 1. Document Carl Shapiro’s cardiac rhythms that occurred in the scenario. The ECG originally showed sinus rhythm with an anterior myocardial infarction. ST Elevation consistent with myocardial infarction at 80 bpm. The patient went into ventricular fibrillation represented by rapid and irregular electrical activity renders the ventricles unable to contract in a synchronized manner, resulting in immediate loss of cardiac output 2. Document the changes in Carl Shapiro’s vital signs throughout the scenario. The patient vital signs at the beginning was were stable: BP- 122/72, HR- 82, conscious state, Spo2: 97%, RR -12, Temp -99F. During the scenario the patient vital signs fluctuate not in large degrees. The most prominent change was when the patient lost his consciousness and became unresponsive. The patient was not breathing, and he had absent pulse. 3. Identify and document key nursing diagnoses for Carl Shapiro. Ineffective cardiac output and cessation of myocardial blood flow. The patient went into Ventricular Fibrillation which cause a sustained burst of multiple, uncoordinated regional ventricular depolarizations and contractions, resulting in an ineffective cardiac output and cessation of myocardial blood flow. 4. Referring to your feedback log, document the assessment findings and nursing care you provided. In this assessment finding the vital signs were stable: at the beginning with a slow progression in the pulse and respiratory rate declining. The patient stated he was not feeling well and became unconscious. At this time the care changed from assessment to providing hands on life saving assessment and interventions. Medical Case 4: Carl Shapiro Guided Reflection Questions 1. How did the scenario make you feel? I was shocked when the patient suddenly stopped breathing. It happened so fast and it was unexpected because his VS were relatively stable, and he didn’t complain of any pain. I was trying to check his carotid pulse and then find a call button. And it seemed to me that these actions took such a long time, when in real life it would’ve happened in seconds. 2. What could have been the causes of Carl Shapiro’s ventricular fibrillation? Mr. Shapiro has a busy work life that includes constant travelling. It can add a great stress to the body that already has some health issues. Moreover, smoking a half a pack of cigarettes a day affects lungs and causes vasocontraction. He has history of hypertension that he manages with medications. He probably was out of shape because he also stated that he was walking to get in shape. He could have a family history of vascular diseases.