Critical Care Nursing Scenario Discussion Essay

Critical Care Nursing Scenario Discussion

You are working in an ICU and a rapid response is called to one of the medical-surgical units. You decide to go to the rapid response with the ICU charge nurse. You arrive to the patient’s room and the patient is pale and breathing rapidly. The primary nurse greets you and thanks you for coming to help. The primary nurse explains that the patient is Mrs. Black and she is a 67-year-old who was admitted a few hours ago for pneumonia. She was admitted with orders for IV antibiotics and fluids. Her vital signs were stable, and she had no complaints. A few minutes ago, Mrs. Black called out to the nurse and stated she could not breathe. Upon assessment, Mrs. Black was using accessory muscles to breath, her pulse oximetry was 78% on 2L of oxygen, her blood pressure was 74/46, heart rate was 136 beats per minute, respirations were 26 breaths per minute, and her temperature was 39.1 Celsius. The primary nurse turned the nasal cannula oxygen up to 6L and sat the head of the bed up. She stated Mrs. Black became very anxious and kept stating she was unable to breath. She decided to call the RRT due to the patient’s sudden change in condition.

The attending physician and respiratory therapist arrive to the RRT. The physician orders a STAT portable chest x-ray and arterial blood gases. The patient is also placed on a non-rebreather at 15L of oxygen. A cardiac monitor is placed on the patient and the patient is sinus tachycardia with a heart rate of 145. The respiratory therapist draws the arterial blood gases. After the gases are drawn, the attending physician orders a STAT transfer to ICU due to the patient’s poor breathing. He asks Mrs. Black if she would want to be intubated with a tube and machine to help her breath if necessary. Mrs. Black states she does want to be intubated and continues to state she is unable to breath and that she needs help. You transfer Mrs. Black to the ICU and obtain report from the medical-surgical nurse. As you are getting report, the ABGs result: PH – 7.12, PaCO2 – 76.4, HCO3 – 26, PaO2 – 55

You enter the room and begin assessing Mrs. Black. You suddenly hear the cardiac monitor alarm and look up to find Mrs. Black in asystole with a heart rate of 0 beats per minute. You check for a pulse and ask Mrs. Black if she is ok. You are unable to feel a pulse and yell for help, call a code, and begin CPR.

Instructions:
For this discussion post, write 300 words or more and answer all questions below. Please use complete sentences and explain your actions. Cite your text as appropriate.

1. What is the goal of a RRT? Do you feel the primary nurse in this scenario should have called a RRT? Explain your answer.

2. Interpret Mrs. Black’s ABGs.

3. As the nurse to walk in and begin the code, what is your primary role in the code?

4. Explain the importance of the code leader and their responsibility in a code situation.

5. The patient is in asystole. Should you provide a shock to this patient using the defibrillator? Why or why not?

6. During the code, the physician asks about the differential diagnosis and any possible causes of this code. Describe at least 5 reversible causes of cardiac arrest. Are there any reversible causes you feel this patient may have? Why or why not?

8. During the code, the code leader states to give Epinephrine IV push. What is the dosage you will provide to the patient? How often can this medication be given during a code situation?

9. After the patient is intubated with an endotracheal tube, you are asked to deliver breaths to the patient via a bag-valve device. How many breaths should you give the patient per minute? Should chest compressions be stopped when providing these breaths? Why or why not?

10. The physician asks you to be the code recorder in this scenario. What is important to document during a code? Provide details on all required documentation.

11. The patient’s husband arrives to the ICU and wants to come in the room during the code. Would you allow him? Why or why not?

Critical Care Nursing Scenario Discussion Essay

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