ShukriKasim33
Case Study: Cardiac Present Problem: Carlos Cabrera is a…
Case Study: Cardiac
Present Problem:
Carlos Cabrera is a 73-year-old Hispanic male who presents to the emergency room with complaints of chest pain, fever, and shortness of breath. He is accompanied by an adult daughter. Carlos’ daughter reports her father has a history of hypertension, asthma, and benign prostatic hypertrophy. Carlos is placed in a room, and vital signs are obtained.
Current VS: P-Q-R-S-T Pain Assessment:
T: 100.8 F/38.2 C (oral) Provoking/Palliative: Deep breath
P: 124 (regular) Quality: Sharp
R: 26 (regular) Region/Radiation: Bilateral chest
BP: 138/89 Severity: 6/10
O2 sat: 90% RA Timing: 2 days ago
The ER provider places an order for a CBC and BMP to be done STAT. A chest X-ray is also performed.
Labs (ED):
Complete Blood Count (CBC)
WBC HGB Hct PLTs
14.2 [3.8-10.4] 12.6 [13.6-16.9] 34 [40-50] 154 [152-324]
Basic Metabolic Panel (BMP) + Mg
Na K Cl CO2 BUN Creat. Gluc Mg
143
[136-144]
5.2
[3.7-5.2]
110
[96-106]
26
[23-29]
16
[6-20]
1.2
[0.8-1.2]
210
[64-100]
1.8
[1.7-2.2]
The chest x-ray demonstrates diffuse bilateral infiltrates suggestive of pneumonia.
1. What data from the present problem is RELEVANT and must be NOTICED as clinically significant by the nurse?
Relevant Data from Present Problem: Clinical Significance:
P: 124, RR:26, O2:90
The provider has ordered IV levofloxacin 500mg IV every 24 hours for treatment of suspected bacterial community-acquired pneumonia. The provider has ordered blood cultures x2, with the first set to be drawn prior to administration of the IV levofloxacin. Mr. Cabrera will be admitted to the medical unit for IV antibiotics and oxygen therapy.
Lab has drawn the first set of blood cultures so the nurse enters the room to administer the IV levofloxacin. Mr. Cabrera is sitting upright on the bed clutching his left arm. His skin is markedly pale and diaphoretic. His breathing appears labored. His daughter is holding an emesis bag in front of his mouth. The daughter sees the nurse enter and remarks, “Oh thank goodness! Dad feels like he may throw up and wants to know if he can get some pepto bismol”.
2. What data is RELEVANT and must be NOTICED as clinically significant by the nurse?
Relevant Data from Present Problem: Clinical Significance:
Additional Information:
The nurse summons the provider to Mr. Cabrera’s room and begins to take another set of vital signs. Mr. Cabrera suddenly slumps over and becomes unresponsive.
3. Describe what the RN’s next steps should be and why:
Next Steps: Rationale:
The Code Team arrives while the RN is administering chest compressions. The patient is placed on a cardiac monitor and the following rhythm is observed:
Pulseless electrical activity (PEA)
4. Using the AHA Adult Cardiac Arrest algorithm, what interventions should the code team deliver to treat the PEA and in what order?
Interventions per AHA Adult Cardiac Arrest Algorithm: Rationale:
CPR is resumed. The Code Leader requests a rhythm check following 2 minutes of high-quality CPR. The following rhythm is observed:
Ventricular Fibrillation
5. Using the AHA Adult Cardiac Arrest algorithm, what interventions should the code team deliver to treat the V Fib and in what order?
Interventions per AHA Adult Cardiac Arrest Algorithm: Rationale:
Mr. Cabrera begins to open his eyes and moan. His skin color has improved. The Code Leader orders compressions to stop and determines peripheral pulses are present and strong. The cardiac monitor displays sinus tachycardia with frequent PVCs.
The Code Leader and team begin to assess Hs and Ts and they continue to stabilize Mr. Cabrera and prepare him for transfer to ICU.
6. Based on known information, review each of the Hs and Ts and identify the likelihood of contributing to the cardiac arrest. Include your rationale.
H & Ts: Likelihood: Rationale:
