nur 2535 post op pain management cardiac arrest 22
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NUR 2535 Post-op Pain Management: Cardiac Arrest
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NUR 2535 Post-op Pain Management: Cardiac Arrest (2/2)
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
, UNFOLDING Reasoning Case Study: STUDENT
Post-op Pain Management 2/2: 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 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.
Current VS:
T: 99.8 F/37.7 C (oral) .
P: 78
R: 12
BP: 92/48
O2 sat: 89% room air 4 liters n/c
What data from the history is RELEVANT and has clinical significance to the nurse?
RELEVANT Data from History: Clinical Significance:
Temp 99.8 Possible infection
Respirations 12, O2 89% on 4L NC Respirations and O2 sats low-due to pain meds?
BP 92/48 BP low-pain meds? Fluid volume/blood loss?
Hx of COPD Pre-existing impact on gas exchange
Hydromorphone PCA bolus 0.2 mg/0.2 mg Opiates decrease respirations
hrs used Q 10 mins.
Pain decreased from 3/10 to 2/10 Pain is controlled.
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 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: /minute
NEURO: Unresponsive, does not arouse or awaken to vigorous physical stimuli
GI: Not assessed
GU: Not assessed
SKIN: Not assessed
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