Respiratory-Cardiac Arrest Clinical

Reasoning 

Sheila Dalton, 52 years old

Primary Concept

Perfusion

Interrelated Concepts (In order of emphasis)

1. Gas Exchange

2. Acid-Base Balance

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Respiratory-Cardiac Arrest Clinical

Reasoning 

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.

Patient Care Begins:

Current VS:

T: 99.8 F/37.7 C (oral)

P: 78

RELEVANT Data from History:

Clinical Significance:

R: 12

COPD

BCPh

:

ro

9n

2/

i

4c

8low back

pain Recent spinal fusion

surgery

History of respiratory issues, likely retains CO2, potential alveoli

dysfunction

Use of pain medication with chronic back pain?

Post-op day 0, need to assess for surgical complications/expected

findings, risk for infection/bleeding

Narcotic use (decr. RR)

Low oxygenation status on 4L NC

Is BP complication of meds, sign of bleeding?

OH2ydsarto:m89o

%rphrooonme uaisre4wliittehrs

n/c

worsened pain

Nausea, relieved with Zofran

Low SpO2 89%

Low BP 92/48

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Respiratory-Cardiac Arrest Clinical

Reasoning 

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...

What assessment data is RELEVANT and must be recognized as clinically significant by the nurse?

RELEVANT Assessment Data: Clinical Significance:

Unresponsive

Ashen pale

Minimal resp.

effort

Liquid emesis in mouth

Weak carotid pulse

24 bpm

Does not awake or arouse to

painful stimuli

signs of cardiac arrest, heart is not pumping blood and

shunting to core is likely occurring

Loss of consciousness from sudden lack of blood flow

Aspiration of gastric contents during arrest could have

occurred

Needs immediate intervention!!!

Current VS:

T: not assessed

P: 24

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