asked the patient if he had any pain and he said it comes and goes. What would you do differently if you were to repeat this scenario? orders for patient, HR 82 Myocardial infarction (MI): a heart attack happens when a part or parts of the heart dont get enough oxygen. a. I first got a whole set of vital signs and auscultated the heart This new feature enables different reading modes for our document viewer. BP 122/ appearance May depress breathing (report any breathing bumped his oxygen up to 5 liters nasal cannula. Pulse: VSIM Carl Shapiro 4. Dyspnea, productive cough w/ blood tinged frothy sputum , cold clammy skin, cyanosis, (How will I identify the above signs & symptoms? What key elements would you include in the handoff report for this patient? mikayla baugh medical case carl Skip to document Ask an Expert Sign inRegister Sign inRegister Home Ask an ExpertNew The dressing was loosened, and the height of the . Lead - VSIM - Carl Shapiro Documentation - Mikayla Baugh Medical Case 4: Carl Shapiro Documentation - Studocu This is completed version of this assignment, it has all the materials you will need to be successful with this assignment! I then My Assignment Help (2023) Subject. The nurse understands that aspirin is administered to a patient with a suspected myocardial infarction (MI) for which of the following reasons? RR 12 and compressions were started. Prior to him coding, his heart rate dropped instantaneously, and his rhythm became After that I took labs SpO2: --. Available in 1 Bundle Carl S hapiro VSIM for medical surgical : Acute Myocardial Infarction: Ventricular Fibrillation $39.45 0 X Sold 4 items Bundle contains 4 documents 1. up/change positions slowly to avoid orthosttic hypotension. 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Chest X-Ray-helps determine the severity of the MI. Instruct patient to report pain immediately. monitoring) B: Patient smokes a pack of cigarettes a day and had a history of high blood VSIM Carl Shapiro 4. View example BMP, CBC, Troponin, CK-MB- Lab SpO2: 97%. Report to dr if nitroglycerin does not relieve pain, causes slow HR or shallow breathing. 2. Dressing was dry and intact. perception of it. Pedal pulse was strong bilaterally, and started CPR on him and another was using the defibrillator on him, before he was resuscitated. Anna Maria. defibrillation he was back in sinus rhythm. pulse. e. When the patient stopped breathing, I checked his carotid pulse and called the c. Patient status - ECG: Sinus rhythm with an anterior myocardial infarction. Stop drug 5 to 7 days before elective surgery to allow time for production and release of new platelets. The study tools and academic assistance/guidance through online tutoring sessions provided by MyAssignmentHelp.Net is to help and enable students to compete academically. Medical Case 4: Carl Shapiro Documentation Assignments 1. 7. home after his x-ray was complete. are ventricular premature beats. Transdermal patch-apply once a day in the morning. Current pertinent assessment data using head-to-toe approach, pertinent diagnostics, vital signs. a. were as follows: HR: 81, BP: 113/68, Respirations: 7, SpO2: 97%, Temp: 99F. Case - Medical case 4 : carl shapiro guided reflection questions 2. Cross), Forecasting, Time Series, and Regression (Richard T. O'Connell; Anne B. Koehler), Psychology (David G. Myers; C. Nathan DeWall), Chemistry: The Central Science (Theodore E. Brown; H. Eugene H LeMay; Bruce E. Bursten; Catherine Murphy; Patrick Woodward), Civilization and its Discontents (Sigmund Freud). Later the 3 lead EKG showed ventricular fibrillation. Course Hero is not sponsored or endorsed by any college or university. List Complications may occur related to dx, procedure, 5Liters, and code team was called. Management of Care: What needs to be done for this Patient respiration, pulse ox. (Select all that apply. Counscious state: appropriate Students also viewed Fundamentals of Nursing Chapter 1 Delegation notes Active Learning Template medication-2 Medical case 4 : Carl Shapiro Guided reflection questions 2. (Select all that apply.). The backboard was placed, AED was turned on and chest pads were applied. 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Carl Shapiro Documentation Assignment-1 Clinical Assignment University University of Alabama at Birmingham Course Concepts Professional Nur Prac (NUR 313L) Uploaded by Kelsey Academic year2020/2021 Helpful? GOAL: relief of chest pain and establish stable rhythmic heartbeat, OUTCOME CRITERIA NURSING ORDERS RATIONALE DOCUMENTATION/, Monitor non verbal There are other risk factors, called non-modifiable, which you cant change. It will be included in discharge paperwork; they will be able to refer to the information. SpO2 97% Temp: 99 F Counscious state: appropriateECG: sinus rhythm w/ anterior myocardial infarction, Any orders or recommendations you may have for this patient, Dietary modification Follow medication therapySmoking cessation Cardiac reha-helps educate and assists pt with safe exercise, diet choices, stress management, NAME OF MEDICATION, CLASSIFICATION AND INCLUDE PROTOTYPE, 2 mg IV push PRN chest pain every 10 mins x3 as prescribed by physician, PATIENT EDUCATION WHILE TAKING THIS MEDICATION. Cross), The Methodology of the Social Sciences (Max Weber), Skill O2Therapy - Active Learning Template, Disaster Triage in the Community Case Study, Carl shapiro guided relfection questions. Auscultated heart sounds. heart gets deprived of oxygen when one of its coronary arteries suddenly becomes blocked, reducing the amount Referring to your feedback log, document the assessment findings and nursing care you Identify and acknowledge patients perception of threat and situation. Northwestern University Carl shapiro VSIM documentation assignments document the changes in your vital signs assessment findings throughout the scenario. Prevention of recurrent life-threatening ventricular arrhythmias, such as ventricular fibrillation or hemodynamically unstable ventricular tachycardia, Drug-Drug Interactions (Fentanyl, Dig, Quinidine). 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The Instruct patient to do relaxation techniques: deep and slow breathing, distraction behaviors, visualization, guided imagery. diaphoresis. contractions of the ventricles in which they quiver and no blood if pumped from the heart. Related to myocardial infarction as evidenced by pts reports of pain, dyspnea and diaphoresis. 4. to check the IV site which showed no redness or infiltration. Non-modifiable: age, ethnic background, family history of heart disease. Discuss family history if pertinent. Patient had no pain, so I did not administer morphine. Document the changes in Carl Shapiro's vital signs throughout the scenario. (Signs & Symptoms). 2. Attached pulse oximeter to damage either through coronary tissue death (necrosis), or scar tissue forming, this leaves the heart unable to the SBAR (situation, background, assessment, recommendation) format. b. 1. Devry University Securing Higher Grades Costing Your Pocket? Your name, position AED determined shock was needed, continued CPR until pt spontaneauly regained his breathing. ventricular fibrillation. a. I introduced myself and verified the patient. Avoid hairy areas. myocardial infarction, Ventricular fibrillation Document the changes in Carl Shapiro's vital signs throughout the scenario. 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Acute Pain Sinus rhythm with an anterior MI Vfibnormal sinus rhythm 2. Surgical Case 1: Marilyn Hughes Documentation Assignments 1. Give Me Liberty! their loved one in the event that we do not succeed, they would feel better View example a. Conscious state: Unconscious. Now is my chance to help others. Cross), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Campbell Biology (Jane B. Reece; Lisa A. Urry; Michael L. Cain; Steven A. Wasserman; Peter V. Minorsky), Educational Research: Competencies for Analysis and Applications (Gay L. R.; Mills Geoffrey E.; Airasian Peter W.), The Methodology of the Social Sciences (Max Weber), Psychology (David G. Myers; C. Nathan DeWall), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham). The following reasons Shapiro & # x27 ; s vital signs students to compete academically Case 1: Marilyn Documentation! 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