Lev <3, BSN, RN 53,630 Views
Joined: Jun 3, '11;
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Oh no! Your patient has gone unresponsive on you. First thing to do is a quick pulse check of their carotid artery.
If you do not detect a pulse within five to ten seconds and your patient wishes to be resuscitated, call for help. Send one person to call the code blue and another to grab the crash cart and defibrillator. Then flatten the bed (max inflate the mattress if you know how) and "jump on their chest" and start compressions. The current Advanced Cardiovascular Life Support (ACLS) guidelines from the American Heart Association call for a compression rate of 100 to 120 compressions per minute.
(If your patient has a pulse, but is not breathing or is breathing very slowly or ineffectively, call for help (code blue) and start providing rescue breaths with a bag valve mask device or "ambu bag" at a rate of one breath every five to six seconds. Give each breath over one second.)
Getting help - time for some delegation!
Make sure your charge nurse and the patient's doctor or provider is aware. Once help arrives, quickly place the patient on the backboard. One staff member should start manually bagging the patient with a bag valve mask device at a compression to ventilation ratio of 30 compressions to two breaths. The other person should hook the patient up to the defibrillator. While your coworker is getting the pads on, continue compressions or switch off with someone if you are tired. In general, someone should switch off doing compressions every two minutes.
There are two popular methods of placing defibrillator pads. The method seen most publicly is anterior-lateral placement. This is usually the method illustrated on the package of the defibrillator pads seen in AEDs. Anterior-lateral placement is great for defibrillation but not for pacing. Anterior-posterior placement is ideal for both pacing and defibrillation, but requires the patient to be turned to place the second pad under the left scapula. When placing the pads, try to avoid nipples. Quickly shave the chest if chest hair is preventing the pads from making contact with skin. Avoid placing the pads over a pacemaker site to avoid damaging the pacemaker.
The defibrillator located on inpatient units generally has two modes. There is the automatic external defibrillator (AED) mode - which is similar in functionality to the AEDs used in the public setting. These defibrillators recognize a fatal arrhythmia and advise a shock if indicated. The other mode is manual where a person who is competent at cardiac arrhythmia recognition recognizes a shockable arrhythmia (either ventricular fibrillation (VF) or "V-fib" or ventricular tachycardia (VT) or "V-tach."). Follow your unit and institutional policies and standards for energy selection if your unit uses defibrillators in manual mode. If using a defibrillator in AED mode, pause compressions while the defibrillator is analyzing the rhythm and then resume compressions until the "all clear" is given before a patient is shocked. As soon as the patient is shocked, compressions should be restarted for a full two minutes. When using a defibrillator in manual mode, compressions need only be paused for the shock and then resumed immediately after defibrillation.
In an emergency situation in a patient without an advanced airway a non rebreather is the first choice unless the patient is not really breathing which in case you use an ambu bag. An oxygen saturation of 56% is bad for anyone, COPD or not.
If there is a rapid response team this would be the time to call and then notify the MD.
If you have questions ask them, but try to avoid extended conversions during report.
When your nurse comes in to give meds, avoid extended conversations, because most likely she has to give meds to a couple other patients too within a time frame.
Don't talk while your nurse is using her stethoscope.
Use your incentive spirometer and tell staff how high you've gone.
Don't dump your urine unless you know they aren't measuring.
Don't refuse to allow BPs in an upper extremity unless you have a legit reason (such as lymph node removal on that side or a DVT).
Use every opportunity to walk if allowed.
Move around in bed - do the exercise PT teaches you.
If your nurse comes into the room, get off your phone.
Don't refuse PT (make sure you are medicated before).
Tylenol will help with pain. Don't refuse tylenol or motrin because you think it won't work. If you are on scheduled pain medicine there is a good reason for that. Take it so we don't have to chase after your pain.
If you are feeling dizzy or lightheaded before PT or before getting up please tell someone. The last thing we want is a fall.
To pop out those veins: dangle the arm, use heat, and place tourniquet above and below the vein.
Use your rapid response team!
Don't ever be afraid to question; whether it's an order, a med, a doctor, a patient, or a fellow nurse!
If you feel that something's wrong, it's probably not right...trust your gut and investigate.
Shower, shower, shower! Where's the shower?
You seen a pen for those patients to sign those discharge papers and hopefully never come back!
When Your Patient Is Mentally Galaxies Away.
"Patient states that pain is "better" after dilaudid administration but continues to rate pain at 10/10. Comfort measures offered, which patient declined. "
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