Case Scenario of Cardiac Arrest patient

Every minute lost without treatment of a patient who is experiencing VF, for the starting defibrillation to be successful and the patient to survive reduces by 7 percent to 10 percent. However, combination of Cardiopulmonary resuscitation and defibrillation increases the chances of survival. There are two types of defibrillation which include external defibrillation (ED) and implanted cardioverter defibrillators (ICDs) (Marenco et al. In a clinical care setting of nursing, it is very critical to pay attention to the status of the patient who is in pre, intra and post thoracic open surgery so as to avert outset of various problems which can occur and make certain that the results of health recovery are met. The past medical history of the patient and the nature of the procedure which was undertaken play a very critical role in the recovery of the patient postoperatively.

Subjective Data M. K. and 80 year old Asian male patient was hospitalized in Emergency department at Tan Tock Seng Hospital with the complaints of progressing shortness of breath which had lasted for 1 and a half weeks. He explained that the shortness of breath was aggravated by minimal exertion or activity. He projected that the shortness of breath which was experiencing was relieved by rest, he also stated to note that he had bilateral swelling of the lower limbs u to the level of the knee over the past one week. The surgical history of the patient is that he had a stent placement and has implanted cardioverter defibrillator approximately 35 years ago. Socially, the patient does not consume alcohol but he has history of smoking cigarette 40 years ago where he used to smoke 1 pack of cigarette daily.

The patient has no history of any food or drug allergy and the family history of the patient is contributing factor to the conditions which he is suffering. His mother was hypertensive and his father had been diagnosed with heart failure. In the review of symptoms of the patient, there were positive results of shortness of breath during an activity, generalized body weakness and increased weight as a result of bilateral lower limbs swelling. The voiding is inadequate and there is no difficulty experienced by the patient. The chest radiography which was done in the morning showed that there was bilateral lung collapse. An echocardiogram showed that there was high injection from 25 percent to 35 percent. There is evidence of rhythm disturbances and abnormal electrical patterns which includes prolonged interval of QT.

Nursing Diagnosis The first intervention will be the activity intolerance which the patient is experiencing as a result of the oxygen supply and demand imbalances which have been noted by the patient. Complications • Burns on the chest wall altering skin integrity • Shocking of a rescuer • Injury to the myocardium • Pulmonary oedema • Cardiac arrest or respiratory system malfunction • Impairment of neurological system and possibility of death Precautions and hazards of using defibrillation • Ensuring that all equipment’s are set well to prevent current leakage and proper grounding (Van et al. • Defibrillation can be risky to those patients who have a lot of weight more than 90 lb • When there are artificial pacemakers which are not functioning. • When a shock is delivered accidentally to the next rescuer Management Perioperative • Evaluating the neurologic status of the patient.

• Assessing the respiratory status of the patient by auscultating the lungs, quality of breathing and monitoring the rate and the depth of breathing • Requesting for oxygen • Assessing the cardiovascular status of the patient monitoring the rhythm and blood pressure, pulse of the patient until he stabilizes. • Monitoring vital signs of the patient • Initiating intravenous antidysrhythmic medications. Ambulation and resting between exercises is paramount because it helps in reducing oxygen demand levels and also maximizing the patient’s energy levels. In order to prevent exhaustion and myocardial overload progression of activities in a slow motion is also critical (Mullen and Brien, 2009). Participation multidisciplinary team is important in the clinical setting of various realistic goals which will be focused on the patient’s well-being before discharge period.

The occurrence of heart failure to this patient is attributed to increased conditions of overload and also due to systolic heart failure, as a result, there is need to minimize the volume overload and enhance sufficient renal clearance. In order to effectively manage on this condition, the interventions will put more attention on daily recording of the patient weight, oxygen therapy, fluid restriction and administration of medications which have been prescribed. Four research questions which can be possed in this case scenario. Due to time constraints, the patient did not receive the required health education which is usually offered by the clinical Nurse specialist. The very first question will be relating to which kind education is offered to the patients during the preoperative period.

The question will be: Does educating the patient post open heart surgery decrease occurrence of infections and hospital readmissions? The second question will be concerned with the education of medical practitioners on how to use the defibrillation machine to resuscitate patients who develops cardiac arrest. The question will be Do all medical practitioners have essential skills and knowledge of how to resuscitate a patient who develops sudden cardiac arrest? The third questions will focus on the ability of the patient to retain education on signs and symptoms of cardiac arrest. St. Louis, MO: Mosby. Marenco, J. P. , Wang, P. , and O’Brien, N. (2009, January). Caring for a patient after coronary artery surgery. Nursing2009CriticalCare, 22-27. Otero, R. Interruption of cardiopulmonary resuscitation with the use of the automated external defibrillator in out-of-hospital cardiac arrest.