to this If using DocuCare, the instructor assigns the same vSim patient which can be, Students are to complete the reflection questions and submit to instructor post. During ventricular fibrillation, pitressin (Vasopressin) may be used in place of epinephrine for the first or second dose. shadow Per physicians orders, IV infusion of NS was started and labs were drawn. Document the changes in Carl Shapiro's vital signs throughout the scenario. NAME OF MEDICATION and CLASSIFICATION MEDICATION: Aspirin (acetylsalicylic acid) CLASSIFICATION: Additional comments: "Try to first choose the mos. rubric provided in the worksheet template. o Plan of Care Concept Map DOB: 7/19/1966 List Complications may occur related to dx, procedure, Weight: 110 kg Fall Risk: Location: Consults: Transfer: Fluid/Rate: PT came into the ED with complaint of chest pain, SOB and diaphoresis. Chest X-Ray- helps determine the Which of the following are cardiac markers assessed in the pt experiencing angina potential myocardial injury? He was ordered supplemental oxygen via nasal canula @ 4L/min to PACKET Student Resources STUDENT INSTRUCTIONS FOR VIRTUAL CLINICAL REPLACEMENT Discuss safety aspects during defibrillation. Carl Shapiro vsim./; complete solutions/rated A Course NURSING NF 214 Institution Herzing University CONCEPT MAP WORKSHEET DESCRIBE DISEASE PROCESS AFFECTING PATIENT (INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS) Coronary artery disease- Increased blood levels of low-density lipoprotein (LDL) irritate or damage the inner layer of coronary vessels. Patient Introduction Carl Shapiro is a 54-year-old male who travels frequently. IV in the R AC NS running at 25 ml/hr AOx 4 Pain is 0/10 after the second dose of nitro Cardiac focused assessment Related to myocardial infarction as evidenced by pts reports of pain, dyspnea and Pt howsuggestive The patient will have a oxygen saturation of 94% or higher Path to Discharge: Diagnosis: HCP: Finnegan, Donna, MD Age: 54 Acute myocardial Take as directed, with water and food to avoid nausea, do not crush or chew. suggested reading area. Pts may not specifically verbalize their pain but rather express it through their behavior, Pain may cause RR to increase due to the pain and anxiety, thise will also increase pts BP, Review pt cardiovascular hx and compare to previous chest pain episodes, May help distinguish pain source and also identify worsening or progression of a pre existin condition, 1.administer supplemental O2 via nasal cannula, Makes more oxygen available to the heart which might help relieve discomfort, Nitroglycerin helps control pain by its vasodilating effects which decreases hearts o2 demand, Pt reported no pain after taking aspirin and nitro. 4. I started off calm, but got a little nervous because I panicked when the patient had no pulse and no oxygen saturation. I can imagine how stressing it must be for them to see Mr. Shapiro lose consciousness due to ventricular fibrillation. - Indigestion 3. Review the smart sense links associated with the Nursing Care, Diagnostics, and Pharmacology, found in the suggested reading area. Continuos ECG- helps monitor for Patients primary diagnosis, date of Appropriate actions you should do to complete this activity include nding appropriate data to provide a o Students are to complete the Lasater Evaluation on each vSim. Cross), Educational Research: Competencies for Analysis and Applications (Gay L. R.; Mills Geoffrey E.; Airasian Peter W.), Campbell Biology (Jane B. Reece; Lisa A. Urry; Michael L. Cain; Steven A. Wasserman; Peter V. Minorsky), Chemistry: The Central Science (Theodore E. Brown; H. Eugene H LeMay; Bruce E. Bursten; Catherine Murphy; Patrick Woodward), Psychology (David G. Myers; C. Nathan DeWall), Civilization and its Discontents (Sigmund Freud), MLA Review Worksheet - assignment given to practice MLA format, Lab 6 Procedures - Online Instructor is White, Lab 4 Procedure - Online Instructor is White, Lab 3 Procedures Sheet - Online Instructor is White, Management Information Systems and Technology (BUS 5114), Introduction to Health Information Technology (HIM200), Elementary Physical Eucation and Health Methods (C367), Introduction To Computer And Information Security (ITO 310), Concepts of Medical Surgical Nursing (NUR 170), Microsoft Azure Architect Technologies (AZ-303), Professional Application in Service Learning I (LDR-461), Advanced Anatomy & Physiology for Health Professions (NUR 4904), Principles Of Environmental Science (ENV 100), Operating Systems 2 (proctored course) (CS 3307), Comparative Programming Languages (CS 4402), Business Core Capstone: An Integrated Application (D083), English 123- 3-4 Assignment Submission- Annotating Your Sources, Chapter 15 Anxiety and Obsessive-Compulsive Disorders, BMGT 364 Planning the SWOT Analysis of Silver Airways, TB-Chapter 16 Ears - These are test bank questions that I paid for. 2. - measures the hearts electrical activity Date: 02/08/2021 suggested reading area. breathing exercise can 2. When a pt is to receive defibrillation, the nurse ensures that which of the following safety measures are implemented? STUDENT INSTRUCTIONS FOR VIRTUAL CLINICAL REPLACEMENT, This activity packet is intended to be used with your assigned virtual patient found in vSim. Each clinical experience in the simulation lasts a maximum of 30 minutes. 5. CLASSIFICATION: VASODILATOR, NITRATES, ANTIANGINALS, 0.4 mg transdermally once a day for 12 to 14 hours as prescribed by physician0.6 mg sublingually every 5 minutes as needed, up to 3 doses, To treat chest pain by increasing blood flow through vasodilation (relaxing/widening the blood vessels to increase blood flow) and decreasing the hearts demand for oxygen. which of the following does the nurse recognize as typical s/s exhibited by pt with angina? supply and demand. Elevated HR & RR (tachycardia & -- leukocytosis This activity provides you no need ), 2. In case any user is found misusing our services, the user's account will be immediately terminated. thorough SBAR report. 2. breathing A. every 15 minutes, 3 doses max B. Case - Vsim carl shapiro 3. modifiable cardiac risk factors can include hyperlipidemia, tobacco, HTN, diabetes, metabolic syndrome, obesity, and physical inactivity. VSIM - CARL SHAPIRO INTRODUCE SELF WASH HANDS IDENTIFY PATIENT ASK ABOUT ALLERGIES OBTAIN CONSENT TAKE TEMPERATURE ASSESS RESPIRATION CHECK RADIAL PULSE ASSESS O2 SAT CONNECT AUTOMATIC BLOOD PRESSURE CUFF AUSCULTATE HEART CONNECT 12 LEAD EKG CONNECT ECG DOTS CHECK HER ASSESS IV ACCESS DO CHEST XRAY CALL MEDICAL DOCTOR PAIN ASSESSMENT - DO YOU non-modifiable cardiac risk factors: family hx, increasing age, gender, and race. The patient will not experience a pain level higher than 0/10 throughout day 8 minutes into the scenario he went into ventricular fibrillation then went unconscious and CPR needed to be performed. 1.The nurse is educating a client on managing gout. Height: 175 cm Bed rest w/ bathroom priviledges Current pertinent assessment data using head-to-toe approach, pertinent diagnostics, vital signs. The website does not provide ghostwriting services and has ZERO TOLERANCE towards misuse of the services. Case - Carl shapiro feedback log & score - acute myocardial infarction: ventricular fibril. Carl is a caucasian male, presenting with HTN and obesity and had hx of cigarette smoking and physical inactivity During CPR, how often should the nurse assess the carotid pulse for return of spontaneous circulation (ROSC)? as ordered for acute angina Case - Carl shapiro concept map worksheet, isbar, pt education worksheet 4. - Assessday - peaked upright or inverted T wave Administer remediation prior to the virtual simulation. Heart rate: 82. When a patient is experiencing angina, the nurse administers nitroglycerin sublingually at what frequency? using the information contained in step five. tachypnea) Healthy heart diet, Patients primary - Watch for small, round, red pinprick spots, bleeding gums, signs of GI bleeding When viewing the past medical history, the nurse identifies which cardiac risk factors specific to Carl Shapiro? This activity creates an opportunity for you to prepare for a virtual clinical experience. Assessing carotid pulse The patient will have a urinary output of at least 30 mL/ hr ASSIGNMENT remediation prior to the virtual simulation. You are to score yourself on the Full Document. thin hair, deteriorating tooth enamel, 2. portion of the myocardium; generally over 1 cm. Submit for review, to the course dropbox. ventricular fibrillation. process or condition, the anticipated physical assessment ndings, vital signs, diagnostics, specic discomfort, jaw pain, left arm pain Copyright 2023 StudeerSnel B.V., Keizersgracht 424, 1016 GC Amsterdam, KVK: 56829787, BTW: NL852321363B01, DESCRIBE DISEASE PROCESS AFFECTING PATIENT, (Include Pathophysiology of Disease Process). LEARN FLOW - STEP SIX Reflection Questions and Lasater Evaluation Pain level: 0/10 Counscious state: appropriate - Patient will develop pressure injuries from immobilization Alerts: cause hypotension, change positions/get up slowly. 1. He reports that he has mild pain and pressure in his lower abdomen. with ambulation to the bathroom. Auscultate lungs and heart, monitor vitals and O cardiovascular hx and FINDINGS - chest pain Code team was activated and CPR was started. to use call of levels working on, diaphoresis and SOB. approach, pertinent most common causes include vasospasm, decreased oxygen supply, and increased demand for oxygen. PT is now stable and on 4 L of oxygen via N/C and continuous ECG monitoring. The Six Step 5. chest pain episodes, May help distinguish Ventricular fibrillation could have been caused by the elevated levels of troponin I and CK-MB. Paste your reflection questions in the box below - tachypnea handling sublingual Your name, position (RN), unit you are Acute MI, v-fib Document the changes in Carl Shapiro's vital signs throughout the scenario. PT is receiving relieve discomfort, Nitroglycerin helps Carl Shapiro immediately and CPR was started. Rotate sites. second Every 3 min, no restriction on # of doses C. Every 5 min, 3 dose max D. Once only, then administer morphine Click the card to flip Adm DX: acute : an American History - Chapters 1-5 summaries, 10 Cualidades DE Josue COMO Lider en la biblia en el antiguo testamento y el ejempolo que no da, Carbon Cycle Simulation and Exploration Virtual Gizmos - 3208158, Leadership class , week 3 executive summary, I am doing my essay on the Ted Talk titaled How One Photo Captured a Humanitie Crisis https, School-Plan - School Plan of San Juan Integrated School, SEC-502-RS-Dispositions Self-Assessment Survey T3 (1), Techniques DE Separation ET Analyse EN Biochimi 1. vSim for Nursing Medical-Surgical Includes 10 virtual patient simulation scenarios and other curricular content based on the National League for Nursing (NLN) Complex Care Medical-Surgical Scenarios (Volume 1). 1:10 Patient status - ECG: Sinus rhythm with an anterior myocardial infarction. Drinks 1-3 drinks a week, Pt will have a stable heart beat, absence of chest pain and normal biomarker levels upon discharge, What are you on Alert for with this patient? Deep breathing exercise can also help lessen pts anxiety which will also help towards maintaining a stable BP. Administer prescribed medications as ordered Complete blood count Perform perineal care and assess for patency and kinking in the foley catheter What are the pros/cons of government and political involvement in Dodd-Frank Act: Exhibit 7.A, p. 145. - fever ANTICIPATED NURSING INTERVENTIONS - Assess for chest pain using mnemonic OPQRST . Height: 175 cm IV of NS @ 25 mL/hr, continuous Submit the completed worksheet. If peripheral IV access cannot be established during cardiac arrest after several attempts by the nurse, the nurse would next consider which access for rapid delivery of medications? View Code Assess for changes in LOC 1. (Include Pathophysiology of Disease Process) The patient will have stable vital signs for at least 10 hours out the 12 hour shift (minimal changes; there will be no trend alert) of infection 1. Fluid/Rate: existin condition, Makes more oxygen 3. alleviate discomfort, assist pt in About Press Copyright Contact us Creators Advertise Developers Terms Privacy Policy & Safety How YouTube works Test new features NFL Sunday Ticket Press Copyright . 4. We can myocardic ischemia, which could further lead to What is the next drug after epi that the nurse should expect to administer to pt in v fib? anxiety which will also aneurysm o If you do not achieve 100% you must go back and re-do the simulation exercise and then 7. To prevent risk of MI in patients with previous MI, unstable angina, and chronic stable angina pectoris PATIENT EDUCATION WHILE TAKING THIS MEDICATION PT was stable and transfered telemetry unit. ECG and SpO2 monitoring and morphine 2mg IV push PRN for chest Chest Pain was improved to 0/10. during v fib, pitressin (vasopressin) may be used in place of epi for the first or second dose. diagnostics, vital - Encourage - Percutaneous SOB Important safety aspects to follow during defibrillation are to first check to see if the PT has a pulse. Chest X-Ray-helps determine the severity of the MI. PT was on supplemental oxygen via nasal canula at 4L/Min to maintain a SpO2 of greater than 92%. Assess for signs SpO2: 98%. He was treated with aspirin and two sublingual nitroglycerins. when the nurse discovers a pt is not visibly breathing, the nurse knows that which of the following is immediate priority? MI, indicating inflammatory response SPO2: 97% Adults: 75 to 325 mg PO daily or 162.5 mg extended-release capsule PO daily PURPOSE FOR TAKING THIS MEDICATION delegated. Vital signs every 4 hours, 3 lead ECG, CBC 2. May cause hypotension, change positions/get up slowly. As cells are deprived of oxygen, comorbidities: Priorities for Managing the Patients Care Today, Monitor continuos ECG, identify any disrythmias, Monitor O2 levels, ensure it remains at or >92 to prevent Adm DX: Acute Myocardial 2. Medical Case 4: Carl Shapiro Documentation Assignments 1. o Pharm4Fun Worksheet (one per medication) increase due to the pain including a focused assessment that reflects all areas of assessment performed in the vSim document. 6. using aspetic technique capillary refill / oxygenation saturation Priorities for Managing the Patients Care Today An acute MI indicates irreversible myocardial injury resulting in necrosis of a significant -- Patient During admission, his lab reports, EKG, stress tests were all normal, what is the c. What are some recommendations to help people with post myocardial infarction depression? Carl is a caucasian male, presenting with HTN and obesity and had hx of cigarette smoking and physical inactivity. breathing, May positively affect 3. -cardiac in 12-20 hr, and returns to normal in Monitor lab studies such as Na+, K+, BUN, and ABGs BMP, CBC, Troponin, CK-MB Monitor lab values to determine if any complications have developed 1. He was admitted through the ED at 1230 with complaints of SOB, chest pain, diaphoresis. 6. Log into thePoint and launch the assigned vSim, following all instructions posted on your learning Acute Coronary Syndrome (Carl Shapiro) 5.0 (1 review) When a patient is experiencing angina, the nurse administers nitroglycerin sublingually at what frequency? BMP, CBC, Troponin, CK-MB-Lab tests for biomarkers--substances released into the blood with existing heart issues, DiaphoreticSOB Cool, moist skin w/ pale appearanceST elevation, Elevated HR & RR (tachycardia & tachypnea), PT may experience chest pain,discomfort, jaw pain, left arm pain & anxiety, Monitor continuos ECG Assess painAuscultate lungs and heart, monitor vitals and O2 Monitor for SOB, dyspnea and crackles as this may signal pulmonary edema following the MI Administer nitroglycerin & other pain meds Administer oxygenPt positioning (fowlers) to decrease chest discomfort and dyspnea, Assess IV sites frequently-IO access is the route use for drug delivery in emergency situations when an IV access cant be stablished, Your name, position (RN), unit you are working on, Patients name, age, specific reason for visit. PT Complete all areas of the attached clinical worksheet. - Stop drug 5-7 days before any surgery to allow time for production and release of new platelets check for pulmonary edema Mr. Carl Shapiro is a 54-year-old male who travels frequently. Myocardial infarction (MI): a heart attack happens when a part or parts of the heart dont get enough oxygen. 2 min if peripheral IV access cannot be established during cardiac arrest after several attempts by the nurse, the nurse would next consider which access for rapid delivery of medications? admission, current orders for patient ASSESSMENT coronary intervention is used to open the occluded coronary artery and promotes reperfusion to vSim. : an American History (Eric Foner), Biological Science (Freeman Scott; Quillin Kim; Allison Lizabeth), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. ASA 325 mg PO and two doses of NTG 0.4 mg. Fatigue, muscle problems (weakness, spasms, uncontrolled muscle twitching, Acute Coronary Syndrome (Carl Shapiro) 40 terms Images bella6678 Prep U Chapter 29 78 terms BenzieBox vSim: Medical Case 1 Kenneth Bronson 16 terms Shania95111 Other sets by this creator PrepU Ch 36: Management of Patients with Musc 51 terms Shania95111 PrepU Ch 37: Management of Patients with Musc 54 terms Shania95111 o Student may take several times using the answer key to provide immediate The PT has a history of uncontrolled HTN therefore it HTN could increase the risk for Cool, moist skin w/ pale ontroponin of sodium admission, current This question was created from Unit 5 Post-Class Using Quotations and Paraphrasing Activities. T/F: if carl shapiro had proceeded into asystole after v fib, continuing to defibrillate would have been the appropriate intervention. (Signs & Symptoms). Infection 2. ineffective tissue perfusion 3. SpO2 97% Check carotid pulse again, ensure PT has proper and adequate oxygenation. Calculate the amount of time needed to bring the radioactivity to 25% for the radioisotope Holmium 166, which has a half life of 26 hours. May cause dizziness, blurred vision, dry mouth. - Administer thromoblytics to dissolve thrombus in the coronary artery , allowing blood flow through the coronary Following the prompts of the defibrillator closely is important. the nurse knows that which factors may increase pt's risk of developing coronary artery disease? 1. CK-MB, complaints of chest pain, SOB, and diaphoretic. Myocardial infarction (MI): a heart attack happens when a part or parts of the heart dont get enough oxygen. Avoid alchohol, Stand up/change positions slowly to avoid orthosttic hypotension. management system (LMS). All sales are final. Transdermal patch-apply once a day in the morning. after daily Course Hero is not sponsored or endorsed by any college or university. To prevent injury to staff! to toe approach, pertinent diagnostics, vital CONTACT PRECAUTIONS Patients name, age, Log into thePoint and launch the assigned vSim, following all instructions included in this PT has (How will I identify the above signs &Symptoms?) Company Registration Number: 61965243 3. paste your questions and answers into the worksheet template. IV sites alcohol. NKA same naming convention and upload them as separate documents lastname_vSimName_pharm1.pdf 3. when performing CPR for Carl Shapiro, what are quality indicators you are performing resuscitation correctly? PT suddenly did not have pulse and no oxygen saturation, team code Get a new set of vital signs and monitor for any trend alerts 3. We're available through e-mail, live chat and Facebook. NKA Clinical Worksheet Assigned vSim: Carl Shapiro Isolation: performing relaxation This activity provides you with the opportunity to create pertinent patient education on the A central line takes more time to place. Management of Care: What needs to be done for this Patient When administering medication to pt w/ suspected MI, the nurse understands that morphine has which of the following beneficial effects? To maintain patient safety, it is important to wash your hands as soon as you enter the room. Educate nursing interventions, and other patient information associated with the patient situation. (Signs & Symptoms) Clinical Worksheet carl shapiro vsim documentation concept map worksheet describe disease process affecting patient (include pathophysiology of disease process) myocardial Skip to document Ask an Expert Sign inRegister Sign inRegister Home Ask an ExpertNew My Library Discovery Institutions Harvard University University of Georgia University of the People artery or decrease pts If Carl Shapiro would have had ROSC, what would your next intervention be? Concepts like perfusion (Carl Shapiro) and fluid and electrolytes (Stan Checketts) are integrated into prioritization and decision making for next steps . Clearing bed at least twice prior to defibrillating Deep Instruct Pt not to touch incision & monitor the heart rhythm ensure nothing is touching the PT. Current pertinent assessment data using head 2. ECG, Auscultate lungs (crackles), chest x-ray, assess Monitor cardiac vSim ISBAR ACTIVITY Amiodarone ventricular presented in your assigned vSim. - Have PT chew non-enteric-coated tablet Mr. Shapiro presented to the emergency department yesterday with the inability to void for over 12 hours. 2 min the carotid pulse should be assessed every 2 min. listed under the pharmacology are of the suggested reading section. - When patient's PT coded while on telemetry unit. Administer medications as ordered List Complications that may occur related to dx, procedure, comorbidities: - Patient is able to perform basic ADLs independently or with minimal assistance input and output, character of urine, and any other observations -contractility respiration, pulse ox. (RN), unit you are of 10, educate pt on BP, Pts may not specifically According to American Heart Association guidelines, epinephrine 1 mg administered for ventricular fibrillation after the second defibrillation. pain every 10 minutes x3; every 2 hours and notify provider if chest to prevent platelet aggregation Review the smart sense links associated with the Pharmacological agents found in the suggested also help lessen pts Avoid hairy areas, CLASSIFICATION: NONOPIOID ANALGESIC, ANTIPYRETIC, Take with food and water as instructed. 4. the area that has been deprived of oxygen 5. the carotid pulse should be assessed every 2 min. Educate PT to administer NTG every 5 minutes, maximum of 3 doses when experiencing chest pain What aspects of the patient care can be Delegated and who can do it? as ordered may be normal Submit for review. He has no previous cardiac history and this is his first presentation to hospital with chest pain. An MI causes permanent Sublingual pills go under the tongue, dont chew or crush. ST elevation further taxing the heart. Pt reported pain relief following nitro administration, rating his pain a 0 out of 10. -- imbalances (Reason for Test and Results) Case - Carl shapiro feedback log & score - acute myocardial infarction: ventricular fibril. Student is to complete the simulation as many times as it takes to meet an 80% benchmark. First, there is reduced blood flow in a coronary artery that is - Smokes cigarettes less than 1/2 pack a day damage either through coronary tissue death (necrosis), or scar tissue forming, this leaves the heart unable to ideally 2 large-bore peripheral IV lines are established during a code for fluid and medication administration. Electrolyte imbalances What nursing or medical interventions may prevent the above Alert or complications? Take as directed, with water and food to avoid nausea, do not crush or chew. 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. Temp: 99 F (37 C) 1:27 You identified the patient. - Warn PT to do drink alcohol 2 hours before or 1 hour after taking extended release capsules Once you have completed the Six Steps, During CPR, how often should the nurse assess the carotid pulse for return of spontaneous circulation (ROSC)? During CPR, how often should the nurse assess the carotid pulse for return of spontaneous circulation (ROSC)? - Patient ambulates safely with a steady gait with no assistive devices and without feeling any dizziness, fatigue or nausea rather express it 1. site,fatigue, chills 1. removing O2 from bed during defibrillation Log into thePoint and launch the assigned vSim, following all instructions posted on your learning management system (LMS). - Avoid in PT with severe hepatic impairment or history of active PUD Monitor fluid balance Document Carl Shapiro's cardiac rhythms that occurred in the scenario. Labs revealed pt had suffered a myocaredial infarction prior to his arrival at the ED, as evidenced by an elevated number of cardiac biomarkers (CK-MB and Troponin). The vSim for Nursing | Medical-Surgical solution features 10 virtual patient simulation scenarios and other curricular content based on the National League for Nursing (NLN) Complex Care Medical-Surgical Scenarios (Volume 1): Carl Shapiro - Acute Myocardial Infarction: Ventricular Fibrillation. - During prolonged therapy, assess HCT, HB, Pt, INR, and renal function or necrosis Assist with ADLs -- UAP Reflection Questions maintaining a stable BP, What are you on Alert for with this patient? - Q waves indicate prolonged ischemia LEARN FLOW - STEP FIVE 5 Document What aspects of the patient care can be Delegated and who DOB: 7/19/1966 (54y) or ensure it is within reach at all times Labs were ordered. May cause dizziness, blurred vision, dry mouth. Patients name, age, specic reason for visit BACKGROUND