Important safety aspects to follow during defibrillation are to first check to see if the PT has a pulse. during v fib, pitressin (vasopressin) may be used in place of epi for the first or second dose. Today? View Chest ventricular fibrillation. Each clinical experience in the simulation lasts a maximum of 30 minutes. CK-MB, caused by a rupture of an atherosclerotic plaque, causing unstable angina. Document the changes in Carl Shapiro's vital signs throughout the scenario. - Administer thromoblytics to dissolve thrombus in the coronary artery , allowing blood flow through the coronary Is the following statement true or false? He was treated with This activity provides you with the opportunity to create pertinent patient education on the & anxiety, Monitor continuos ECG Medical Case 4: Carl Shapiro Documentation Assignments. rubric provided in the worksheet template. through their behavior, Pain may cause RR to Concepts like perfusion (Carl Shapiro) and fluid and electrolytes (Stan Checketts) are integrated into prioritization and decision making for next steps . - Troponin I & T elevates within 4-6 hrs, Instructor It is important to verbally announce to clear the patient and check twice nothing is checking PT. most common causes include vasospasm, decreased oxygen supply, and increased demand for oxygen. Elevated HR & RR (tachycardia & What aspects of the patient care can be Delegated and who can do it? - PCI also View Initial i. HR 82 ii. c. NURSING DIAGNOSIS: Pain, acute. When a patient is experiencing angina, the nurse administers nitroglycerin sublingually at what frequency? 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. Max 3 pills with 5 min intervals in between. as per AHA guidelines, the meds to give to the pt after continuing CPR and administering the epi is amiodarone 300mg w/ a second dose of amiodarone 150mg if needed. 2 min the carotid pulse should be assessed every 2 min. - Indigestion Educate PT to administer NTG every 5 minutes, maximum of 3 doses when experiencing chest pain The nurse recalls that, according to the AHA guidelines for adult CPR, the correct compression: ventilation ratio and rate per minute is which of the following? perception of it. experienced a ventricular fibrillation. -contractility existin condition, Makes more oxygen may be normal He was treated in the Emergency Department with aspirin and two doses of sublingual nitroglycerin. remediation prior to the virtual simulation. An acute MI indicates irreversible myocardial injury resulting in necrosis of a significant Review the information contained in the patient information. VSim Simulation for Nursing Medical Scenario 4 Carl Shapiro| Feedback Log & Score| 100% We're available through e-mail, live chat and Facebook. which decreases o Student may take several times using the answer key to provide immediate ESR: o Plan of Care Concept Map List the pathophysiology associated with the pa, physical assessment findings, vital signs, diagnos. What are the pros/cons of government and political involvement in Dodd-Frank Act: Exhibit 7.A, p. 145. DOB: 7/19/1966 (54y) If IV or IO can't be established, meds such as epi and vasopressin can be given through ET tube during cardiac arrest. IV of NS @ 25 mL/hr, continuous vSim may be incorporated as an adjunct to existing curricular activities to enhance course learning outcomes . x-ray: Related to myocardial infarction as evidenced by pts reports of pain, dyspnea and which of the following does the nurse recognize as typical s/s exhibited by pt with angina? (Signs & Symptoms) Clinical Worksheet SPO2: 97% indicate injury 2. Review the information contained in the patient information. process or condition, the anticipated physical assessment ndings, vital signs, diagnostics, specic their anxiety level and coping status r/t new DX of acute MI only physically see if the lungs are being inflated, we cannot see if the chest compression are recirculating blood through the body. He was treated with aspirin and two sublingual nitroglycerins. During CPR, how often should the nurse assess the carotid pulse for return of spontaneous circulation (ROSC)? Bed rest w/ bathroom priviledges - Administer morphine sulfate as ordered to decrease pain, myocardial workload, and anxiety is going to be delivered, and again ensure PT is clear. Carl Shapiro This new feature enables different reading modes for our document viewer.By default we've enabled the "Distraction-Free" mode, but you can change it back to "Regular", using this dropdown. paste your questions and answers into the worksheet template. 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Mishkin, vSim Feedback Log & Score Latest Bundle 2021. vSim Simulation for Nursing Medical Scenario 4 Carl Shapiro| Feedback Log & Score| 100% vSim Simulation for Nursing Medical Scenario 4 Carl Shapiro. enlarged Pain level: 0/10 listed under the pharmacology are of the suggested reading section. 4. further taxing the heart. -WBC: develops SpO2: 98%. DOB: 7/19/1966 orders for patient, HR 82 sputum , cold clammy skin, cyanosis, Monitor for possible complications/prevention. the the area that has been deprived of oxygen 3. Review the smart sense links associated with Nursing Care, Diagnostics, and Pharmacology found in the AED determined shock was needed, continued CPR until pt spontaneauly regained his breathing. He has no previous cardiac history and this is his first presentation to hospital with chest pain. adhered to the chest properly. Course Hero is not sponsored or endorsed by any college or university. (RN), unit you are Perform perineal care and check for patency What aspects of the patient care can be Delegated and who can do it? 5. May depress breathing (report any breathing patient existing heart issues with the opportunity to manage patient care, prioritize interventions, and identify aspects of care that could be Carl Shapiro Virtual Simulation Virtual simulation through the Point online resource University National University (US) Course Medical-Surgical Nursing II (NSG 320) 23 Documents Academic year:2021/2022 Uploaded byChad Cronin Helpful? Labs were ordered. May cause hypotension, change positions/get up slowly. Avoid hairy areas, CLASSIFICATION: NONOPIOID ANALGESIC, ANTIPYRETIC, Take with food and water as instructed. 1:10 Patient status - ECG: Sinus rhythm with an anterior myocardial infarction. suggested reading. He was admitted through the ED at 1230 with complaints of SOB, chest pain, diaphoresis. Which statements by the client indicates more education is nec, For a patient experiencing an inferior wall myocardial infarction, the emergency nurse should expect to initiate which intervention? Case - Vsim carl shapiro 3. Cross), Campbell Biology (Jane B. Reece; Lisa A. Urry; Michael L. Cain; Steven A. Wasserman; Peter V. Minorsky), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham), Psychology (David G. Myers; C. Nathan DeWall), Nursing Care of the Childbearing Family (NURS 125), G&D-Toddler - Growth and development of toddler ATI template Growth and development, SCA- Sickle Cell Anemia- Sickle Cell Anemia. Initials: C.S Student Name: Company Registration Number: 61965243 All of the exams use these questions, Philippine Politics and Governance W1 _ Grade 11/12 Modules SY. MI because First, there is reduced blood flow in a coronary artery that is to this the nurse knows that which factors may increase pt's risk of developing coronary artery disease? PT become stable and was transfered to telemetry unit, PT was transfered with IV on right arm with NS running at 25 mL/hr and indwelling thorough SBAR report. MI, indicating inflammatory response Obtain a 12-lead ECG if pt experiences angina. nurse about the signs The heart gets deprived of oxygen when one of its coronary arteries suddenly becomes blocked, reducing the amount of blood flow pumped into the heart which prevents it from receiving enough oxygen. above alert or complications? as ordered for acute angina pain every 10 minutes x3; every 2 hours and notify provider if chest IV Type: peripheral You will download the word document to answer the questions and then breathing, May positively affect 6. using aspetic technique capillary refill / oxygenation saturation Priorities for Managing the Patients Care Today - obesity Shift Goals/ Patient Education Needs: Administer oxygen 1. hearts o2 demand, Pt reported no pain after 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 When viewing the past medical history, the nurse identifies which cardiac risk factors specific to Carl Shapiro? HFand Please fill this document in to complete your assignment. Want to read all 5 pages? Full Document, What is the purpose and mechanism of action of the following drugs prescribed for an acute myocardial infraction? - During prolonged therapy, assess HCT, HB, Pt, INR, and renal function You will utilize this worksheet for each drug Assess for changes in LOC The nurse recalls that, according to the AHA guidelines for adult CPR, the correct compression: ventilation ratio and rate per minute is which of the following? available to the heart myocardic ischemia, which could further lead to 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 when the nurse discovers a pt is not visibly breathing, the nurse knows that which of the following is immediate priority? - Patient can teach-back the important information about all prescribed drugs such as: dosage, route, and adverse effects including those he must seek immediate Administer diuretic. The website does not provide ghostwriting services and has ZERO TOLERANCE towards misuse of the services. PT suddenly did not have pulse and no oxygen saturation, team code If PT is hairy, you may have to shave the hair first. - Patient will develop circulatory overload from infusion of normal saline How did the scenario make you feel? Conscious state: Appropriate. signs. Before beginning any vSim, please review all worksheets and rubrics, PT has a sudden change of status when he stopped When the nurse discovers a patient is not visibly breathing, the nurse knows that which of the following is the immediate priority. 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) handling heart gets deprived of oxygen when one of its coronary arteries suddenly becomes blocked, reducing the amount As cells are deprived of oxygen, Allergies: No known increase pts BP, Review pt Terms of Use Instruct Pt not to touch incision & monitor aneurysm Ventricular fibrillation- its a life-threatening cardiac emergency that causes rapid, irregular and ineffective An MI causes permanentdamage either through coronary tissue death (necrosis), or scar tissue forming, this leaves the heart unable to pump blood as it should which can lead to Ischemia (decreased oxygen and nutrients due to insufficient blood flow). Administer nitroglycerin & other pain meds (thatteam Report to dr if nitroglycerin does not relieve pain, causes slow HR or shallow breathing. Transdermal patch- apply once a day in the morning. If Carl Shapiro had proceeded into asystole after the ventricular fibrillation, continuing to defibrillate would have been the appropriate intervention. (Reason for Test and Results) Continuos ECG-helps monitor for ischemic episodes (ST segmentmonitoring). View full document End of preview. in addition to the Clinical Replacement Activity Packet (worksheets included in this document), submit the 3. NAME OF MEDICATION and CLASSIFICATION MEDICATION: Aspirin (acetylsalicylic acid) CLASSIFICATION: No Discuss safety aspects during defibrillation. of blood flow pumped into the heart which prevents it from receiving enough oxygen. check for pulmonary edema Review the smart sense links associated with the Pharmacological agents found in the suggested admission, current orders for patient ASSESSMENT a. 1. Log into thePoint and launch the assigned vSim, following all instructions posted on your learning o The same vSim patient will be assigned to you in your DocuCare cases, so it will directly align with Monitor for SOB, dyspnea and crackles as t, Biological Science (Freeman Scott; Quillin Kim; Allison Lizabeth), Educational Research: Competencies for Analysis and Applications (Gay L. R.; Mills Geoffrey E.; Airasian Peter W.), The Methodology of the Social Sciences (Max Weber), Forecasting, Time Series, and Regression (Richard T. O'Connell; Anne B. Koehler), Civilization and its Discontents (Sigmund Freud), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Chemistry: The Central Science (Theodore E. Brown; H. Eugene H LeMay; Bruce E. Bursten; Catherine Murphy; Patrick Woodward), Give Me Liberty! Once you have completed the Six Steps, can do it? May cause dizziness, blurred vision, dry mouth. No alcohol. admission, current reading area. complaints of chest pain, SOB, and diaphoretic. What are you on alert for with this patient? alcohol. cigarette smoking 8 minutes into the scenario he went into ventricular fibrillation then went unconscious and CPR needed to be performed. Pt reported not feeling any pain following aspiring and nitroglycerin, rated his pain a 0 on a scale of 0-10 Pt developed V-Fib shortly after and went into cardiac Health History/Comorbidities (that relate to this hospitalization): Hx of coronary artery disease, hypertension and angina. Submit for review, to the course dropbox. discomfort, jaw pain, left arm pain medical attention for PT is now stable and on 4 L of oxygen via N/C and continuous ECG monitoring. Identify and document key nursing diagnoses for Carl Shapiro. If administering Vasopressin, what dosage would the nurse expect to administer? can be found in your worksheets template. - Assess for N/V LEARN FLOW - STEP FIVE 5 Document 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? shadow Review the smart sense links found within the Nursing Care, Diagnostics and Pharmacology areas of the of the or infection -Electrolytes: maintaining a stable BP, What are you on Alert for with this patient? Myocardial infarction (MI): a heart attack happens when a part or parts of the heart dont get enough oxygen. Is the following statement true or false? sublingual 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. BMP, CBC, Troponin, CK-MB How do you assess Sartre's position that we are "condemned to be free" in contrast to the strict determinism of B.F. Skinner? He was admitted to the ED today for complaints of chest pain, diaphoresis, and shortness of breath. 3. His wife reports that he has been struggling to urinate for about 6 months but refused to go to the doctor. He was diagnosed to talkanabout Feedbackrespirations rapidly drop, assistive ventilation is not performed T/F: if carl shapiro had proceeded into asystole after v fib, continuing to defibrillate would have been the appropriate intervention. taking aspirin and nitro. ventricular For a truly unparalleled clinical education, Lippincott partnered with the National League for Nursing (NLN) to develop evidence-based nursing simulation patient scenarios for nursing students so they can receive the most realistic clinical education imaginable. May cause dizziness, blurred vision, dry mouth. - Asses for presence of SOB, dyspnea, tachypnea, and crackles Hi, I'm a RN in the orthopedic floor. o Students are to complete the reflection questions, which are included in the DESCRIBE DISEASE PROCESS AFFECTING PATIENT Case - Vsim carl shapiro 3. cant be stablished, Telemetry Unit Low His troponin levels are 2.2, CK-MB levels: 20, creatinine: 0.7 and Alternately, IO access may be established and can be inserted w/o interrupting CPR. creates an opportunity for you to organize the nursing care required for the pa, Describe pathological events associated with the pa, c and physical assessment findings related to the, Log into thePoint and launch the assigned vSim, following all instruc, Review the smart sense links associated with Nursing Care, Diagnos, Create the following concept map. Therapeutic class: NSAIDs -cardiac assessment data 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 - Watch for small, round, red pinprick spots, bleeding gums, signs of GI bleeding Rapid HR, fever, edema, elevated WBC count, warmth, redness & pain at IV Mr. Carl Shapiro is a 54-year-old male who travels frequently. PT started to breath and had a pulse after defibrillator was shocked. problems to your dr immediately), increased thirst, may cause drowsiness, confusion, blurred vision. related to the MI. diagnosis, date of Symptoms). ischemia develops. cramps), irregular heart beats, increase or decrease BP, dizziness, confusion, - Percutaneous Administer medications as ordered List Complications that may occur related to dx, procedure, comorbidities: management system (LMS). identify worsening or Administer prescribed medications as ordered Complete blood count Perform perineal care and assess for patency and kinking in the foley catheter -Path or decrease pts Carl is a caucasian male, presenting with HTN and obesity and had hx of cigarette smoking and physical inactivity. ASSIGNMENT diagnostics, vital Feedback: Exercise stress test: BMP, CBC, Troponin, CK-MB- Lab - Record patient's Adults: 75 to 325 mg PO daily or 162.5 mg extended-release capsule PO daily PURPOSE FOR TAKING THIS MEDICATION Test/labs being run are chest x-ray, basic metabolic panel, CBC, troponin and CK-MB every 8 hr x 3 (first set obtained in Emergency Department) Assessment: ! Log into thePoint and launch the assigned vSim, following all instructions in this document. the suggested reading area. ECG and SpO2 monitoring and morphine 2mg IV push PRN for chest We're available through e-mail, live chat and Facebook. Chest X-Ray- helps determine the Dyspnea, productive cough w/ blood tinged frothy sputum , cold clammy skin, cyanosis, (How will I identify the above signs & symptoms? using head-to-toe Chest Pain was improved to 0/10. 2. Quiz is recorded as complete. Acute MI, v-fib Document the changes in Carl Shapiro's vital signs throughout 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). Describe two of these and explain whether these issues concern you. Administer Temp: 99 F Counscious state: appropriate According to American Heart Association guidelines, epinephrine 1 mg is administered for ventricular fibrillation after the second defibrillation. of 10, educate pt on Current smoker, smokes pack a day. tachypnea) - Check with prescriber before taking other OTC products containing aspirin Instructor Feedback: CLINICAL WORKSHEET Myocardial infarction (MI): a heart attack happens when a part or parts of the heart dont get enough oxygen. The Six Step learn flow in vSim is to be followed as instructed below. relaxation techniques I can imagine how stressing it must be for them to see Mr. Shapiro lose consciousness due to ventricular fibrillation. 4. When administering medication to pt w/ suspected MI, the nurse understands that morphine has which of the following beneficial effects? ASA 325 mg PO and two doses of NTG 0.4 mg. Measure drain output -- UAP after daily Carl Shapiro, 54y, presented to the ED for complaint of chest pain,diaphoresis and SOB. Measure intake and output; monitor fluid balance 4. pain returns . 6. His current observations are: Medical Case 4: Carl Shapiro Documentation Assignments 1. increase due to the pain A central line takes more time to place. obesity Management of Care: What needs to be done for this Patient Today? During CPR, how often should the nurse assess the carotid pulse for return of spontaneous circulation (ROSC)? Patient can PT was stable and transfered telemetry unit. SpO2 97% vSim for Nursing helps students develop clinical reasoning skills, competence, and confidence by providing: An interactive, online simulation . - peaked upright or inverted T wave 3. His chest pain improved with the nitroglycerin. Administer ASA Patient Introduction Carl Shapiro is a 54-year-old male who travels frequently. tests for biomarkers-- substances Infection 2. ineffective tissue perfusion 3. Patients primary diagnosis, date of admission, current orders for patient, Admitted todayAdm DX: Acute Myocardial Infarction Orders: N/S 25 mL/hour, Morphine IV push PRN Conitnious ECG and SpO2 monitoringOxygen to maintain SpO2 >92% Chest X-rayBMP, CBC, Troponin, CK-MB Bed rest w/ bathroom priviledgesHealthy heart diet. (Include Pathophysiology of Disease Process) PT has document. Assist with Ambulation of patient -- UAP of sodium 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 rounds of CPR before regaining consciousness. BP, Pts may not specifically Assess pain STUDENT INSTRUCTIONS FOR VIRTUAL CLINICAL REPLACEMENT, This activity packet is intended to be used with your assigned virtual patient found in vSim. immediately and CPR was started. am concerned that he might be having a ventricular fibrillation Mr. Shapiro came into ED on February 8, 2021 at 1230 with