Resuscitation Clinical Dilemma
Agnes Peters, 82 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
●Collaboration
●Ethics
●Clinical Judgment
●Communication
NCLEX Client Need Categories Percentage of Items from Each
Category/SubcategoryCovered in
Case Study
Safe and Effective Care Environment
●Management of Care 17-23%
●Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12%
Psychosocial Integrity 6-12%
Physiological Integrity
●Basic Care and Comfort 6-12%
●Pharmacological and Parenteral Therapies 12-18%
●Reduction of Risk Potential 9-15%
●Physiological Adaptation 11-17% Cardiac Telemetry Strip:I.Initial Scenario
History of Present Problem:
Agnes Peters is an 82-year-old Caucasian female with a medical history of heart failure, COPD, and chronic kidney disease who resides in a skilled care facility. Agnes puts her call light on and says she is having chest pain and difficulty breathing. Upon entering the room, you notice that she is pale, diaphoretic and has labored breathing. Her breath sounds are diminished bilaterally and she has coarse bibasilar crackles. Her VS are T: 97.9 F/36.6 C (o) P: 98 (irreg) R: 32 BP: 148/90 O2 sat 86% room air.
Recognizing a problem, you push the call for immediate assistance button and delegate another nurse to call 911. Oxygen is administered per face mask. In ten minutes an ambulance arrives and the paramedics are given report. A peripheral IV is placed by the paramedics and a 12 lead EKG reveals sinus rhythm with frequent multifocal PVCs and 3-
4 mm ST elevation in leads V1-V4. She receives ASA 325 mg PO, nitroglycerin 0.4 mg subl. and is transported emergently to the emergency department (ED).
Personal/Social History:
Agnes is widowed and has no children. She has a brother, Dennis, who is 78 years old and visits her once a week. She has a living will which states that she is a DNI (do not intubate) but wants to be resuscitated if her heart stops.
What data from the histories is important & RELEVANT; therefore it has clinical significance to the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem:Clinical Significance:
History of heart failure, COPD, and chronic
kidney disease.
Pale, diaphoretic, labored breathing. Breath sounds diminished bilaterally.
Coarse bibasilar crackles.
Pulse irregular.
RR 32
O2 86% on room air.
EKG reveals sinus rhythm with frequent multifocal PVCs and 3-4 mm ST elevation.With the many conditions patient has, it increases patient’s mortality. Pale, diaphoretic, labored breathing, irregular pulse, increased RR are all
signs of shock.
Crackles could be due to pulmonary edema or pneumonia. Excessive fluid
is on the lungs.
Low O2 levels indicate hypoxemia.
Multifocal PVCs could indicate injury to the heart.
ST elevation could be due to the chest pain patient is experiencing.
RELEVANT Data from Social History:Clinical Significance:
Widowed No children
Brother 78 and visits once a week.
Living will states she is a DNI but wants to be
resuscitated.It is important to note that patient is a DNI but wants to be resuscitated. Do
not intubate only perform CPR.
Bother is only one available to represent patient with making decisions.
II.The Dilemma Begins…
Current Concern:
During transport to the ED, Agnes went into the following rhythm:
Agnes Peters, 82 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
●Collaboration
●Ethics
●Clinical Judgment
●Communication
NCLEX Client Need Categories Percentage of Items from Each
Category/SubcategoryCovered in
Case Study
Safe and Effective Care Environment
●Management of Care 17-23%
●Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12%
Psychosocial Integrity 6-12%
Physiological Integrity
●Basic Care and Comfort 6-12%
●Pharmacological and Parenteral Therapies 12-18%
●Reduction of Risk Potential 9-15%
●Physiological Adaptation 11-17% Cardiac Telemetry Strip:I.Initial Scenario
History of Present Problem:
Agnes Peters is an 82-year-old Caucasian female with a medical history of heart failure, COPD, and chronic kidney disease who resides in a skilled care facility. Agnes puts her call light on and says she is having chest pain and difficulty breathing. Upon entering the room, you notice that she is pale, diaphoretic and has labored breathing. Her breath sounds are diminished bilaterally and she has coarse bibasilar crackles. Her VS are T: 97.9 F/36.6 C (o) P: 98 (irreg) R: 32 BP: 148/90 O2 sat 86% room air.
Recognizing a problem, you push the call for immediate assistance button and delegate another nurse to call 911. Oxygen is administered per face mask. In ten minutes an ambulance arrives and the paramedics are given report. A peripheral IV is placed by the paramedics and a 12 lead EKG reveals sinus rhythm with frequent multifocal PVCs and 3-
4 mm ST elevation in leads V1-V4. She receives ASA 325 mg PO, nitroglycerin 0.4 mg subl. and is transported emergently to the emergency department (ED).
Personal/Social History:
Agnes is widowed and has no children. She has a brother, Dennis, who is 78 years old and visits her once a week. She has a living will which states that she is a DNI (do not intubate) but wants to be resuscitated if her heart stops.
What data from the histories is important & RELEVANT; therefore it has clinical significance to the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem:Clinical Significance:
History of heart failure, COPD, and chronic
kidney disease.
Pale, diaphoretic, labored breathing. Breath sounds diminished bilaterally.
Coarse bibasilar crackles.
Pulse irregular.
RR 32
O2 86% on room air.
EKG reveals sinus rhythm with frequent multifocal PVCs and 3-4 mm ST elevation.With the many conditions patient has, it increases patient’s mortality. Pale, diaphoretic, labored breathing, irregular pulse, increased RR are all
signs of shock.
Crackles could be due to pulmonary edema or pneumonia. Excessive fluid
is on the lungs.
Low O2 levels indicate hypoxemia.
Multifocal PVCs could indicate injury to the heart.
ST elevation could be due to the chest pain patient is experiencing.
RELEVANT Data from Social History:Clinical Significance:
Widowed No children
Brother 78 and visits once a week.
Living will states she is a DNI but wants to be
resuscitated.It is important to note that patient is a DNI but wants to be resuscitated. Do
not intubate only perform CPR.
Bother is only one available to represent patient with making decisions.
II.The Dilemma Begins…
Current Concern:
During transport to the ED, Agnes went into the following rhythm:
