Nursing 206 Case Study Cardiac Tamponade

Case Study 20 - Cardiac Tamponade Difficulty: Intermediate Setting: Hospital Index Words: cardiac tamponade, pericardiocentesis, dopamine titration, crisis management Giddens Concepts: Perfusion HESI Concepts: Perfusion Name: Donita Massey Date: Sept 27, 2018 Scenario You are the charge nurse on the intermediate cardiac care unit in a large hospital. One of the patients, R.J., is being cared for by a new graduate nurse under your supervision. R.J. was admitted at 1300 after an auto accident in which he sustained a chest contusion and fractures of the fourth and fifth ribs on his left side. At about 2000 hours, his wife runs up to you at the nurses’ station and says, “I think my husband just had a heart attack. Come quick!” She follows you into his room, where you find him still in bed. He is breathing and is cyanotic from the neck up. His pulse is rapid but very weak. 1.What will your first action be? Immediately call a code blue 2. What immediate care will you provide to R.J.? Administer oxygen immediately and ensure that the IV is patent to provide IV fluids. 3. Given R.J.’s admitting diagnosis, what differential diagnoses do you consider? Due to the history of R.J.’s initial history of a chest contusion and rib fractures he can be diagnosed with: 1) pneumothorax – this is possible due to the broken ribs and blunt chest