DEFIBRILLATION AND ITS CONSEQUENCES

Updated 8/26

Scenario: A Code Blue is in progress in the Emergency Room.
The medical staff have gathered around the bedside to assist.
Unfortunately, the nurse on the left got distracted . She begins
to move the paddles towards the nurse on the right.

How could this happen? It is easy to make a mistake when there
is so much goingon in a confined space. It is important to follow
all the security guidelines for a Code Blue, like making sure no
one is close to the bedside prior to defibrillation.

Hemodynamics and its meaning

Hemodynamics refers to blood flow.

 The heart is a pump, which pumps blood around the body.
 If there is damage, like a myocardial infarction, the heart's
 function will be impaired.

Signs and symptoms include: chest pain,
shortness of breath and EKG changes.

A cardiopulmonary arrest can happen anywhere.
In an ICU setting, trained staff members (ACLS)
are usually on hand when a Code Blue is called.

Learn more about this topic by clicking on the link:
Hemodynamic Monitoring

The image above shows a Code blue in progress. This is 
happening in the Emergency Room. Always follow your

Institution's policies and procedures for Code Blue. 

What is the role of the nurse who is assigned to the Code Blue?

The nurse has an important role in effective communication.
There are many responsibilities.

- staying calm in a chaotic situation
- giving clear instructions to coworkers
- ensuring that MD orders are conveyed correctly

- proper documentation of vital signs and all treatments /
  interventions that take place ( defibrillation for example)
  - the nurse becomes the " binding force

Addressing lethal rhythms

There are some EKG rhythms that are considered to be lethal.

Immediate intervention is necessary for good outcomes. Here are
the most lethal rhythms:

Asystole - sometimes referred to as " flat-line. The electrical
heart's conduction system is not functioning. There are no
ventricular contractions. The patient is pulseless and
unresponsive.

Ventricular Tachycardia - There may or may not be a pulse
present. The ventricles are beating rapidly and there is no atrial
activity. Blood flow to the vital organs is compromised.

Ventricular Fibrillation -  There is a chaotic rhythm and no
atrial activity. The ventricles are quivering , so there is no 
cardiac output. There is no pulse and the patient may become
unresponsive. Immediate action to defibrillate is usually done.

***American Heart Association has protocols in place for each
EKG rhythm.

Learn about : the ABG and Code Blue

Learn more about : The Circulatory System

CARE PLANNING AND PATIENT EDUCATION IS A MUST

Updated 6/25

Dear nurses,

Care planning and patient education is a must!

See below.

Learn more about : Care planning

Learn more about: ICP MONITORING for the layperson

REHABILITATION OF THE STROKE PATIENT

Updated 4/25

Dear nurses,

New information on stroke and its involvement,

can be accessed by clicking on the links:

Stroke and its involvement

Video: Why Therapy

Scenario: In the image above, Ann is an opera
singer. While on stage, she suddenly starts having
trouble getting her words out. Her right arm also
feels weak. These symptoms are classic of someone
experiencing a stroke.

Learn more by clicking on the link:

Stroke and its prevention

FIBROMYALGIA AND ARTHRITIS

Updated 4/26

Fibromyalgia is identified as a nervous
system condition,which is chronic. It
affects both muscles and joints. 

Pain is common, as well as tenderness
and stiffness.Diagnostic tests such as: 
thyroid studies , CBC and ESR would
likely be done.

Physical therapy and an exercise regimen, is
included in the plan of care.
Learn more about: Fibromyalgia and
 The importance of Therapy

Scenario: In the image above, Mrs.M sustained 
a fracture of the neck of the femur. ORIF (Open
Reduction Internal Fixation) of her hip fracture
was done in the Operating Room. 

Learn more about: Muscles, bones and joints

Learn more about:
Why Therapy 
The Aging Process

About Multiple Sclerosis:
The cause of Multiple Sclerosis is not yet 
fully understood. It is considered to be an
autoimmune disease that involves the central
nervous system.

Learn more about :Multiple sclerosis

WHAT IS A STROKE?

What is a stroke?

A stroke is also known as a brain attack.

Identifying strokes and treatment

A stroke may be hemorrhagic (caused by bleeding) or
ischemic (embolic) caused by a clot or plaque in a blood
vessel. 

Bleeding ( hemorrhagic) into the brain may be caused
by trauma or rupture of a blood vessel due to high
blood pressure. ICP monitoring may be necessary for 
the patient with a hemorrhagic stroke.

In the case of an embolic stroke, a blood clot may
obstruct the flow of blood in the brain. This will also
affect oxygen to the brain.

Embolic strokes are usually treated with drugs such
as TPA ( Tissue Plasminogenic Activator). Antihypertensive
drugs and anti- seizure medications may also be ordered.

Reperfusion Therapy and its uses

Reperfusion Therapy is a form of treatment that
is used for patients who have a myocardial infarction

(MI) with STEMI. Typically, the patient with a
completely blocked coronary artery, would
demonstrate STEMI on the EKG.

TPA ( Thrombolytic Plasminogen Activator)
is not only used for reperfusion in patients
who had a myocardial infarction, it is also
used in the treatment of embolic strokes.

Dearnurses.com is no longer available.

Learn more about: Cranial nerves and 
Subarachnoid hemorrhage

ELBOW FRACTURE AND ITS CONSEQUENCES

Updated 4/25

Scenario: Sara slipped and fell while playing tennis.
She was transported to the Emergency Room, for 
further evaluation. X-Ray of her elbow revealed 
a fracture. 

The elbow has a hinge joint. There are three bones
that make up the elbow : humerus, radius and ulnar.

Volkmann's contracture may further complicate a
fractured elbow. Poor circulation (ischemia) may
occur during the healing process.

Learn more, by clicking on the link:

Spinal injury

UNDERSTANDING WHAT HAPPENS TO THE BURNT PATIENT

Updated 4/25

Scenario: Sam is a cook in a restaurant. He was
not prepared for his sleeve catching on fire. He 
suffered second and third degree burns. Sam was
transported to the Emergency Room.

Overview of burns

Burns may be caused by electricity, heat , cold,
chemicals and more. Complications of burns
include: possible sepsis, dehydration, contractures
and loss of electrolytes.

Skin grafting is sometimes done to cover the 
burnt area. Healthy tissue is taken from another 
part of the body, to cover the damaged area. The
grafted area, eventually becomes fused with the 
tissue around it.

Addressing hyperthermia 

Hyperthermia is recognized as a temperature which is above
normal. A severe form of this condition may be recognized
as heat stroke. ( temperature above 104 degrees). Heat stroke

if left untreated, may lead to further problems.

The hypothalamus is the temperature regulating center of the brain.

Injury to this part of the brain like trauma,  may also result in

hyperthermia. Antipyretics are used to decrease the temperature

and prevent hyperthermia.

Cooling measures like a cooling blanket, may also be used.

EDUCATING YOUR PATIENT ABOUT STROKE PREVENTION

Updated 4/25

Ann is an opera singer. She is experiencing stroke 
symptoms while on stage.

What is a stroke?

A stroke is also known as a brain attack. It may be hemorrhagic

( caused by bleeding) or ischemic ( embolic), caused by a clot 
or plaque.

Can a stroke be prevented?

It is suggested that a stroke can be prevented. People who
smoke frequently, eat a diet rich in cholesterol foods and
do not exercise regularly, are considered to be at risk.

High blood pressure and obesity also puts someone at risk.
Lifestyle changes such as regular exercise, eating a diet with
fresh fruits and vegetables, as well as high fiber may help to
reduce stroke risk.

Addressing the care plan and brain surgery.

                                   Helpful suggestions for stroke prevention.

 

SEIZURE ACTIVITY AND ITS CAUSES

                                     Dearnurses.com is no longer available.

Updated 4/25

Dear nurses,

New information about seizures and its causes, have been
added. See below.

What is a seizure?

A seizure is considered to be a sudden outburst of
uncontrollable electrical activity from the neurons
in the brain. Involuntary contraction of muscles
usually occur and last for a short period. Seizures
may vary in duration and frequency.

Patient safety during a seizure

When a seizure occurs, patient safety should

 be a major concern. A patient who has a 
history of seizures, should already be on
anticonvulsant medications.
A "seizure precations " sign is usually
posted over the bed.

Here are some helpful hints:

- Follow MD orders

- Protect the patient from harm

- Maintaining a patent airway; turn head to the side, if necessary,
  to prevent airway obstruction

- Keeping bed rails up , to prevent the patient falling out of bed

- Monitoring duration and character of seizure

- After seizure, assessment and documentation of, vital signs, O2 saturation,

- notifying MD of patient status

The patient with preeclampsia is at risk for seizures.
Learn more by clicking on the Link: Preeclampsia

Learn more by clicking on the link: Hormones

ENTERAL AND PARENTERAL NUTRITION

Dearnurses.com is no longer available.

Updated 4/25

Dear nurses, 

Learn more about this topic by watching the video:
Sessions for nurses 14

TPN is Total Parenteral Nutrition. It is a type of nutrition
which is given intravenously. It is ordered by the doctor .

                     

This topic continues here: TPN administration 

  

          You may also watch the video for more information: Sessions 59

                        Aspiration pneumonia and prevention

Enteral feeding may be ordered by the doctor, for the patient
who is unable to swallow. The patient with a brain injury , 
stroke or on mechanical ventilation, may may require tube feeding.

The potential for Aspiration of Tube feeding should be reflected in
the plan of care.

Aspiration pneumonia should be avoided.
Helpful hints:
-Follow MD orders
- check for residuals and abdominal distention
- check lung sounds
Learn more about this topic by watching the video:
Sessions for nurses 14

RESPIRATORY DISTRESS - ASSESSMENT AND INTERVENTION

Updated 1/25

Dear nurses,

Dearnurses.com is no longer available.

New links have been added below.

New links have been added below.

- Assessment and intervention of the patient in respiratory distress

- pneumonia

- CHF (Congestive Heart Failure)

- pneumothorax

- ARDS ( Adult Respiratory Distress Syndrome

Scenario: Nick was admitted to the hospital with a
history of lung cancer. He calls the nurse with complaints
 of a sudden onset of shortness of breath and sharp chest pain. 

Learn more about this topic : X-RAY and pulse oximeter.

UNDERSTANDING THE CLINICAL SETTING

Updated 8/25

Dear nurses,

A nurse who is new to the clinical setting, knows all
too well it is a challenge.

Learn more about : CPR

Cardiogenic shock

Hemodialysis

Learn more about: Care planning

Learn more : Altitude sickness

HAPPY 4TH OF JULY, 2009 TO ALL NURSES

Updated 4/25

Dear nurses,

Just to wish you all a safe and happy July 4th, weekend. 

Enjoy learning more about clinical nursing, below.

The clinical scenario below, demonstrates the situation
 of a new nurse. She is assigned to the ER and is really
 scared. She does not know how to get organized.

Learn more: Organizational skills

Above is a scenario on dehydration.

Nick and Tina decided to go backpacking

in a desert place. It is unclear why they did
not make adequate preparation and take 

enough fluids.

It is midday and they are lost.They are beginning
to feel thirsty, tired and light headed.These are

some of the symptoms of dehydration. Sweating 

which also causes fluid loss, may go unnoticed. 

Electrolyte imbalances may be caused by sweating 

and fluid loss.

Learn more by watching the video:

Sessions 57- Hydration vs. Dehydration

PAIN ASSESSMENT FOR NURSES

Updated 1/25

Dear nurses,

Dearnurses.com is no longer available. Please click
on the link for more updated information: 

Pain assessment

Scenario 1: In the image above, the nurse in the green 
top has been enjoying a lengthy conversation with a friend. 
She has no idea one of the patients is having chest pain.

Learn more by clicking on the link below:
Clinical judgement

   Helpful information for the clinical nurse

  

  In the image above, Lynn is a new graduate who
  is full of expectation. She arrives early on her new
  unit. But her hopes are shattered when her preceptor
  suggested that she is too busy to do an orientation.

It is unfortunate, but this does happen on occasion.
Although Lynn is off to a rough start, there are some
things she can do to make her situation easier.
Learn more by clicking on the links below:

Diagnostic tests

Medical abbreviations

Avoiding Medication errors

    The role of the Preceptor 

A Preceptor has a very important role to play in
training new nurses. Typically, a nurse who is 
assigned to this role, has a significant number of
years of experience and is able to utilize the learned
skills in a meaningful way.

The role of a preceptor often impacts the way a new 
nurse sees the nursing profession and may even have
an effect on what is expected.

Learn more : The Nursing Process

Learn more about  : Chest pain and the EKG

Learn more about : Organizational skills