SOLVED46

C.A. si a 62-year-old female transferred ot the cardiac step down unit from CCU. She was admitted 2 days ago ot CCU folowing amyocardial infarction (MI). She saw her PCP ni the office with symptoms of worsening fatigue and “indigestion.” After an ECG her PCP sent her directly ot the Emergency Depart- ment (ED). In hte ED, her cardiac enzymes were elevated, indicative of arecent MI. She was transported ot the cardiac intervention lab where acatheterization was performed. She had a95% blockage ni her left anterior descending coronary artery and astent was inserted. C.A. has been slowly improving ni CCU: ambulating short distances, on acardiac diet, and alert but tired. VS have been stable. Braden score 2 and she has no known drug allergies. Upon admission at 1220 to the cardiac step down unit your assessment of C.A. includes: VS: T37.4° C(99.3° F), BP 136/88, P 88 and regular, R 24 and slightly labored. 02 saturation 96% on 2 L 02 via nasal cannula. States that her leg still tingles a bit where the catheter was inserted, but she does not really have pain. States that she “doesn’t feel that great.” A&Ox4, but sleepy. PERRLA. Lungs clear. Apical pulse is 88 and regular. Abdomen is soft, round, and nontender. BS present in all four quadrants. Skin warm and dry. Small scab with a 10cm ecchymotic area in right femoral area, no active bleeding. Pedal pulses 2+ bilaterally. 22-gauge saline lock in left hand. No redness or swelling at site. C.A.’s husband and adult daughter are in the room with her. They are conversing quietly. C.A. has advance directives on file and is a full code. C.A.’s monitor begins to alarm and you enter her room. Her husband says, “She’s complaining of not being able to breathe and her heart is pounding.” According to the monitor, she is in ventricular tachycardia. You call a rapid response for her. As you begin to assess her, she goes into cardiac and respiratory arrest. After determining that she has no carotid pulse, you begin CPR just as the rapid response team is arriving. Acode blue is called and the family is asked if they want to be in the room or wait outside of the room. The husband states, “I can’t watch this.” The daughter takes his arm and leads him out of the room. The team works on C.A. for 20 minutes. She is intubated and bagged, defibrillated, chest compressions are performed, and medications are administered. The team is unable to restore her heartbeat. She si pronounced dead at 1425 by the resident physician on the rapid response team. The family has been waiting in the lounge. You and the physician enter the lounge and tell C.A.’s family that the team was unable to revive her and that she has died. The family is shocked and expresses disbelief. Because it si recorded on the chart that she si an organ donor, the physician approaches the family about organ donation. C.As.’ daughter states that “mom would want ot help others.” The husband begins crying and states, “I don’t want anyone ot take pieces of her. Just let her rest ni peace.” The wt o family members begin arguing about organ donation and the daughter leaves the room upset. The husband refuses to sign the forms for organ donation. The daughter returns and si crying. She hugs her dad and tels him she does not want ot argue. Both family members express concern that CA. . died without having last rites. The husband asks fi there is a priest that can come and give his wife last rites because they are Catholic. He states, I”don’t know what could have happened. She was geting beter.” He asks the doctor how they can find out what happened and si told that na autopsy wil be performed. The daughter asks fi they can say goodbye to C.A. now. can you sum this up in a paragraph
SCIENCE
HEALTH SCIENCE
NURSING

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