Case study 1
1. Explain why it was important for the nurse to call the medical emergency team (MET) urgently. What was the life threatening condition that Paula might have been at risk of at the time of the MET call?
It was important for the nurse to call medical emergency team as Paula‘s condition was getting worse on the post-operative day 3. She was suffering from severe nausea and at night she vomited 800ml of bilious liquid. She started to become restless and short of breath and
subsequently turned pale and clammy. Additionally vital signs recorded by the nurse such as temperature, blood pressure, respiratory rate, pain scale etc. met the criteria for MET call.
Paula’s condition was life threatening and there was a risk of cardiac arrest in acute care setting if not treated immediately.
2. Discuss the pathophysiology of the life threatening condition in Paula’s case. List three (3) signs or symptoms of the condition that were seen in Paula. Nurse has noticed some of the symptoms or signs, which indicates the life threatening condition of Paula. Some of the symptoms or signs noticed by nurse were as follows
Her temperature was 35.8 °C
Her blood pressure was 92/42mmHg
Her heart rate was 128bpm
Her respiratory rate was 28/minute
Her spO2- 94% on room air
Her numeric pain scale was 6/10
Apart from it, Paula was diagnosed with paralytic ileus after diagnostic studies performed during the MET call.
3. Paula’s life threatening condition (identified in question 1 & 2) can lead to a cardiac arrest in acute care settings if not treated immediately. Describe what is involved during Advanced Life Support (ALS) in relation to:
When the symptom of acute cardiac arrest is noticed, then the MET Team has given advanced life support to Paula, in order to save her life.
a) Cardiopulmonary resuscitation rate: Cardiopulmonary resuscitation technique in which chest is compressed to upsurge the blood circulation and to provide oxygen to the brain of the patient. Cardiopulmonary resuscitation rate should be 100per minute.
b) Breaths can be delivered via:
Breaths can be delivered via ventilation, if the patient condition is severe and if his heart is not responding after the chest compression.
c) Airway may be maintained by Airway can be maintained by turning the patient to the back and lifting the chin .
d) Medications used when shockable
e) Medications used when non shockable
f) Three (3) conditions that should be considered and corrected during CPR During CPR airways should be maintained in such a way that it doesn’t interrupt CPR FOR more than 20 seconds. Drugs should be given to the patients considering their condition. Try to
minimize the interruptions of ALS on CPR.
g) Post resuscitation care should include
4. Describe the nursing interventions and expected outcomes in relation to Paula’s condition and thelisted problems..
Nausea and vomiting:
As Paula was suffering from nausea, so was suggested to take fluids in her diet. But when her condition became worse, Met team was called and they have has inserted the nasogastric tube for lavage in order to minimize the discomfort due to nausea and vomiting.
b) Insertion of indwelling catheter & an hourly urine output measurement:
As Paula condition was severe, in dwelling catheter was inserted by the MET team. It was inevitable for the nursing staff to record strict fluid balance and it was also suggested to monitor any signs of complications and measure hourly urine output for the next 24 hours .
c) Uncontrolled pain with patient controlled analgesia (PCA) Paula underwent a bowel resection. Perioperatively, she refused epidural anaesthesia placement, so morphine was initiated via patient controlled analgesia (PCA) as an alternative method for post – operative pain management. But on the post-operative day 3, she was experiencing uncontrolled pain at the rate of 6/ 10 and So MET team was called.
5. List the equipment’s required in women catheterisation.
Women catheterization is the process of inserting the catheter in the women’s bladder. Several equipment’s are required for women catheterization, they are as follows.
1. Antiseptic solution
2. 6 ml lignocaine gel
3. Sterile glove( 2 pairs)
4. 12-14 female Foley catheter
5. Urine collection bag
6. 10ml of saline filed syringe
7. Catheterization pack