During clinical this week, the student nurse got the opportunity of an observational experience in a Specialty Care Unit. The student was directed to the Surgical Intensive Care Unit (SICU) to observe a patient that was critically ill and receiving extensive treatment. The student observed a nurse caring for a patient while administering therapeutic hypothermia after cardiac arrest.
The patient L.E. is a 73 year old male. The patient has no history of coronary artery disease or any problems with his heart. Yet, he suffered an event of ventricular fibrillation which he was shocked for followed by a massive heart attack while unaccompanied at a restaurant. Upon arrival to the Southcoast Hospital he went into ventricular tachycardia in the Emergency Room and was shocked a second time. According to the Southcoast critical care manual, these events are part of the inclusion criteria for therapeutic hypothermia after cardiac arrest. He fits the first inclusion criteria listed which is: cardiac arrest with return of spontaneous circulation (ROSC) with initial rhythm of ventricular fibrillation, pulseless ventricular tachycardia, pulseless electrical activity or asystole. The protocol has been provided at the end of the paper.
The Arctic Sun is an experimental study but has various supportive data. When a person such as L.E. experiences a heart attack, one of the body’s responses is increased body temperature. An increased body temperature contributes to ischemic brain damage post cardiac arrest. The Arctic Sun is a system that provides targeted temperature management in the neurologically impaired patient. Pads are placed on approximately 40% of the body and a temperature probe is inserted. L.E. had two temperatur...
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... and many nurses have not yet had the experience of implementing it. It is complex and challenging and the importance of a multidisciplinary approach is critical. The nurse has to rely or her own judgment while valuing and recognizing the expertise of other team members. The article summarizes article perfectly, “One life saved by means of successful implementation of the therapy, "Therapeutic Induced Hypothermia", is an example of science translated into practice on account of commitment, collaboration and achievement of the multidisciplinary team.
Works Cited
Voelzing, L., Willoughby, L., & Loree, K. (2008). Therapeutic induced hypothermia: when every minute counts -- a multidisciplinary team approach. Dynamics, 19(2), 43. Retrieved from EBSCOhost.
http://www.medivance.com/html/contributions_tempManagement.htm
This essay will discuss the risks for patients during the preoperative, intraoperative and postoperative stages of the perioperative journey and how both patients and healthcare professionals involved in the perioperative stages can work together to prevent perioperative hypothermia.
Inadvertent perioperative hypothermia is a common anesthesia-related complication with reported prevalence ranging from 50% to 90%.(ref 3,4 of 4) The clinical consequences of perioperative hypothermia include tripling the risk of morbid myocardial outcomes and surgical wound infections, increased blood loss and transfusion requirements, and prolonged recovery and hospitalization.(ref 5)
While the respiratory and cardiovascular systems are most reliant on one another, all body systems require a functioning circulatory cycle in order to thrive. Blood circulation and consistent transfer of oxygen to cells is required to maintain cell and tissue life. Disturbances to this process will cause cells and tissues to die (Red Cross 48). This state of balance and functioning body systems is referred to as homeostasis, defined as a “condition of equilibrium in the body’s internal environment due to constant interaction of body’s many regulatory processes” (Tortura 8). Changes or disruptions to homeostasis are regulated by the Endocrine and Nervous systems of the body. The endocrine system is made up of glands placed throughout the body
The first was to see how long it would take to lower body temperature, and the next to decide how best to resuscitate a frozen victim. The doctors submerged a naked victim in an icy vat of water. They would insert an insulated thermometer into the victim’s rectum in order to monitor his or her body temperature. The icy vat proved to be the fastest way to drop the body’s temperature. Once the body reached 25 degrees Celsius, the victim would usually die.
...1, February). Preprocedure warming maintains normothermia throughout the perioperative period: A quality improvement project. Journal of Perianesthesia Nursing, 26(1), 9-14.
The nursing discipline embodies a whole range of skills and abilities that are aimed at maximizing one’s wellness by minimizing harm. As one of the most trusted professions, we literally are some’s last hope and last chance to thrive in life; however, in some cases we may be the last person they see on earth. Many individuals dream of slipping away in a peaceful death, but many others leave this world abruptly at unexpected times. I feel that is a crucial part to pay attention to individuals during their most critical and even for some their last moments and that is why I have peaked an interest in the critical care field. It is hard to care for someone who many others have given up on and how critical care nurses go above and beyond the call
As the quantity of patients expanded, it ought to have been obvious that one registered Nurse and one Licensed Practical Nurse were insufficient to look after the patients. The emergency department ought to be viewed as a high priority location, and should have staffed with more Registered Nurses; Licensed Practical Nurse essentially do not have the training and abilities to assess patients or delegate the workload. Dangerous actions such as moderate sedation on a patient with no supplemental oxygen or EKG observing. The patient seems to have been overmedicated, with insufficient time between medications to decide his actual level of
Nobody is perfect. We all make mistakes. Some of the best lessons in life are learned from making a mistake. But in the healthcare world making mistakes means losing lives. This has started to happen so frequently there has been a term coined – Failure to Rescue or FTR. Failure to rescue is a situation in which a patient was starting to deteriorate and it wasn’t noticed or it wasn’t properly addressed and the patient dies. The idea is that doctors or nurses could’ve had the opportunity to save the life of the patient but because of a variety of reasons, didn’t. This paper discusses the concept of FTR, describes ways to prevent it from happening; especially in relation to strokes or cerebrovascular accidents, and discusses the nursing implications involved in all of these factors.
Whittemore R. (2000). Graduate student scholarship. Consequences of not "knowing the patient". Clinical Nurse Specialist. 14(2), 75-81.
... sending signals from the brain to the other parts of the body so that the body can respond to its environment properly, but in this situation, all the systems, including the nervous system overworked to serve the requirements of the body, leading to heat exhaustion.
Thermoregulation has a significant role in regulation of homeostasis. Nevertheless, its heat production and heat conservation mechanisms of major thermoreceptors are unknown. In response to cooling, temperature (core and oral temperature, skin temperature), cardiovascular (blood pressure, heart rate, stroke volume, cardiac output, total peripheral resistance, mean arterial pressure) and respiratory (minute ventilation, respiratory rate, oxygen consumption, metabolic rate and tidal volume) systems’ parameters are measured when we keep our subjects exposing to cold environmental temperature. Furthermore, to determine the dominant thermoreceptor when perceiving conflicting information, these temperature and cardiovascular parameters are measured repeatedly. Our studies showed that in response to cooling, core temperature was relatively constant. However, skin temperature dropped substantially due to vasoconstriction feedback.
Hypothermia happens when your body temperature drops way below normal, causing to circulatory, respiratory and nervous systems to slow down. Normal body temperature is around 37 degrees Celsius hypothermia happens if your temperature drops to 35 degrees Celsius or below.
The patient has high temperature, and extreme sweating as well as visible chills on body.
Although students were not allowed in the recovery unit, I was able to talk to one of the recovery nurses. I learned that a nurse’s duty of care includes monitoring the patient’s vital signs and level of consciousness, and maintaining airway patency. Assessing pain and the effectiveness of pain management is also necessary. Once patients are transferred to the surgical ward, the goal is to assist in the recovery process, as well as providing referral details and education on care required when the patient returns home (Hamlin, 2010).