Chapter 37 Resuscitation
Answer: Stand behind the patient & perform 5 subdiaphragmatic upward trusts slightly above the navel. Chin tilt the patient's head back & check to see if any object is visible. (Never use finger sweep unless you can see the object.) (If the patient becomes unconscious activate EMS & perform CPR.)
A 37 year old male patient is eating his lunch & chatting with his wife. Then suddenly he grasp his throat & was not able to speak. What should the nurse do next?
Answer: When the patient has or is suspected to have head/neck trauma, because it can cause damage to the spine.
When do you not perform the head-tilt or jaw thrust maneuver?
Answer: To avoid distending the esophagus & stomach which ultimately prevents regurgitation & aspiration.
Why should a rescue breath last 1 minute long?
Answer: No
If an AED is used on a patient & the patient is in the recovery position do you remove the electrodes?
Answer: Check for responsiveness by shouting & shaking her. Assess for normal breathing & pulse with her in the supine position. (10 seconds) If she's lifeless or not breathing normally activate the EMS. Provide the dispatcher with: The address where help is needed. Describe the situation. Her current condition. What actions have been taken. (If need be the dispatcher will send out the resuscitation team who is ACLS certified.)
A 46 year old female at the grocery store suddenly falls to the floor. What should you do?
Answer: Elderly patients are more at risk for fractured ribs during CPR. Elderly patients may have poor circulation & may have brain damage after receiving CPR. Elderly patients on anticoagulents may bruise on site of chest compressions.
A 97 year old female patient has osteoporosis & is currently taking heparin becomes unconscious while talking to the nurse.The nurse determines that the patient is unresponsive, the carotid pulse is palpable, & no breathing is detected. What should the nurse consider before performing CPR?
Answer: Check to make sure he's not a DNR before performing the Chain of Survival.
A 98 year old patient in hospice becomes unconscious. What should the nurse do?
Answer: Hold the infant face down, but up, & support the infant with the forearm. Slap the infant's back 5 times using the heel of your hand between the shoulder blades. Then turn the infant on to her back. Use 2 fingers to give 5 chest thrusts (1/sec) in the middle of the breastbone just below the nipple line. Alternate between the back & chest thrusts until the object is dislodged. (Never use finger sweep unless you can see the object.) (If the infant becomes unconscious activate EMS & perform CPR.)
A conscious 8 month old patient is grasping for air & has a bluish tint to her skin. What should the nurse do next?
Answer: a) Patient A who has had a cerebral vascular accident. (Stroke) Rationale: A person with a stroke is at high risk for choking and aspirating a bolus of food as a result of hemiparalysis (half-sided paralysis) of the muscles that control the face, tongue, and throat.
A nurse is managing care for all the following patients. For whom would the nurse most anticipate an airway obstruction? a) Patient A who has had a cerebral vascular accident. (Stroke) b) Patient B who has had a full mouth extraction of teeth. c) Patient C who has had biopsy of a tongue lesion. d) Patient D who has had facial cosmetic surgery.
Answer: After every 5 cycles of CPR & assessing for no longer than 10 seconds.
A nurse is performing CPR when should she assess the patient for pulse & normal breathing?
Answer: Perform the Heimlich maneuver by administering subdiaphragmatic thrusts or chest thrusts.
A patient is grasping his throat & is able to nod his head when the nurse asked if he needed help. What should the nurse do?
Answer: g) Assess responsiveness e) Check for breathing. b) Activate the EMS. f) Give chest compressions at a rate of 100-120 d) Open the airway. a) Combine compressions with rescue breaths at a ratio of 30:2 I) Pause for ventilation & AED is in place. h) Attach the AED & follow instructions. c) Perform CPR fo 2 min & assess for pulse.
Arrange the following adult resuscitation steps in the correct sequence: a) Combine compressions with rescue breaths at a ratio of 30:2 b) Activate the EMS. c) Perform CPR fo 2 min & assess for pulse. d) Open the airway. e) Check for breathing. f) Give chest compressions at a rate of 100-120 g) Assess responsiveness h) Attach the AED & follow instructions. I) Pause for ventilation & AED is in place.
Answer: Side lying. Rationale: Keeps airway open & prevents choking on fluids.
As the patient is recovering after CPR he/she is placed into the recovering position. What does this patient look like?
Answer: Position yourself superior to the patient's head. Gently grasp the side of jaw on both sides & tilt upward. (Do not do this if the patient has or is suspected of head/neck injury to avoid damaging the spine.)
How you perform the jaw thrust technique?
Answer: c) Shout, "Everybody clear." Rationale: The nurse must ensure that no one is touching the victim before administering the shock from the AED.
Before administering the shock from an AED, what action should the nurse take first? a) Implement the recovery position. b) Loosen the victim's belt. c) Shout, "Everybody clear." d) Give 3 rescue breaths.
Answer: A sudden malfunction of the heart causing it to not contract or keep a normal heartbeat rhythm.
Define cardiac arrest.
Answer: Place heel of hand on the chest between the nipples & the other hand on top with interlocking fingers. Compress down 1/3 of the chest (2") at a rate of 100-120 compressions per minute. Total: 30 compression/ 2 one second breaths
Describe CPR on a child 1-8 years old.
Answer: Place heel of hand on the chest between the nipples & the other hand on top with interlocking fingers. Compress down 1/3 of the chest (2-2.4") at a rate of 100-120 compressions per minute. Total: 30 compression/ 2 one second breaths
Describe CPR on an adult.
Answer: 1 Rescuer- Place 2 fingers in chicken feet form on the midline of the chest. 2 Rescuer- Use 2 thumbs with hands encircling the chest. Compress down 1/3 of the chest (1.5") at a rate of 100 compressions per minute. Total: 30 compression/ 2 one second breaths
Describe CPR on an infant under 1 year of age.
Answer: Place the heel of one of your hands on the lower part of the sternum, but above the xiphoid. Place your other hand on top & interlock the fingers. Position your body directly over the patient in order to administer straight downward compressions & allowing it to recoil.
Describe what position should you be in for CPR.
Answer: Compressions are administered initially before giving any rescue breaths because during the first few minutes of cardiac arrest, the oxygen content in arterial blood is adequate for maintaining cellular function. Opening the airway and giving rescue breaths delays time for circulating oxygenated blood. Rescue breathing become necessary as resuscitation efforts continue.
Explain the reason that chest compressions are now initially preferable before administering rescue breathing upon finding someone who is unresponsive & now breathing normally.
Answer: Checking for a pulse when initially finding a person suspected of having cardiac arrest has been de-emphasized because the assessment tends to take valuable time away from beginning effective chest compressions. Untrained (and sometimes trained) rescuers tend to delay chest compressions when they have difficulty feeling the pulse or are unsure if a pulse actually exists. If pulse assessment is performed, it should take less than 10 minutes to confirm that one is present or absent.
Give a reason for the deemphasis on checking a pulse as a method for determining heart contraction on individuals who are unresponsive.
Answer: Hospital- Call a code Community- Call 911
How do you activate the emergency medical system (EMS) in a hospital? In a community?
Answer: The patient can speak or cough, which means that there are some air being exchanged.
How do you know if they patient has a partial airway obstruction?
Answer: Place your hand on the patient's forehead & use 2 fingers on your other hand to tilt the chin upward.
How do you perform the head-tilt/ chin-lift technique?
Answer: Assess the patient for the need to perform the Chain of Survival. Perform CPR. Turn it on & follow the audio/verbal instructions. Apply the electrodes. Press analyze. After 5-15 sec the AED will say shock or no shock. If it says "no shock" continue CPR for 5 cycles & reanalyze. If it says "give shock", shout clear, press shock, perform 5 cycles of CPR, & reanalyze.
How do you use the AED?
Answer: Squeezing the heart between the sternum & vertebrae increases ventricle pressure. Pressure on the thoracic vessels increases blood flow.
How does chest compressions promote circulation?
Answer: How much time had passed before CPR? How long has CPR been performed without change in condition? Age of the patient. Patient's diagnosis. Level of arterial blood gas. Levels of electrolytes.
How is discontinuing CPR determined for a patient who is not resuming normal breathing & no pulse is felt?
Answer: The infant's ability to cry.
How would you determine whether or not an infant has a partial airway obstruction?
Answer: Laryngectomy- Seal your lips around the stoma & blow air into the stoma. Tracheostomy Tube- Close the nose & blow air into the trach opening.
How would you perform rescue breath for a laryngectomy? Tracheostomy tube?
Answer: Abdominal Thrusts, Back Blows, & Chest Thrusts
Name the 3 different physical methods that may force the obstructing object out of an unconscious patient's airway.
Answer: CAB- Circulation, Airway, Breathing Hands Only Chest Compressions CPR- Cardiopulmonary Resuscitation
Name the 3 methods for early cardiopulmonary resuscitation.
Answer: 1) Recognizing a cardiac arrest & activating EMS. 2) Immediately perform CPR focusing on chest thrusts. 3) Perform rapid defibrillation if appropriate 4) Perform advanced life support 5) Perform post cardiac arrest care. (Using speed to assist the patient will increase chance of survival.)
What are the 5 steps for the Chain of Survival?
Answer: Issues swallowing Choking on vomit Insufficient chewing Eating large pieces of food Laughing or talking while eating Eating when intoxicated Inhaling foreign objects from the mouth
What are the common causes of airway obstruction?
Answer: Ineffective Airway Clearance Impaired Spontaneous Ventilation Impaired Gas Exchange Decreased Cardiac Output Ineffective Cardioplumonary Tissue Perfusion Ineffective Cerebral Tissue Perfusion Ineffective Renal Tissue Perfusion Decisional Conflict
What are the nursing implications for resuscitation?
Answer: Coughing or gagging while eating Wheezing Persistently attempting to clear throat Making hoarse or wet vocal sounds Resisting efforts to be fed Being unable to speak Holding throat Being unable to breathe Exhibiting cyanosis
What are the signs of a partial or complete airway obstruction?
Answer: Loss of consciousness & eventually will lead to death. Rationale: Not enough oxygen is getting to the tissues.
What can happen if there is an airway obstruction?
Answer: The effectiveness of rescue breathing is determined by observing that the chest visibly rises. If the airway is not opened or the mouth/nose is not sealed, there will be an inadequate volume of air that reaches the lungs.
What criteria are used to determine if rescue breathing is being delivered effectively?
Answer: Narcotic overdose. (Follow the instructions & picture guides to administer the injection.)
What does Naloxone (evzio) treat?
Answer: An advance airway is placed.
What happens if the patient's breathing does not resume normally?
Answer: 94%-99% Oxygen 35-45 mmHg of Normocarbia (PaCO2) (Sometimes hypothermia is induced for 24 hours to stay within 89.6-98.6 degrees Fahrenheit.)
What is administered to a postresuscitation patient to keep the systolic blood pressure about 90 mmHg?
Answer: AED is a portable battery device that analyzes heart rhythms & gives a shock to restore normal heart beat. On an adult place the pads top right chest & on left side of the body beneath the nipple. If pediatric pads are not available place one on the front center of chest & one on the back between the shoulder blades. (Ultimately follow the picture guidelines.)
What is automated external defibrillator (AED) & where does the pads go on an adult? Child 1-8 years old?
Answer: It's the concentration of CO2 at the end of an exhale. The higher the measurement the better the chance is for survival. >15 mmHg = Tissues are receiving oxygen. <10 mmHg after 20 min of CPR = Requires decisions to be made about discontinuing CPR.
What is end tidal carbon dioxide (ETCO2) & why is it important?
Answer: When the victim is grasping his or her their hands.
What is the universal sign for aspiration?
Answer: Watch to see the rise & fall of the chest. Feel for air escaping from the nose or mouth.
What should you be assessing while performing CPR?
Answer: It's recommended to use a one way valve mask or other protective barriers to prevent acquiring infectious diseases. Continuous chest compressions without breaths are better than not attempting to resuscitate. Rescue breathing should be 10 breaths per min lasting 1 second long each.
What should you know about performing rescue breathing?
Answer: Inserting endotracheal tube. Giving supplemental oxygen. AED
What type of advanced life support does the paramedics perform?
Answer: Encourage & support the patient while they continue to try to relieve the partial obstruction. If the situation gets worst activate the EMS.
What would you do for a patient who is coughing & tells you that he/she is choking?
Answer: c) Early Activation of EMS Rationale: After a quick initial assessment, the nurse summons emergency service personnel.
When a person is in cardiac arrest, what is the first step the nurse takes in the Chain of Survival? a) Early CPR b) Early Cardiac Defibrillation c) Early Activation of EMS d) Early ALS
Answer: You can feel a pulse & the patient resumes breathing. Rescuers are tired. (10 second window) The patient has become worst. The patient is DNR or no chest compressions are allowed. ACLS has arrived to defibrillate.
When can you stop performing CPR?
Answer: 1 Rescuer- 30 compressions to 2 breaths. 2 Rescuer- 15 compressions to 2 breaths/ rescuer. (Both have 10 seconds to switch off after every 2min. to avoid fatigue)
When there is 1 rescuer available to perform CPR on an adult how many chest compression is done? 2 rescuers?
Answer: When it's an infant/small child or if the mouth breathing is not possible/unsuccessful. Close the patient's mouth & blow air into the nose.
When would you perform mouth to nose breathing? How?
Answer: c) Inability to speak Rationale: Inability to speak or make vocal sounds indicates occlusion of the passageway between the upper and lower airway.
Which of the following is the best evidence that the nurse should implement the Heimlich maneuver to relieve an airway obstruction in a conscious person? a) Forceful coughing b) Attempts to clear throat c) Inability to speak d) Audible wheezing
Answer: b) A stuffed animal with button eyes. Rationale: The child is at risk for accidental choking with any toy that has small parts or pieces that can be broken off or separated.
Which of the following should the nurse instruct parents of a 6 month old child to avoid when purchasing a toy, because of the risk for accidental choking? a) A teething ring with gel filling. b) A stuffed animal with button eyes. c) A mobile with suspended objects. d) A ball measuring 5 inches in diameter.
Answer: To ventilate the lungs through the mouth, nose, or stoma.
Why do healthcare providers perform rescue breathing?
Answer: The patient may be to sweaty or hairy.
You're attempting to apply AED electrodes, but it won't stick to the patient's skin. Why?
