BACHELOR OF SCIENCE IN NURSING:

INTENSIVE NURSING PRACTICUM

RLE LCP MODULE RLE LCP UNIT WEEK
3 1 1

CARDIOPULMUNARY RESUSCITATION

 Read course and laboratory unit objectives

 Read study guide prior to class attendance
 Read required learning resources; refer to course unit
terminologies for jargons
 Participate in weekly discussion board (Canvas)
 Answer and submit course unit tasks

At the end of this unit, the students are expected to:

1. Apply the nursing process in the care of groups of clients across the lifespan with conditions
and/or in situations needing cardiopulmonary resuscitation:
a. Assess the client’s total health condition and resources.
b. Formulate nursing diagnoses based on the given scenario.
c. Develop a plan of care for individuals with conditions and/or in situations needing CPR.
d. Implement a plan of care applying the appropriate principles, guidelines, and steps in
administering CPR to client(s).
e. Evaluate the outcomes(s) of care post CPR administration.
2. Demonstrate competencies of a beginning staff nurse, nurse leader, and researcher.
3. Promote personal and professional growth by showing independence in performing varied
tasks and responsibilities.
Skills laboratory equipment and materials

To facilitate the practice of students’ nursing skills, the following rules must be implemented:
1. The use of the Nursing Skills laboratory equipment and materials appropriate of the given
case scenario are allowed.
2. Use resources from the required readings.
3. Students must perform the tasks in the worksheet at a given period.

Key Areas of
Competency Expected Performance and Criteria
Responsibility
1. Safe and Demonstrates knowledge Identifies the client’s health status in
Quality Nursing about the clients’ health status determining the need for CPR.
Care and set priorities in nursing
care based on clients’ needs
Provides sound decision Gathers and analyzes data relevant to the
making in the care of client’s health condition perform the correct
individual/ family considering CPR procedure.
their beliefs and Values
Promotes safety, comfort, and Maintains a safe environment and performs
privacy age-specific CPR procedures and protocols
safely ensuring privacy in all aspects of care.
Administers medications and Conforms to the 10Rs of medication
other health therapeutics administration and health therapeutics
safely (accurately and
correctly)
2. Management of Organizes workload to Identifies nursing tasks and performs them
Resources facilitate client care. based on priorities.
Finishes tasks on time.
Observes appropriate protocols and
institutional policies.
Utilizes resources to support Ensures availability, completeness, and
client care by ensuring proper functionality of equipment and nurse’s
functioning of equipment paraphernalia relevant to the performance of
CPR procedures.
3. Health Develops health education Implements applicable age-appropriate health
Education plan based on assessed education activities to the client based on
learning needs needs assessment
4. Legal Adheres to practices in Acts and performs nursing tasks related to
Responsibility accordance with the nursing CPR procedures in accordance with
law, institutional policies and established norms of conduct expected of a
protocols, and other relevant nurse and an OLFU student as well as with the
legislation. other relevant legislation.
 Key Areas of
Competency Expected Performance and Criteria
Responsibility
5. Ethico-moral Adheres to Code of Ethics of Maintain the privacy and confidentiality of
responsibility Nurses and respect rights of client’s information.
the client and other individualsAccepts responsibility and accountability on
involved in the care of the the decisions made relating to the client’s
client. care.
6. Personal and Project a professional image Performs nursing tasks according to
Professional of the nurse professional standards.
Development Demonstrates good manners and right
conduct at all times.
Observes proper grooming and hygiene.
Adapts to changes willingly by being open to
new strategies or approaches relevant to the
performance of CPR.
7. Quality Identifies and reports Identifies and reports inadequacies and
Improvement variances and recommends problem(s) encountered in the provision of CPR
appropriate solutions. procedures and processes.
Recommends practical and appropriate
solutions.
8. Research Enhances competency level in Specifies researchable problems related to
the utilization of different forms CPR procedures and related client care.
of data gathering and Gather, analyze, and interpret relevant data.
principles of assessment and
nursing care.
Analyzes and interprets data, Utilizes findings in research in the provision of
disseminate findings and CPR-related measures and client care.
apply recommend actions.
9. Records Maintains accurate and Records outcome of client care.
Management updated documentation of Submits legible, accurate and updated
client care observing legal documentation and/or information regarding
imperatives in documentation the client care.
and record keeping.
10. Communication Identifies verbal and non- Interprets and validates client’s body language
verbal cues and facial expressions
Uses appropriate information Utilizes appropriate means and/or channels of
technology to facilitate communication to support the delivery of care
communication. to clients with conditions needing CPR.
11. Collaboration Collaborates plan of care with Respects the role of other members of the
and Teamwork the other health care team health care team in administering CPR
members. measures to the client.
Refers the client to the appropriate allied
health team partners.
THE CASE OF JANE DOE

A 47-year-old lady collapsed suddenly while waiting at a bus stop. A

bystander called the emergency hotline / EMS to report what he had
witnessed but doesn’t want to touch nor do anything due to COVID-19
scare. The hotline personnel stated, “The ambulance is on its way,” and
requested the bystander to stay with the lady until the ambulance arrives.

The lady regained consciousness after what seemed like a minute to the
bystander. She tried to stand on her own when she heard a shout that
help is coming. The sound of the ambulance siren seems to have alerted the lady on what the
bystander meant. She still tried to get up by grabbing on to the nearest Bus Stop pole, but without
success. She simply leaned back on the pole exhausted. The ambulance then arrived. (Refer to
the timeline of events below.)

Timeline of Events
13:57 Call to EMS
13:58 Ambulance leaves station
14:06 Ambulance arrives on scene
14:39 Ambulance leaves scene for hospital
14:45 Ambulance arrives at hospital

The EMS unit dispatched to the scene included 3 team members: 1 paramedic, one EMT and an
EMS nurse. Upon arrival of the ambulance, the bystander hailed to the nurse and narrated what
happened. A few seconds later, the lady was observed to have collapsed again. After positioning
the lady on the ground, compression-only CPR was started by the paramedic while the AED is being
prepared by the EMT.

The paramedic student observed the lady to be gasping, and immediately the nurse replaced the
paramedic performing compressions while the paramedic student ventilated the lady with a bag-
valve device connected to a small oxygen tank. The lady was found to be in ventricular fibrillation
(VF). A 200-joule biphasic shock was delivered, and BLS continued with minimal interruption. No
medical history for this patient was available on scene.

At this time, the lady, still in VF, began moving her hands toward her chest and grabbed the hands
of the nurse, who at this time was performing the compressions. While the compressions were
paused, the patient became flaccid again; thus, compressions were restarted. The team decided not
to intubate the patient, since her level of consciousness indicated it would not be possible without
sedation and concentrated on the quality of BLS delivery.

Efforts to gain vascular access became difficult since the patient had folded her hands and would
not allow the paramedics to straighten them. BLS continued without interruption for a total of three
rounds of two minutes each, with a total of three 200-joule shocks every two minutes. Without
vascular access, no epinephrine was administered. The airway was then managed with an
oropharyngeal airway and the bag-valve device.
At this time the administration of parenteral ketamine 5mg slow IV push was needed. The paramedic
obtained vascular access via an intraosseous device to the left tibia and administered the drug while
CPR is continued. The patient was noted to maintain purposeful movements.

After another three shocks and six minutes of CPR, the patient achieved ROSC, and her heart
rhythm changed to ventricular tachycardia. Two synchronized shocks were delivered until the rhythm
changed to sinus tachycardia with a corresponding pulse. At this time the patient became restless,
and the crew administered IO midazolam. The patient was hemodynamically stable, and the
electrocardiogram showed no signs of ischemia, ST elevation or other changes suggesting a reason
for the cardiac arrest. The nearest hospital’s intensive cardiac care unit advised transport to the ER.
On the short ride to the hospital, the patient woke up and was fully aware of what had happened.

TASKS: Complete the following activities to provide high quality, individualized care for the patient.
Accomplish the worksheet below (Prehospital Care Record)

1. Quick Assessment (5 mins) – You are the bystander. Collect, organize and document
information about the patient. Data will be used to
a. Inform the emergency hotline of the situation.
b. For you to be able to implement the necessary and appropriate interventions.
2. Implementing Care (20 minutes)
a. Perform compression-only CPR (single-rescuer)
b. Perform 2-rescuer-CPR
c. Prepare and administer Ketamine 20mg slow IV push (Recall correct procedure in
medication administration)

INSTRUCTIONS TO DILUTE KETAMINE TO PROPER STRENGTH (Lee, 2020)

• Draw up 1mL of ketamine 100mg/mL in a 10 mL syringe
• Add 9 mL of normal saline to into the syringe
• Gently roll the syringe in between hands for 10 seconds

3. Ongoing Care (15 minutes) - document the care that has been provided as follows:
a. Using the CHART (Complaint, History, Assessment, Rx – Drugs, Treatment) format – so
that this is communicated with other healthcare professionals.
b. Discharge instructions (METHOD)
 .
Disposition Procedures & Meds Patient Survey Situation Unit Information

Adapted from PreMIS (https://ncems.org)

Patient Care Report Narratives
Time: C:

Date: H

A:

R:

T:

_________________ ________ _____________________ _______________

Patient Received By Date Drv/Medic Certification & Number
_________ ________________________ _________________
Date Medic 1 Certification & Number
_________ ________________________ _________________
Date Medic 2 Certification & Number
 BLS Checklist – Adult (Single Rescuer)
Skill Tested YES NO
1. The student secures the scene. (Scene is safe)
2. Assesses patient responsiveness. (No pulse present, no breaths observed;
checks for no longer than 10 seconds))
3. Demonstrates correct CPR hand placement and body positioning over
patient.
4. Demonstrates correct compression rate (100-120/min) and depth (2 in.).
5. Allows for complete chest recoil between compressions.
6. Demonstrates opening the airway (head tilt/chin lift, jaw thrust).
7. Gives effective breaths, and observes visible chest rise.
8. Have the student perform a second round of CPR. (AED has arrived, switch
providers giving compressions)
9. Demonstrates correct placement of AED, without interrupting CPR. (AED
analyzes rhythm)
10. Student clears patient for rhythm check and shock. (Shock delivered)
11. Student immediately returns to CPR after shock delivered.

(Evaluation Tool – refer to the given checklist)

Date Completed:
Date Submitted:
AHA (2020). Highlights of the 2020 American Heart Association (AHA)
Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency
Cardiovascular Care (ECC). Retrieved from https://cpr.heart.org/-
/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc
_guidelines_english.pdf

ASHP Board of Directors (26 May, 2020). Ketamine use in prehospital

and hospital treatment of the acute trauma patient: A Joint position
statement. Retrieved from https://www.ashp.org/-/media/assets/policy-
guidelines/docs/endorsed-documents/endorsed-documents-ketamine-use-In-prehospital-and-
hospital-treatment.ashx?la=en&hash=DEE12083F0C0E2B80ED774857794 FDDAE2D9209D

Hinkle, J. and Cheever, K. (2017). Brunner & Suddharth’s Textbook of Medical-Surgical Nursing,
14th ed. USA: Wolters Kluwer
Lee, J. (13 October, 2020). Prehospital ketamine administration dosing, uses for EMS. Retrieved
from https://www.wms1.com

ncems.org (n.d). PreMIS Preliminary Report (Rrevision2) https://www.ncems.org/pdf/PreMIS

PreliminaryReport.pdf

Wacht, O. (August 2015). Case study: Combative cardiac patient, EMS World Print Online Expo.
Retrieved from https://www.emsworld.com/article/12087677/case-study-combative-cardiac-
patient

WHO (May 2019). Fact sheet: Emergency medical teams (EMTs). Retrieved from
https://reliefweb.int/sites/reliefweb.int/files/resources/WHO%20Fact%20Sheet%20-
%20Emergency%20Medical%20Teams.pdf