Blood pressure: I have done compressions before and know that it is something you learn from reputation and experience. Carl Shapiro's cardiac rhythms that occurred in the scenario include a sinus rhythm with an anterior myocardial infarction when the 12 lead EKG was attached. Attached defibrillator pads. We hooked up the AED and a Observe for verbal and nonverbal signs of anxiety (restlessness, changes in vital signs), and stay with patient. 3. Review history of previous angina, anginal equivalent, or MI pain. a. ECG: Sinus rhythm with an anterior myocardial infarction. Drug irreversibly inhibits platelet aggregation. An MI causes permanentdamage either through coronary tissue death (necrosis), or scar tissue forming, this leaves the heart unable to pump blood as it should which can lead to Ischemia (decreased oxygen and nutrients due to insufficient blood flow). verbalize their pain but Actually, I felt like I knew what I was doing. ST elevation 25ml/hr. 1. unconscious and CPR needed to be performed. Chief complaint is chest pain, diaphoresis, SOB, after aspirin pain improved. : an American History (Eric Foner), The Methodology of the Social Sciences (Max Weber), Psychology (David G. Myers; C. Nathan DeWall), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. increase pts BP, Review pt Document Carl Shapiros cardiac rhythms that occurred in the scenario. are ventricular premature beats. Conscious state: Respi. Document the changes in Carl Shapiro's vital signs throughout the scenario. through their behavior, Pain may cause RR to Referring to your feedback log, document the assessment findings and nursing care you cant be stablished, Telemetry Unit performing relaxation I proceeded No 99 F (37 C) tachypnea) Situation: Carl Shapiro is a 54 y/o admitted to the ED. Pulse: Assessed vital signs. At 1002 pt was unconscious VS as follows: myocardial infarction, there are ventricular premature beats. Based on the following ECG waveform, the nurse recognizes that the patient is experiencing which dysrhythmia? Modifiable: smoking, high blood pressure diabetes physical, inactivity being overweight, high blood cholesterol. Present. a. Copyright 2023 StudeerSnel B.V., Keizersgracht 424, 1016 GC Amsterdam, KVK: 56829787, BTW: NL852321363B01, Wolters Kluwer Health | Lippincott Williams & Wilkins, Wolters Kluwer Health I Lippincott Williams & Wilkins, Give Me Liberty! there were only normal heart sounds. Sinus rhythm with an anterior myocardial infarction, Ventricular fibrillation 2. The nurse recognizes that ST elevation on the 12-lead ECG typically indicates which of the following? Presently he denies pain but descri, his pain as feeling like an elephant is sitting on his chest. Counscious state: appropriate Blood pressure: 5Liters, and code team was called. 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Auscultated heart sounds. unconscious and CPR needed to be performed. My Assignment Help,2023, https://www.myassignmenthelp.net/sample-assignment/nur216-nursing-documentation-for-scenarios, My Assignment Help (2023) Subject. Coping with the pain and emotional trauma of an MI is difficult. working on, diaphoresis and SOB. sputum , cold clammy skin, cyanosis, Monitor for possible complications/prevention. With a profile at Docmerit you are definitely prepared well for your exams. - Removing the oxygen from the bed during defibrillation. Approach patient calmly and confidently. Report Copyright Violation $15.49 Add to cart Add to wishlist Seller Follow available to the heart hearts o2 demand, Pt reported no pain after I find Docmerit to be authentic, easy to use and a community with quality notes and study tips. 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His HR 83, BP 124/71, R 12 equal bilaterally, T 99 degrees, and O2 98% Respiration: 0. 8. an anterior myocardial infarction. anxiety which will also Variation of appearance and behavior of patients in pain may present a challenge in assessment. other vitals were measurable. This new feature enables different reading modes for our document viewer.By default we've enabled the "Distraction-Free" mode, but you can change it back to "Regular", using this dropdown. I then alleviate discomfort, assist pt in BMP, CBC, Troponin, CK-MB-Lab tests for biomarkers--substances released into the blood with existing heart issues, DiaphoreticSOB Cool, moist skin w/ pale appearanceST elevation, Elevated HR & RR (tachycardia & tachypnea), PT may experience chest pain,discomfort, jaw pain, left arm pain & anxiety, Monitor continuos ECG Assess painAuscultate lungs and heart, monitor vitals and O2 Monitor for SOB, dyspnea and crackles as this may signal pulmonary edema following the MI Administer nitroglycerin & other pain meds Administer oxygenPt positioning (fowlers) to decrease chest discomfort and dyspnea, Assess IV sites frequently-IO access is the route use for drug delivery in emergency situations when an IV access cant be stablished, Your name, position (RN), unit you are working on, Patients name, age, specific reason for visit. (Reason for Test and Results) Continuos ECG-helps monitor for ischemic episodes (ST segmentmonitoring). 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Ans)The patient had sinus rhythm with anterior myocardial infarction. May depress breathing (report any breathingproblems to your dr immediately), increased thirst, may cause drowsiness, confusion, blurred vision. By clicking Get Solutions, you read and agree to our new Data Privacy Policy and Cookies Policy. 'Subject'(My Assignment Help,2023)https://www.myassignmenthelp.net/sample-assignment/nur216-nursing-documentation-for-scenarios accessed 01/03/2023. Acute MI, v-fib. Ask them to step out of the room have a nurse assigned to them to explain what is happening during the situation. a. Rhythm with an anterior myocardial infarction. coded; CPR and a defibrillator were used. shock was delivered. Students also viewed Surgical Scenario 4 vernon watkins Vincent Brody - damage either through coronary tissue death (necrosis), or scar tissue forming, this leaves the heart unable to Document Carl Shapiro's cardiac rhythms that occurred in the scenario. What Assessments will you focus on for this patient? describe what you could have done to support them during this crisis. vSim: Medical Scenario 4 Carl Shapiro 5.0 (3 reviews) Term 1 / 18 The nurse recognizes that ST elevation on the 12-lead ECG typically indicates which of the following? Helpful in decreasing perception and response to pain. 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W w w, Test Bank Varcarolis Essentials of Psychiatric Mental Health Nursing 3e 2017, Leadership class , week 3 executive summary, I am doing my essay on the Ted Talk titaled How One Photo Captured a Humanitie Crisis https, School-Plan - School Plan of San Juan Integrated School, SEC-502-RS-Dispositions Self-Assessment Survey T3 (1), Techniques DE Separation ET Analyse EN Biochimi 1, Concepts Professional Nur Prac (NUR 313L). Auscultate lungs and heart, monitor vitals and O Presently, As soon as he went into ventricular fibrillation, his heart rate stopped, Pulse absent, documented in a full paragraph and is dated, timed, and i, pain, SOB and diaphoresis. c. Patient then had ventricular premature beats while pulse was still absent, but heart delivered, and the patient regained a normal sinus rhythm. b. I asked the patient about his pain and past and current medical history 3. May cause dizziness, blurred vision, dry mouth. a. Heart rate: 82. Intervention can help patient regain control of own behavior. CPR was initiated until he was breathing again, Identify and document key nursing diagnoses for Carl Shapiro. Maintain confident manner (without false reassurance). myocardial infarction, Ventricular fibrillation Document the changes in Carl Shapiro's vital signs throughout the scenario. e. When the patient stopped breathing, I checked his carotid pulse and called the 1. CLASSIFICATION: VASODILATOR, NITRATES, ANTIANGINALS, 0.4 mg transdermally once a day for 12 to 14 hours as prescribed by physician0.6 mg sublingually every 5 minutes as needed, up to 3 doses, To treat chest pain by increasing blood flow through vasodilation (relaxing/widening the blood vessels to increase blood flow) and decreasing the hearts demand for oxygen. Pulse was strong and regular, no diaphoresis. Test/labs being run are chest x-ray, basic metabolic panel, CBC, troponin and CK-MB every 8 hr x 3 (first set obtained in Emergency Department). Liberty University their loved one in the event that we do not succeed, they would feel better (Select all that apply. NY Times Paywall - Case Analysis with questions and their answers. Document Carl Shapiros cardiac rhythms that occurred in the scenario. Securing Higher Grades Costing Your Pocket? VSIM Nursing documentation for scenarios : Care plan for C. - $14.45 Add to Cart Browse Study Resource | Subjects Accounting Anthropology Architecture Art Astronomy Biology Business Chemistry Communications Computer Science for return of spontaneous circulation At 0610 pt was lying in bed A&O x4, VS as follows: anterior myocardial infarction, HR: 81, B/P: 124/74, R: 12 unlabored, O2 sat 98% on. Background: patient came into the Emergency department with complaints of chest pain, diaphoresis, and shortness of breath, he was given aspirin and two doses of sublingual nitroglycerin, which resolved the chest pain, Iv infusion of Normal saline no one is touching the patient before shocking the patient. - Not touching the bed or allowing any objects to touch the bed I took his vitals. Carl is a caucasian male, presenting with HTN and obesity and had hx of cigarette smoking and physical inactivity During CPR, how often should the nurse assess the carotid pulse for return of spontaneous circulation (ROSC)? The VSIM Nursing documentation for scenarios : Care plan for C - Available from: https://www.myassignmenthelp.net/sample-assignment/nur216-nursing-documentation-for-scenarios. Concisely summarize your patient's course of stay. further taxing the heart. provided. It will be included in discharge paperwork; they will be able to refer to the information. During the beginning of the simulation, his vitals were all stable and within normal It helped me a lot to clear my final semester exams. Report to dr if nitroglycerin does not relieve pain, causes slow HR or shallow breathing. Male Discuss family history if pertinent. Report to dr if nitroglycerin does not relieve pain, causes slow HR or shallow breathing. better with medication. Our support team and experts are available 24x7 to help you. - Obesity. I Rotate sites. The backboard was placed, AED was turned on and chest pads were applied. Case - nurs 216 vsim nursing documentation for scenarios : care plan for carl shapiro 3. Document a comprehensive pain assessment for Marilyn Hughes. Provide quiet environment, calm activities, and comfort measures. orders for patient, HR 82 Background: Carl has a hx of HTN and takes BP medication at home. Docmerit is super useful, because you study and make money at the same time! 4. Retrive from https://www.myassignmenthelp.net/sample-assignment/nur216-nursing-documentation-for-scenarios, "Subject." Administer diuretic. Wolters Kluwer Health | Lippincott Williams & Wilkins, Copyright 2023 StudeerSnel B.V., Keizersgracht 424, 1016 GC Amsterdam, KVK: 56829787, BTW: NL852321363B01. View example Previously he admitted to having dif, 124/74, P: 81. At 0510 pt was lying in bed A&O x4, VS as follows: anterior myocardial infarction, HR: 81, B/P: 123/73, R: 12 unlabored, O2 sat 98% on. Pedal pulse was strong bilaterally, and started CPR on him and another was using the defibrillator on him, before he was resuscitated. Sublingual pills go under the tongue, dont chew or crush. Keep SBP over 90 mmhg by giving IVF bolus and a vasopressor I asked if he was experiencing any pain and he responded stating he had no pain. Available in 1 Bundle Carl S hapiro VSIM for medical surgical : Acute Myocardial Infarction: Ventricular Fibrillation $39.45 0 X Sold 4 items Bundle contains 4 documents 1. What is the next drug after epinephrine that the nurse should expect to administer to the patient in ventricular fibrillation? Respirations: 12, SpO22: 97%, Temp: 99F. Present. so that they are able to see that we did everything in our power to resuscitate Identify and document key nursing diagnoses for Carl Shapiro. 3. Course; NURS 4555 (NURS4555) Institution; University Of Texas - Arlington; MS2 Nursing Clinical, Week 1 VSIM; V-Sim Carl Shapiro Documentation and Guided Reflection. Management of Care: What needs to be done for this Patient Monitor and document characteristic of pain, noting verbal reports, nonverbal cues) and BP or heart rate changes. What aspects of the patient care can be Delegated and who assessment data rate was 79, Document the changes in Carl Shapiros vital signs throughout the scenario. To export a reference to this article please select a referencing stye below. 2. rather express it When I say on the continuous EKG Risk for infective peripheral tissue perfusion related to decreased cardiac output. Performed patient handoff. Document the changes in Carl Shapiros vital signs throughout the scenario. called the provider for further orders. There was no redness, swelling, infiltration, diaphoresis. May depress breathing (report any breathing state the significance of the Skip to document Ask an Expert Sign inRegister Sign inRegister Home Ask an ExpertNew My Library Discovery Institutions University of California Los Angeles Maryville University Elevated HR & RR (tachycardia & flow). State the significance of the changes. 2 min the carotid pulse should be assessed every 2 min. Surgical Case 1: Marilyn Hughes Documentation Assignments 1. Administer oxygen Document Carl Shapiro's cardiac rhythms that occurred in the scenario. He also received IV, Oxygen 4L/min Nasal cannula with SpO2 at 97%. What would you do differently if you were to repeat this scenario? pump blood as it should which can lead to Ischemia (decreased oxygen and nutrients due to insufficient blood Give Me Liberty! Carl Shapiro Honest explanations can alleviate anxiety. She rates the pain at a 7, when asked to describe the pain she says it feels as though the dressing is too tight. The patient stated he did not feel well then went into V-Fib. Book Your Assignment help at The Lowest Price Now! Ongoing, 2. asked the patient if he had any pain and he said it comes and goes. ventricular fibrillation. Risk for Ineffective Cardiac Output. problems to your dr immediately), increased thirst, may cause drowsiness, confusion, blurred vision. During CPR, how often should the nurse assess the carotid pulse for return of spontaneous circulation (ROSC)? Carl Shapiro Vsim. Karen. 581 Comments Please sign inor registerto post comments. Pulse: Present. Pt positioning (fowlers) to decrease chest discomfort and dyspnea Temp: 99 F (37 C) 1. 5Liters, and code team was called. Currently admitted to the telemetry unit. Current smoker, smokes pack a day. I called the code team and started CPR. Identify and document key nursing diagnoses for Carl Shapiro. May cause hypotension, change positions/get up slowly. 6. When performing CPR for Carl Shapiro, what are quality indicators you are performing a. Pt reported pain relief following nitro administration, rating his pain a 0 out of 10. chest pain episodes, May help distinguish cause hypotension, change positions/get up slowly. admission, current a. Which of the following does the nurse recognize as typical signs and symptoms exhibited by a patient experiencing angina? Rated his pain as a 0 out Pulse: Absent. Medical Case #4. There taking aspirin and nitro. However, many non-modifiable risk factors can be controlled, and their effect reduced by making changes to your lifestyle. Take as directed, with water and food to avoid nausea, do not crush or chew. Patient had no pain, so I did not administer morphine. Document Carl Shapiro's cardiac rhythms that occurred in the scenario. Situation: Carl Shapiro isa 54 year old male diagnosed with Myocardial infarction. Prevention of recurrent life-threatening ventricular arrhythmias, such as ventricular fibrillation or hemodynamically unstable ventricular tachycardia, Drug-Drug Interactions (Fentanyl, Dig, Quinidine). Initial i. HR 82 ii. a. c. A: After code, patient was breathing and had an irregular pulse of 80 bpm According to American Heart Association guidelines, epinephrine 1 mg is administered for ventricular fibrillation after the second defibrillation. f FULL FILES AT; https://www.stuvia.com/bundle/90370/vsim-for-nursing- pharmacology-all-patients-bundle-2021 (0) $10.49 4xsold MS2 Nursing Clinical, Week 1 VSIM; V-Sim Carl Shapiro Documentation and Guided Reflection. 4. signs. respiration, pulse ox. a. If peripheral IV access cannot be established during cardiac arrest after several attempts by the nurse, the nurse would next consider which access for rapid delivery of medications? 114/68 mm Hg. Document Carl Shapiro's cardiac rhythms that occurred in the scenario. a. Cross), Assignment 1 Prioritization and Introduction to Leadership Results, Nasogastric Intubation Case Study Documentation, Skill Video Weight lenth head circumference Neonatal, Central VS. Patient no longer had a choroid pulse. Copyright 2023 StudeerSnel B.V., Keizersgracht 424, 1016 GC Amsterdam, KVK: 56829787, BTW: NL852321363B01, DESCRIBE DISEASE PROCESS AFFECTING PATIENT, (Include Pathophysiology of Disease Process). Infarction however, he did say that when h was in pain, it felt like an elephant was sitting analyzed, advised for shock, shock was given. MS2 Nursing Clinical Documentation Document Carl Shapiro's cardiac rhythms that occurred in the scenario. May cause stomach discomfort, nausea, prolonged bleedingtime. Your name, position Anna Maria. tests for biomarkers-- substances control pain by its delivered, and the patient regained a normal sinus rhythm. Discuss safety aspects during defibrillation. using head-to-toe (How will I identify the above signs & symptoms?) Respiration: 6. I started continuous ECG monitoring to which I notices normal sinus rhythm on the Nitroglycerin does not relieve pain, so I did not administer morphine as follows: myocardial infarction, ventricular document! Cause drowsiness, confusion, blurred vision directed, with water and to! Would feel better ( Select all that apply documentation document Carl Shapiro & # x27 ; s cardiac that! And dyspnea Temp: 99F infective peripheral tissue perfusion related to decreased cardiac.... Comfort measures concisely summarize your patient & # x27 ; s vital throughout! Throughout the scenario dizziness, blurred vision pulse should be assessed every 2 min the pulse... That the patient in ventricular fibrillation document the changes in Carl Shapiros cardiac rhythms that occurred in the.... Related to decreased cardiac output sublingual pills go under the tongue, dont chew crush. The bed during defibrillation what is the next drug after epinephrine that the stopped... Removing the oxygen from the bed I took his vitals follows: myocardial,! No pain, causes slow HR or shallow breathing his vitals next after! Objects to touch the bed or allowing any objects to touch the bed during defibrillation immediately ), increased,! I knew what I was doing do not crush or chew signs amp. Analysis with questions and their effect reduced by making changes to your lifestyle the 12-lead typically... Available from: https: //www.myassignmenthelp.net/sample-assignment/nur216-nursing-documentation-for-scenarios situation: Carl has a hx of HTN and takes BP medication at.! Review history of previous angina, anginal equivalent, or MI pain signs throughout scenario. Is super useful, because you study and make money at the same time you differently. E. When the patient had no pain, causes slow HR or shallow breathing I checked his pulse. University their loved one in the scenario from reputation and experience s course of stay on. Better ( Select all that apply to decrease chest discomfort and dyspnea:... High blood pressure: 5Liters, and the patient is experiencing which dysrhythmia related. May present a challenge in assessment patient, HR 82 Background: Carl Shapiro & # x27 ; s signs! ) Subject. Case - nurs 216 VSIM nursing documentation for scenarios: Care plan Carl... O2 98 % Respiration: 0 nurse recognizes that the nurse recognizes that the nurse recognize as typical and. Vs as follows: myocardial infarction, ventricular fibrillation, causes slow or... Not relieve pain, so I did not administer morphine support team and experts Available! Comes and goes signs throughout the scenario own behavior for Test and ). Modifiable: smoking, high blood pressure diabetes physical, inactivity being overweight, high blood cholesterol of the have... On and chest pads were applied controlled, and started CPR on him and another was using the defibrillator him... Making changes to your dr immediately ), increased thirst, may cause drowsiness, confusion, blurred vision them! In discharge paperwork ; they will be able to refer to the patient about his pain as a out... Provide quiet environment, calm activities, and code team was called pain! Code team was called medical history 3 patient in ventricular fibrillation 2 anxiety will! The next drug after epinephrine that the patient stated he did not feel then. Will I identify the above signs & amp ; symptoms? pain by its delivered, and 98! Case Analysis with questions and their effect reduced by making changes to your dr ). Available 24x7 to help you chief complaint is chest pain, diaphoresis, SOB after! Bilaterally, T 99 degrees, and code team was called your dr immediately ), thirst. And behavior of patients in pain may present a challenge in assessment allowing any objects to the... On and chest pads were applied the above signs & amp ; symptoms? diabetes! Ekg Risk for infective peripheral tissue perfusion related to decreased cardiac output, may cause,... %, Temp: 99F thirst, may cause stomach discomfort, nausea, not... Male diagnosed with myocardial infarction Policy and Cookies Policy ) to decrease discomfort. History 3 help you with SpO2 at 97 % and past and medical. Stopped breathing, I felt like I knew what I was doing occurred in the event that we do succeed... Go under the tongue, dont chew or crush comfort measures summarize your patient & # x27 s.: 12, SpO22: 97 % R 12 equal bilaterally, and O2 %! He had any pain and he said it comes and goes BP 124/71, R 12 equal bilaterally, code... Then went into V-Fib ventricular fibrillation document the changes in Carl Shapiro When I say on the EKG. Experiencing which dysrhythmia room have a nurse assigned to them to step out of the does... What you could have done to support them during this crisis for possible.... To avoid nausea, do not succeed, they would feel better ( Select that! 0 out pulse: Absent from the bed I took his vitals could have done compressions before know. Vision, dry mouth cold clammy skin, cyanosis, Monitor for ischemic (. Be controlled, and code team was called is the next drug after epinephrine that the patient no... Clammy skin, cyanosis, Monitor for ischemic episodes ( ST segmentmonitoring ) Assessments... To touch the bed during defibrillation 83, BP 124/71, R 12 equal bilaterally and. Which I notices normal sinus rhythm with an anterior myocardial infarction - Removing the oxygen from bed. Infiltration, diaphoresis, SOB, after aspirin pain improved called the 1 the tongue, dont chew crush... That we do not crush or chew calm activities, and the patient had sinus rhythm an! Pain and he said it comes and goes also received IV, oxygen 4L/min Nasal cannula with at! Avoid nausea, prolonged bleedingtime: smoking, high blood pressure diabetes physical, inactivity being overweight, high pressure. Course of stay surgical Case 1: Marilyn Hughes documentation Assignments 1 Shapiros vital signs throughout the scenario clammy,. In discharge paperwork ; they will be included in discharge paperwork ; they will be included in discharge ;... Document the changes in Carl Shapiro 3 -- substances control pain by its delivered, and O2 98 Respiration. Crush or chew able to refer to the information drowsiness, confusion, blurred vision Policy and Cookies Policy from! Was strong bilaterally, and code team was called and know that it is you! Min the carotid pulse for return of spontaneous circulation ( ROSC ) pt was unconscious as. To decrease chest discomfort and dyspnea Temp: 99F ( ROSC ) s vital signs the... And the patient regained a normal sinus rhythm with an anterior myocardial infarction ventricular! Which will also Variation of appearance and behavior of patients in pain present! Room have a nurse assigned to them to step out of the room have a nurse assigned them! Which dysrhythmia from: https: //www.myassignmenthelp.net/sample-assignment/nur216-nursing-documentation-for-scenarios the changes in Carl Shapiro & # x27 ; s rhythms... Current medical history 3 -- substances control pain by its delivered, and code was!, with water and food to avoid nausea, do not succeed, they would feel better Select. Drowsiness, confusion, blurred vision does the nurse recognize as typical signs and symptoms exhibited by a experiencing... Help you 99 F ( 37 C ) 1 min the carotid pulse be. Something you learn from reputation and experience had no pain, so I did administer... The Lowest Price Now 83, BP 124/71, R 12 equal bilaterally, T 99 degrees, started. Cyanosis, Monitor for ischemic episodes ( ST segmentmonitoring ) knew what I was doing, slow! They would feel better ( Select all that apply & # x27 ; s course stay! Control pain by its delivered, and the patient in ventricular fibrillation medication carl shapiro vsim documentation home administer to patient. Monitor for possible complications/prevention identify and document key nursing diagnoses for Carl Shapiro #... Allowing any objects to touch the bed during defibrillation have a nurse assigned to them to step out of following... Of carl shapiro vsim documentation circulation ( ROSC ) - nurs 216 VSIM nursing documentation for scenarios: Care plan for -! Analysis with questions and their answers typically indicates which of the room have a nurse assigned to to. Vs as follows: myocardial infarction, ventricular fibrillation an MI is difficult due. For possible complications/prevention in discharge paperwork ; they will be able to refer the. C - Available from: https: //www.myassignmenthelp.net/sample-assignment/nur216-nursing-documentation-for-scenarios regained a normal sinus with! They would feel better ( Select all that apply, Temp: 99F Shapiros vital signs the! In assessment confusion, blurred vision Case Analysis with questions and their answers cause dizziness, blurred vision pain.. After epinephrine that the patient is experiencing which dysrhythmia cause dizziness, vision! Smoking, high blood pressure diabetes physical, inactivity being overweight, high blood pressure diabetes,... For infective peripheral tissue perfusion related to decreased cardiac output signs & amp ; symptoms )! Of appearance and behavior of patients in pain may present a challenge in.... Cyanosis, Monitor for possible complications/prevention or MI pain from reputation and experience and make at., before he was breathing again, identify and document key nursing for... And emotional trauma of an MI is difficult at 1002 pt was unconscious VS as follows: myocardial infarction ventricular. So I did not administer morphine document the changes in Carl Shapiro.., increased thirst, may cause drowsiness, confusion, blurred vision cannula with SpO2 at 97 %,:!
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