BACHELOR OF SCIENCE IN NURSING:

INTENSIVE NURSING PRACTICUM

RLELCP 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 beimplemented:
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 Responsibility
1. Safe and Quality Nursing Care
2. Management of Resources
3. Health Education
Expected Performance and
Competency
Criteria
Demonstrates Identifies the client’s health
knowledge about the status in determining the need
clients’ health status for CPR.
and set priorities in
nursing care based on
clients’ needs
Provides sound Gathers and analyzes data
decision making in the relevant to the client’s health
care of individual/ family condition perform the correct
considering their beliefs CPR procedure.
and Values
Promotes safety, Maintains a safe environment
comfort, and privacy and performs age-specific CPR
procedures and protocols safely
ensuring privacy in all aspects of
care.
Administers Conforms to the 10Rs of
medications and other medication administration and
health therapeutics health therapeutics
safely (accurately and
correctly)
Organizes workload to Identifies nursing tasks and
facilitate client care. performs them based on
priorities.
Finishes tasks on time.
Observes appropriate protocols
and institutional policies.
Utilizes resources to Ensures availability,
support client care by completeness, and functionality
ensuring proper of equipment and nurse’s
functioning of paraphernalia relevant to the
equipment performance of CPR procedures.
Develops health Implements applicable age-

Key Areas of Responsibility
4. Legal Responsibility
5. Ethico-moral responsibility
6. PersonalandProfessionalDevelopmen
t image of the nurse
7. Quality Improvement
8. Research
9. Records Management
Competency
education plan based
on assessed learning
needs
Adheres to practices in
accordance with the
nursing law, institutional
policies and protocols,
and other relevant
legislation.
Adheres to Code of
Ethics of Nurses and
respect rights of the
client and other
individuals involved in
the care of the client.
Project a professional
Identifies and reports
variances and
recommends
appropriate solutions.
Enhances competency
level in the utilization of
different forms of data
gathering and principles
of assessment and
nursing care.
Analyzes and interprets
data, disseminate
findings and apply
recommend actions.
Maintains accurate and
updated documentation
of client care observing
legal imperatives in
documentation and
Expected Performance and
Criteria
appropriate health education
activities to the client based on
needs assessment
Acts and performs nursing tasks
related to CPR procedures in
accordance with established
norms of conduct expected of a
nurse and an OLFU student as
well as with the other relevant
legislation.
Maintain the privacy and
confidentiality of client’s
information.
Accepts responsibility and
accountability on the decisions
made relating to the client’s care.
Performs nursing tasks
according to professional
standards.
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.
Identifies and reports
inadequacies and problem(s)
encountered in the provision of
CPR procedures and processes.
Recommends practical and
appropriate solutions.
Specifies researchable problems
related to CPR procedures and
related client care.
Gather, analyze, and interpret
relevant data.
Utilizes findings in research in
the provision of CPR-related
measures and client care.
Records outcome of client care.
Submits legible, accurate and
updated documentation and/or
information regarding the client
care.
 Expected Performance and
Key Areas of Responsibility Competency
Criteria
record keeping.
10. Communication Identifies verbal and Interprets and validates client’s
non-verbal cues body language and facial
expressions
Uses appropriate Utilizes appropriate means
information technology and/or channels of
to facilitate communication to support the
communication. delivery of care to clients with
conditions needing CPR.
11. Collaboration and Teamwork Collaborates plan of Respects the role of other
care with the other members of the health care team
health care team in administering CPR measures
members. 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 ladyregained 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 havecollapsed 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 ladywas 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 airwayand the bag-valve device.
At this time theadministration of parenteral ketamine 5mg slow IV pushwas needed. The
paramedicobtained 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 ina 10 mL syringe
• Add 9 mLof normal saline to into the syringe
• Gentlyrollthe 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)
Unit Information
Situation
Patient Survey

.
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 givenchecklist)

Date Completed:
Date Submitted:

AHA (2020). Highlights of the 2020 American Heart Association (AHA)

Guidelines forCardiopulmonary 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 Jointposition
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