COLLEGE OF NURSING

DHAMTARI

SUBJECT- MEDICAL SURGICAL NURSING – I

TOPIC- DEMONSTRATION ON CPR

SUBMITTED TO;
MADAM MRS T.M SINGH
ASSOCIATE PROFESSOR SUBMITTED BY;
MISS ANGEL DAVID
COLLEGE OF NURSING
MSC 1ST YEAR
DHAMTARI. COLLEGE OF NURSING
DHMATARI.
SUBJECT - MEDICAL SURGICAL NURSING-I

TOPIC - DEMMONSTRATION ON “ CPR

NAME OF EVALUATOR - Mrs. T.M SINGH {Associate Professor , MEDICAL SURGICAL NURSING}

NAME OF STUDENT - Miss. ANGEL DAVID {MSc. Nursing 1st year}

PLACE -

TIME -

DATE -

METHOD OF TEACHING - LECTURE, DISCUSSION, QUESTIONING AND ANSWERING,

AV-aids - EQUIPMENTS AND PATIENT.

LANGUAGE - ENGLISH,

PREVIOUS KNOWLEDGE - BEFORE STARTING THE PROCEDURE I ENQUIRED THAT THE STUDENTS ARE HAVING
SOME KNOWLEDGE REGARDING THE ASSIST IN CPR
Central objective: - At The End Of The Class Demonstration Student Will Be Able To Acquire The Knowledge
Regarding CPR CARDIOPULMONARY RESUSCITATION.

Specific objectives: - At the end of demonstration students will able to: -

1. Introduce the Assist in CPR.

2. Identify the purpose and contraindications of Assist in CPR
3. List out the indication of Assist in CPR
4. Describe the general instruction regarding insertion of Assist in CPR.
5. Enlist the article of Assist in CPR
6. Explain the preparation of patient before going to Assist in CPR
7. Assist the Assist in CPR
8. Describe the complication of Assist in CPR
9. Explain the follow up care after Assist in Colostomy Summarize and conclude the topic of Assist in
CPR.
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1. 1 min. Self I am Miss Angel David , M. Sc.(N) 1 st yr. student, College Listening It helps in
Introduction. of Nursing, Dhamtari. Today I am going to demonstrate making good
the procedure of CPR. IPR with class.

After
2. 1 min. Introduction of Lecturing Answering. introducing the
the topic. INTRODUCTION topic the
Resuscitation includes all measures that are applied to students are
revive patients who have stopped breathing suddenly and going to tell
unexpectedly due to either respiratory or cardiac failure. what
Cardiac arrest is one of the common causes for cardio resuscitation is.
respiratory failure. When a person stops beating clinical
death occurs within 4 to 6 minutes, the cells of the Brain.
Which is sensitivity to the paucity of oxygen begin to
deteriorate. If the O2 supply is not restored, the patient
suffers irreversible brain damage and biological death
occurs.
What is the
3. 2 min. Enlist the Discussion Answering Definitions of
DEFINITION
Definition of CPR?.
CPR. According to Bailliere’s Nurses Dictionary-
“CARDIOPUMONARY relating to the heart and lungs C.
resuscitation (CPR) whereby life saving measures are
commenced to maintain the respiration and circulation of a
patient who has sustained a cardiac arrest.”
According to Brunner &Suddarth’s ; Text book of
M.S.N. “ CARDIOPULMONARY provides blood flow to
vital organs until effective
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Circulation can be reestablished.”

4. 1 min. Enumerate the INDICATION:- CPR should be performed immediately Discussion Answering What are the
Indication & on any person who has become unconscious and is found indication and
contraindicate- to be pulse less. Assessment of cardiac electrical activity contraindication
ion for CPR. via rapid “rhythm strip” recording can provide a more for CPR.
detailed analysis of the type of cardiac arrest, as well as
indicate additional t/t options.
 Ventricular fibrillation (VF).
 Pulse less ventricular tachycardia (VT).
 Pulse less electrical activity (PEA).
 A systole.
 Pulse less Bradycardia.

CONTRAINDICATIONS : The only absolute contra

indication to CPR is a do not resuscitation order or other
advanced directive indicating a person’s desire to not be
resuscitate in the event of cardiac arrest. A relative
contraindication to performing CPR is if a clinical
justifiably feds that the intervention would be medically
futile.
3min. What are the
5. Describe the type BASIC LIFE SUPPORT:- Essentially, there are eight types of CPR.
of the CPR and steps for performing adult Basic life support:- Questioni-ng. Answering
steps According a) Check victim’s responsiveness.
to type of C.P.R. b) Activate the Emergency Medical Service (EMS).
c) Position the unresponsiveness.
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d) Open the victim’ airway.
e) Check for breathing.
f) Give 2 slow breaths.
g) Check for a pulse.
h) Perform rescue procedures based on findings:
either rescue breathing or CPR.
I. Check Responsiveness:- The first step is to
recognize that a person’s is unresponsive. The
simplest method to determine unresponsiveness is to
tap the victim’s shoulder and shout “Are you okay”?
Do not forcefully shake the victim, since he or she
may have a spine injury.
II. Activate EMS:-If the victim is unresponsive,
activate the EMS immediately, to avoid unnecessary
loss of time in acquiring advanced cardiac life
support. Direct a bystander to activate the EMS. If
no by standers are present, activate the EMS
yourself.
III. Position the Unresponsive Victim: - An
unresponsive victim lying face down must be turned
over so CPR can be given, if necessary. If you must
turn the victim over, keep the head, neck, and
shoulder aligned to avoid any twisting of the body.
To turn an unresponsive victim.
IV. Open the Airway:-
1) The most important maneuver in performing
rescue breathing is opening
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the victim’s airway.
2) The most common cause of airway
Obstruction in an unconscious person is
blockage by the tongue.
3) When a victim’s airway is opened, the lower
jaw is moved forward, bringing the base of the
tongue (which is attached to the lower jaw) for
ward also and away from the back of the
throat.
4) The easiest way to open an injured person’s
airway is by tilting the head and lifting the
chin.
5) To perform the head–tilt-chin-lift, place one
hand, palm down, on the victim’s forehead and
push down ward so the head tilts back.
6) Then place the index and middle fingers of
your other hand under the lower edge of the
chin to lift the jaw.
7) Simply opening the victim’s airway sometimes
results in restoration of lower edge of the chin
of lift the jaw.
8) If you suspect a spine injury, results in
restoration of breathing. If the airways remains
blocked, tilt the head slowly and gently until
the airway is open enough to allow breath to
go in.
9) Another technique for a victim with a possible
spine injury is to use a jaw thrust without a
head tilt. While
 stabilizing the head, place the fingers of
victim’s lower jaw on each side of the
each hand behind the angles of the
Head and move the lower jaw forward without
tilting the head backward.
10) If the airway does not open, it may be
necessary to tilt the head slightly.

V. Check for Breathing:-

1. After determining unresponsiveness and
opening the airway, the next step is to look,
listen, and fed for breathing.
2. Look to see whether there is any visible
movements of the victim’s chest, listen for air
by placing your ear next to the victim’s mouth
and nose.
3. If Breathing is present, you will see the
victim’s chest rise and fall, hear air coming
from the victim’s mouth and nose, and fed air
against your check.
4. This process should take only 3 to 5 seconds.
Place a breathing unconscious victim in the
recovery position.
VI. Perform Rescue Breathing:- If a victim is not
breathing, perform rescue breathing by using one of
the following methods mouth. Sequence of
Cardiopulmonary Resuscitation: A – airway, B-
Breathing, C- Circulation. Perform external chest
compressions: External chest compressions are
 required only if a pulse is not present.

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III. After each minute of rescue breathing, you

should fed for a pulse. If a pulse cannot be
felt, external chest compression must be
given.
1. If there is no pulse initially, external chest
compression must be given in addition to rescue
breathing.
2. This procedure is known as cardiopulmonary
resuscitation (CPR).
3. External chest compressions require a smooth
application of pressure over the lower half of the
sternum.
4. External pressure applied to the sternum causes
pressure in the chest (intrathoracic) to increase,
thus producing blood movements to the brain.
5. Compression must not be sharp or jabbing or
applied over the lip of the sternum.
6. Proper hand position and placement on the victim’s
chest are necessary to avoid. Internal injury such as
bushing of the heart, laceration of the liver, or
rupture of the spleen.
 2) ADVANCE CARDIAC LIFE SUPPORT:-The
provision of basic life support – airway maintenance,
ventilator assistance , and external chest compression is
the first step toward facilitating survival for the victim of
cardiopulmonary arrest. Airway and ventilator support-

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1) Oxygenation: -Essential aspect of resuscitation
is to achieve optimal ventilation and
oxygenation. Although artificial ventilation
provide a normal partial pressure of O2 there is
arterial
-Hypoxemia because of diminished cardiac
output intrapulmonary shunting and ventilation
perfusion mismatched which can be corrected
with supplementary O2.
2) Airway adjuncts: There is a possibility of
continued soft tissue obstruction which can be
relieved by or pharyngeal and nasopharyngeal
airway, oral air way must be of proper size and
positioned so that the patients tongue is
completely encircled by the airway.
3) Masks: A well-fitting mask can be used to
supply higher concentration of oxygen through
an oxygen insufflations inlet.
4) Ventilation Circuits: If the patient’s
spontaneous ventilation is inadequate
assistance is provided using manual ventilating
 unit. There are 2 types of manual resuscitators
which are self-refilling and non-self-refilling
units. The self-refilling units are referred as bag
mark devices or ambu bags. The non self-
refillingmagill circuit with 1 piece unit.

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5) Endotracheal intubation : In most of the
cardiopulmonary arrests ventilation can be
achieved by simple airway restoration.
Endotracheal intubation should be attempted by
experienced person when all the equipment is
ready. After placing the endotracheal tube in
place good airway control is possible, with
better regulation of
,airway pressure and ventilator pattern is offered.
Ventilation and tube function is to be monitored
closely as there is danger of blocked or
malfunctioning endotracheal tube.
6) Support of Circulation: Support of Circulation:
Chest compression during advanced cardiac life
support is performed in the same manner as
Basic Life Support.
Electrocardiographic Monitoring
1. ECG Monitoring – is essential during resuscitation.
 Many defibrillators have the built in ECG
monitoring circuit and quick look paddles. Such
units sense the patients ECG pattern from the
defibrillator paddle upon application and display.
For continuous monitoring standard ECG machine
or monitoring unit with display screen is used.

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1. Defibrillation – In ventricular fibrillation a pre
cordial thump is employed by going a sternum to a
height of 8-12 inches. If this reverts the rhythm to
sinus bolus lidocaine is given. If ventricular
fibrillation persists proceed to Basic Life Support
and defibrillation.
2. Electrical defibrillation- electrical defibrillation
involves passing an electrical current through a
fibrillating heart allowing for uniform
depolarization and organized cardiac
electromechanical activity. To use
3. The paddles and apply to the chest to determine
rhythm. Select the energy level marked in
Joules(100-300).
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S. Drug Pharmacological Indication for
N effects use
1. Potassiu Correction of Refractory
m hypokalemia. cardiac/ventri-
chloride. cular arrhythmia
due to
hypokalemia.
Bronchospasm
due to secretion
Deriphyl Bronchial dilatation. or Bronchial
2 li-ne. asthma/COPD.
 Bronchospasm
due to secretion
Aminop Bronchial dilatation. or Bronchial
3 hy-lline. asthma/COPD.
1.Shock-
Hypovolemic,
Hydroco 1. suppresses anoxic Anaphylatic.
4 rt-isone. tissue damage. 2.Bronchial
(Efcorli 2. Membrane asthma(Acute)
n). stabilizer. 3. Decreases
3. Protect against intracranial
circulating toxins. pressure.
4. Suppression of 4. Acute adrenal
harmful insufficiency.
inflammation.

GENERAL INSTRUCTION What are the

1. CPR techniques are used in persons whose respiration Questioni-ng Discussion. general
7. 2min. Enlist the and circulation of blood have suddenly and instruction for
General CPR procedure.
unexpectedly stopped.
Instruction of
CPR. 2. The immediate responsibilities of the resuscitator are:
a) To recognize the signs of cardiac arrest.
b) To protect the patient’s brain from anoxia.

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c) To call for help.
3. The CPR must be initiated within 3 to 4 minutes in
order to prevent permanent brain damage.
4. The CPR techniques should not be discontinued for
more than 5 seconds before normal circulation and
ventilation of lungs are established.
5. Before CPR is attempted in a patient, make sure
that the airway is clear.
6. Cardiac compression help to stimulate the
 circulation.
7. The artificial breathing and the cardiac massage
should correspond to the normal respiration and
pulse rate. The ratio of cardiac compression to
ventilation rate is 5:1 i.e. 5 cardiac compression to
1 ventilation. Cardiac compression given at the rate
of 60 per minute. Ventilation are given at the rate
of 12 per minute.
8. When there are 2 rescuers, both position
themselves on either sides of the victim i.e. one
rescuer does artificial ventilation while the other
does external cardiac compressions. The ratio of
cardiac compression to ventilation rate is 15:2.
9. The circulation of blood is initiated with the
external cardiac massage because, the pressure
exerted on the pliable sternum squeeze the heart
against the spine forcing

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blood out of the heart into aorta.
10. Watch for complications that may occur during the
cardio – pulmonary resuscitation.
11. Discontinue the procedure only when you are that
the respirations and circulation reestablished.
12. Patient’s vital sign are watched constantly over a
period of 24 to 48 hours after the cardiac arrest,
 because of the danger of recurring another cardiac
arrest at any time.
13. A naso-gastric incubation and aspiration of gastric
contents are necessary for a patient with full
stomach to prevent vomiting and aspiration of
vomits into the lungs.

8. 1 min. Discuss the PRELIMINARY ASSESSMENT:- Discussion Discussion what are

Preliminary 1. Pulse Rate should be checked before the procedure Preliminary
Assessment of with proper Rhythm. Assessment
C.P.R. 2. Check the Respiration Rate. for CPR.
3. Vital signs like B.P. and temperature should be
checked first.
4. The level of consciousness should be checked.
5. Check for the chest movement and pupil of the
Eye.
EQUIPMENTS FOR PROCEDURE:- BLS What are the
9. 2 min. Enlist the Equipment 1:- Ambu bag. Lecture. Answering. equipment’s for
Equipment used Rational 1:- To compress O2. C.P.R.
in the C.P.R. Equipment 2:- Face mask.
procedure. Rational 2:- To fit with Ambu bag.
Equipment 3:- I.V. Cannula

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Rational 3:- To insert in patient’s vein for giving
Emergency drugs.
Equipment 4:- Thermometer, B.P. Apparatus,
Stethoscope.
 Rational 4:- for measuring vital sign.
Equipment 5:- ECG machine.
Rational 5:- To monitor the cardiac rhythm.

ACLS
Equipment 1:- Laryngoscope.
Rational 1:- To visualize the tracheal opening.
Equipment 2:- E.T. tube
Rational 2:- To insert in patient’s oral cavity if
Initial CPR does not work.
Equipment 3:- Ventilator.
Rational 3:- To insert in patient’s E.T. tube if
patient’s does not initiates breathing
after 30 chest compression.
Equipment 4:- defibrillator.
Rational 4:- To initialize shock if heart rate is not
coming to proper rhythm.
10. 1 min. Demonstrate the Discussion Answering. What are the
steps of STEPS OF PROCEDURE:- One Rescuer- steps of
Procedure. Step 1:- Determine unresponsiveness. procedures of
Rational 1:- To check the level of consciousness. CPR.
Step 2:- Place victim in a supine position.
Rational 2:- To maintain proper position.
Step 3:- Open the airway with the head tilt chin.
Rational 3:- For correctly passing of air through
chin.
Step 4:- Place ear on mouth and nose and fed for
Respiration.

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Rational 4:- To check level of respiration.
Step 5:- If the person is breathing but unconscious
place him in the rescue position.
Rational 5:- To continue the breathing.
Step 6:- If the victim is not breathing obtain
barrier device.
Rational 6:- To start Breathing.
Step 7:- Place mask over mouth and nose and
deliver 10 to 12 breaths/min.
Rational 7:- For maintaining proper mouth closed
and escape from the mask.
Step 8:- Check for pulse at carotid artery for 5 to
10 seconds.
Rational 8:- To check the rate of heart beat.
Step 9:- If no pulse, begin chest compressions.
Rational 9:- To begin pulse rate.
Step 10:- Place one hand over lower half of
sternum and place.
Step 11:- Straighten arms and elbows. Keep
shoulders directly over hands.
Rational 11:- Correct way of giving CPR.
Step 12:- Compress chest 1½ to 2 inches. Perform
15 chest compressions at a rate of
80/100 minute.
Rational 12:- After 15 Compression usually stopped heart
beat begins.
Step 13:- After the 15 compressions, deliver 2
slow rescue breaths.
Rational 13:- If breathing is still stoped to start
breathing
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Step 14:- After 4 cycles, reassess.
Rational 14:- Reassessing is very essential if person start
breathing then we have to stop CPR.
Step 15:- If the person is pulse less and apneic
continue CPR.
Step 16:- If pulse has returned begin rescue
breathing.
Rational 16:- To bring breathing in normal rate.
Step 17:- If effective breathing and pulse has
returned to normal place the victim in
the recovery position.
Rational 17:-This will comfort the patient from the
excursion of the CPR.

Two rescuers:-
Step 1:- Two rescuer CPR is preferable.
Rational 1:- CPR Procedure will be more easy.
Step 2:- One rescuer performs chest compressions
while the other performs rescue
breathing.
Rational 2:- CPR giving Technique will be easier
for rescuer
Step 3:- The compression ventilation cycles is 5:1
after 5 chest compressions one breath is
delivered.
Rational 3:- This will reduce the exersion of the
Patient.
Step 4:- When the rescuer performing chest
compression becomes fatigued, the
rescuers should change positions.
Rational 4:- Make the Procedure easy for rescuer.
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11. 3 min. After care of the POST RESUSCITATION CARE OF THE PATIENT:- Questioni- ng Questioni-ng What are after
patient and the 1. Providing cardio Respiratory support to optimize care of the
equipments. tissue perfusions, especially to the brain. patient after
2. Transport the patient to the hospital emergency CPR?
department.
3. Attempt to identify the precipitating causes to the
arrest.
4. Institute measures such as Anti Arrhythmic therapy
to prevent recurrence.

After Care of the Equipments:-

1. Place all the equipments in correct places/at a right
place.
2. Clean the laryngoscope if it is used clean it with
spirit swab or Anti septic lotion.
3. Place all the emergency drugs in a crash trolly and
arrange it properly.
4. Throw all the broken ampoules in the dust Bin.
5. Remove the gloves and discard it.
6. Place the Ambu bag at a right place and disconnect
the mask and also place the mask at correct place,
keep that in mind that mask should be clean with
spirit swab so that it can be used in another patient.

Discuss the COMPLICATIONS:- Lecture. Answering

12. 1 min. Complication-s 1) Damage to the cervical spine due to What are the
of C.P.R. Complications
of C.P.R?
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Hyperextension of the neck.
2) Fracture of the rid and xiphoid process.
3) Hemopericardium.
4) Pneumothorax.
5) Intra-abdominal hemorrhage.
6) Gastric distension of air.
7) Aspiration of the vomitus into the lungs.
Lecturing Listening What are the
13. 1 min. Summary. SUMMARY – summary of
a) Introduction of topic. Procedure
b) Definition. CPR?
c) Indication.
d) Contra indication.
e) Types of CPR.
f) Classify the drugs used during CPR.
g) General instruction of C.P.R.
h) Preliminary assessment.
i) Equipments with Rational.
j) Steps of procedures.
k) After care of the patients and Articles.
l) Complications.
Lecturing Listening What is the
14. 1 min. Conclusion. CONCLUSION – After my demonstration students will conclusion of
be able to give answer regarding “Cardio Pulmonary C.P.R.?
Resuscitation” their steps, Equipment, After care of
articles and unit, definition purpose etc.

EVALUATIONS:- Verbal Question- Questioni-ng Answering What are the

15. 1 min. Evaluation. Evaluation of
Que. (1) Discuss the drugs used in CPR with their C.P.R?
indication and Action.
Ans. (a) Students are able to give some name with
their actions
Que. (2) Give Complications of CPR.
Ans. (b) They tell the complications of CPR.

BIBLIOGRAPHY

1. ANNEE G. PERRY : BOOK OF BASIC SKILLS AND PROCEDURE, PUBLISHED BY MOSBY BROTHERS, PRINTED IN
UNITED STATES OF AMERICA, 2ND EDITION, 1996, PAGE NO. 356-359
2. SR. NANCY: BOOK OF FUNDAMENTAL OF NURSING, PUBLISHED BY MOSBY PRINTED ON 2004, 2ND EDITION,
P P. 174-179.
3. SR. NANCY: BOOK OF FUNDAMENTAL OF NURSING, PUBLISHED BY LIPPINCOTT MANUALS, 2ND EDITION,
P P. 452.
4. PERRY & POTTER: BOOK OF FUNDAMENTAL OF NURSING, PUBLISHED BY LIPPINCOTT MANUALS, 2ND
EDITION, PP. 368-369.
5. PATRICA A. POTTER: BOOK OF BASIC SKILLS AND PROCEDURE, PUBLISHED BY MOSBY & COMPANY,
PRINTED IN UNITED STATES OF AMERICA, 2ND EDITION, PAGE NO. 342-347.