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Basic Rhythm Analysis

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CASE STUDY SYNTHESIS PAPER
GREG BOIVIE
NURS 221
MAY 24th, 2011

Case Study Synthesis Paper
Tami is a 56-year old woman, 5’6” tall and weighs 136 kg. She came in for an ERCP to remove gallstones at 0800. The surgery went well and she woke up at 1130 denying any pain. At 1300 she had abdominal pain of 9/10 and received Toradol 60mg IVP. By 1350 she was complaining of back pain of 9/10 and she was given Morphine 2mg IVP and denied any pain 10 minutes later. Come 1530 the patient’s vitals were stable on room air, she ambulated to the bathroom independently and at 1535 a loud thud was heard in the bathroom. The patient was found lying on the floor with a laceration above her left eyebrow, not responsive to verbal commands and breathing at a rate of 4 per minute.
We will discuss the immediate concerns and treatment for the patient and then we will go back and see what could have been done differently with the patient to prevent the situation that occurred.
The nurse immediately assessed the ABC’s and activated the MET team. The patient had an open airway, was breathing at 4 per minute and had a weak carotid pulse at a rate of 40 per minute and blood pressure of 82/44. The primary concern for the patient was Risk for Complications of Decreased Cardiac Output r/t bradycardia secondary to vasovagal stimulation while having a bowel movement. According to Kyrillos and Pineda (2005), vasovagal episodes are caused by triggering baroreceptors that increase vagal response leading to a sympathetic withdrawal which can cause syncope. They are common to all age groups and can occur during defecation. (Kyrillos & Pineda, 2005, p. 61) So when the patient went into the bathroom to have a bowel movement, straining to have a bowel movement caused her heart rate to slow down, her blood pressure to drop, her respirations to slow which caused her to have a syncopal

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