Describe your actions in the following situations.
1. You are documenting your patient’s heart rhythms in his medical record for the shift. A peer is sit- ting near you and doing the same. You see that RN document the patient’s heart rhythm as sinus rhythm, when you know the patient has had a trial fibrillation the whole shift.
2. The physician is rounding on your patient. The pa- tient has had an elevated blood pressure of 160/90 despite already having received all of her antihy- pertensive medications for the day. The patient has reported to you that she is also experiencing a head- ache. You tell the doctor about the blood pressure reading and the patient’s headache. You request that the physician order another medication to help lower the patient’s blood pressure. The physician says to you, “Oh, she’ll be fine” and begins to walk away.
3. You are caring for an elderly woman. Her daugh- ter is at her bedside. The patient has been having recurrent flare-ups of congestive heart failure and has been readmitted to the hospital three times in the last month. Each time she returns, the swelling in her extremities and her difficulty breathing is worse than the time before. The physician rounds on the patient and her daughter and shares that the health care team will work to help her, but it appears that her heart is getting weaker again,
and the congestive heart failure is going to con- tinue to get harder to manage. After the doctor leaves, you enter the room. The patient is sleeping and the daughter is quietly crying.
4. You run to the room of a patient where the code blue alarm has been activated. Your team is doing CPR and attaching the code cart to the patient. You put on gloves and step in to help. As you approach the bed of the patient, you look at the patient’s wrist and see a do not resuscitate brace- let on his arm.
5. You are caring for a patient with paranoid schizo- phrenia and a heart dysrhythmia. It is time to ad- minister his 9 A.M. meds. When you enter the room with the medications that the patient takes to prevent ventricular tachycardia, he begins scream- ing, “No, I won’t take those medications, you’re trying to poison me!”
6. You are caring for a patient who is recovering from a myocardial infarction. You have been talk- ing to her about her new cardiac diet and what she can do to be healthy when she leaves the hospital. You discuss eating low amounts of salt, a well-rounded diet rich in fruits and vegetables, and avoiding fried and sugary foods. Later in the day, you pass the patient’s room and see her eat- ing fried chicken and French fries that her family brought.