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Carl Shapiro Simulation

The document outlines the initial steps for assessing and managing a patient with chest pain, including verification of patient identity, vital signs, and specific orders for medication and monitoring. It details the interpretation of lab results indicating a likely non-ST elevation myocardial infarction (NSTEMI) and provides guidance for patient education on medications, lifestyle changes, and warning signs. Additionally, it includes a structured SBAR communication template for reporting to the healthcare provider.

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Stacey Phillips
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20 views4 pages

Carl Shapiro Simulation

The document outlines the initial steps for assessing and managing a patient with chest pain, including verification of patient identity, vital signs, and specific orders for medication and monitoring. It details the interpretation of lab results indicating a likely non-ST elevation myocardial infarction (NSTEMI) and provides guidance for patient education on medications, lifestyle changes, and warning signs. Additionally, it includes a structured SBAR communication template for reporting to the healthcare provider.

Uploaded by

Stacey Phillips
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Initial Steps

 Wash hands, introduce yourself


 Verify patient name & DOB
 Explain procedure/purpose of care
 Assess:
o Chest pain (use PQRST)
o Heart sounds (S1/S2, irregular?)
o Lung sounds (crackles?)
o Peripheral pulses (+1), cap refill
o Vital signs (BP, HR, RR, Temp, SpO₂)
o Skin (clammy, diaphoretic?)

Review Orders

 Vital signs: q4h


 O₂ therapy: 4 L/min NC – maintain SpO₂ > 92%
 Continuous cardiac & pulse ox monitoring
 Nitroglycerin SL 0.3 mg q5min x3 PRN chest pain
 Aspirin 324 mg PO PRN (chew)
 Morphine 4 mg IM PRN chest pain x1
 Nitropaste 1-inch q6h
 Furosemide 40 mg PO daily
 NS at 25 mL/hr
 Venipuncture q8h x3: BMP, CBC, CK-MB, troponin
 Call MD with lab results

Key Lab Interpretation

 CK: 250 (↑)


 CK-MB: 20 (↑)
 Troponin: 2.2 (↑) = cardiac damage
 CBC & CMP: within normal range
 EKG: sinus tachycardia, then NSR
 Chest X-ray: cardiomegaly, no acute airway issue

If Chest Pain Occurs

1. Reassess pain level (0–10 scale)


2. Give Nitro SL (monitor BP!)
3. Wait 5 mins, reassess, repeat x3 if needed
4. If unresolved, give Morphine 4 mg IM
5. Notify provider immediately

SBAR to Provider

S: “Mr. Shapiro is experiencing chest pain again.”

B: “He was admitted for angina with elevated troponin.”

A: “Pain rated 6/10, given Nitro x2 with minimal relief. Vitals stable. BP 108/70.”

R: “Request further orders or possible transfer to higher level of care.”

The PQRST method is a systematic approach to assessing pain:

Letter Meaning Questions to Ask


What were you doing when the pain started? What makes it
P Provocation/Palliation
better/worse?
Q Quality Can you describe the pain? (sharp, dull, pressure, burning, etc.)
R Region/Radiation Where is the pain located? Does it radiate anywhere?
S Severity How would you rate the pain on a scale of 0 to 10?
T Timing When did it start? Is it constant or does it come and go?

Use this to evaluate chest pain and to determine if interventions like nitroglycerin are effective.

Normal
Lab Value Interpretation
Range
< 0.04 Very elevated – indicates myocardial injury
Troponin 2.2 ng/mL
ng/mL (likely MI)
CK (Creatine Elevated – suggests muscle damage, but not
250 U/L 30–170 U/L
Kinase) specific to the heart
Elevated – more cardiac-specific, supports MI
CK-MB 20 ng/mL < 6 ng/mL
diagnosis
CBC & CMP WNL Normal No abnormalities noted
Sinus tachy →
EKG — Initially elevated HR, now normalized rhythm
NSR
Indicates enlarged heart, possible chronic heart
CXR Cardiomegaly —
strain or fluid overload
These confirm the patient has likely had a non-ST elevation MI (NSTEMI).

Morphine 4 mg IM should be given with the following needle specs for adult IM injections:

 Needle gauge: 21–23 gauge


 Needle length: 1–1.5 inches
 Syringe size: 3–5 mL
 Site: Deltoid or ventrogluteal (ventrogluteal preferred for comfort and safety)

22 gauge, 1.5-inch needle

Patient Education

 Why he’s on cardiac monitor and O2


 What nitro/aspirin/morphine/furosemide do
 Report chest pain, dizziness, or SOB immediately
 Importance of heart-healthy diet & lifestyle
 Take meds exactly as prescribed

Diagnosis & Condition

 Explain that angina is chest pain caused by reduced blood flow to the heart.
 He likely had a mild heart attack (NSTEMI) based on labs and EKG findings.
 Emphasize the seriousness but reassure that he’s in a monitored setting.

Medications

 Nitroglycerin: Used for chest pain; take while sitting or lying, may cause
headache/dizziness.
 Aspirin: Prevents blood clots; must be taken as prescribed even if no pain.
 Morphine: For unrelieved chest pain; may cause drowsiness or slowed breathing.
 Furosemide (Lasix): Helps reduce fluid buildup; take early in the day, may increase
urination.

Lifestyle and Diet

 Follow a heart-healthy diet: low in sodium, saturated fats, and cholesterol.


 Stop smoking (if applicable), limit alcohol, avoid stimulants.
 Begin a cardiac rehab or moderate exercise program once cleared.
 Manage stress through mindfulness, relaxation techniques, or counseling.
Warning Signs to Report

 New or worsening chest pain


 Shortness of breath
 Swelling in legs or feet
 Dizziness or fainting
 Sudden weight gain (>2 lbs/day or 5 lbs/week)

Follow-Up

 Stress the importance of taking medications exactly as prescribed


 Keep follow-up appointments
 Get labs and EKGs as scheduled

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