Respiratory-Cardiac Arrest Clinical Reasoning Case Study

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Prepare your students for licensure and real-world practice with this salient scenario that contextualizes nursing care and priority setting with a patient who develops respiratory/cardiac arrest due to narcotic oversedation.

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Case Study Scenario:

Sheila Dalton is a 52-year-old woman who has a history of chronic low back pain and COPD. She had a posterior spinal fusion of L4-S1 earlier today. Her pain is currently controlled at 2/10 and increases with movement. She was started on a hydromorphone patient-controlled analgesia (PCA) with IV bolus dose that is 0.2 mg and continuous rate of 0.2 mg/hour.

The nurse reported that Sheila’s nausea has improved after receiving ondansetron IV four hours ago. She has had increased pain despite using the PCA every 10 minutes. Her pain has decreased from 6/10 to 2/10 since the PCA bolus was increased from 0.1 mg to 0.2 mg of hydromorphone IV one hour ago.


Key Components:

1. Develop Critical Thinking

  • By applying and using knowledge most important to practice

2. Develop Clinical Reasoning

  • By recognizing relevant clinical data to identify the nursing priority

3. Develop Clinical Judgment

  • Outcome when student interprets, notices, and responds appropriately

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