Collabrative Case Study

Collabrative Case Study

University of Phoenix

Nur 402

Theoretical Foundations of Professional Nursing

Kimberly Frommel, MSN, RN

Collaborative Case Study

This is a case study of the collaborative care that happens in order for the hospital to meet its STEMI (ST-Elevation Myocardial Infarction) guidelines. The STEMI guidelines are for STEMI patients to go from hospital door to dilation in less then 90 minutes. The dilation is the part of the cardiac catherization done in the cardiac catherization lab.

This case study is going to show collaboration between emergency medical services paramedics and EMT's (Emergency Medical Technicians), the emergency room staff, the Cardiac Catherazation staff, the hospital laboratory staff, the hospital supervisor, pastoral care, physicians, patients family, and the patient.

Background

A 47 year old Caucasian male starts experiencing chest pain, shortness of breath with diaphoreses after mowing his lawn. While resting the patient starts experiencing a headache and left arm pain, it is 6:45 pm on a Monday. His wife calls 911.

The fire department is the first to respond with an EMT, they take his vital signs, place a non rebreather oxygen mask on him giving him 15 liters of oxygen. The ambulance arrives with a paramedic who connects the patient to a cardiac monitor which shows ST elevation. The patient is quickly given sublingual nitro and 3, 81 mg chewable aspirin, while the fire departments personnel are bringing the stretcher to the patient. Meantime a brief medical history report is being obtained from the family. The patient is loaded into the back of the ambulance and the family is giving information on where the patient is being taken. The Paramedic obtains IV access on the patient, gives the patient 4mg of morphine IV, IV fluids and an inch of nitro paste on his chest. He then performs a 12 lead EKG that shows ST elevation. . The ambulance driver radios their dispatch that they are responding code 3 to the local hospital. The paramedic calls the emergency room and gives report to a nurse that they are on their way in with a STEMI, a brief report is given. It is 7:15pm. The nurse taken report notifies the charge nurse that EMS is bringing in a STEMI patient. The charge nurse notifies one of the emergency room physicians and the staff that will be responsible for the patient and clears a room and prepares for the patients arrival. In preparing for the patients arrival the nurse will place a computer in the one corner of the room to register the patient and document everything that happens, a nurse is assigned to this duty. The EKG machine is placed in the room to obtain an EKG on arrival, supplies to start a second line a draw blood are gathered and placed at bedside to be ready along with the STEMI drug box.

On arrival at 7:25pm the patient is placed in the room, the paramedic shows his 12 lead EKG strip to the physician. Meanwhile a second EKG is being done at the bedside and is also given to the physician, who then diagnosis the patient as a STEMI. Meanwhile a nurse is registering the patient in the computer system and ordering labs, portable chest x-ray, according to hospital protocols for chest pain and charting everything that is being done, and orders from the physician. The patient is being connected to the hospital monitor, vital signs being taken by staff personnel. Also a second IV site is being started, blood drawn and sent to the hospital lab for analysis. The patients is being undressed and placed in a hospital gown. Meantime the emergency room secretary has placed a call to the on call cardiologist to call the ER physician, has called the hospital supervisor to advise we have a STEMI, in which the hospital supervisor calls in the on call cath lab personnel. The secretary also pages the on call pastor care person to assist with the family.

The secretary then gets the family, they are allowed up to three visitors, to come back and see the patient. With the patients permission the family is being informed by the emergency room physician as to the patient's conditions and plan of treatment. At 7:50 pm the Cardiologist arrives and assesses the patient. He explains to the patient his condition to and the plan of care the physician would like to follow. After the patient states understanding the nursing staff obtains consents. The cath lab team arrives and the patient is taking to the cath lab, pastoral care takes the family to the cath lab waiting area. It is 8:10 pm on a Monday evening.

Collaboration

Collaboration started