Jack Reacher, Case Study Example

This paper will discuss the report of Jack-Reacher, who suffered from surgical cardiac arrest with CPR. The pathophysiology of these disorders will be addressed, and the nursing treatments required to treat them. The interventions used for Jack-Reacher’s case are determined by a thorough assessment and evaluation of his condition. They involve independent interventions initiated by nurses, collaborative interventions from other multidisciplinary team members, and dependent interventions ordered from doctors. The paper will be concluded with goals intended for patient care and the outcome of the problem. This will be achieved after evaluation of the specific outcome in comparison with the actual results of the initiated intervention.

Pathophysiology

Cardiac arrest is a sudden disruption of heart functionality, respiration, and awareness. This condition causes problems in the heart’s electrical system that disrupts the heart from pumping action and stops the blood flow in the patient’s body (Philip, 2020). When the heart stops, the shortage of oxygen-rich blood can result in death or irreversible brain damage within minutes: Whence, the patient, appears to be struggling to breathe or becomes unconscious. In the worst-case scenario, the patient becomes unconscious with no pulse. This results in the patient’s immediate and drastic signs and symptoms during evaluation. This results in Mr. Jack-Reacher experiencing chest pain, discomfort, and rapid, irregular heartbeat upon admission to the hospital (Kevin et al., 2021). Jack-Reacher’s case of cardiac arrest results was concluded after evaluation and assessment of the immediate signs he exhibited. Therefore most of the symptoms associated with cardiac arrest are mainly associated with the reparatory system due to a high rate of breathing or no indication of breathing from the patient. Therefore it varies depending on the patient’s arrival state in the hospital.

The critical nursing interventions involved Performing Cardiopulmonary resuscitation (CPR), a lifesaving technique useful in many emergencies. Then quickly check the patient’s breathing rate. Jack-Reacher’s ventricular fibrillation breathing rate was not normal, so the nurse initiated the CPR (Shuvy et al., 2021). The nurse pushed hard and fast on Jack-Reacher’s chest at the rate of 100 to 120 compressions a minute. Afterward, the nurse checked on the person’s airway and delivered rescue breaths after 30 compressions. The nurse continued the compression process to ensure a portable ventilator was available. Later the nurse used a defibrillator to provide him with step-by-step instructions to achieve ventricular fibrillation. While initiating the ventricular fibrillate, he continued the compressions until the charging was done. The nurse defibrillator provides Mr. Jack-Reacher’s heart rhythm. The arrival at rhythm was fast according to the indication of AD (Elsaid et al., 2019). The nurse shocked the heartbeat rhythm to initiate immediate resuming of CPR. The nurse-led AZCOR guidelines but 200j proved unsuccessful in achieving vibration rhythm of the heart in a defibrillator (Nademanee et al.,2019). Therefore the nurse initiated more cycles of shocks and monitored the progress of the ventricular fibrillation for 15 minutes.

The monitoring process involved ICU monitoring ventilation required, oxygenation status, assessing the mental status and neurovitals, checking arterial blood gas and labs, checking eyes for reaction to light, and measuring internal and external response (Patel et al.,2021). Therefore the assessment from the ambulance records showed an airway adjunct Insitu -guedels airway size of 100mm after ventilation via bag valve mask. Fifteen minutes of monitoring in Ventricular Fibrillation were GCS 3/15 E1V1M1, Pupils fixed and dilated size 5mm, the temperature of 36.9, diaphoretic, and finally Glucose 6.8mm. The monitoring process involved ICU monitoring ventilation required, oxygenation status, assess the mental status and neurovitals, checking arterial blood gas and labs, checking eyes for reaction to light, and Measure the ins and outs

After carrying out the assessment and thorough monitoring of the patient’s progress, Jack-Reacher’s thorough diagnosis showed that he was suffering from Cardiac arrest (Nademanee et al., 2019). Therefore, the doctor required updates after the test result to update him on the patient’s current medical state. A doctor is required to carry out a surgery depending on his diagnosed condition. Therefore the doctor orders the patient to be transferred to the operation room for coronary artery bypass grafting surgery. The surgery involves restoration of blood flow to the heart by stitching veins or arteries in place beyond a blocked or constricted coronary artery. The surgery’s main reason is to help the heart get more blood and minimize the frequency of racing heartbeats. Team members who collaborated during the surgery section, nurses, assisted in preparing equipment required during surgery, such as blades, scalpels, scissors, and saws (Kulik et al., 2018). Other assignments involved preparing the patient by dressing him in proper garments for surgical sections, removing the attached IV in his vein, and adequately administering oxygen during the procedure. The significance of the surgery team is to ensure the elimination of errors during the intervention.

Blood tests, X-rays, and electrocardiogram information concerning the patient for surgery were presented on the doctor’s order. This is to ensure that the risks of developing complications are low depending on the general health condition of Jack-Reacher (Van Dijk et al.,2018). The risk of developing complications is detected after performing an emergency procedure and other medical conditions. The records were meant to show the analysis of the general diagnosis that provided the doctor with relevant information before he carried out the operation(Duceppe et al., 2017). Other details, such as the age of Jack-Reacher, were vital too. The coronary artery bypass grafting procedure took place for 6 hours. According to the doctor’s analysis, the blood vessels were deeply attached, resulting in the extraction of the vessel from the arm. This procedure consumed maximum time to be concluded. Depending on the doctor’s orders, the patient was transferred to the recovery room and signed nurse for frequent monitoring of the patient.

Clinical physicians carried out the necessary blood test, x-rays and scanning, and electrocardiogram procedures on the patient and ensured the patient’s health record was available to the doctor (Shen, & Dubey, 2019). The health p physician was involved in the monitoring section of Jack-Reacher’s progress when he was still on the ventilation equipment that showered his breathing stability. Recording every reading at a given time interval ensured the detection of any unusual pattern and respiration rates after the analysis. Jack-Reacher was diagnosed with Cardiac arrest; therefore, a respiratory therapist was involved during the consultation to provide solutions when the patient’s oxygenation had deteriorating oxygen saturation levels (Benzo & McEvoy, 2019). The respiratory therapist plans oxygen therapy and obtains a prescription from the provider. The health record officer assisted in recording readings from the defibrillator. This is to ensure the intervention provided by nurses has a consistent effect on Jack-Reacher’s condition.

To ensure patient safety, a nurse’s care plan is significant. It involves patient requirements related to the heart rate (Leng et al., 2021). The care plan plays a vital role while assessing and monitoring the patient. The guidance will assist in achieving goals and objectives to ensure that the patient’s treatment is successful. A thorough review of subjective and objective symptoms and vital signs is part of the patient assessment process. Nurses are in charge of collecting and keeping this information, while CNAs can assist with vital sign collection. Therefore, the medical plan will consist of the required intervals to ensure that the patient progresses.

Also, making a determination base on level headed and abstract information gathered during the patient appraisal. This is discrete from a clinical conclusion given by a doctor or medical caretaker professional. Attendants select normalized analyze endorsed by the Australian conclusion and the executives rules pertinent to the patient’s condition, side effects, and dangers with coronary illness (Ralph et al., 2021).

The third guideline is the anticipated goals directly related to Jack-Reacher’s cardiac arrest condition. They involve the short term goals and long term goals. Some short-term goals will include maintaining oxygen saturation of 88>-92 percent (Mayhob, 2017). This ensures that hypoxia and hypoxia are avoided to ensure no risk of oxygen toxicity. Ensure targeted temperature management by involving therapeutic hypothermia intervention that significantly improves the neurological outcomes after cardiac arrest. This would involve escalated infusion of ice-cold (4° C), isotonic, non-glucose-containing fluid to a volume of 30 ml/kg (Brandy 2021). The recommended temperature in therapeutic hypothermia is 36 and below degrees. Lastly, to ensure hemodynamic optimization. This involves the titration of oxygen to maintain an arterial oxygen saturation of ?92-98%. This ensures that cerebral blood flow is potentially reduced in PaCO2 levels (Getahun et al., 2022). Other considerations may involve the implantation of moderation of glycemic control measures in a normal range where hypoglycemia risk is increased; thus, attention should mainly focus on prevention (Shakouri et al., 2015). The rate of cytolysis is recommended at a time. The plan provides the guideline for the goal and outcome expected for the patient’s recovery to avoid major development of patient complications during the assessment (Ferrell et al., 2019). Therefore physical involvement in Jack-Reachers’ assessment is required to ensure that the intervention in mind every intervention in mind is directed mainly to patient safety and quality service. According to the plan development highlighting goals and how to achieve them, the patient’s outcome from interventions should provide primary success for the patient’s recovery.

The fourth rule in the arrangement is carried out. This includes starting explicit nursing intercessions for the patient (Ackley et al., 2019). This part additionally notes what nursing-explicit consideration the nursing group has performed for the patient. In conclusion is assessment. This includes giving clarifications of how really the patient’s condition answered the nursing medicines or how well the objectives were reached or not. The medical caretaker reconsiders the arrangement on the off chance that the objectives are not met (Lall et al., 2018). If the objectives were reached, the nurse might elect to add additional objectives and interventions. The expectation in Jack-Reacher’s case, depending on the intervention, is positive, although it required a high assessment and monitoring technique. This may also be a device for adding more goals in the assessment period. The assessment of the nurse plan, the goals, and the objective because the intervention outcomes turned out to be successful (Smith et al.,2015). The only other goal considered involved ensuring no overcrowding in the patient recovery room to maintain a pure ventilated room.

What’s more, nursing care plans are quite possibly the best apparatuses for attendant to follow the nursing implicit set of principles and record that they did as such in case of a claim or claims of neglecting to keep care guidelines (Blackwood et al., 2019). This is only one of the many reasons all medical attendants and nursing aides ought to be acquainted with every patient’s nursing care plan and update it depending on the situation. This plan also assists in designing the patients’ needs to ensure a quality patient experience.

In conclusion, Jack-Reacher’s thorough assessment and evaluation interventions provided quality outcomes to the patient and also helped attain the set goals

References

Ackley, B. J., Ladwig, G. B., Makic, M. B. F., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing diagnosis handbook E-book: An evidence-based guide to planning care. Elsevier Health Sciences. https://books.google.com/books?hl=en&lr=&id=GyOJDwAAQBAJ&oi=fnd&pg=PR1&dq=implementation+of+interventions+in+nursing+diagnosis&ots=I9j4v1IsmM&sig=FnEeQ1hg4B5jMGX9K3QTVMZ-3hs

Benzo, R., & McEvoy, C. (2019). Effect of health coaching delivered by a respiratory therapist or nurse on self-management abilities in severe COPD: analysis of a large randomized study. Respiratory care, 64(9), 1065-1072. https://rc.rcjournal.com/content/respcare/64/9/1065.full.pdf

Blackwood, D. H., Walker, D., Mythen, M. G., Taylor, R. M., & Vindrola?Padros, C. (2019). Barriers to advance care planning with patients as perceived by nurses and other healthcare professionals: a systematic review. Journal of clinical nursing, 28(23-24), 4276-4297. https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.15049

Brandy Gleason (2021). nursing care plans explained  https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwiSneHVmc33AhXW3YUKHZqWC3IQFnoECAMQAQ&url=https%3A%2F%2Fnursejournal.org%2Farticles%2Fnursing-care-plans-explained%2F&usg=AOvVaw2Q6Cyn_w0SpMXMB85SYDbL

Duceppe, E., Parlow, J., MacDonald, P., Lyons, K., McMullen, M., Srinathan, S., … & Devereaux, P. J. (2017). Canadian Cardiovascular Society guidelines on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery. Canadian Journal of Cardiology, 33(1), 17-32. https://www.sciencedirect.com/science/article/pii/S0828282X16309801?casa_token=bYLPlUelcfgAAAAA:KMKBjeNv3sLHrv-nB7s2DYf35mvSB0AWLfuolyFu6iqVMCkRn02nzBKEVU5__c_UYACvoyUcSNt0

Elsaid, O., McCullough, P. A., Tecson, K. M., Williams, R. S., & Yoon, A. (2020). Ventricular fibrillation storm in coronavirus 2019. The American Journal of Cardiology, 135, 177-180. https://sci-hub.yncjkj.com/10.1016/j.amjcard.2020.08.033

Ferrell, B. R., Twaddle, M. L., Melnick, A., & Meier, D. E. (2018). National consensus project clinical practice guidelines for quality palliative care guidelines. Journal of palliative medicine, 21(12), 1684-1689. https://www.liebertpub.com/doi/full/10.1089/jpm.2018.0431

Getahun, Y. A., Bizuneh, Y. B., Melesse, D. Y., & Chekol, W. B. (2022). Assessment of practice and barriers of oxygen therapy in critically ill patients among nurses: A survey from University of Gondar Comprehensive Specialized Hospital Northwest, Ethiopia, 2021. Annals of Medicine and Surgery, 76, 103481 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8933666/pdf/main.pdf

Kevin Patel; John E. Hipskind; Shanna W. Akers. (2021). Cardiac Arrest (Nursing) https://europepmc.org/article/NBK/nbk568720#free-full-text

Kulik, L. A., Connor, J. A., Graham, D. A., & Hickey, P. A. (2018). Pressure injury prevention for paediatric cardiac surgical patients using a nurse-driven standardized clinical assessment and management plan. Cardiology in the Young, 28(9), 1151-1162. https://sci-hub.yncjkj.com/10.1017/S1047951118000975

Lall, D., Engel, N., Srinivasan, P. N., Devadasan, N., Horstman, K., & Criel, B. What changed at primary care for persons with chronic conditions: A theory of change-based evaluation of interventions to redesign primary care. Primary Care For Chronic Conditions in Rural India: Towards a Person-Centered Model, 119. https://cris.maastrichtuniversity.nl/files/89268624/c7384.pdf#page=122

Leng, M., Wei, L., Shi, X., Cao, G., Wei, Y., Xu, H., & Wei, H. (2021). Mental distress and influencing factors in nurses caring for patients with COVID 19. Nursing in critical care, 26(2), 94-101. https://onlinelibrary.wiley.com/doi/epdf/10.1111/nicc.12528

Mayhob, M. (2017). Nurses’ knowledge, practices, and barriers affecting a safe administration of oxygen therapy. J Nurs Health Sci, 7(3), 42-51. https://www.academia.edu/download/56760542/D0703024251.pdf

Nademanee, K., Haissaguerre, M., Hocini, M., Nogami, A., Cheniti, G., Duchateau, J.,& Veerakul, G. (2019). Mapping and ablation of ventricular fibrillation associated with early repolarization syndrome. Circulation, 140(18), 1477-1490. https://www.ahajournals.org/doi/full/10.1161/Circulationaha.118.039022

Patel, K., Hipskind, J. E., & Akers, S. W. (2021). Cardiac Arrest (Nursing). https://europepmc.org/books/nbk568720

Philip J. (2020). Pathophysiology and etiology of sudden cardiac arrest https://www.uptodate.com/contents/pathophysiology-and-etiology-of-sudden-cardiac-arrest

Ralph, A. P., Noonan, S., Wade, V., & Currie, B. J. (2021). The 2020 Australian guideline for prevention, diagnosis, and management of acute rheumatic fever and rheumatic heart disease. Medical Journal of Australia, 214(5), 220-227. https://onlinelibrary.wiley.com/doi/abs/10.5694/mja2.50851

Shakouri, S. K., Salekzamani, Y., Taghizadieh, A., Sabbagh-Jadid, H., Soleymani, J., Sahebi, L., & Sahebi, R. (2015). Effect of respiratory rehabilitation before open cardiac surgery on respiratory function: a randomized clinical trial. Journal of cardiovascular and thoracic research, 7(1), 13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378669/pdf/JCVTR-7-13.pdf

Shen, S. C., & Dubey, V. (2019). Addressing vaccine hesitancy: Clinical guidance for primary care physicians working with parents. Canadian Family Physician, 65(3), 175-181. https://www.cfp.ca/content/cfp/65/3/175.full.pdf

Shuvy, M., Koh, M., Qiu, F., Brooks, S. C., Chan, T. C., Cheskes, S., & Ko, D. T. (2019). Health care utilization prior to out-of-hospital cardiac arrest: A population-based study. Resuscitation, 141, 158-165. https://sci-hub.yncjkj.com/10.1016/j.resuscitation.2019.04.033

Smith, J. E., Rickard, A., & Wise, D. (2015). Traumatic cardiac arrest. Journal of the Royal Society of Medicine, 108(1), 11-16. https://journals.sagepub.com/doi/abs/10.1177/0141076814560837

Van Dijk, S. T., Van Dijk, A. H., Dijkgraaf, M. G., & Boermeester, M. A. (2018). Meta-analysis of in-hospital delay before surgery as a risk factor for complications in patients with acute appendicitis. Journal of British Surgery, 105(8), 933-945. https://academic.oup.com/bjs/article-abstract/105/8/933/6095436