3Signature of observing RN (thus validating SAO ‘Situation’ as a true and accurate account)Name in Full: Kelvin Jacksons Signature:Designation: Senior Registered Nurse Date: 3rd March 2018Signature of Student (CNA540)Name in Full: Mary Kinn Signature:Designation: Registered Nurse Date: 3rd March 2018Reflections on YOUR actions in this SAO. Could they have been improved/changed? Support with appropriate literature.This was my first time to deal with a patient with biventricular failure while still, thepatient had a permanent pacemaker and at end-stage cardiomyopathy. My experience withbiventricular failure has been with patients who do not have a history of end-stagecardiomyopathy. For these reasons I did not know what to do. After further research, Ifound that Arora (2015, p.411) gives a case history for the prevalence of shortness ofbreath from patients with permanent pacemakers. Further research gave insight on why thepatient was immediately prescribed 2 packaged red blood cells. As Soares et al (2017,p.585) indicate, PRBC is crucial for patients with heart failure does not only restores theanemia deficiency but also improve oxygen transportation in the body. The ejection fraction measurements gave a 20-25%. Mankad (2016) proposes that thenormal EF is above 55%. This indicates that the LV of the patient was not pumpingadequate blood. The information regarding failure on the ventricles is further backed byhigh levels of urea in the blood which indicate the failure of the ventricles to pump enoughblood to the kidney to eradicate urea in the blood (Arnold, 2018, p.3). Troponin levels werefound to be 42%. According to Ahmed (2014, p.1), normal troponin levels fall below 40%.A 42% level of the I and T proteins indicate mild muscle damage from the heart as a resultof biventricular failure.A failure within the left ventricles to pump enough blood was the major cause of theincreasing SOB. Since the patient relies on the permanent pacemaker to generate impulsesby regulating how the ventricles pump blood as indicated by Krames patient education(2010, p.4). Specifically, the Leads are tasked with sending timed electrical pulses to theventricles to maintain a steady heartbeat. According to the analysis of the images at theechocardiogram and notification from the monitor regarding irregular heartbeats, thepatient’s pacemaker had a failure to pace within the leads as it failed to generate anadequate electrical impulse. Further EKG tracing indicated a missing pacemaker spike. Theblue team nurses recommended that the patient was in need of an LV lead insertion to dealwith the Biventricular failure since the EF is less than 35% as recommended by Cooper(2015,p.20). The deliberator was essential in ensuring that the ventricles still generatedimpulses.For this experience, I have learned different ways of evaluating a patient. When I first metMr. Smith, his caregiver was complaining about the pacemaker, though I thought the

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