Case Study: Analysis of Deteriorating Patient Health and Outcomes

This case study analyzes the scenario of a coronary patient, Derek, whose health deteriorates after being transferred from the CCU to the hospital. The analysis focuses on the nurses' failure to recognize and address early warning signs of cardiac arrest, such as declining blood pressure, irregular pulse, and respiratory rate. The study examines the actions and omissions of the healthcare team, including the failure of the SHO to examine the patient promptly and the incorrect procedures carried out by the nurses. The patient suffered a cardiac arrest due to the negligence of the healthcare staff. The study further explores the required medications, triggers associated with the distress, and necessary patient and family teaching. The analysis emphasizes the application of the 2019 ACC/AHA Guideline to prevent cardiac arrest, highlighting the importance of monitoring vital signs and employing a team-based approach to patient care. The case underscores the importance of prompt recognition of deteriorating patient conditions and adherence to best practice guidelines.

Running head: DETERIORATING PATIENT HEALTH 1
Deteriorating Patient Health
Name
Institutional Affiliation

DETERIORATING PATIENT HEALTH 2
DETERIORATING PATIENT HEALTH
Concept Map
Deteriorating Patient Health
https://m.youtube.com/watch?v=2JxIEPhB5GQ
https://m.youtube.com/watch?v=3zY7AAQX2mk
https://m.youtube.com/watch?v=LmVYtpALSO8 (Chosen)
What is happening?
The coronary patient (Derek) is transferred from the
CCU to the hospital during the afternoon. His blood
pressure keeps getting lower, but the nurses are
ignoring early warning signals of the impending
cardiac arrest until Derek suffered a cardiac arrest.
Most of the nurses, like Cheryl, made mistakes and
failed to carry out the correct procedures. The patient
tells her he is tired, but despite being aware, the
blood pressure is low, Cheryl, but only shows the
patient to sleep. The SHO is being called to come and
examine the patient but failed to come saying he is
busy until the patient suffered a cardiac arrest. Bev
Robson (staff nurse), for example, left the patient
without knowing his cardiac condition. Jack Winters
(qualified nurse) noted that the BP was down (75/45),
and pulse was low and no record of respiratory rate
through the Tuesday night. Kirani Moris-noted that
the breathing is shallow and clammy.
Who is present/called/and WHY?
There are qualified nurse, staff nurses and
health care worker present in this case.
They include Bev Robson –staff nurse,
Kirani Morris-staff nurse, Jack Winters-
qualified nurse and Cheryl Ames-
healthcare support worker. They are
present to monitor Derek’s condition to
deter any cardiac arrest.
What is being recorded if anything and
why?
The respiratory rate (RR), Blood pressure and
pulse rate are being recorded. These are
recorded to monitor the patient conditions and
early warning of the possible cardiac arrest to
prevent it from occurring.
What was the patient outcome - Positive or
Negative? Why?
Adverse outcome. The care team ignored the
early warnings. They did not monitor the BP,
RR, and pulse as required. The SHO failed to
come and examine the patient despite being
reminded by staff nurse-Kirani Moris. Cheryl
carried out the wrong procedure and could even
stop doing what was required by insisting the
patient should rest. No medication was given to
prevent the impending arrest. Nurse Bev Robson
also left the Hospital even without knowing the
condition of the patient nor did she record the
RR.
What medications are needed and Why?
The angioplasty and stent placement or percutaneous
coronary revascularization is needed to restore as well
as improve the flow of the blood. This would improve
the BP and RR, which are exceedingly low to prevent
cardiac arrest. Blood thinners to reduce the tendency
of blood to clot. Pacemakers will help keep a steady
heart rhythm, and ICDs can shock abnormal rhythm
back to normal (Siao et al., 2015)
What Patient teaching would be required for
patient and family?
The patients should be taught about how to
exercise for a minimum of 30 minutes most days
of the week. The patient and family should be told
how to eat right by consuming a diet low in
unhealthy fats alongside high in fruits alongside
vegetable. The patient and family should be taught
how to lose weight. The patient should be
prepared to avoid smoking and also how to reduce
emotional stress (Lin et al., 2016).
What triggers would be associated with the
distress? Why?
The thickened muscles trigger by disrupting the
electrical system of the heart culminating in fast or
irregular heartbeats. The arteries get clogged with
deposits like cholesterol, which reduces the flow of
blood to the patient’s heart. The electrical impulses
became erratic leading to arrhythmia or irregular
heartbeat leading to a problem with the pump.
What would you be looking for or recognizing
to decrease the chance of the deterioration?
I would be checking for BP, RR and pulse
BPG and indicate why chose it. Be specific as to which guideline you are using and why??
The BPG chosen is the New 2019 ACC/AHA Guideline. It is best practice that helps prevent
cardiac arrest (Arnett et al. 2019). ACC/AHA BPG is useful because it acknowledges the
promotion of a healthy lifestyle throughout a person’s life as the best way to address
cardiovascular diseases. Moreover, it recommends that a team-based care approach remains an
effective strategy to prevent cardiovascular diseases like the case of the coronary artery disease
suffered by Derek in this case. It also recommends that clinicians need to evaluate the SDH
affecting the patient to inform the treatment decisions. It also supports the consumption of a
healthy diet, engagement in at least 150 and 75 minutes a week of moderate-intensity and
vigorous-intensity PA, respectively ((Arnett et al. 2019).

DETERIORATING PATIENT HEALTH 3
References
Arnett, D. K., Blumenthal, R. S., Albert, M. A., Michos, E. D., Buroker, A. B., Miedema, M. D., ... & Himmelfarb, C. D. (2019). 2019
ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. Journal of the American College of Cardiology,
26029. https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000678
Lin, C. H., Ng, Y. Y., Chiang, W. C., Karim, S. A., Do Shin, S., Tanaka, H., ... & Ong, M. E. H. (2016). Variation of current protocols
for managing out-of-hospital cardiac arrest in prehospital settings among Asian countries. Journal of the Formosan Medical
Association, 115(8), 628-638. https://core.ac.uk/download/pdf/82451963.pdf
Siao, F. Y., Chiu, C. C., Chiu, C. W., Chen, Y. C., Chen, Y. L., Hsieh, Y. K., ... & Yen, H. H. (2015). Managing cardiac arrest with
refractory ventricular fibrillation in the emergency department: conventional cardiopulmonary resuscitation versus
extracorporeal cardiopulmonary resuscitation. Resuscitation, 92, 70-76. file:///C:/Users/noahh/Downloads/managing-cardiac-
arrest-with-refractory-ventricular-fibrillation-in-the-emergency-department-conventional-cardiopulmonary-resuscitation-
versus-extracorporeal-cardiopulmonary-resuscitation.pdf

DETERIORATING PATIENT HEALTH 4
Appendix: YouTube Links
https://m.youtube.com/watch?v=2JxIEPhB5GQ
https://m.youtube.com/watch?v=3zY7AAQX2mk
https://m.youtube.com/watch?v=LmVYtpALSO8 (Chosen)