PDP Exemplar Presentation Nick Ehrhardt ICU Augustana College
PDP Exemplar
Presentation
Nick Ehrhardt
ICU
Augustana College
Had felt nauseated night before.
Day of hospitalization, found in bed by granddaughter :
“cold, barely breathing, lips blue.”
Ambulance called.
a sketch of my memory of working in C.G.’s room.
C.G.
Admitted to MCK ED.
Sys BP 50’s, pH 7.06, EF 15%, ST elevation.
Diagnosis: Acute anterolateral MI.
Started on Levophed and transferred to Cath
Lab.
-occluded LAD “widowmaker”
and OM coronary arteries.
-stents placed
-Intra-arterial balloon pump (IABP) placed.
-Transferred to ICU.
Story of Hospitalization
Stroke, DM,
Renal Insufficiency,
hyperlipidemia, arthritis, neuropathy,
memory loss.
Refuses medication,
“has not taken any medication for past year”
Past Medical History
Neuro:
GCS 3-5, intermittent deep
pain response, no
cough/gag response, Min
pupillary Response
Cardiovascular:
HR 100’s
MAP, sagging <60
Weak pulses (doppler)
2-3+ pitting Edema LE
Scleral Edema,
Pulmonary:
ETT, scant blood tinged
secretions.
Coarse/Dim Lung sounds
GI/GU:
Freq. loose watery stools
5-10cc/hr urine output
Temps ~101
Labs: RBC 3.6 Plt 126
D-dimer 20,000, Na 123,
AST 23921, ALT 9767
HCO3 9
Assessment
Physiology Concept Map
Dr Notes:“I am not sure how
much myocardium
there is to salvage.
She is critically ill,
cardiogenic shock.
I think her mortality
rate is going to be
extremely high.”
Acute Interventions
focus on cardiac and
systemic reperfusion
MedsHeparin Drip, Amiodorone
Levophed, Dobutamine
Novolin Drip, 3% Hypertonic
Saline
Clindamycin, Ceftriaxone,
Prognosis
IABP
“We may be able to keep this patient alive, but to what end, and at what
cost?”
Flash Forward
The following shift:
-Palliative Care meeting with family during
development of a Code Blue.
-“goals discussed with family, and the decision
was made to stop the code and transition to
comfort care after a few moments of the code”
-”monitors put in privacy mode and cords, etc
removed.” palliative care/chaplaincy at
bedside.
Time of Death:
1207
Collaboration between:-ICU nursing team.
(Updates on VS, assessments,
IABP operation, patient cares, family needs)
-Nursing and managing/consulted providers
(Intensivist, cardiology, neurology,
nephrology, Endocrinology, ID, IR,
palliative care, social work, chaplaincy.)
Interprofessional Collaboration
-Manage Interventions
-Ensure dignity for patient
-Allow for Mourning/closure by family,
and adequate time for decision making
-Utilize ICU as a steward of life/death
journey
Nursing Plan
-Confidence
-Competence
-But as is the case while
working with many ICU patients...
it is easy to start feeling like an...
What I Learned/Professional Growth
Loving Kindness
Practicing Metta
Meditation
while working
with C.G.
Loving Kindness
Self ---- Local ---- Global
Thanks to:
Emily Miller
ICU
Darcy and the
PDP program
Avera