Case Study Overdose Nurse Z.H
Emergency situation: Overdose
Scenario
You are on duty in the emergency department (ED) when a "code
blue" is called. As
... [Show More] the code nurse, you grab the crash cart and run
to the code, which is in the employee lounge of the operating room.
On the couch, you find a nurse, Z.H., unconscious, dusky, and barely
breathing.
1. What immediate assessment of Z.H. do you need to perform?
A- Check her airway to see if it is patent
B- Make sure she is able to efficiently breath
C- Monitor for impaired perfusion (presence of a pulse)
D- Assess her neurological status/sensation
2. What intervention has the greatest priority?
a. Obtaining a STAT toxicology screen
b. Connecting her to the portable ECG monitor
c. Establishing an IV line with 0.9% normal saline
d. Supporting respirations by manually ventilating her
3. What assessment finding would lead you to suspect an opioid
overdose is the reason for
Z.H.'s condition?
a. Hypertension
b. Fever and tachycardia
c. Constricted pupils and bradypnea
d. Diaphoresis and cool, clammy skin
4. Z.H.'s respiratory rate is 8 and shallow. The respiratory therapist
intubates her and continues to ventilate her manually. You attach
ECG leads to her chest and find the results shown in the figure.
What is your interpretation of Z.H.'s rhythm?
Sinus bradycardia
Z.H. is given an ampule of 50 mL D50W, 1 mg naloxone (Narcan),
and 0.5 mg atropine IV push. Her respirations improve slightly, and
her pulse increases to 56 beats/min. She is transported to the ED.
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Case Study Overdose Nurse Z.H
5. Describe the purpose of administering the combination of D50W,
atropine, and
naloxone.
Naloxone- Reverses the effects of the opioids to correct her depressed
RR
D50W- Will increase her BG
Atropine- Will reverse her bradycardia by increasing her HR
= All these medications together will improve her vitals from their depressed
state and bring her to baseline values.
6. What treatment will Z.H. require in the ED?
The ED nurse will need to administer O2, IV fluids, and labs for a toxicity screening.
The naloxone has a short half-life, so the nurse may need to administer more if she
relapses.
7. Within 30 minutes of receiving the naloxone, Z.H. is starting to
respond. Why do you need to continue to observe her closely?
Select all that apply.
a. Z.H. may develop pulmonary edema after receiving naloxone.
b. A common adverse effect of naloxone is the onset of atrial fibrillation.
c. The duration of action of the drugs taken may exceed that of naloxone.
d. The risk of developing diabetic ketoacidosis is high after receiving
naloxone and
D50W.
e. Rapidly reversing the effects of the drug overdose will cause a rebound
decline in level of
consciousness.
8. The physician orders an additional 0.6 mg naloxone IV STAT. The
vial in the accompanying illustration is available. How many
milliliters will Z.H. receive?
0.6mg x (1mL/1mg) = 0.6 mL
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Case Study Overdose Nurse Z.H
Answer: 0.6 mL
After the additional dose of naloxone, Z.H.'s level of consciousness
and respiratory effort significantly improve, allowing her to be
extubated.
9. What information do you need to obtain from Z.H.?
The nurse needs to know interview ZH about the series of events that led to
her overdose.
1. History of drug abuse (how long?)
2. What type of substances
3. Reason for overdose (suicide?)
10. In response to your questions, Z.H. tells you that she took
fentanyl and that she has been using fentanyl she has taken from
the hospital "periodically" for the past several months. How does
the Health Insurance Portability an [Show Less]