Assignment in 118 (lecture)

Please submit this assignment in PDF format. Answer the following questions in a brief and
concise manner. Thank you.
1. Cardiopulmonary resuscitation in cardiac emergency involves two main tasks that
healthcare workers need to perform: (1) high quality compressions and (2) effective rescue
breaths. What are the characteristics of high-quality compressions and rescue breathing?

Cardiopulmonary resuscitation (CPR) is a lifesaving technique that's useful in many

emergencies, such as a heart attack or near drowning, in which someone's breathing or
heartbeat has stopped. The American Heart Association recommends starting CPR with
hard and fast chest compressions.

CPR can keep oxygen-rich blood flowing to the brain and other organs until emergency
medical treatment can restore a normal heart rhythm. When the heart stops, your body no
longer gets oxygen-rich blood. The lack of oxygen-rich blood can cause brain damage in
only a few minutes.

The American Heart Association uses the letters C-A-B to help people remember the order
to perform the steps of CPR.

• C: compressions
• A: airway
• B: breathing

Compressions: Restore blood flow

Compressions means you'll use your hands to push down hard and fast in a specific way
on the person's chest. Compressions are the most important step in CPR. Follow these steps
for performing CPR compressions:

1. Put the person on his or her back on a firm surface.

2. Kneel next to the person's neck and shoulders.
3. Place the lower palm (heel) of your hand over the center of the person's chest,
between the nipples.
4. Place your other hand on top of the first hand. Keep your elbows straight and position
your shoulders directly above your hands.
5. Push straight down on (compress) the chest at least 2 inches (5 centimeters) but no
more than 2.4 inches (6 centimeters). Use your entire body weight (not just your
arms) when doing compressions.
6. Push hard at a rate of 100 to 120 compressions a minute. The American Heart
Association suggests performing compressions to the beat of the song "Stayin' Alive."
Allow the chest to spring back (recoil) after each push.
7. If you haven't been trained in CPR, continue chest compressions until there are signs
of movement or until emergency medical personnel take over. If you have been
trained in CPR, go on to opening the airway and rescue breathing.

Airway: Open the airway

If you’re trained in CPR and you’ve performed 30 chest compressions, open the person’s
airway using the head-tilt, chin-lift maneuver. Put your palm on the person’s forehead
and gently lift the chin forward to open the airway.

Breathing: Breathe for the person

Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the

mouth is seriously injured or can’t be opened. Current recommendations suggest
performing rescue breathing using a bag-mask device with a high-efficiency particulate
air (HEPA) filter.
 1. After opening the airway (using the head-tilt, chin-lift maneuver), pinch the nostrils
shut for mouth-to-mouth breathing and cover the person's mouth with yours, making
a seal.
2. Prepare to give two rescue breaths. Give the first rescue breath — lasting one second
— and watch to see if the chest rises.
3. If the chest rises, give a second breath.
4. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give a second
breath. Thirty chest compressions followed by two rescue breaths is considered one
cycle. Be careful not to provide too many breaths or to breathe with too much force.
5. Resume chest compressions to restore blood flow.
6. Continue CPR until there are signs of movement or emergency medical personnel
take over.
2. What are the main differences of neurogenic shock to other types of shock such as
hypovolemic shock when it comes to the manifestations and causation?

According to what I have read, the patient is experiencing a predominant parasympathetic

stimulation that causes vasodilation lasting for an extended period, leading to a relative
hypovolemic state in neurogenic shock. The overriding parasympathetic stimulation that
occurs with neurogenic shock causes a drastic decrease in the patient's systemic vascular
resistance and bradycardia.

Neurogenic shock can be caused by spinal cord injury, spinal anesthesia, or other nervous
system damage. It may also result from the depressant action of medications or from lack
of glucose. Normally, during states of stress, the sympathetic stimulation causes the BP
and heart rate to increase. In neurogenic shock, the sympathetic system is not able to
respond to body stressors. Therefore, the clinical characteristics of neurogenic shock are
signs of parasympathetic stimulation. It is characterized by dry, warm skin rather than the
cool, moist skin seen in hypovolemic shock. Another characteristic is hypotension with
bradycardia, rather than the tachycardia that characterizes other forms of shock.

3. Environmental emergencies can ruin hundreds of thousands to millions of lives. What are
your thoughts and ideas in order for you and your family to survive some of the following
disastrous events?

a. Landslide
For me, we should be aware of the natural forces or events that can cause landslides
in our area. We should be alerted when there is heavy rainfall. Because of this, it
might lead to further disasters like landslides.

We should watch for imminent danger: listening for unusual sounds that might
indicate moving debris, such as trees cracking or boulders knocking together; be
alert for any sudden increase or decrease in water flow and notice whether the water
 changes from clear to muddy; be alert when driving - watch for collapsed pavement,
mud, fallen rocks and other indications of possible debris flow.

Landslide is a very disastrous event. For us to survive, we should evacuate

immediately.

b. Extreme floods
Floods are among the most frequent and costly natural disasters. Even though this
is frequently occurring, we should not forget about the precautions when flooding
is present.

For us to stay safe, we should not forget to turn off the power and water mains if
instructed to do so; we should boil tap water until water sources have been
declared safe; we should avoid contact with floodwater; we are advised not to use
gas or electrical appliances that have been flooded; we should dispose of any food
that comes in contact with floodwater

During these times, it is essential to continue to listen to local radio or news tv for
the latest information and updates. It is also recommended to evacuate
immediately when the water level is increasing in the area.

c. Volcanic eruption
An erupting volcano can blast ash, lava, solid rocks, and gases into the air, creating
hazards that can kill people, disrupt air travel and destroy property many miles
away.

During a volcanic eruption, it is advisable to listen to a local station on a radio or

television for updated emergency information and instructions. We should follow
any evacuation orders issued by authorities instead of being stubborn.

It is important to close all windows and doors to keep volcanic ash from entering
the house. And also, as additional protection for the health of the family, I would
like to recommend wearing a dust mask to protect against lung irritation from small
particles; wearing goggles to protect the eyes; keeping the skin covered as much as
possible.

d. Heat stroke
Heat exhaustion is one of the heat-related syndromes. Symptoms range in severity
from mild heat cramps to heat exhaustion to potentially life-threatening heatstroke.
Heat exhaustion can begin suddenly or over time, usually after working or playing
in the heat, perspiring heavily, or being dehydrated.
Untreated, heat exhaustion can lead to heatstroke, which is a life-threatening
condition. If you suspect heat exhaustion, take these steps immediately:

• Move the person out of the heat and into a shady or air-conditioned place.
• Lay the person down and elevate the legs and feet slightly.
• Remove tight or heavy clothing.
• Have the person drink cool water or other nonalcoholic beverage without
caffeine.
• Cool the person by spraying or sponging with cool water and fanning.
• Monitor the person carefully.

Contact a doctor if signs or symptoms worsen or if they don't improve within one
hour.
Heatstroke occurs when your body temperature rises rapidly and you're unable to
cool down. It can be life-threatening by causing damage to your brain and other
vital organs. It may be caused by strenuous activity in the heat or by being in a hot
place for too long.
Heatstroke can occur without any previous heat-related condition, such as heat
exhaustion.
If you suspect heatstroke, call your local emergency number. Then immediately
move the person out of the heat, remove excess clothing, and cool him or her by
whatever means available, for example:

• Place in a tub of cool water or a cool shower.

• Spray with a garden hose.
• Sponge with cool water.
• Fan while misting with cool water.
• Place ice packs or cool wet towels on the neck, armpits and groin.
• Cover with cool damp sheets.

Let the person drink cool water to rehydrate, if he or she is able. Don't give sugary,
caffeinated or alcoholic beverages to a person with heatstroke. Also avoid very cold
drinks, as these can cause stomach cramps.
Begin CPR if the person loses consciousness and shows no signs of circulation,
such as breathing, coughing or movement.
4. Discuss some of the Filipino family values/culture/ practice associated in critical care and
its effect on their end-of-life decision making process? Cite an example.

When it comes to making end-of-life health care decisions, religion, family and home are
powerful influences on many terminally ill Filipino immigrants in America.

Only God can decide when life ends” is why many seriously ill Filipino patients and their
family members tend to balk at approving advance care directives to physicians, for
example. Advance directives completion rates among patients were a low ten percent,
according to one study, most probably due to their religious belief that illness is pre-
destined, thus making the directives pointless.

Fatalism
Many Filipinos have fatalistic views or “bahala na” (what will happen happens, it’s God’s
will) when confronted with serious or life-threatening illness. This is a common finding in
the growing body of research in the United States supporting a “culturally competent”
delivery of palliative care. Palliative care administered by an interdisciplinary team
prevents or manages symptoms and pain from serious illness is the fastest growing trend
in health, where the population of elderly is increasing. Palliative care is meant to improve
the patient’s quality of life, whether or not cure can be achieved. Hospice care is one of its
components.

Hoping for a miracle

Patel observes that the tendency to eschew palliative care is often based on religious belief,
including divine healing.

She says terminally ill Filipino patients she encountered often asked for “really aggressive
care” regardless of discomfort, usually hoping for a miracle.

Indeed, a small qualitative 2007 research on elderly female Filipino immigrants in Vallejo,
California, by R. Verder-Aliga, published in the Journal for Filipino Studies, showed that
most of the participants believed that certain illnesses that could not be treated by modern
medicine could be cured through divine intercession.

In a case study cited by Dr. Mark T. de la Cruz and Dr. VJ Periyakoil of Stanford University
School of Medicine, in “Health and Health care of Filipino American Older Adults,” a
patient, Mr. Bautista, was diagnosed with terminal pancreatic cancer.

Mr. Bautista and his wife found it difficult to shift their hopes from cure to comfort care
because he strongly believed he was just being tested by God, and that miracles could
happen.

Prayers, pilgrimages
Prayers, novenas, even pilgrimages to holy sites, are common weapons in a Filipino
patient’s arsenal for healing.
 Religious beliefs can sometimes roil family dynamics, especially if there are generational
and cultural differences within the family.

The case of Michael Cantos, a 15-year-old Filipino American who had recurrent metastatic
Ewing sarcoma, was cited by Polly Mazanec and Mary Kay Tyler in “Cultural
Considerations in End-of-Life Care,” American Journal of Nursing, March 2003.

Cantos was becoming distressed that his maternal grandmother kept praying the rosary by
his bedside, which he didn’t think would do him or her any good.

His palliative care providers saw that their challenge was to find a way of mediating
without upsetting him and his grandmother. They had become aware that harmonious
family support is very important to Filipino patients.

Family influence
One study found that patients and family caregivers named two important aspects of a
peaceful death–the family’s willingness to take care of the patient and belief in God
(Romulo Virola, National Statitistical Coordination Board, 2010).

Filipino families, and the premium they place on maintaining group harmony, greatly
influence patients’ decisions about health care, reported Stanford doctors De la Cruz and
Periyakoil.

When Willie Briones’ father, 94-year-old Gonzalo, was diagnosed leukemia, he called his
family together for counsel.

“He wanted to make sure that everybody was with him and supported his preference for
hospice instead of seeking treatment, which he thought would only make him suffer
needlessly,” said Briones, a San Francisco resident.

Care providers, therefore, must treat the Filipino family “as a unit of care, which is different
from the western mode,” cautions Dr. Periyakoil, director of Stanford University’s
Palliative Care Education and Training Program.

5. Make a powerpoint presentation about yourself then submit it in PDF format. (maximum
of 5 slides)

a. What specific area in nursing practice are you going to pursue (Pedia, Telemetry,
OR etc) and why? Locally or abroad? Why?
b. What are your goals probably 1-10-20 years from now both personally and
professionally? Describe how your future would like?
c. How are you going to get to these goals? How do you want yourself to be known
by people?
d. What and who are your motivation (driving force) for you to achieve these things?
6. You will be watching a video about a medication error that was done in a patient named
Jane Hughes. Please pay particular attention on the different system errors in the care
setting. After watching the video, kindly answer all these guide questions. Video is
uploaded in Cella.

a. What can you say about Mr. Ramesh (pharmacist) when he questioned the
irregularity of ordering Vincristine and Methotrexate on the same day? Why do you
think does he gave in to what Dr. Livingstone wanted even if Standard Operational
Procedures were in place?

I got nervous straight away when I watched the part where the pharmacist
questioned the irregularity of ordering Vincristine and Methotrexate on the same
day. With the questions of the pharmacist, I suspect that something may happen to
the patient, Jane Hughes. I think Mr. Ramesh gave in to what Dr. Livingstone
wanted even if Standard Operational Procedures were in place because Dr.
Livingstone will take full responsibility of that matter.

b. The level of competence of Dr. Campbell was not yet known for all the healthcare
workers in the area and yet he was allowed to perform the procedure without the
assistance of the oncology consultant (Dr Livingstone). What do you think are the
SOP’s that must be observed in this particular scenario that was not implemented?
In this scenario, I think the “Rights of Giving Medication” was done, except for the
right route. Based on what I have read vincristine is neurotoxic and must only be
administered intravenously. But because of the administration of the 2 medications
on the same day, it was mistaken to be also given intrathecally.
One thing I noticed is the verification of Vincristine. They only compared it with
the patient’s wristband but did not compare it with the doctor’s order. They forgot
about reading the label three times – before removing medication from the stored
location, before removing from original the container/prepping for participant
administration, and before returning to storage area or discarding the unit dose
wrapper. What I think about the situation is that they administer the drug just to be
finished with Jane Hughes’ procedure immediately.
c. What is the effect of the drug Vincristine if administered intrathecally?
Vincristine has a high neurotoxicity level. If given intrathecally by accident, it can
cause ascending radiculomyeloencephalopathy, which is almost always fatal.
d. What is the importance of making sure SOP in the health care setting were being
implemented? What are the different factors why these SOP’s are not being
implemented especially if its between a staff nurse or pharmacist and a doctor?
Medication errors are the number-one error in health care. Safe and accurate
medication administration is an important and potentially challenging nursing
 responsibility. With the Standard Operational Procedure, we can prevent
medication errors from happening. SOPs can provide a regulatory framework and
guidelines for the safe and appropriate administration of medication.
I think one of the factors that might affect the implementation of the SOP between
different healthcare professionals is miscommunication about the drug to be
administered. In some situations, the nurse misunderstood the handwritings of the
doctor. And also, for example in emergency settings, healthcare professionals
sometimes forget about the different protocols in medication administration which
leads to errors and adverse effects for the patient.
e. Is it right to put all the blame to Dr. Campbell? Or would you rather look at the
system in place? Support your answer.

For me, Dr. Campbell should not be the only one to be blamed in this situation. Of
course, we should look on the whole story - from the part where Dr. Livingstone
ordered the medication; the pharmacist questioned the medication; the nurses who
handled the medication; and, the two doctors who were there during the procedure.
From there, we can see who should be accountable in this situation.

f. If you were Dr. Campbell, how would you feel? What are your legal ramifications
in this scenario?

I would feel frustrated because of my incompetency. Of course, as a healthcare

professional, I want to do my best for my patient despite the situation. As what I
can see in the situation, Dr. Campbell did his best in giving the medication
correctly but the verification of the medication is not enough as they did not
checked the doctor’s order.

Doctors, like other professional people, are expected to exercise proper care in their
work. If they neglect to do so and their patients are harmed they can expect to be
criticised. Over the past decade, this criticism has increasingly taken the form of
civil action against the doctor by patients or their families who seek financial
recompense. More rarely, a patient dies as a result of alleged negligence and the
Crown Prosecution Service considers that a criminal charge of manslaughter is
justified.

g. If you were Ms. Jane Hughes, how would you feel and how would you react to
the situation?

If I were Ms. Jane Hughes, I would feel devastated because knowing that
medications can treat my condition or alleviate the symptoms but it can also cause
harmful effects for the patient, especially if it is given incorrectly.
REFERENCES:
https://www.mayoclinic.org/first-aid/first-aid-cpr/basics/art-
20056600#:~:text=Cardiopulmonary%20resuscitation%20(CPR)%20is%20a,hard%20and%20f
ast%20chest%20compressions.
https://www.redcross.org/get-help/how-to-prepare-for-emergencies/types-of-
emergencies/landslide.html
https://www.redcross.org/get-help/how-to-prepare-for-emergencies/types-of-
emergencies/flood.html
https://www.redcross.org/get-help/how-to-prepare-for-emergencies/types-of-
emergencies/volcano.html
https://www.mayoclinic.org/first-aid/first-aid-heat-exhaustion/basics/art-20056651
https://www.mayoclinic.org/first-aid/first-aid-heatstroke/basics/art-
20056655#:~:text=If%20you%20suspect%20heatstroke%2C%20call,water%20or%20a%20cool
%20shower.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140826/
https://globalnation.inquirer.net/86151/immigrants-rely-on-god-family-home-in-making-end-of-
life-care-decisions
https://ctsi.ucla.edu/researcher-resources/files/docs/sop-medication-admin.pdf
https://www.safetyandquality.gov.au/sites/default/files/migrated/National-Medication-Alert-
Vincristine-administration-PDF-376KB.pdf
https://pubmed.ncbi.nlm.nih.gov/17355029/#:~:text=Vincristine%20has%20a%20high%20neur
otoxicity,which%20is%20almost%20always%20fatal.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118964/

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