Case Study 1
A pediatric home care agency has had difficulty covering weekend shifts for Jack Bell, a 2-year-old boy with bronchopulmonary dysplasia (BPD). Jack has a tracheostomy tube and is ventilator-dependent. Jack has recently been weaned from mechanical ventilation during the daytime. His home care agency receives a call from a nurse, Lisa, who is seeking weekend work. Lisa tells the agency scheduler that she has no ventilator experience, but does have tracheostomy care skills. The scheduler, who is not a nurse, assigns Lisa to care for Jack during the day shift when Jack is off the ventilator. When Lisa arrives for her first shift with Jack, she notices the night nurse removing Jack from the ventilator for the day shift. The night nurse reports that Jack has had increased secretions, but that his oxygen saturation remained above 94% throughout the night. She advises Lisa to closely monitor Jack for signs of infection during the next 12 hours. One hour into Lisa’s shift, Mrs. Bell, Jack’s mother, leaves for work. Soon Jack’s breathing becomes labored and his oxygen saturation drops to 91%. Jack’s heart rate and work of breathing steadily increase, and Lisa has difficulty managing his copious tracheal secretions. Lisa calls Mrs. Bell, who tells Lisa to put Jack back on the ventilator with supplemental oxygen. Lisa informs Mrs. Bell that she has no ventilator experience and does notknow what to do. Mrs. Bell states that she will leave work immediately and will be home within 30 minutes. Jack’s pulse oximeter sounds a continuous alarm when his oxygen saturation drops below 91%. As Lisa anxiously waits for Mrs. Bell to arrive, she silences the pulse oximeter each time it alarms hoping that the monitor will self-correct. After
10 minutes, Jack’s respiratory distress leads to a full respiratory arrest. Lisa calls 911 for help. The 911 supervisor dispatches an ambulance to the Bell home and provides Lisa with special cardiopulmonary resuscitation (CPR) instructions for a child with a tracheostomy. Eight minutes later, Mrs. Bell and the emergency crew arrive simultaneously. Jack is unresponsive and pulseless.
Case Study 1A pediatric home care agency has had difficulty covering weekend shifts for Jack Bell, a 2-year-old boy with bronchopulmonary dysplasia (BPD). Jack has a tracheostomy tube and is ventilator-dependent. Jack has recently been weaned from mechanical ventilation during the daytime. His home care agency receives a call from a nurse, Lisa, who is seeking weekend work. Lisa tells the agency scheduler that she has no ventilator experience, but does have tracheostomy care skills. The scheduler, who is not a nurse, assigns Lisa to care for Jack during the day shift when Jack is off the ventilator. When Lisa arrives for her first shift with Jack, she notices the night nurse removing Jack from the ventilator for the day shift. The night nurse reports that Jack has had increased secretions, but that his oxygen saturation remained above 94% throughout the night. She advises Lisa to closely monitor Jack for signs of infection during the next 12 hours. One hour into Lisa’s shift, Mrs. Bell, Jack’s mother, leaves for work. Soon Jack’s breathing becomes labored and his oxygen saturation drops to 91%. Jack’s heart rate and work of breathing steadily increase, and Lisa has difficulty managing his copious tracheal secretions. Lisa calls Mrs. Bell, who tells Lisa to put Jack back on the ventilator with supplemental oxygen. Lisa informs Mrs. Bell that she has no ventilator experience and does notknow what to do. Mrs. Bell states that she will leave work immediately and will be home within 30 minutes. Jack’s pulse oximeter sounds a continuous alarm when his oxygen saturation drops below 91%. As Lisa anxiously waits for Mrs. Bell to arrive, she silences the pulse oximeter each time it alarms hoping that the monitor will self-correct. After10 minutes, Jack’s respiratory distress leads to a full respiratory arrest. Lisa calls 911 for help. The 911 supervisor dispatches an ambulance to the Bell home and provides Lisa with special cardiopulmonary resuscitation (CPR) instructions for a child with a tracheostomy. Eight minutes later, Mrs. Bell and the emergency crew arrive simultaneously. Jack is unresponsive and pulseless.
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