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Asked by Belcia01

I. Scenario 

History of Present Problem: 

William “Butch” Welka is a 72-year-old male with a history of heart failure, COPD, hypertension, diabetes type II and dementia who has been hospitalized for exacerbation of heart failure three times the past six months. He has been a resident of Pineville Estates, a local long-term care facility, the past four months because his dementia progressed and his wife, Rita, was unable to care for him. 

 

Personal/Social History: 

Butch has been married to Rita for 51 years. They have three adult children who visit him weekly. Rita comes to visit 

Butch every day after work. Butch was a salesman for 35 years before he retired seven years ago. Butch believes he is at Pineville Estates for rehab, but his family is concerned that it is no longer safe at home if he were alone. Rita was recently awarded guardianship due to his declining mental status. He is a full code.  

 

What data from the histories is important & RELEVANT; therefore it has clinical significance to the nurse? 

(Reduction of Risk Potential) 

RELEVANT Data from Present Problem: Clinical Significance: 

 

 

 

 

 

 

 

 

 

   

RELEVANT Data from Social History: Clinical Significance: 

 

 

 

 

 

 

 

   

 

II. The Dilemma Begins… 

Current Concern: 

When the nurse enters his room to administer his morning medications, she notices that Butch does not respond verbally. When she approaches him, she notices that his color is pale and is diaphoretic. His radial pulse is faint and thready, and his respiratory rate is labored with a rate of 30/minute. Butch calls out, “Please help me!” and becomes unresponsive. The nurse is unable to palpate a carotid pulse and has no spontaneous respirations. She begins CPR while another staff calls 911. Paramedics arrive five minutes later and determine that he is in ventricular fibrillation. He is intubated, a peripheral IV is established and epinephrine and amiodarone are administered.  

He is transferred to the emergency department, and upon arrival, he is found to be in asystole. After 10 minutes of CPR, and additional boluses of epinephrine and amiodarone, he remains in asystole. The emergency room physician collaborating with the healthcare team ends aggressive measures. Butch’s cardiac rhythm is asystole and his death is pronounced. 

When his wife arrives 15 minutes later not knowing if Butch is dead or alive, she is approached by the nurse who communicates what has just transpired. Rita is in shock and disbelief because he looked so good when she visited him yesterday. She insists on staying in the room. There is no other family in the area, and Rita is all alone. 

 

What data from the current concern is important & RELEVANT; therefore it has clinical significance to the nurse? 

(Reduction of Risk Potential) 

RELEVANT Data from Current Concern: Clinical Significance: 

 

 

 

 

 

 

 

 

 

   

 

III. Resolving the Dilemma 

1. Interpreting RELEVANT clinical data, what is the essence of this clinical dilemma? (Management of Care) 

 

 

 

 

2. Could additional members of the healthcare team be used in this situation? Why? (Management of Care) 

 

 

 

 

 

3. What is the nursing PRIORITY? (Management of Care) 

 

 

 

 

4. What are the PRIORITY nursing interventions? (Management of Care) 

PRIORITY Nursing Interventions: Rationale: Expected Outcome: 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   

 

 

 

5. What is the expected response of the wife that indicate nursing interventions were effective? (Management of Care) 

 

 

 

 

 

 

 

 

6. What principles of therapeutic communication can be utilized to develop trust and encourage dialogue between the nurse and wife? (Psychosocial Integrity) discussion related to his or her health 

 

 

 

 

 

 

 

 

 

 

7. What is the wife likely experiencing/feeling right now in this situation? 

(Psychosocial Integrity/Basic Care and Comfort) 

 

 

 

 

 

 

 

 

 

8. What can the nurse do to engage with this patient/family experience, and show that she matters to me as a 

person? (Psychosocial Integrity/Basic Care and Comfort) 

 

 

 

 

 

 

 

 

 

 

9. What was learned from this case study that you will incorporate into your practice? (Management of Care) 

 

 

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SCIENCE
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NURSING

 

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