1. PDP Exemplar
Presentation
Nick Ehrhardt
ICU
Augustana College

2. 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.

3. 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

4. Stroke, DM,
Renal Insufficiency,
hyperlipidemia, arthritis, neuropathy,
memory loss.
Refuses medication,
“has not taken any medication for past year”
Past Medical History

5. 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

6. Physiology Concept Map

7. 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
Meds
Heparin Drip, Amiodorone
Levophed, Dobutamine
Novolin Drip, 3% Hypertonic
Saline
Clindamycin, Ceftriaxone,
Prognosis
IABP

8. “We may be able to
keep this patient
alive, but to what
end, and at what
cost?”

9. 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

10. 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

11. -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

12. -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

13. Loving Kindness
Practicing Metta
Meditation
while working
with C.G.
Loving Kindness
Self ---- Local ---- Global

14. Thanks to:
Emily Miller
ICU
Darcy and the
PDP program
Avera