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  1. Hayes, Kimberly Drummond BS, RN

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THIS WAS THE homestretch-my last clinical day of my last semester before graduating from nursing school in less than a month. I was assigned to a 20-bed inpatient rehabilitation unit in an acute care hospital. This unit specializes in the care of patients with complex disorders, including those who've experienced an amputation, stroke, or solid-organ transplant.


My preceptor and I were caring for six patients on the 1900-0700 shift. One of those patients, Mrs. R, 70, was about 1-month postbilateral lung transplant. I was already familiar with Mrs. R's clinical status because I'd cared for her the week before. She had a tracheostomy, was receiving low-flow oxygen via a tracheostomy mask, and was receiving I.V. fluids through a peripherally inserted central catheter.


After receiving patient handoff, my preceptor and I proceeded to assess Mrs. R first because she seemed to be the least stable of our six patients. We were told that blood culture specimens had been drawn earlier, and that glucose and insulin infusions had been started to treat hyperkalemia.


During my assessment, I found Mrs. R to be awake, alert, and oriented x3; her vital signs were stable, and she appeared to be in no acute distress. Although she was receiving I.V. fluids, she was anuric. Her bladder scan was negative, and I auscultated bilateral basilar pulmonary crackles. I notified my preceptor and Mrs. R's physician of my assessment findings, discontinued her I.V. fluids as ordered, and planned on continuing to assess her frequently during the remainder of my shift.


Putting knowledge into practice

After assessing my other patients and administering medications, I began my charting. Unfortunately, the quiet of the night was abruptly interrupted by the sound of running in the hallway. As I heard a "condition A" (cardiac arrest) announced overhead, I hurried to Mrs. R's room while my preceptor ran for the crash cart. Mrs. R was unresponsive, pulseless, and apneic. I immediately started CPR until the code team arrived and took over. After my preceptor and I gave the code team a brief, targeted history, I ran for needed supplies. The code team successfully resuscitated Mrs. R, and she was transferred to the ICU.


Although I'd completed an American Heart Association Basic Life Support retraining course 2 months earlier and participated in many emergency situations in our school's simulation lab, I always wondered how I'd react in a real patient emergency. This clinical experience with Mrs. R reassured me that I'd know what to do. Nursing students shouldn't be afraid to take action in an emergency as we've been taught. Although facing the reality of professional nursing practice can be daunting, nursing students should feel confident that their training has prepared them to take the proper action when the time comes.