| Procedure-4 Cardiopulmonary resuscitation (CPR) for an adult
Assessing 1. The patient: Systemic conditions: Unresponsiveness or unconsciousness; breathlessness; lack of aorta pulse, especially carotid pulse. Skin is pale or in cyanosis. Cardiac sound is disappeared. Local conditions: Exam if there is any foreign matter in the oral cavity or laryngopharynx (throat), if the dentures can be taken out, if the complexion is cyan, and if the pupils are dilated. 2. Environment: The environment clean, quiet and spacious or not. 3. Equipment: Gauzes, a flashlight and a hard surface (a bed or wood). Planning 1. Expected objectives: （1)Respiration is resuming and heart is beating again. Pulse can be touched. Dilating pupils reduces. Consciousness resumes. （2)No complications happen. （3)Finish the procedure in the given time (3 minutes) correctly. 2. Preparing: （1)The nurse: The unit, cap, shoes and mask. （2)The patient: Lessen the tension or the fears, and empty the excretion. （3)Assemble equipment: Gauzes, a flashlight and a hard surface (a bed or wood). （4)Environment: The ward should be clean, spacious, quiet and appropriate light. Close the windows and keep warm. Action 1. Assess unresponsiveness or unconsciousness: See a patient on the bed unresponsive, shake his (her) shoulder and call his (her) name, then press orbital cavity and philtrum to see if responsiveness or consciousness exists. Then observe the complexion, check his (her) pupils, listen for the sounds of breathing and palpate the pulse. 2. Call out for the doctor, if the patient unresponsive or unconscious. 3. Open the airway and determine if thewww.med126.com person is breathing. （1)Lay the patient in a supine position, a hard surface, then untie his (her) bottoms of clothes and loosen the belt. （2)If a neck has no trauma, you can open the patient’s airway by placing your hand on the patient’s forehead, pressing back and down; and placing your other hand under the bony part of the patient’s chin and lifting it up. （3)Use the index finger to push the foreign body against the opposite side of the throat to dislodge, and remove itwww.med126.com/kuaiji/. If dentures can be taken out, remove them. （4)Look at the chest, to see if it rises and falls, listen for sounds of breathing and feel for any air exchange against your cheek to determine if the person is breathing. If it is determined that the patient is not breathing, rescue breathing must be performed at once. 4. Mouth-to-mouth ventilation: （1)Place a gauze on the patient’s mouth. Grasp the nose with the fingers of your hand on the patient’s forehead, and lift up the chin with the other hand. （2)The nurse should take a breath and create an airtight seal with his or her lips around the person’s mouth. Huff emphatically until the chest rises. （3) Leave the patient’s mouth and loosen the fingers which the nose is grasped with. Then observe that the chest falls and any air exchange can be felt against the cheek. The patient is allowed to exhale passively between breaths. （4)Breathe into the patient’s mouth twice. The nurse takes a new breath before each rescue breath. Ventilate the adult patient 14 to16 times a minute. 5. Assess heart is stopping beating: Check for circulation at the carotid pulse in the neck. If there is no pulse, external chest compressions must be applied. 6. External chest compressions: （1)Kneel at the side of the patient, slide the two fingers of your hand along the lower rib margin until you reach the xiphoid process where the ribs meet the sternum. Place the two fingers of another hand above the xiphoid process and the first hand above the two fingers. （2)Place the heel of the first hand on the lower half of the sternum. Pick up the fingers of the first hand and interlace these fingers with the fingers of the second hand. （3)The nurse’s shoulders should be directly over the hands, with arms straight. Pressure is directed down onto the sternum, with the energy coming from the shoulders, rather than from the arms or hands. （4)The adult chest is compressed from 4 to 5 cm, at the rate of 80 to 100 times a minute, with a ratio of 15 compressions to 2 breaths. If two nurses take over CPR, the ratio is five compressions to one ventilation. Check the pulse after 2 cycles of CPR carried out. 7. Check if the pulse and breath are resumed: Respiration is resuming and heart is beating again. Pulse can be touched. Dilating pupils reduces. Consciousness resumes. The color of face, lips, nails and skin turns red. Dilating pupils reduces. Systolic pressure is more than 8KPa (60mm Hg). These show that the cardiopulmonary resuscitation is effective. 8. If no pulse is found, resume CPR before the pulse is checked again. If pulse and breath are found, advanced life support should be implemented. 9. Heath education: Explain the aims of cardiopulmonary resuscitation to the patient and family numbers. Evaluating 1. Respiration is resuming and heart is beating again. Pulse can be touched. Dilating pupils reduces. Consciousness resumes. 2. No complications happen. 3. The nurse has carrying out the procedure expertly and correctly. 4. Finish the procedure in the given time correctly. Aims Cardiopulmonary resuscitation is a technique that externally supports the circulation and ventilation (breathing) with manual methods in a victim of cardiopulmonary arrest. It helps to provide oxygen to the brain, heart, lungs, and other organs and to resume the function of the brain, until advanced life support can be given. Precautions 1. The position of external chest compressions should be right and the strength should be even. Compressing too lightly can lead to labour in vain, while compressing too suddenly and violently can result in ribs or sternum fracture, hemopneumothorax, heart injury and so on. 2. The time’s ratio of compression and loosening is 1:2. Because it will take long time that blood enter the left ventricle after loosening compression. If the time of compression is longer than of loosening the compression, blood entering into the left ventricle will be deficient. 3. Pay attention to the appropriate cooperation, during doing mouth-to-mouth ventilation. If only a nurses takes over CPR, the ratio of mouth-to-mouth ventilation and external chest compressions is 15 compressions to 2 breaths; while two nurses, the ratio is five compressions to one ventilation. Huffing should be done during the loosening the compression. 4. The frequency of compression: Adult: 80 to 100 times a minute; child: 100 to 120 times a minute; infant: 140 times a minute. The frequency of depth: Adult: 4 to 5 cm; child: 2.5 to 4 cm; infant: 1 to 2 cm. Compress a child using one hand, while an infant using only two fingers. 5. The frequency of mouth-to-mouth ventilation: Adult: 14 to 16 times a minute; child: 18 to 20 times a minute; infant: 30 to 40 times a minute. Every volume of ventilation is 800 ml generally and not more than 1200 ml. The volume is too large or huffing too fast can lead to flatulence. 6. The common reasons of failure during cardiopulmonary resuscitation are obstruction of the respiratory tract and not an airtight seal around the person’s mouth. Air enter the stomach and can not be vented, which leads to severe flatulence, even matters in the stomach return into the respiratory tract and vomitus pour out from the mouth and nostrils. | 
