Becoming familiar with the basics of cardiopulmonary resuscitation is essential for all nurses, as for you may require these skills at any moment at work or during your time off. As a nurse, the general public will turn to you for assistance, so any hesitation could cause a poor outcome for the person in need. You should become very comfortable with the basics of CPR and then always seek out training opportunities where you can practice your skills, for this will make you efficient and confident when an emergency arises.
When performing CPR, you will be providing oxygen to the brain, heart, and other vital organs. Therefore, implementing your efforts quickly will decrease the likelihood of organ damage from the lack of oxygen.
Sequence of Essential Nursing Actions
- Determine Unconsciousness
- Check for pulse at carotid artery
- Open the airway using the head tilt-chin lift method
- Check breathing and deliver breaths
Over the years, the sequence for CPR has changed as research has demonstrated that circulating blood through the body is extremely important. The current recommendations follow the CAB formula.
- C – Compressions
- A – Airway
- B – Breathing
For an adult patient, you want to immediately call for assistance since a defibrillator is often required. If you are working in a hospital or a health care office, be sure you are familiar with how to activate the code team. Typically, the first responder calls out for assistance or hits a code button in the patient’s room and then the next team member calls in the official code. During emergencies, it is imperative to be very specific when asking for assistance – directly point to or name the person who will be responsible for each action to avoid confusion. For example, say, “Mary you call the code, Jane do compressions, Bob you are on airway, Sara record…” and so on. There will be many people around, but without direction, the area will quickly become loud and confusing.
- Stand or kneel next to the patient’s chest – The patient should be supine on a flat surface. Many hospital beds have a CPR lever, which will quickly deflate the air mattress. Otherwise, a flat board should be placed under the patient’s back.
- Position your hands – Place the heel of one hand on the lower half of the sternum and then place your other hand on top of the first hand
- Compress the chest at least 2 inches and at rate of at least 100 compressions a minute – You want to allow recoil of the chest after each compression as this allows the heart to refill completely before the next compression
- Interruptions during chest compressions should be minimized
- Compression to Ventilation Rate: 30 to 2 in adults
- If two rescuers are present, switch positions (compressor and ventilator) every 5 cycles to prevent rescuer fatigue
Open the airway using the head tilt-chin lift method unless the victim has sustained a head, neck, or spinal cord injury, in which case you will use the jaw thrust maneuver.
- Give 2 breaths each over one second – watch for the chest to rise
- Allow the patient to exhale in between breaths
- Rescue breathing – 1 breath every 6 to 8 seconds (8 to 10 breaths per minute)
Automated External Defibrillator (AED)
An AED is used to convert ventricular fibrillation into a perfusing rhythm. Be sure to use the adult size pads – child sized pads will not provide an effective shock.
- Attach the AED pads to the patient’s chest
- Turn on the AED and follow the instructions
- If a shock is to be delivered, be sure no one is touching the patient
- After a shock, immediately resume CPR for 2 minutes then assess for a pulse
- If no shock is advised, continue CPR and recheck rhythm every 2 minutes
Reviewing this information frequently will provide you with the confidence to respond quickly during an emergency. As you learn and prepare for your NCLEX-RN, studying hard and often is very helpful and will pay off in the end.