CARDIOPULMONARY-CEREBRAL RESUSCITATION (CPCR)

INTRODUCTION:-
Cardiopulmonary resuscitation (CPR) is a life saving technique useful in many emergencies,
including cardiac arrest or respiratory arrest, in which someone's breathing or heart beat has
Stopped CPR is effective only if performed within 7minuites of the cardiac or respiratory arrest
Nurses are the most important health care personnel who should effectively care for more
complex cases, including interventions for patients with cardiopulmonary arrest, initiating basic
life support (BLS) and a adding in advanced life support (ALS)
DEFINITION
Cardiopulmonary-cerebral resuscitation (CPCR) is a comprehensive term used to describe both
the basic principles of cardiopulmonary resuscitation (CPR) as well as advanced life support and
post resuscitation care.
PURPOSE OF CPR
 To maintain an open and clear airway (A).
 To maintain breathing by artificial ventilation (B).
 To maintain circulation by external cardiac massage (C).
 To save life of the patient.
 To provide basic life support till medical and advanced life support arrives.
INDICATIONS OF CPR
Cardiac Arrest:
 Ventricular fibrillation.
 Ventricular tachycardia.
 Asystole.
 Pulseless electrical activity.
Respiratory Arrest :
This may be the result of the following :
 Drowning.
 Stroke.
 Foreign body in throat.
 Smoke inhalation.
 Drug overdose.
 Suffocation.
 Accident, injury.
 Coma.
 Epiglottis paralysis.
PRINCIPLES OF CPR:
  To restore effective circulation and ventilation.
 To prevent irreversible cerebral damage due to anoxia. When the heart fails to maintain
the cerebral circulation for approximately four minutes the brain may suffer irreversible
damage
GENERAL INSTRUCTIONS FOR EFFECTIVE CPR
CPR technique is used in person whose respiration and circulation of blood have suddenly and
unexpectedly stopped. There are no need of attempting CPR techniques in patients in the last
stage of an incurable illness and in persons whose heartbeat and respiration have been absent for
more than six minutes
The immediate responsibilities of the resuscitator are
To recognize the signs of cardiac arrest.
Protect the patient's brain from anoxia by immediately starting artificial ventilation of the lungs
and external cardiac massage
Call for help
The cardio pulmonary resuscitation must be initiated within three to four minutes in order to
prevent brain damage
Strike the centre of the chest sharply with the side of the clenched first twice
Call for assistance
Clear the airway of the false teeth, vomitus food material etc
Initate ventilation and external cardiac massage without wasting time
The CPR techniques should not be discontinued for more than five seconds before normal
circulation and ventilation of lungs are established except
When the patient is moved to a hard surface
When endotracheal intubation is being carried out (maximum time allowed for these two
procedures is 15 seconds)
Before CPR is attempted in a patient, make sure that the airway is clear
CPR TIME LINE
0-4 minutes brain damage unlikely
4-6 minutes brain damage possible.
6-10 minutes brain damage probable
Over 10 minutes probable brain death
MAIN STAGES OF RESUSCITATION
Chest compressions
Chest compressions will be initiated sooner and ventilation only minimally delayed until
completion of the first cycle of chest compressions
A (Airway)-ensure open airway by preventing the falling back of tongue, tracheal intubation if
possible
B (Breathing) start artificial ventilation of lungs

CPR GUIDELINES ACCORDING. TO AMERICAN HEART ASSOCIATION

 The 2010 CPR Guidelines rearranged the order of CPR steps
 American Heart Association wants rescuers to practice C-A-B. chest compressions first,
then airway and breathing
 You can hold your breath for a minute or two without having brain damage, victims of
cardiac arrest can go a minute or two (actually a lot longer than that) without taking a
breath
 By starting chest compressions first, the victim only has to hold his breath an extra 18
seconds while blood gets flowing again
 Chest compressions should be started immediately on anyone who is unresponsive and is
not breathing normally. Oxygen will be present in the lungs and bloodstream within the
first few minutes, so initiating chest compressions first will facilitate distribution of that
oxygen into the brain and heart sooner
 The new guidelines also recommend that during CPR, rescuers increase the speed of
chest compressions to a rate of at least 100 times a minute. In addition, compressions
should be made more deeply into the chest, to a depth of at least 2 inches in adults and
children and 1.5 inches in infants.
SITE FOR CARDIAC COMPRESSION
 First of all trace the last rib and follow the rib to the notch where the rib meet the
sternum. Then place the heel of the other hand on the lower part of the sternum about 1-
1.5 inch above the palpating hand. The palpating hand is then placed on the top of the
hand, which is resting on the sternum. Both hands should be parallel.
 Keep fingers off the chest or interlocked
 If fingers are resting on the chest, force will be dissipated.
 The artificial breathing and the cardiac massage should correspond to the normal
respiration and pulse rate
 The ratio of cardiac compression to ventilation is 5: 1 that is 5 cardiac compressions one
ventilation. Cardiac compression is given at the rate of 60 per minute
  Ventilation is given between the cardiac compression without interrupting or slowing the
rate of compressions. Thus 60 cardiac compressions and 12 ventilations per minute are
achieved.
 The ratio is 5: 1 when there are two rescuers.
 When there is only one rescuer, interrupt compressions after every 15 compressions to
give two quick deep lung infiltrations. This results in a cardiac compression to the
ventilation ratio of 15:2.

PRECAUTIONS
 The patient should be placed on a hard surface
 The body of the patient should be horizontal because the blood pressure generated is not
adequate to pump the blood upto the head.
 Assess properly and indicate CPR within three minutes of arrest.
 Do not interrupt CPR for more than seven seconds.
 Give CPR by maintaining basic steps. ( A.B.C ).
 Give compression only over sternum not on ribs.
 When you are giving cardiac compression, fingers should be in upward direction
to prevent rib fracture.
CONTRAINDICATIONS:
 Do not resuscitate when a decision not to resuscitate has been noted in the chart.
 Patient on anticoagulant therapy
 Any history of central nervous system damage
 Severe uncontrolled hypertension.
 Recent trauma to head or cranium
 Neoplasm with increased bleeding risk.
 Active peptic ulceration
 Known history of ischemic stroke.
ASSESSMENT
Determine that the client is unconscious. Shake the client and shout at him or her to confirm
iconscious rather than being asleep
Assessment for the presence of respiration.
Assess carotid artery for pulse
EQUIPMENTS:
 A hard, flat surface
 No additional equipment is necessary but in hospital setting, an emergency cart with
defibrillator and cardiac monitoring should be the bedside. Crash card usually contains
 Airway equipment
  Suction equipment
 Intravenous equipment
 Laboratory tubes and syringes.
 Pre packed medications for advanced life support.
PROCEDURE-
One rescuer-adult, adolescent client
1. Assess the response by tapping or gently shaking chent while shouting-Are u ok?
It prevents injury to a client who is not experiencing cardiac and respiratory arrest.
2. Call for helps or activate or activate the emergency medical system because the majority of
adults with sudden cardiac arrest in ventricular fibrillation.
3. Turn client on to the back while supporting head and neck. Place a cardiac board under the
back or place client on the floor a firm surface is needed for adequate compression of the heart
beneath the sternum
4 Position self face the client on your knees parallel to the client, next to the head, to begin to
assess the airway and breathing status.
AIRWAY:
 If the client is conscious and unresponsive you need to make sure that his airway is clear
of any obstruction. Open the airway
 The most commonly used methods is the head tilt /chin lift method. With the client lying
flat on his back, place your hand on his forehead and your other hand under the tip of the
chin
 Use the modified jaw thrust if a neck injury is suspected Place hands at the angles of the
lower jaw and lift, displacing the mandible forward while tilting the head backward.
 Assess for respiration. Place your ear over the client's mouth and observe the chest for
rising with respiration The breaths may be faint and shallow-look, listen and feel for any
signs of breathing for 3 to 5 seconds.
BREATHING:
 With the clients airway clear of any obstructions gently support his chin so as to keep it
lifted up and the head tilted back. Pinch his nose with your fingertips to prevent air from
escaping once you begin to ventilate.
 Form a seal over the client mouth using either your mouth or the appropriate respiratory
assist device
 Take a deep breath and place your mouth over the clients. As you assist the person in
breathing, keep an eye on his chest. Try not to over- inflate the client lungs.
 Give two full breaths of 0.5 to 2 seconds. Between each breath allow the clients lungs to
relax place your ear near his mouth and listen for air to escape and watch the chest fall
the client exhales
  In the events of serious mouth or jaw injury that prevents mouth to mouth ventilation,
mouth to nose ventilation may be used by tilting the head with one hand and using the
other hand to lift the jaw and close the mouth If the client is breathing but still
unresponsive turn on to side (recovery position)
CIRCULATION
 In order to determine if the clients heart is beating, place two finger tips on his carotid
pulse, located in the depression between the windpipe and the neck muscles and apply
slight pressure for 5 to 10 seconds on the side next to which you are kneeling
 If there is no pulse then the client's heart is not beating and you will have to perform
chest compressions
 Maintain position on knees parallel to sternum.
 Positions the hands for compression: using the hand nearest to the legs place middle and
index finger on the lower ridge or near ribs and move fingers up along ribs to the costa
lsternal notch (in the centre of the lower chest).
 Place middle finger on this notch and the index finger next to the middle finger on the
lower end of the notch
 Place the heel of the other hand along the lower half of the sternum, next to the index
finger
 Remove first hand from the notch and place heel of that hand parallel over the hand on
the chest and interlock the fingers, keeping them off client's chest.
 Keeping the hands on the sternum, extent the elbows, locking the elbows, with your
shoulders directly over the client chest.
 Using your body's weight, compress the client's chest.
 The depth of the compression should be approximately 1 and half to 2 inches at the rate
of 80 to 100 compressions per minute. 2 hands-2 inches. If you feel or hear cracking
sounds, you may be pressing too hard. Do not stop your rescue efforts damaged cartilage
or cracked ribs are far less serious than a lost life. Simply apply less pressure as you
continue compression
TWO HANDS TWO INCHES
The heel of the hand must completely release pressure between compressions, but it should
remain in contrast contact with the client's skin to allow the heart to fill with blood
Use the mnemonic one and two and three and to keep rhythm and timing Finish the cycle by
giving the client 2 breaths. This process should be performed four times-30 compression and 2
breaths after which remember to check the client carotid artery for pulse and any signs of
consciousness
TWO RESCUERS-ADULT. ADOLESCENT-
1 When the second rescuer arrives the first rescuer stops CPR after completing two ventilations
and assesses for carotid pulse for 5 seconds.
2. The second rescuer moves into the chest compression position. Plus and deliver one
ventilation
3. The second rescue begins chest compression while counting out loud. The compression rate is
100 per minute
4 The first rescuer gives two slow ventilations after 30 cardiac compressions. The first rescuer
also assesses carotid pulse during chest compressions to evaluate effectiveness
5. If the second rescuer wishes to change the position, he or she states, change, one and two and
three and four and five
6. The first rescuer delivers the ventilation then moves into the chest compression positions.
7. The second rescuer moves to the ventilator position and assesses for carotid pulse for 5
seconds
CHILD CPR: According to the American heart associations guidelines child cpr is administered
to any victim under the age of 8. If the child is unresponsive and you are alone with him, start
rescue efforts immediately and perform CPR for at least 1to 2 minutes before dialing
AIRWAY, A child breaths may be extremely faint and shallow look, listen and feel for any signs
of breathing. If there is none tongue may be obstructing the airway and preventing the child from
breathing on his own. If the child is still not breathing after his airway has been cleared you will
have to assist him in breathing, look, listen, feels for breath
BREATHING IF the child remains unresponsive and still not breathing on his own, pinch his
nose with your fingertips or cover his mouth and nose with your mouth creating a tight seal and
give two breaths
CIRCULATION Check the child's carotid artery for pulse by placing two fingertips and
applying slight pressure on his carotid artery for 5 to 10 seconds.
COMPRESSION: When performing chest compression on a child proper hand placement is
even more crucial than with adults. Place two fingers at the sternum and then put the heels of you
other hand directly on top of your fingers. The rule to remember is I hand I inch
INFANT CPR:
According to generally accepted guidelines, infant CPR is administered to any victim under the
age of 12 months, Check the infant for responsive by patting his feet and gently tapping his chest
or shoulders. If he does not react immediately check his airway
AIRWAY- It is normal for an infant to take shallow and rapid breaths, so carefully look, listen
and feel for breathing. If you cannot detect any signs of breathing the tongue may be obstructing
the infant's airway. When clearing an infant's airway it's important not to tilt the head too far
hack. Infant airway is extremely narrow and overextending the neck may actually close off the
air passage
SNIFFER'S POSITION:-
Breathing, cover the infant's mouth and nose with your mouth creating a seal and give quick,
gentle puff from your cheeks Let the victim exhale on his owns watch his chest and listen and
feel for breathing. If does not breathe on his own again place your mouth over his mouth and
nose and give another small puff if the infant remains unresponsive Immediately check his
circulation
PUFF FROM THE CHEEKS::
CIRCULATION - An infant's pulse is checked at the brachial artery, which is located inside of
upper arm, between the elbow and the shoulder. Place two fingers on the brachial artery applying
slight pressure for 3-5 seconds. If you do not feel a pulse within that time, then the infant's heart
is not beating and will need to perform chest compressions.
COMPRESSIONS. Place three fingers in the center of infant's chest with the top fingers on an
imaginary line between the infant's nipples. Raise the top finger up and compress with the
bottom two fingers. The compression should be approximately to the depth of the infant's chest
Infant hand placement
Count aloud as you perform 5 cycles of 30 compressions are 2 breaths before checking the infant
for breathing and pulse. If there is no pulse, continue administering 30 compressions/2 breaths
until an ambulance arrives. If at any point the infant regains a pulse but still does not breathe on
his own, give him one rescue breath every 3 seconds.
DEFIBRILLATION
Immediate defibrillation if witnessed arrest and automated external defibrillator available
compressions before defibrillation if unwitnessed or arrival at the scene 4-5 minutes. One shock
followed by immediate CPR
IMPORTANCE OF EARLY DEFIBRILLATION
Most frequent arrest rhythm VF/VT
Treatment is defibrillation
Successful conversion diminishes over time
VF tends to deteriorate to asystole.
NOT USED FOR
 Sinus rhythm
 Bradycardia
 A Systole
DRUGS USED DURING CPR
Inj Epinephrine
Inj. Atropine
Inj. Lidocaine
Inj. Magnesium sulphate
Inj Dopamine
Inj Sodium bicarbonate
Inj Calcium chloride
Inj. Dobutamine
SIGNS OF EFFECTIVE RESUSCITATION
 Constriction of pupils, key sign that brain is sufficiently oxygenated
 Distinct carotid pulsation with each cardiac compression.
 Blinking upon stimulation of the eyelids.
 Breathing that begins spontaneously.
 Movement and struggling
 Decreased cyanosis
SIGNS OF INEFFECTIVE RESUSCITATION
 Incorrect resuscitative techniques
 Heart is drained of its blood by hemorrhage or cardiac tamponade.
 Blood supply to the heart is obstructed by the presence of pulmonary embolus
 Severe chronic lung disease has destroyed lungs capacity to oxygenate blood
 Lungs are filled with vomitus as a rescue of aspiration during cardiac massage
POST RESUSCITATION MEASURES
 Skilled after care is essential for the patient who has suffered an arrest
 Continuous vigilance must be ensured by a skilled person for 48-72 hours.
 If the patient is not in the intensive care unit shift him there for consent observation and
expert care
 Monitor ECG, CVP and blood pressure
 Check the oral cavity and jaw position as his tongue may fall and obstruct the airway
 Temperature is taken every hour A high temperature usually indicates cerebral damage or
cerebral edema
 Blood gas and Ph determinations are done to detect metabolic acidosis
 A chest X-ray film is obtained using portable equipment. Ribs often are accidentally
fractured during cardiac massage
 Insert an endotracheal tube if not already in place. This maintains an open airway for the
unconscious patient.
  Give oxygen continuously for 48 hours following resuscitation by an endotracheal tube or
mask
 Insert foley's catheter Urine output is one of the measures of the cardiovascular status
 Start IV infusion to administer enough fluids in the patient.
 Record the procedure on the nurse's record with date and time
 A nasogastric intubation and aspiration of contents of stomach are necessary for a patient
with a full stomach to prevent vomiting and aspiration of vomitus into lungs
BIBLIOGRAPHY
Shabbeer P Basheer, S. Yasen khan "A concise text book of advanced nursing practice"
published by EMMESS medical publishers, edition 1", page no. 297-324.
S. Nancy "principles and practice in nursing" published by NR brothers, edition 5, page no. 286-
292
Linda s. Williams paula d. Hopper "medical surgical nursing" published by F.A Davis company,
page no. 406-412
Brunner & suddarth's "A text book of medical surgical nursing published by Lippincott Williams
& Wilkins, edition 10th, page no: 810-815

NET REFERENCE:

 https://www.ncbi.nlm.nih.gov
 https://www.jeehp.org/journal
 https://onlinelibrary.wiley.com

https://www.theguardian.com/science/2012/jan/06/memory-loss-begins-at-45-says-study

https://thegoalchaser.com/memory-quotes/
https://www.cdc.gov/mmwr/volumes/67/wr/mm6727a1.htm
INTRODUCTION
In the primary care context, memory loss is a common complaint. It is more common in the
elderly, though it can also be reported by younger adults. Clinicians and patients frequently
worry that memory loss is a sign of impending dementia because most people experience some
worsening of memory with aging. Therefore, prevention of memory loss is important among the
elderly. Through the use of the ICE package, which is specifically designed for middle-aged
adults who are male, investigators raise awareness of early signs of dementia in this population.
NEED FOR STUDY
Memory is the process by which we utilize the knowledge from the past to apply it to the
present. Amnesia, often known as memory loss, is an uncommon form of forgetfulness in which
a person cannot recall recent events, memories from the past, or both. Depending on what's
causing it, the memory loss may be temporary and go away quickly, or it may persist and worsen
over time. The purpose of this research study is to raise awareness among researchers about
memory loss, particularly in the middle-aged population.
The majority of middle-aged people have memory loss as a result of stress, excessive alcohol and
drug use, smoking, tobacco use, lack of sleep, head injuries, nutritional deficiencies, and certain
medical disorders (HIV, stroke). Amnesia signs and symptoms (disorientation, partial and total
memory loss, incapacity to recall family members or locations, anxiety, shame) can be
minimized by offering basic health care services and health education to the idle aged group. to
raise or improve middle-aged people's understanding of forgetfulness and to improve their
attitudes toward memory loss. Alzheimer's disease affects between 2.4 and 4.5 million people in
the United States. As per the National Institute on Aging Thus, researchers came to the
conclusion that middle-aged people (40–65) are more susceptible to memory loss. Therefore, this
study offers middle-aged people awareness and encouragement.
The researchers also discovered that there are insufficient inferential statistics on middle-aged
people's attitudes and knowledge about memory loss
“Every man’s memory is his private literature.” Aldous Huxley
The nervous system is the body's primary control and communication system. Every idea, deed,
and feeling is a reflection of its activity. There are two types of neural systems: the central
nervous system and the peripheral nervous system. The central nervous system is made up of the
spinal cord and brain. The brain is the intellectual hub that enables memory, creativity, learning,
and thought.
The brain, which is made up of the cerebellum, medulla oblongata, pons, midbrain, and
cerebrum, makes up approximately one-fiftieth of the body weight. The main portion of the brain
is called the cerebrum, and the cerebral cortex is made up of nerve cell bodies or grey matter in
its superficial region
The cerebral cortex is primarily responsible for mental processes related to learning, memory,
intelligence, and sense of responsibility.
Memory is the unique capacity of our minds to preserve or recall what has previously been
encountered or learned through hearing, and eventually allow us to utilize it through replication
or resuscitation. It's a multifaceted process that includes recognition, recall, retention, and
learning. Memory is crucial to our ability to learn and develop psychologically. We manage new
situations by drawing on our memories of earlier events, which aids in our relearning of
problem-solving and critical thinking.
Memory loss is an uncommon form of forgetfulness in which a person may be unable to recollect
recent experiences, memories from the past, or both. One of the most prevalent complaints in
primary care is memory loss. It is especially prevalent among the elderly, although younger folks
may also report it. Memory impairment occurs gradually over several years due to the
progressive, irreversible degradation and atrophy of the cerebral cortex, which causes mental
deterioration.
The typical process of time-related change known as aging starts at birth and lasts the entirety of
a person's life. Cognitive abilities including thinking, memory, and IQ start to deteriorate around
the age of 40 and reach their peak in the

Need for the study

According to the CDC, more than one in nine adults aged 45 and older experience self-reported
memory loss or confusion
Statement of the Problem

A study to evaluate the effectiveness of Information Education and Communication (IEC) on

knowledge and attitude regarding Memory Loss among Middle Aged Adults in a selected rural
area at padappai
Objectives
1. To assess the level of knowledge and attitude regarding memory loss among middle aged
adults.
2. To evaluate the effectiveness of Information Education Communicaton (IEC) on
knowledge and attitude regarding memory loss among middle aged adults.
3. To find out the relationship between the level of knowledge and at regarding memory
loss among middle aged adults.
4. To determine the association between the level of knowledge regarding memory
loss among middle aged adults with their selected demographic variables.
5. To determine the association between the level of attitude regarding memory
loss among middle aged adults with their selected demographic variables.
Jectives
• To assess the existing knowledge level regarding memory loss among Middle Age Adult
(males).
• To assess the Attitude level regarding memory loss among Middle Age Adult (males).
• To administer the IEC package regarding memory loss among Middle Age Adult (males).
• To evaluate the effectiveness of IEC package regarding memory loss among Middle Age Adult
(males).
• To assess & compare the pre-test, post-test knowledge & attitude score regarding memory loss
among Middle Age Adult (males).

Hypotheses H1 : There will be a significant difference between the mean pre-test and posttest
score of knowledge regarding memory loss among middle aged adults.
H2 : There will be a significant difference between the mean pre-test and posttest score of
attitude regarding memory loss among middle aged adults.
H3 : There will be a significant relationship between the knowledge and
attitude regarding memory loss among middle aged adults.
H4 : There will be a significant association between the post-test level of
knowledge regarding memory loss among middle aged adults with their
selected demographic variables.
H5 : There will be a significant association between the post-test level of
attitude regarding memory loss among middle aged adults with their selected
demographic variables

Research methodology
Research approach
Quantitative Research Approach will be applied this study.
Research design
Research design selected for the study is pre experimental-one group pre- test post-test design.
Pre test Treatment Post test
O1 X O2

O1: Assess the existing level of knowledge and attitude regarding memory loss.
X: IEC package regarding memory loss.
O2: Assess the post-test level of knowledge and attitude regarding memory loss.
Study population
middle age adults of Padappai include: Middle age adult (males) i.e. 60 people.
Sample population
Middle Age Adult (males and females),Paddappai.
Sample size
60 Middle Age Adult (Males and Females)
Sampling technique
The non-probability convenience sampling technique will be used for data collection.
Development and description of tools
A structured knowledge questionnaires regarding memory loss will be developed to
assess the effectiveness of the IEC package on Knowledge and attitude regarding memory loss.
The tools for the data collection consist of three sections.
Section A
This section deals with demographic variables like Age, gender, marital status, religion education status,
occupation status, family monthly income, type of family, residential type, previous exposure about
awareness regarding memory loss.
Section B
Structured questionnaires to assess the knowledge among middle age adult (males and Femals)
regarding memory loss. Total 40 questions were formulated.
S.n Score Level of knowledge
o

1 28-40 Adequate knowledge

2 10-28 Moderate knowledge
3 3 <10 Inadequate knowledge

Section C
Likert’s scale regarding memory loss to assess the level of attitude among middle age adult
Total Statements: 20
1-12: Positive statements (Disagree - 1, Uncertain - 2, Agree-3)
13-20: Negative statement (Disagree -3, Uncertain - 2, Agree -1)
Total score: 60
Maximum score is about 60 marks and minimum score is 20 marks
S.No Level of Attitude Score

1 Favorable Attitude 48-60

2 Moderately Favorable 36-47
Attitude
3 Unfavorable Attitude 24-35