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Part 1 Location: Hospital surgical floor   Time: 07:00 Handoff report from the nurse leaving the s

Question
Answered step-by-step
Asked by ProfHeatMonkey101

Part 1

Location: Hospital surgical floor  

Time: 07:00

Handoff report from the nurse leaving the shift:

Situation: Linda Waterfall is a 48-year-old patient of Dr. Samuels. She is scheduled for a left mastectomy this morning at around 08:30.

Background: Linda is a Native American woman who was diagnosed with an aggressive form of breast cancer after a biopsy just a few days ago. She told me that her family lives far away and that they wanted her to come home to meet with the tribal healers before scheduling the surgery. She did not do that and instead took the first available date for the surgery. She’s been a little nervous, and while getting checked in, she mentioned that she has not been sleeping well. She shared that her mother died of complications of surgery. She also said she’s worried about the cancer and very unhappy about losing her breast. Her cousin, Alice, brought her to the hospital this morning and is staying with her until she has to go into surgery.

Assessment: I’ve checked her in, and she is settled in room 2046. Now we’re just waiting on the call from surgery (Dr. Samuels). Her consent forms are signed and on the chart. I started her on intravenous (IV) dextrose 5% lactated Ringer’s. It’s infusing at 80 mL/h through an 18-gauge catheter in her right forearm. Her vital signs at check-in were as follows: heart rate, 80 beats/min; respiratory rate, 18 breaths/min; blood pressure, 135/85 mmHg; and temperature, 37.2°C (99.0°F). She has a small incision on the left breast from a biopsy last week. Her stitches were removed yesterday. The incision is dry and uncovered. She’s able to get to the toilet without assistance, and she will receive a urinary catheter in surgery. She reports she has had nothing by mouth since before midnight. She takes no regular medications at this time and refused to take her preoperative lorazepam.

Recommendation: As I mentioned, she seems pretty nervous, so I recommend checking in on her and introducing yourself. I told her I would be leaving at 07:00, so she should be expecting someone new.

 

 

Opening Questions
How did the simulated experience of Linda Waterfal’s case make you feel?
Talk about what went well in the scenario.
Reflecting on Linda Waterfall’s case, were there any actions you would do differently? If so, what were these actions and why?

Scenario Analysis Questions*
PCC       What priority problem(s) did you identify for Linda Waterfall? If the nurse did not recognize or respond appropriately to Linda’s concerns, what could the ramifications be?
PCC/I     Discuss the importance of a medication bundle for Native Americans.
T&C       What other individuals in addition to the primary care team should be involved in Linda Waterfall’s case?
PCC       In Linda Waterfall’s situation, what therapeutic communication techniques would be most effective?

Concluding Questions
Describe how you would apply the knowledge and skills that you obtained in Linda Waterfall’s case to an actual patient care situation.

 

Part 2 

A 52-year-old patient has just arrived in the Emergency Department with complaints of severe abdominal pain, nausea, and vomiting over the last few days. His abdomen is distended. He has poor skin turgor and dry mucous membranes. He has not urinated since yesterday. He has felt “dizzy” and “weak” all evening. He thought it might be the flu, but decided to come in because the stomach pains were getting worse. He has signed informed consent for treatment and labs have been drawn.

 

 

 

 

 

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Opening Questions

How did the scenario make you feel?

 

Scenario Analysis Questions*

PCC/EBP/S               When reflecting on the care of Stan Checketts, what are signs and symptoms you can assess in the next patient you care for who might be at risk for dehydration?

EBP/QI                        Discuss signs and symptoms of hypovolemic shock. 

PCC/EBP                    Discuss assessment and expected findings in a small bowel obstruction. 

PCC/S/I/EBP           What key questions does the nurse ask in an acute abdominal pain assessment?

PCC/EBP/S               In evaluating Stan Checketts’ laboratory values, what if any abnormalities did you find?

PCC/EBP/S               Stan Checketts had a nasogastric (NG) tube inserted for gastric decompression. What are the preferred methods for confirming placement of the NG tube? 

T&C/EBP/S/PCC   What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format. 

 

Concluding Questions

What would you do differently if you were to repeat this scenario? How would your patient care change?

Feedback Log 

You arrived at the patient’s side.

0:00

You introduced yourself.

Patient status – ECG: Sinus tachycardia. Heart rate: 128. Pulse: Present. Blood pressure:

0:10

107/77 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 90%. Temp: 99 F

(37 C)

0:18

You washed your hands. To maintain patient safety, it is important to wash your

hands as soon as you enter the room.

 

You identified the patient. To maintain patient safety, it is important that you

quickly identify the patient.

0:53

You sat the patient up.

0:57

You put an emesis basin at the bedside. This was a good idea.

1:05

You looked for normal breathing. He is breathing at 28 breaths per minute. The

chest is moving normally on both sides.

Patient status – ECG: Sinus tachycardia. Heart rate: 128. Pulse: Present. Blood pressure:

1:10

109/77 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 90%. Temp: 99 F

(37 C)

1:34

You attached the pulse oximeter. It is a good idea to monitor the saturation and

pulse here. This will allow you to reassess the patient continuously.

1:51

You checked the radial pulse. The pulse is strong, 130 per minute and regular. It

is correct to assess the patient’s vital signs.

Patient status – ECG: Sinus tachycardia. Heart rate: 128. Pulse: Present. Blood pressure:

2:10

110/78 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 90%. Temp: 99 F (37

 

You examined the patient’s skin. There is decreased skin turgor. His skin is quite

cold.

Patient status – ECG: Sinus tachycardia. Heart rate: 128. Pulse: Present. Blood pressure:

3:10

109/78 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 90%. Temp: 99 F

(37 C)

3:33

You listened to the abdomen of the patient. You could hear hyperactive sounds

from the abdomen.

4:00

You listened to the lungs of the patient. The breath sounds are normal.

Patient status – ECG: Sinus tachycardia. Heart rate: 128. Pulse: Present. Blood pressure:

4:10

109/78 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 90%. Temp: 99 F

(37 C)

4:20

You listened to the heart of the patient. There were only normal heart sounds.

This is reasonable.

4:24

You placed a nasal oxygen cannula. This was part of your orders.

4:27

You turned the oxygen on.

4:38

You asked the patient if he had any pain. He replied: ‘Yes, I have some pain.’

4:46

You asked: How bad is the pain? He replied: ‘Not too bad, it’s about a 4

 

:58

You asked the patient if he could describe his pain. He replied: ‘It’s a cramping

kind of pain in my stomach.’

5:08

You asked the patient if he needed anything for the pain. He replied: ‘Yes. That

would be great.’

Patient status – ECG: Sinus tachycardia. Heart rate: 128. Pulse: Present. Blood pressure:

5:10

105/76 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 92%. Temp: 99 F

(37 C)

5:17

You asked the patient how he felt. He replied: ‘I feel dizzy.’

5:26

You asked the patient if he felt nauseated. He replied: ‘Yes, I am.’

5:34

You asked the patient if he had any difficulty in breathing. He replied: ‘No, my

breathing’s fine.’

5:42

You asked the patient if he had had anything to eat or drink today. He replied:

‘No, I haven’t eaten anything yet today.’

5:48

You asked the patient what the emesis looked like. He replied: ‘It looked normal.’

6:03

You tried to assess any IVs, but the patient didn’t have any.

Patient status – ECG: Sinus tachycardia. Heart rate: 126. Pulse: Present. Blood pressure:

6:10

108/78 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 93%. Temp: 99 F

(37 C)

6:39

You obtained IV access in the arm. It’s correct to obtain IV/IO access here.

7:02

You attached the automatic noninvasive blood pressure (NIBP) measurement

cuff. This will allow you to reassess the patient continuously.

After inserting an IV, you must flush the cannula.

Patient status – ECG: Sinus tachycardia. Heart rate: 125. Pulse: Present. Blood pressure:

7:10

109/78 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 93%. Temp: 99 F

(37 C)

7:16

You attached a 3-lead ECG. It is correct to attach the monitor to the patient.

7:29

You assessed the patient’s IV. The site had no redness, swelling, infiltration,

bleeding, or drainage. The dressing was dry and intact. If you are in doubt, it is

always a good idea to reassess any IVs the patient has.

7:47

You asked if the patient was allergic to anything. He replied: ‘Yes. I’m allergic to

demerol. I got a skin rash the last time.’

8:06

You identified the patient. If you are in doubt, it is always a good idea to repeat

the identification.

Patient status – ECG: Sinus tachycardia. Heart rate: 125. Pulse: Present. Blood pressure:

8:10

106/76 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 94%. Temp: 99 F

(37 C)

8:17

A 0.3 mg dose of buprenorphine was injected IV. It was reasonable to give an

opioid here. It is important to use the basic rights of medication administration to

ensure proper drug therapy..

Remember to flush the cannula after drug administration.

9:06

You flushed the cannula. It is reasonable to flush the cannula here.

Patient status – ECG: Sinus tachycardia. Heart rate: 124. Pulse: Present. Blood pressure:

9:10

107/77 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 94%. Temp: 99 F

(37 C)

9:13

You administered 4 mg of ondansetron.

9:21

You flushed the cannula.

9:42

You started a bolus of 500 mL normal saline, given over 30 minutes.

You should request an abdominal x-ray here as ordered.

9:57

You provided patient education. This is correct. It is important to use every

opportunity to provide patient education.

Patient status – ECG: Sinus tachycardia. Heart rate: 123. Pulse: Present. Blood pressure:

10:10

106/76 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 94%. Temp: 99 F

(37 C)

10:11

You asked: How bad is the pain? He replied: ‘Not too bad, it’s about a 2.’

10:34

You checked the capillary refill time. The capillary refill time is more than eight

seconds.

10:59

You looked for normal breathing. He is breathing at 29 breaths per minute. The

chest is moving normally on both sides.

Patient status – ECG: Sinus tachycardia. Heart rate: 122. Pulse: Present. Blood pressure:

11:10

106/76 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 94%. Temp: 99 F

(37 C)

11:26

You checked the radial pulse. The pulse is strong, 120 per minute and regular.

12:00

You took a venous blood sample. This was correct as part of completing the order

for a metabolic panel.

Patient status – ECG: Sinus tachycardia. Heart rate: 120. Pulse: Present. Blood pressure:

12:10

105/75 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 94%. Temp: 99 F

(37 C)

12:16

You provided patient education.

12:43

You listened to the heart of the patient. There were only normal heart sounds.

13:06

You identified the patient. If you are in doubt, it is always a good idea to repeat

the identification.

Patient status – ECG: Sinus tachycardia. Heart rate: 118. Pulse: Present. Blood pressure:

13:10

105/75 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 94%. Temp: 99 F

 

37 C)

13:29

You placed a nasogastric tube.

Patient status – ECG: Sinus tachycardia. Heart rate: 117. Pulse: Present. Blood pressure:

14:10

103/74 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 94%. Temp: 99 F

(37 C)

14:46

You requested an abdominal x-ray.

Patient status – ECG: Sinus tachycardia. Heart rate: 118. Pulse: Present. Blood pressure:

15:10

103/73 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 94%. Temp: 99 F

(37 C)

Patient status – ECG: Sinus tachycardia. Heart rate: 118. Pulse: Present. Blood pressure:

16:10

108/76 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 93%. Temp: 99 F

(37 C)

16:20

You asked the patient how he felt. He replied: ‘I feel a little better. Thanks for

asking.’

16:26

You asked the patient if he felt nauseated. He replied: ‘Yes, a little.’

16:32

You asked the patient if he needed anything for the nausea. He replied: ‘No. I’m

okay.’

16:40

You asked the patient what other symptoms he had. He replied: ‘I’ve been

vomiting.’

 

16:57

You provided patient education.

Patient status – ECG: Sinus tachycardia. Heart rate: 118. Pulse: Present. Blood pressure:

17:10

108/77 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 93%. Temp: 99 F

(37 C)

17:15

You phoned the provider in order to discuss the patient.

Patient status – ECG: Sinus tachycardia. Heart rate: 118. Pulse: Present. Blood pressure:

18:10

106/76 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 92%. Temp: 99 F

(37 C)

18:52

You examined the patient’s skin. There is decreased skin turgor. His skin is quite

cold.

19:07

You examined the patient’s abdomen and pelvis. The abdomen is bloated and

tender.

Patient status – ECG: Sinus tachycardia. Heart rate: 118. Pulse: Present. Blood pressure:

19:10

106/76 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 92%. Temp: 99 F

(37 C)

19:22

You examined the back and spine. There is nothing to find on examination of the

back and spine.

19:33

You examined the patient’s arms. There is nothing to find on examination of the

arms.

Patient status – ECG: Sinus tachycardia. Heart rate: 118. Pulse: Present. Blood pressure:

20:10

 

atient status – ECG: Sinus tachycardia. Heart rate: 118. Pulse: Present. Blood pressure:

21:10

108/77 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 92%. Temp: 99 F

(37 C)

Patient status – ECG: Sinus tachycardia. Heart rate: 118. Pulse: Present. Blood pressure:

22:10

108/77 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 92%. Temp: 99 F

(37 C)

Patient status – ECG: Sinus tachycardia. Heart rate: 118. Pulse: Present. Blood pressure:

23:10

109/78 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 92%. Temp: 99 F

(37 C)

23:59

You washed your hands.

Patient status – ECG: Sinus tachycardia. Heart rate: 117. Pulse: Present. Blood pressure:

24:10

107/76 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 91%. Temp: 99 F

(37 C)

Patient status – ECG: Sinus tachycardia. Heart rate: 117. Pulse: Present. Blood pressure:

25:10

109/77 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 91%. Temp: 99 F

(37 C)

25:24

You placed a nasal oxygen cannula. This was part of your orders.

25:29

You started giving the patient warm, humidified oxygen.

Patient status – ECG: Sinus tachycardia. Heart rate: 115. Pulse: Present. Blood pressure:

26:10

110/77 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 93%. Temp: 99 F (37

C)

Patient status – ECG: Sinus tachycardia. Heart rate: 112. Pulse: Present. Blood pressure:

27:10

106/76 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 95%. Temp: 99 F

(37 C)

27:14

You listened to the abdomen of the patient. You could hear hyperactive sounds

from the abdomen.

27:27

You examined the patient’s abdomen and pelvis. The abdomen is bloated and

tender. There is decreased skin turgor. His skin is quite cold.

27:46

A patient handoff was performed.

Vomiting results in a loss of hydrogen ions and potassium from the stomach,

leading to a reduction of chlorides and potassium in the blood and to metabolic

alkalosis. Dehydration and acidosis develop from loss of water and sodium. With

acute fluid losses, severe hypovolemia and hypovolemic shock may occur, and

fluid resuscitation is critical. Treatment of metabolic alkalosis is aimed at

reversing the underlying disorder (small bowel obstruction, in this patient). Severe

dehydration is managed by administering sodium chloride (isotonic) fluids to

restore normal fluid volume. Serial abdominal x-rays are used to assess

progress. In this case, the obstruction is secondary to adhesions from prior

surgeries.

You got 96%

 

 

 

 

 

 

 

 

 

SCIENCE
HEALTH SCIENCE
NURSING
NUR 3262L

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