Amber Rhodes ticket PDF

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Simulation Lab Admission Ticket

Patient Name: Amber Rhodes SIM Visit: #3 Diagnosis and Demographic information: Preeclampsia, Biracial Female Allergies: Penicillin DOB: March 12 Age: 35

Goals: • Performs safe patient care using DCN protocol (CO 1, 2, 3, 4, 5, 6, 8, 9, 10) • Performs a head-to-toe assessment and recognizes normal and abnormal findings (APPLYING) (CO 2, 4, 8, 9) • Designs an individualized nursing plan of care based on subjective/objective assessment data (CREATING) (CO 1, 2, 3, 4, 5, 6, 8) • Performs safe medication administration (APPLYING) (CO 10) • Uses therapeutic communication to actively engage patient and family in plan of care (APPLYING) (CO 7) • Demonstrate teamwork and collaboration skills, including delegation (APPLYING) (CO 5) • Evaluates the patient’s responses to nursing interventions (EVALUATING) (CO 2, 4, 9) Review (skills): 1. Assessment of basic environmental safety and measures to maintain a safe environment (SWIPE/BRowN COW) 2. Safe medication administration process 3. Head-to-toe and OB focused assessment (BUBBLE LE) for the intrapartum patient 4. Fetal heart rate and uterine contraction interpretation 5. Intrauterine resuscitation measures Complete the following homework on pp. 15-18, due 24 hours prior to your simulation class: Use your Maternity & Women’s Health Care Book by Lowdermilk, et al 12th edition 1. Briefly define and describe the following conditions, including signs & symptoms: (pp. 583-596)  Gestational Hypertension: Development of hypertension after week 20 of pregnancy in a previously normotensive woman without proteinuria or other systemic findings (Lowdermilk, 2020, 584).  Preeclampsia: Development of hypertension and proteinuria in a previously normotensive woman after 20 weeks of gestation or in the early postpartum period. In the absence of proteinuria, the development of new-onset hypertension with the new onset of any of the following: thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or cerebral or visual symptoms (Lowdermilk, 2020, p 584)

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Eclampsia: Development of seizures or coma not attributable to other causes in a preeclamptic woman (Lowdermilk, 2020, p 584). HELLP Syndrome: laboratory diagnosis for a variant of preeclampsia that involves hepatic dysfunction, characterized by hemolysis (H), elevated liver enzymes (EL), and low platelet (LP) count (Lowdermilk, 2020, p 587).

2. What are maternal risk factors for developing Preeclampsia? (p. 586 box 27-1)  Risk factors for preeclampsia include advanced maternal age, nulliparity, unmarried status, African American race, multiple fetuses, chronic hypertension, diabetes, and history of preeclampsia (Lowdermilk, 2020, p 584). 3. What are common lab changes (increase or decrease) associated with the following disorders: (p. 586, table 27.3)  Preeclampsia: H&H may increase, fibrinogen 300-600 mg/dL, fibrin split can be absent or present, creatinine >1.1 mg/dL, creatinine clearance 130-180 mL/min, burr cells or schistocytes are absent, uric acid >5.9 mg/dL, bilirubin is unchanged or increased  HELLP syndrome: H&H is decreased, fibrinogen is decreased, fibrin split products are present, creatinine is increased, creatinine clearance Is decreased, burr cells or schistocytes are present, uric acid >10 mg/dL, and bilirubin increases (Lowdermilk, 2020, p 586). 4. List 4 medications to lower blood pressure in severe preeclampsia (p. 595)  Methyldopa, Labetalol, nifedipine, and a thiazide diuretics (Lowdermilk, 2020, p 595). 5. What does IV magnesium sulfate treat and how does it work? (p. 593)  Magnesium sulfate is the medication of choice for preventing and treating seizure activity. It is unclear how magnesium sulfate works to prevent and treat eclamptic seizures. It may cause vasodilation in the peripheral and cerebral circulation, prevent or decrease cerebral edema, or function as a central anticonvulsant (Lowdermilk, 2020, p 593). 6. What are signs and symptoms of magnesium toxicity? (p.593)  Symptoms of magnesium toxicity include absent DTRs, decreased respiratory rate, and decreased level of consciousness (Lowdermilk, 2020, p 593). 7. What is the antidote for magnesium sulfate toxicity? (See your OB med log)  Calcium gluconate 8. List 2 education points for a woman receiving magnesium sulfate.  Explain the purpose of the medication to the patient

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Explain what symptoms of toxicity are and what to look for.

9. Develop a potential nursing care plan for Amber Rhodes ( see patient report below) based on the knowledge gained from your ticket. Choose ONE priority nursing diagnosis, then follow the template guidelines to complete the care plan on the following page. Amber Rhodes is a 35-year-old, G1 P0 (0000), at 33 weeks gestation. Allergy to PCN. Her DOB 3/12. Her BMI is 27. She is biracial; father is black, and mother is white. She presented to her OB clinic today with complaints of a “bad headache that has lasted 2 days, unrelieved by Tylenol, and blurred vision”. In the last two days she has also noticed that her hands and feet have become “very swollen”. She had a 5 lb. weight gain in the past week. Her blood type is A+, GBS is unknown. Her VS in the office: BP 168/96, HR 98, RR 20, O2 Sat 94% on RA, and Temp 98.4 F (36.9 C). DTRs are 3+ and no clonus, and 3+ pitting pedal & ankle edema. 2+ protein on urine dip. FHR assessment: 150 baseline, moderate variability, no accelerations or decelerations noted. No contractions noted. Amber has noticed less fetal movement in the last few days. SVE was closed (not dilated)/thick (0% effaced)/high (presenting part not in pelvis) and membranes are intact. She has arrived and has been admitted to L&D and is awaiting your RN assessment…

Priority Problem Nursing Diagnosis (NANDA approved)

R/T (Pathophysiology of diagnosis, cannot AEB (of diagnosis) Refers to the problem be medical diagnosis) NOT the R/T. This is assessment data

Priority Risk Nursing Diagnosis (NANDA approved) Risk for maternal injury

Risk Factors: Elevated BMI, high blood pressure

Assessment Data (Include at least three to five [total] objective, subjective, and/or historical pieces of data that would lead to the nursing diagnosis

Goal (One goal that is patient focused and SMART: Specific, Measurable, Attainable, Reasonable, and Time specific)

Nursing Interventions (List three nursing and/or order driven interventions that relate to your goal)

Subjective… -headache that won’t go away

Patient will participate in treatment and/or environmental modifications to protect self and enhance safety.

1. RN will educate the patient about preeclampsia

Objective… -BP of 168/96 -BMI 27

2. RN will check for any alterations in level of consciousness

3. RN will assess DTR Historical…

Rationale (Provide a reason why each intervention is indicated and/or therapeutic, and provide reference for each in APA format, DO NOT COPY AND PASTE) 1. Education can help prevent the progression of preeclampsia and will help patients get help early on (Ackley, et al., 2020)

2. Alterations in levels of consciousness can indicate the progression of

Outcome Evaluation (How will you know when the goal has been met? Provide specific data you will be assessing; what will your evidence be?) The goal was met. The patient was able to verbalize the teaching from the nurse. The nurse teach the patient what to look for when doing the DTRs.

preeclampsia to eclampsia (Ackley, et al., 2020)

3. DTRs are vital in knowing if the preeclampsia is under control (Ackley, et al., 2020)

Review the following medications from your Med Log: Use dimensional analysis to determine the calculations needed for administration. Show your work. 1. Magnesium Sulfate 4g in 100ml NS bag IVPB over 15 minutes (loading dose) - the infusion pump is set to what rate (ml/hr)? a. 400 mL/hr 2. Magnesium Sulfate 2g/1hr IVPB continuous infusion (maintenance dose), IV bag concentration 10g/250mL NS - the infusion pump is set to what rate (ml/hr)? a. 50 mL/h 3. Calcium Gluconate 1g IV direct, vial concentration 1000 mg/10mL - how many ml will you give? a. 10 mL 4. Hydralazine 5mg & 10mg IV direct, vial concentration 20mg/mL - how many ml will you give for each dose (5mg & 10mg)? a. For 5 mg: 0.25 mL b. For 10 mg: 0.5 mL 5. Betamethasone (Celestone Soluspan) 12mg IM, vial concentration 6mg/mL - how many ml will you give? a. 2 mL

References Ackley, B. J., & Ladwig, G. B. (2020). Nursing Diagnosis handbook: an evidence-based practice guide to planning care. Twelfth edition. Maryland Heights, Missouri: Mosby Elsevier.

Lowdermilk, D.L, Perry, S.E, Cashion, K., Alden, K.R, & Olshansky, E.F (2020). Maternity & Women’s Health Care. Elsevier. 12th edition....