Carla Hernandez Guided questions PDF

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Name: Amy Dang Instructor: Diep Pham

Maternity Case 4: Carla Hernandez Guided Reflection Questions Opening Questions How did the simulated experience of Carla Hernandez’s case make you feel? -

I felt really nervous, especially when the patient was moaning. This simulation gave me an amazing experience with umbilical cord prolapse when the baby needs interventions right away to stay alive.

Describe the actions you felt went well in this scenario. The actions that went well in this scenario: -

Calling the provider, and the surgeon team to get her ready for a C-section.

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Giving her Terbutaline to slow down her contractions

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Giving Lactated Ringer’s 500 mL IV bolus for abnormal FHR

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Comforting her

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Repostioning the baby to release pressure on the umbilical cord.

Scenario Analysis Questions1 EBP Consider the emergent nature of umbilical cord prolapse. What nursing actions should be initiated immediately? Why? Immediately wear sterile glove and place hand into patient's vagina to push the fetus off the umbilical cord so that the baby can get enough oxygen. Contact surgical team and physician for an emergency C-section. PCC

What is the priority need for Carla Hernandez at this time?

1 The Scenario Analysis Questions are correlated to the Quality and Safety Education for Nurses (QSEN) competencies: Patient-Centered Care (PCC), Teamwork and Collaboration (T&C), Evidence-Based Practice (EBP), Quality Improvement (QI), Safety (S), and Informatics (I). Find more information at: http://qsen.org/

From vSim for Nursing | Maternity and Pediatric. © Wolters Kluwer Health.

Repositioning her: knee-to-chest, trendelenburg, hips higher than chest, modified Sims to release compression on umbilical cord. Making sure the baby gets enough O2, preventing fetal complications, attaching non-rebreather mask for her, administering Terbulatine to slow down her contraction and getting everything ready for C-section.

T&C

What key elements would you include in the handoff report for this patient? Consider the situation-background-assessment-recommendation (SBAR) format.

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She is having umbilical cord prolapse which is causing the baby to have bradycardia. FHR was only 105 bpm, I already push the baby off the cord.

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The provider broke her water

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Her vital signs are stable: BP 140/82, P 90 bpm, RR 15, Sp02 97, T 99.

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Her pain level is 2/10.

S/QI/I Based on your experience with Carla Hernandez’s case, reflect on possible nursing actions for enhanced safety and quality improvement. In emergency situations like this, a nurse should know what to prioritize when assessing the patient to enhance safety and quality improvement. Monitoring both mother and fetal heart rate, assessing the vagina, asking how the mother feels should be the nurse’s prioritization.

Concluding Questions Reflecting on Carla Hernandez’s case, were there any actions you would do differently? Explain. I would have prioritized assessing the fetal heart rate and assessed the patient’s vagina to see what was happening to her the baby and assessed why the baby was experiencing bradycardia. Describe how you would apply the knowledge and skills that you obtained in Carla Hernandez’s case to an actual patient care situation. I would be really careful about administering the patient pain medication, especially in this case when the FHR is dropping so opioids like will make the situation worse.

From vSim for Nursing | Maternity and Pediatric. © Wolters Kluwer Health.

From vSim for Nursing | Maternity and Pediatric. © Wolters Kluwer Health....