Christopher parrish Clinic (3)Correct PDF

Preview

Summary

Vsim clinical...

Description

CONCEPT MAP WORKSHEET DESCRIBE DISEASE PROCESS AFFECTING PATIENT (INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS) Cystic Fibrosis This is a hereditary disease that affects the lungs and digestive system This body produces a sticky mucous that obstructs the lungs and pancreas This mucous obstruction leads to the inability for enzymes to breakdown and help digest food and nutrients

DIAGNOSTIC TESTS (REASON FOR TEST AND RESULTS) Total protein to asses protein levels

PATIENT INFORMATION Christopher Parrish 18 Y/O

ANTICIPATED PHYSICAL FINDINGS I anticipate finding low protein and Used lowered nutrient levels. Patient was not experiencing any severe pain. Anticipate finding low body mass index and Lost 12 pounds over past two weeks.

Male BMPUsed to measure electrolyte levels HCO3 Used assess the acid-base disturbance

White non-Hispanic

ANTICIPATED NURSING INTERVENTIONS Educate The patient about the importance of diet Educate patient about intake and output Assist with enteral tube feeding, and risk of aspiration Consult nutritionist experts Flushed and checked placement of NG tube before initiating tube feeding

vSim ISBAR ACTIVITY INTRODUCTION Your name, position (RN), unit you are working on

SITUATION Patient’s name, age, specific reason for visit

BACKGROUND Patient’s primary diagnosis, date of admission, current orders for patient

ASSESSMENT Current pertinent assessment data using head to toe approach, pertinent diagnostics, vital signs

RECOMMENDATION Any orders or recommendations you may have for this patient

STUDENT WORKSHEET Student Registered Nurse Memorial Hospital

Christopher Parrish 18-year-old male Cystic fibrosis No known allergies Recent unintentional loss of 13.5 lbs. Primary Dx- Cystic fibrosis Admitted on 04/18/2020 Orders- Vital signs every 4 hours, daily input and output, daily weight, chest X-ray, NG tube insertion. Diet-high calorie, high protein, regular diet, supplement with high protein snacks. Fluid nutrition (1.5 kcal) 720 kcal over 8 hours during the night. Snack consisting of 2 multivitamin tablets provided PO every morning Medications: Pancrelipase enzymes 5 capsules PO before meals and tube feedings, 3 capsules PO with snacks Head= all findings normal/ neuro assessment normal/ pupils dilated 4 mm Chest= all findings normal/ normal heart sounds/ clear lung sounds Abdomen= all findings normal/ normal bowel sounds Arms= all findings normal Legs= All findings normal Skin= all findings normal, normal turgor, adequate hydration Mucosa= moist, no signs of dehydration Vitals= BP 122/72, Temp 99 F, Pulse 84 regular, RR 12, SpO2 96% on room air I would recommend continuous assessment of dietary intake Consult with nutrition Assisting with enteral tube feedings and assessment of NG tube

PHARM-4-FUN PATIENT EDUCATION WORKSHEET NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE

MEDICATION: pancrelipase

CLASSIFICATION: digestive agent, pancreatic enzyme

PROTOTYPE: Zenpep

SAFE DOSE OR DOSE RANGE, SAFE ROUTE

PO 500- 2500 lipase units per meal PURPOSE FOR TAKING THIS MEDICATION

Increased digestion of fats, carbohydrates, and proteins in the GI tract

PATIENT EDUCATION WHILE TAKING THIS MEDICATION

Take only as indicated Follow diet plan prescribed by HCP Chew and or swallow tablets quickly with lots of liquid Label this product correctly to avoid mix-up Notify HCP if vomiting, diarrhea, nausea, abdominal distention, joint swelling, or constipation occur

Clinical Worksheet Date: 04/18/2020 Initials:

Assigned vSim: Christopher Parrish

Student Name: Diagnosis: Cystic fibrosis

HCP: Dr. Richard Barlowe

Isolation: No

CP Age: 18

Length of Stay:

Consults:

IV Type: N/A Location: N/A

Fall Risk:

Critical Labs:

Other Services: Wound care

Albumin Prealbumin CMP Consults Needed:

M/F:

Nutrition

Fluid/Rate:

1 day

No

Allergies: None

Transfer:

Occupational/ physical therapy

male Code Status: Full Code

N/A

N/A

Why is your patient in the hospital (Answer in your own words and include the History of present Illness)?: My patient is in the nursing facility due to a worsening of cystic fibrosis which has caused his dietary intake to become impaired leading to unintentional weight loss.

Health History/Comorbities (that relate to this hospitalization): The patient has a history of cystic fibrosis

Shift Goals/ Patient Education Needs: 1. Client will be able to explicit knowledge dietary needs 2. Client will improve dietary intake 3. Client will be able to ingest an adequate amount of his meals 4. Client will be able to understand her need to watch for BMI

Path to Discharge: Client will have improved his dietary intake and continue to follow the prescribed HCP diet and medication therapy

Path to Death or Injury: Client will neglect diet and will begin to deteriorate due to a lack of adequate nutrition.

Alerts: What are you on alert for with this patient? (Signs & Symptoms)

Management of Care: What needs to be done for this Patient Today?

1.

Further weight loss

1. This patient needs to have NG tube placement assessed

2.

Electrolyte imbalance

2. Assistance with feedings

3.

Inadequate diet tolerance

3. Vital signs taken to monitor overall status 4. Measurement of intake and output

What Assessments will focus on for this patient? (How will I identify the above signs &Symptoms?)

5.

Administration of prescribed medications to inadequate nutrient breakdown

1.

Continuous assessment intake

6.

Receive hydration and proper nutrition as prescribed

2.

Assessment of labs

Priorities for Managing the Patient’s Care Today 1. Continuous assessment of intake and output

3.

Assessment urine and stool 2.

Ensure diet is follows as tolerated

3.

Ensure prescribed medications are administered

4.

Ambulation to avoid weakness

List Complications that may occur related to dx, procedure, comorbidities: 1.

Atrophy of musculoskeletal components

2.

Decay of teeth

3.

GERD

What nursing or medical interventions may prevent the above Alert or complications? 1.

Continuous changing assistance with dietary intake

2.

Educating client on need to follow prescribed diet

3.

Educating client to remain sitting up after tube feedings

4.

Provide Pancrelipase as prescribed before meals, feedings, and snacks

What aspects of the patient care can be Delegated and who can do it? The collection and recording of output can be delegated to a UAP. Nutritional assessment can be delegated to a nutritionist.

Christopher Parrish Guided Reflection Question Opening Questions How did the simulated experience of Christopher Parrish’s case make you feel? In this simulation I was very nervous because I did not give the pancrelipase in the correct order to the patient and I repeated the scenario until I got it right. Now I feel confident in the medication administration to the patient and also in assessing and start a tube feeding. Talk about what went well in the scenario. What went well in this client’s case is that he was educated on diet, tube feeding, and the risks of aspiration. This will prepare him to receive the necessary nutrition. Reflecting on Christopher Parrish’s case, were there any actions you would do differently if you were to repeat this scenario? If so, how would your patient care change? I believe the case went very smoothly; however, I would like to have better assessed urine output for signs of dehydration. Scenario Analysis Questions PCC What priority problem(s) did you identify for Christopher Parrish? Mr. Parrish’s priority problem was the nutritional deficit. This may cause electrolyte imbalances and essential nutrient insufficiencies. These problems can alter normal body function and cause musculoskeletal atrophy. PCC

What potential problems could arise due to Christopher Parrish’s identified Vitamin D deficiency? The patient may experience atrophy of muscles and organs, decay of bones and teeth, electrolyte imbalance, anorexia, and even insufficient quantities of essential nutrients.

PCC

Discuss the relationship between pancreatic enzymes, malabsorption, and CF. Patients with CF are unable to produce essential enzymes that help breakdown and absorb food nutrients. This causes an inability to gain necessary calories and nutrients needed by the body.

PCC/S/EBP

What are important assessments related to administration of enteral feedings? Important assessments to consider are the placement of the tube, bowel movements, check for tubular obstruction, and assessment of the gastric contents.



 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/

PCC/T&C

Using Erikson’s developmental stages, discuss the importance of peer

relationships/support group with other young adults with cystic fibrosis.

A peer support group may help the patient in this case be able to identify with those similar to him. This may lead to acceptance and confirmation of who he is. S/EBP Identify potential patient safety issues related to nutritional status in the care of Christopher Parrish. Some of the safety issues related to the nutritional status include weakness that may cause falls. Other issues can include nervous system defects from potassium and sodium imbalances. T&C

What other interprofessional team members should be involved in Christopher Parrish’s care? An important team member to include in this case is a nutritionist to assess his case with an HCP and help prescribe a diet that meet his needs.

Concluding Questions Describe how you would apply the knowledge and skills that you acquired in Christopher Parrish’s case to an actual patient care situation. Given the obtained knowledge, I would implement education regarding the importance of nutrition and reaching out for help if those nutritionals needs cannot be met independently in this kind of patient.

Clinical Judgement Components Scoring: Exemplary = 4 point Accomplished = 3 points Developing = 2 points Beginning = 1 point Noticing: Focused Observation: Recognizing Deviations from Expected Patterns: Information Seeking:

EAD B

Score: vSim 1  A  E  E

EAD B EAD B

Total for category:

11

Interpreting: Prioritizing Data: Making Sense of Data:

 

E E

   

A E E E

 

E E

EAD B EAD B

Total for category: 8 Responding: Calm, Confident Manner: EAD B Clear Communication: EAD B Well-Planned Intervention/Flexibility: EAD B Being Skillful EAD B

Total for category: 15 Reflecting: Evaluation/Self-Analysis: EAD B Commitment to Improvement: E A D B

Total for category: 8

Score: vSim 2

Score: vSim 2...