Clinical v Sim Assignments Jackson Weber PDF

Preview

Summary

med...

Description

CONCEPT MAP WORKSHEET DESCRIBE DISEASE PROCESS AFFECTING PATIENT (INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS) Epilepsy is a disorder of the central nervous system that effects the function of the brain causing recurrent or unprovoked seizures resulting from disruption of electrical communication of the neurons of the brain. The neurons fire when they shouldn’t and fail to fire when they should. Epilepsy can be an acquired disorder due to brain injury but in majority of cases the cause is unknown.

DIAGNOSTIC TESTS (REASON FOR TEST AND RESULTS) EEG- to determine the electrical activity in the brain Serum glucose and electrolytes to determine precipitating factors

PATIENT INFORMATION 5 yo male patient with 2 years history of tonicclonic seizure disorder

ANTICIPATED PHYSICAL FINDINGS Contusion, wounds, abrasions, confusion, tongue biting injuries, urinary incontinence, anxiety

Cardiac Apnea Monitor CT or MRI: to determine location of seizure activity in the brain

ANTICIPATED NURSING INTERVENTIONS Focused assessment of cardiac, respiratory, and neurological function Pain assessment using the FACES scale Health hx including information of onset of seizures, seizure control, date of last seizure and length of time it lasted, precipitating causes Assessment of medication compliance Oxygen administration IV assessment Lab serum, glucose, electrolytes and therapeutic levels of medication Pt and family education of epilepsy and medication purposes and potential complications Pt safety and comfort Seizure precautions

vSim ISBAR ACTIVITY

STUDENT WORKSHEET

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

SITUATION

Jackson Weber, 5 yo M, seizure disorder

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

Epilepsy, admitted on 7/18/2020, -Seizure precautions -Vital signs q4H -Neuro checks q4H -Cardiac apnea monitor -Continuous pulse ox-2 L O2 per nasal cannula -Nonrebreather mask with 100% supplemental O2 -D5 ½ NS + 20 mEq KCl/L at 58/min-Phenobarbital elixir 50 mg PO BID -Regular diet, Strict I&O, daily weights -Activity as tolerated VS T 98 BP 118/79 SpO2 99% RR 14 Pain level: 0 out of 5 HR 100 ECG: sinus rhythm

Recommendation to continue to monitor and regain therapeutic levels of Phenobarbital as well as pt and family education on importance of maintain medication administration as prescribed.

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

MEDICATION: Phenobarbital

CLASSIFICATION: Anticonvulsant

PROTOTYPE: barbiturate SAFE DOSE OR DOSE RANGE, SAFE ROUTE IV (Adults and Children >1 mos): 15-18 mg/kg in a single dose or divided dose, maximum loading dose 20 mg/kg IV (Neonates): 15-20 mg/kg in a single or divided dose IV, PO (Adults and Children >12 yo): 1-3 mg/kg/day as a single dose or 2 divided doses IV, PO (Children 5-12 yo): 4-6 mg/kg/day in 1-2 divided doses IV, PO (1-5 yo): 6-8 mg/kg/day in 1-2 divided doses IV, PO (Infants): 5-6 mg/kg/day in 1-2 divided doses IV, PO (Neonates) 3-4 mg/kg/day once daily, may need to increase up to 5 mg/kg/day by 2nd week of therapy PURPOSE FOR TAKING THIS MEDICATION Inhibits transmission in the nervous system and raises seizure threshold; anticonvulsant

PATIENT EDUCATION WHILE TAKING THIS MEDICATION Take medication as prescribed by HCP Do not discontinue medication without consulting HCP May cause drowsiness Notify HCP for fever, angioedema, sore throat, mouth sores, rash, unusual bleeding or bruising, nosebleeds, or petechiae Pt may experience irritability, hyperactivity, and sleep disturbances that may diminish in a few weeks or may continue

Clinical Worksheet Date: 7/18/2020 Initials:

Student Name: Diagnosis: Epilepsy

HCP:

Length of

Consults:

Assigned vSim: Jackson Weber Isolation:standard

J.W. Fall Risk: Age: 5 M/F:M

IV Type: peripher al Location: left forearm

Critical Labs: Hgb: 12 HCT: 35 Cl: 97 HCO3: 28 Phenobarbital: 8

Other Services:

Consults Needed:

Transfer: Stay:1 day

Code Status:Full Allergies:NKA

Fluid/Rate: 58 mL/hr of potassium chloride in 5%dextrose and NS

Why is your patient in the hospital (Answer in your own words and include the History of present Illness)?: Patient has a history of seizures from the age of 2 and has successfully managed on medication regimen of Phenobarbital. A lack of compliance to the prescribed medication lowered the levels of Phenobarbital below the therapeutic range causing a recurrence of seizures. Health History/Comorbities (that relate to this hospitalization): Hx of epilepsy diagnosed age 2

Shift Goals/ Patient Education Needs: 1. Patient safety 2. Education regarding medication purpose and compliance 3. Maintain SpO2 >92% 4. Pt remains alert and oriented appropriate for developmental level Path to Discharge: Pt and pt’s family accept education regarding the importance of taking Phenobarbital as is prescribed and Phenobarbital is returned to its therapeutic levels relieving the pt from further seizure activity.

Path to Death or Injury: Pt and pt family remain noncompliant with prescribed medication Phenobarbital, levels continue to fluctuate below therapeutic levels. Seizure activities continue sporadically and pt suffers aspiration.

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.

Mental status changes

1. Maintain pt safety

2.

Hypoxia

2. Assessment of neurological function before and after seizures

3. aspiration

4.

Continuous SpO2

5.

Continuous NIBP

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

6.

Respiratory assessment

1.

Neurological assessment

7.

Pt education of medication

2.

Pulse oximetry monitoring

Priorities for Managing the Patient’s Care Today 1. Pt safety

3.

Respiratory assessment 2.

Neurological assessment

3.

Respiratory assessment

4.

Pt education

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

Injury from falls

2.

Aspiration

3.

Stroke

What aspects of the patient care can be Delegated and who can do it? Maintaining Pt safety I&Os VS

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

1.

Neurological assessment

2.

Respiratory assessment

3.

Continuous pulse ox monitoring

4.

Continuous NIBP

Clinical Worksheet

Reflection Questions Paste your reflection questions in the box below

Opening Questions How did the simulated experience of Jackson Weber’s case make you feel? The scenario made me a bit flustered for the suddenness of the seizure initially but eventually was able to rely on my educational experiences to take the appropriate steps to keep the patient safe. Describe the actions you felt went well in this scenario. I felt the assessments went well, the respiratory and neurologic assessments as well as the utilization of the pain scale. Scenario Analysis Questions1 EBP/S What priority problem did you identify for Jackson Weber? The priority problems for the patient was the risk for injury, the insufficient knowledge of medication administration, the low level of the medication Phenobarbital, and the low oxygenation. EBP

What complications might Jackson Weber face if safety precautions are not taken during the seizure activity and if treatment is not implemented after the seizure? The patient could sustain injury due to the lack of medication administration as prescribed, hypoxemia as it relates to the lack of effective breathing pattern and aspiration.

PCC What should the nurse teach Jackson Weber’s mother regarding the ongoing care of his condition? The pt should wear a medical alert bracelet at all times, be supervised during activities such as swimming, maintain proper medication administration as prescribed by his HCP, and obtain regular laboratory studies to determine therapeutic levels of medication. PCC/S What seizure precautions should be taken by the nurse in anticipation of and at the onset of Jackson Weber’s seizure? How might such precautions vary from hospital to hospital? The nurse should remove from the area during a seizure, and turn the patient on the side lying position to prevent aspiration. The side rails of the bed should be fitted with seizure pads and a medical alert bracelet should be worn at all time. PCC/S Describe strategies to empower Jackson Weber and his mother in the management of his seizures. Providing both patient and parent with printed information to refer back on both during and after education. The nurse should provide patient education at a developmentally appropriate level. Explain the purpose of the medication and the potential complications of failure to adhere. T&C List potential team members in Jackson Weber’s care. (Explain your answer.) The patient, family, HCP, pharmacist, nurse, social worker, and neurologist would all be a part of the team caring for J.W. The patient needs to be taught self care, the family is key in both managing the illness until the patient is able to care for himself and for reinforcing educational material. The pharmacist may explain the medication purpose, dosages, and side effects. The nurse can provide pt education, comfort, and be the advocate the patient requires. The HCP can treat the patient’s ongoing medical needs. The social worker can provide the family with the support and resources they need. The neurologist may monitor the progression of the illness, and provide ongoing evaluation of the medications effects on seizure activity.

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/

T&C/I What key elements would you include in the handoff report for this patient? Consider the situation-background-assessment-recommendation (SBAR) format. The VS, pain level of 0 on a scale of 0-5, the hx of seizures, the current reason for admittance and seizure activity since admittance as well as the laboratory reporting below therapeutic levels of Phenobarbital. The patient’s respiratory and neurologic assessment results before and changes to baseline after seizure occurrence. Oxygen therapy by NRB running at 12L/min. The recommendation would be to attempt to return the medication levels to therapeutic levels and continue to monitor as well as provide education to pt and family.

Concluding Questions Reflecting on Jackson Weber’s case, were there any actions you would do differently? If so, what were these actions, and why would you do them differently? I would attempt to provide developmentally appropriate education as well as provide emotional support, an action limited in the virtual simulation. I feel education is best absorbed in environments that encourage open communication in a positive way. Describe how you would apply the knowledge and skills you obtained in Jackson Weber’s case to an actual patient care situation. In a real situation I would use the steps in maintaining patient safety as well as seek causes for the increased seizure activity such as in this case where the medication regime was not followed as prescribed.

Clinical Judgement Components Scoring: Exemplary = 4 point Accomplished = 3 points Developing = 2 points Beginning = 1 point Score: vSim 1

Noticing: Focused Observation: Recognizing Deviations from Expected Patterns: Information Seeking:

EAD B EAD B EAD B

Total for category: Interpreting: Prioritizing Data: Making Sense of Data:

EAD B EAD B

Total for category: Responding: Calm, Confident Manner: EAD B Clear Communication: EAD B Well-Planned Intervention/Flexibility: EAD B Being Skillful EAD B Total for category: Reflecting: Evaluation/Self-Analysis: EAD B Commitment to Improvement: E A D B

Total for category:

Score: vSim 2

Score: vSim 2...