Jared Griffin Clinical Packet PDF

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CONCEPT MAP WORKSHEET DESCRIBE DISEASE PROCESS AFFECTING PATIENT (INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS)

Methicillin-Resistant Staphylococcus Aureus (MRSA) = an infection with a mutated strain of Staphylococcus bacteria o Resistant to Methicillin and other antibiotics o Easily spread by direct person-to-person contact Community-associated MRSA infection: o Most found in young, healthy people (EX: athletes) w/o recent health care exposure

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DIAGNOSTIC TESTS (REASON FOR TEST AND RESULTS)

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Cultures of blood, nasal secretions, skin, or soft tissue are positive for the bacteria CBC with differential could reveal an elevated WBC count = indicating infection

Patient Information

-Jared Griffin is a 63-yearold African-American male who had a right total knee arthroplasty (TKA) yesterday morning -Patient has a history of MRSA (diagnosed 3 years ago) -Has a history of osteoarthritis and mild hypertension

ANTICIPATED NURSING INTERVENTIONS

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Use meticulous hand hygiene o Use appropriate PPE Use standard and contact precaution Provide skin and wound care Obtain wound cultures (as ordered) Provide any assistance w/ambulation o Consult with physical therapists (ROM exercises) o Dietician o Infection control team Provide emotional support to the patient and family member(s) Allow the patient to any feelings and concerns Provide an open discussion and any questions honestly and clearly o Use terms they’ll understand o Include patient education

Anticipated Physical Findings

Signs and symptoms related to the primary site of infection such as joints, skin, and respiratory - Skin: edema, erythema, painful, warm to touch, pus - Furuncle: abscess with purulent drainage

vSim ISBAR ACTIVITY WORKSHEET INTRODUCTION

STUDENT 

Hi, my name is Jonelle, and I am a student nurse from Nova Southeastern University. I’m rotating on the Orthopedic unit 0800

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Patient is Jared Griffin a 63-year-old African-American male who had a right TKA (total knee arthroplasty) yesterday morning

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Admitted 04/02/2020; admitting diagnosis: right TKA surgery Mr. Griffin has a history of MRSA o Diagnosed: 3 years ago, during a surgery for a hammertoe Mr. Griffin also has a history of: o Osteoarthritis o Hypertension Allergies = Codeine

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

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 ASSESSMENT

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

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Vital signs performed: BP: 135/80 mmHg, Pulse: 80 bpm (radial), RR: 15 bpm, T: 99.8F (ear), SpO2: 97% Pain level: 2/10. Patient states “It hurts a bit when I bend my knee” (as expected). Nothing has made the pain better Right knee examined: o Right knee can bend 75 degrees Dressing cover for skin lesion on lower right leg Normal elasticity of the skin Color is normal and not sweating, normal elasticity, normal turgor Neural assessment performed: passed Incentive spirometer used as order (10 times every hour)

RECOMMENDATION Any orders or recommendations you may have for this patient

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Continue with contact precaution Observe for signs and symptoms of infection Assess vital signs Pain assessment o Medicate patient before wound dressing Consult: o Physical therapy, occupational therapy o Dietician o Infection control team Orders: o Hydrochlorothiazide 25mg PO twice daily o Enoxaparin sodium 40mg subcutaneously daily o Oxycodone/ Acetaminophen 10/325 mg PO every 4hrs PRN for pain o Vital signs and neurovascular checks every 4hrs o BMP (basal metabolic panel) o Check labels

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

MEDICATION:  Oxycodone – Acetaminophen  Enoxaparin – Sodium

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CLASSIFICATION: Oxycodone – Acetaminophen: opioid analgesics Enoxaparin – Sodium: low molecular weight heparin

PROTOTYPE: Oxycodone – Acetaminophen: morphine Enoxaparin – Sodium SAFE DOSE OR DOSE RANGE, SAFE ROUTE Oxycodone – Acetaminophen: 5-10mg q 3-4hrs PRN for pain Enoxaparin – Sodium: 30mg every 12 hrs. PURPOSE FOR TAKING THIS MEDICATION

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Oxycodone – Acetaminophen: Pain Enoxaparin – Sodium: to prevent blood clots (patient post-op from knee surgery)

PATIENT EDUCATION WHILE TAKING THIS MEDICATION  

Oxycodone – Acetaminophen: - Patient can become dependent (both mentally and physically) when drug is used for a long time - Withdrawal side effects Enoxaparin – Sodium: - Bruising or bleeding (especially prolonged bleeding) - Bloody or black, tarry stools - Hypotension or a sensation of feeling dizzy or faint - Back pain: burning, pricking, tickling, or tingling sensation

Clinical Worksheet Date: 03/05/21 Initials: JG

Student Name: Jonelle Wray Diagnosis: Right TKA

Age: 63 M/F: M

Length of Stay:

HCP: Dr. Lonny Washington

Consults: Physical therapy, occupational therapy, and dietician

Assigned vSim: Jared Griffin Isolation: contact

Fall Risk:

post-op

Code Status: Full code

IV Type: peripheral IV Location: right hand

Fluid/Rate: Clindamycin 600mg IV 8hrs for 3 doses

Critical Labs: CBC w/o differential Basic Metabolic Panel Prothrombin Time

Other Services:

Consults Needed:

1.5 days surgery Allergies: and Codeine geriatric

Transfer:

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Why is your patient in the hospital (Answer in your own words and include the History of present Illness)?: Mr. Griffin had a right total knee arthroplasty (TKA) yesterday morning. Patient has a history of MRSA, which was diagnosed 3 years when had surgery for his hammertoe. The patient also has a history of osteoarthritis and hypertension Health History/Comorbities (that relate to this hospitalization): MRSA Osteoarthritis

Shift Goals/ Patient Education Needs: 1. Proper wound care to prevent infection - Educate patient on the importance of proper wound - Observe for signs and symptoms of infection

2. Educate patient on the use of the incentive spirometer - patient education on the importance proper airway clearance and lung expansion

3. Educate patient about the use of PPE 4. Educate patient about the importance of proper diet when dealing with hypertension - consult w/ dietician 5. Patient will ambulate w/ assistance upon discharge - consult w/ physical therapists and occupational therapy Path to Discharge:  Patient will be able to over and protect any wounds or breaks in the skin and how to perform wound care.  Patient will be able to use assistive device, such as a walker, crutches cane  Safe ambulation practices Path to Death or Injury:  Improper safety precautions (i.e., inadequate hand hygiene, not wearing the correct PPE, not following both standard and contact precautions)

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

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

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Pressure ulcer – redness, warmth, edema, purulent discharge

Today?

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Pain – facial expressions (grimacing), moaning, and restlessness

1. Turn and reposition patient on a schedule

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Infection and complications - DVT, pressure ulcer, HAIs, etc.

2. Perform wound care

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

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Educate patient about the use of incentive spirometer

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Educate patient about wound care

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Educate patient about the use of PPE

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Braden Scale: Skin integrity – inspect the wound for any redness, drainage, temperature, and lesions

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Perform active and passive ROM exercises

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Pain Assessment – PQRST also observe patient’s body language and notice cues

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Administer medications order by HCP

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Physical examination – check for signs and symptoms of DVT and any other needs to notify the HCP

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Maintain standard and contact precautions

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Morse Scale: Fall risk – patient is a geriatric who just had invasive knee surgery

Priorities for Managing the Patient’s Care Today 1. Repositioning the client 2.

Wound care

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ROM exercises and ambulation

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Medication

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

DVT

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Immobility at the right knee

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Wound appearance – notice any signs of infection: drainage, color, smell, or edema

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Infection

What nursing or medical interventions may prevent the above Alert or complications? 1. Turn and reposition the patient on schedule (i.e., every hour; “I will reposition patient every two hours. UAP Johnson will turn on the odd hours) 2.

Increase the client’s activity after surgery

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Enforce safety measures to reduce the risk of injury (i.e., falls) – assist with any ambulation and ROM exercises to unaffected limbs

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Perform daily wound care and wound specimen collection

What aspects of the patient care can be Delegated and who can do it?  Repositioning the client on the odd hours  ADLs – bathing, eating, changing  I & O – accuracy just needs to be checked

Clinical Worksheet Reflection Questions Paste your reflection questions in the box below 

Opening Questions o How did the simulated experience of Jared Griffin’s case make you feel?

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I felt more prepared this time and I wasn’t as nervous. I was able to improve on any mistakes that I made last week and implement them in this week’s simulation. Overall, I feel good about the Jared Griffin vSim experience Talk about what went well in the scenario.

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 I was able to effectively educate the patient on the importance of the use of incentive spirometer and wound care. Reflecting on Jared Griffin’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?

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I gave him a certain medication at the wrong time but now I know to read the electronic health record more carefully.

Scenario Analysis Questions* o EBP/S What priority problem(s) did you identify for Jared Griffin?  o

Patient tested positive for MRSA (infection control; contact and standard precautions)

EBP/S

 Post-op right TKA surgery What potential problems could arise from improper infection control practices?

EBP

Entire hospital becomes at risk. Hospital must do a full investigation and mandatory shut-down. Primary cause of the spread is a risk for legal ramifications. Discuss the relationship between the spread of hospital-acquired infections (HAIs) and proper infection control? 

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Performing proper infection control (standard, droplet, airborne precautions) decreases the risk of spreading the pathogen. All healthcare personnel

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PCC/T&C

should perform proper hand hygiene, infection control precautions, etc. Discuss the importance of patient education on proper infection control practices.

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T&C

 Decreases the risk of potential spread of the infection for the both the patient at hand and the entire hospital What other interprofessional team members should be involved in Jared Griffin’s care?

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Physical therapy, OT

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Infection control team

 Dietician (patient education on the importance of diet when dealing with hypertension) Describe the safety measures that should be incorporated in Jared Griffin care. 

Standard and contact precautions

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Assistance w/ any ambulation

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Fall risk measures: - Side rails up x2 -

Call light within reach A b l i d i

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Concluding Questions o Describe how you would apply the knowledge and skills that you obtained in Jared Griffin’s case to an actual patient care situation

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I would implement patient education on the incentive spirometer, wound care, and diet. I would also maintain surgical asepsis when dressing the wound. Maintain both standard and contact precautions. While assisting with any ambulation needs and ROM exercises.

Nursing Notes: Patient was AAOx3. Vitals performed: BP: 135/80 mmHg (LUE, sitting), Pulse: 80 bpm (radial), RR: 15 bpm, T: 99.8F (ear), SpO2: 97%. Pain assessment performed: Pain level: 2/10. Patient states “It hurts a bit when I bend my knee” (as expected). Nothing has made the pain better. Administered pain medication: Oxycodone/ Acetaminophen 10/ 325mg PO (every 4hrs PRN for pain) Right knee examined: Right knee can bend 75 degrees. Used standard and contact precautions: patient diagnosed with MRSA 3 years ago during a surgery for a hammertoe (A foot condition in which the toe has an abnormal bend in the middle joint.) Performed a wound dressing (wet-to-dry dressing) while using sterile technique. Covered wound with ABD bandage (signed and dated) – provided patient education on the importance of wound care. Wound was slightly red, slight edema, no drainage, no signs of infection. – Pain medication administered before dressing. Performed neural assessment patient: passed, no signs of neurological deficit. Patient used incentive spirometer as ordered (10 x 1hr) – provided patient w/ education on the use of incentive spirometer. Patient also history of HTN and osteoarthritis (monitor both). Assess patient for fall risk, side rails up x2. Help with any needed ambulation: restroom, bathing, etc.) Consulted with physical therapists (ROM exercises). Consulted with dietician and consulted the infection control team. Contact HCP communicated w/ ISBAR. Patient tolerated assessment and procedure well. Call light left within reach. Check back on patient in 1hr to see if pain medication was effective.

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

Score: vSim 1

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...