Jared Griffin Vsim Word Documentation PDF

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ACUTE CARE SIMULATION - JARED GRIFFIN Learner Objectives:  Assess patients and recognize expected and abnormal findings  Use the nursing process to plan, implement and evaluate care of the patient  Respond to changes in patient status  Ensure patient and healthcare provider safety  Use critical thinking when making clinical judgments and decisions  Use therapeutic communication techniques  Demonstrate proper use of PPE

There are six steps to the simulation. Step 1 Introduction for the simulation Review Jared Griffin’s medical record.

Step 2 Complete Preparation Assignment for Simulation Please answer all questions thoroughly. Type your answers in the appropriate boxes and submit your completed assignment in the Blackboard drop box. Patient: Jared Griffin Question 1. What are the 3 most important orders for this patient?

1. Clindamycin 600 mg IVP Every 8 hours 2. Enoxaparin 40 mg SQ Daily 3. Oxycodone 10 mg orally PRN Q4 for Pain

Question 2.

1. Neurovascular checks and vital signs as ordered

What are the three most important nursing assessments for a postoperative total knee arthroplasty patient?

2. Assessment of incision and dressing for any type of infection or drainage as ordered. 3. Pain management

Question 3. Describe a thorough neurovascular assessment for a postoperative patient.

Question 4. What nursing interventions should the nurse anticipate for a postoperative total knee arthroplasty patient?

The neurovascular assessment of the extremities is performed to evaluate: Test each nostril for smell reception with various agents and interpretation Ability to close eye lids Test for downward and inward movement of the eye As the patient to open and clench jaw while you palpate the jaw muscle. Test face and neck for pain sensations, light touch, and temperature. Ask the patient to raise his eye browse, smile, show teeth, and puff out cheeks. Have the patient to say “ah,” and yawn to observe the upward and downward movement of the soft palate, elicit gag response, note his ability to swallow. Ask the patient to swallow and speak, note his hoarseness. Ask the patient to protrude tongue and push tongue against cheek. Comparison of assessment findings bilaterally is extremely important. Even subtle changes can have significant implications. Remember to include neurovascular assessment findings of all extremities in your documentation and to notify the appropriate health care provider of any changes. Pain and edema are also assessed during this examination.

Observe incision for bleeding and infection Check the color of the patients skin Ice Pack to incision for pain/ swelling Neurovascular checks Pain medications as ordered Labs as ordered Observe Hemovac and empty as ordered

Knee immobilizer at night Physical therapy ass ordered Dangle feet off side of bed often Use incentive spirometer as ordered

Step 3 View the Video: Donning and Removing PPE https://www.youtube.com/watch?v=quwzg7Vixsw and complete the Quiz. Step 4 Complete the Virtual SIM: Jared Griffin. Scenario Guide: During your visit with Jared, he provides the following information. Document everything you would say and do including your response to his assessment (verbal/physical) findings. Time of Day: 8:00 am Initial Patient Condition:

Patient Discussion

RR: 16 HR: 78 BP: 140/90 SpO2: 98% RA Temp: 100.9 Other: NA Pain level: 3/10 Lung sounds clear bilaterally

Jared Griffin Nov. 31, XXXX

“Today is April XX, XXXX and I am at the Hospital. Donald Trump is the President.”

Expected Actions of the Nurses (verbal response/assessment/ intervention) Good morning, my name is Taylor and I am your nurse and will be taking care of you today. Can you tell me your name and date of birth please?

Thank you, can you tell me the current president, today’s date, and me where you’re at right now? Do you have any pain right now? If so can you rate it on a scale from 0-10, 0 being no pain and 10 being the worst pain you have experienced.

“My pain level is about a 7.”

Okay, can you describe the pain for me? Does anything make it worse or better?

“I’m feeling a little sore this morning after getting up.”

Okay, I will see what the physician has ordered you for pain. I will also roll a towel under your ankle to

elevate the leg just a little, then I will re position you in the bed, raising the head of the bed to about a 45-degree angle. We will see if that helps decrease the pain.

“Can I get my pain medication?”

Yes, the physician has ordered you Oxycodone 10 mg as needed every 4 hours for your pain I will get that now. After I administer the medication I will come back in 30 minutes, to reassess the pain. If it still hurts I will call the doctor to see what our next options are. If you need me before then, just ring your call light.

“I got up on my own to the side of the bed and stood by the bedside.” It was hard to get around with all those tubes. I am glad the nurse took the hemovac drain out.”

I am happy to hear that you are trying to ambulate and are eager to regain your strength back. However, the next time I want you to use your call light. You are still unsteady on your own, you could also potentially get caught up In all the wires and fall. You always want a nurse in here before trying to get up. This will prevent a lot of possible injuries that could occur and would only prolong your hospital stay and your healing time. I know it has to be difficult to have to depend on other people. Just remember that is why I am here. I want to help you and get you back to normal and living your normal routine as soon as possible.

“I can bend my knee to about 75 degrees. The doctor told me to keep bending it or use the

I am sure it is painful, and it hurts. But it is very important that you continue to try and reach your goal of 90 degrees. This will help you in t

machine until it gets to 90 degrees, but I don’t think I will be able to do that.”

he long run with your recovery and getting back to your normal daily routine. Just keep working with physical therapy and doing the exercises they have you to perform. I am here for you and I will do whatever is necessary to help you with any questions, concerns, or help manage your pain. I am right outside your door.

“I can feel all right with both legs. Right leg feels a little warm today.” “What does this mean?”

This is normal after surgery because the body increases blood flow to the knee to support the healing process. This increased blood flow results in the warmth, swelling and redness often experienced by the patient. As the healing process progresses, the warmth, swelling and redness dissipate.

“Why am I in isolation here at the hospital?”

You are in isolation here at the hospital because

“What about at home? Are my family and friends at risk of being infected when they visit me?”

Yes, the risk of transmitting MRSA to them is small but is possible to spread this by touching your nose and then touching someone else. Washing your hands with soap and water or alcohol gel after touching your nose and before touching others will help to prevent the spread of MRSA to others.

Step 5 Complete the Post Simulation Discussion Response Questions: 1. Based on Jared’s assessment, what signs/symptoms of infection does he exhibit? Age, immunosuppression, presence of incision, elevated temperature, slightly elevated White Blood Cell count, HBG and HCT is lower than normal. 2. What else would you want to know about his neurovascular checks? Skin turgor, Capillary refill time, Motor function, has the patient felt any numbness or tingling or any type of change in sensation, Skin color, and note if any edema is present, facial appearance of his smile, speech, tongue. 3. Are there any vital signs and/or lab values that concern you? If so, please explain.

Slightly elevated White Blood Count, which could indicate that he is at risk for infection, decreased Hematocrit and Hemoglobin. His blood pressure is elevated. He has a history of mild hypertension; so, we need to keep a close eye on this and make sure he gets his blood pressure medication as ordered. He also as an elevated temperature.

4. After reviewing Jared’s current medications, are there any medications you would question? If so, please explain. I would question Enoxaparin 40mg SQ Daily. Since this an anticoagulant the daily blood draw for the CBC is most problematic since bleeding at the site may occur. Risk for bleeding is a primary concern with this medication. 5. Identify the top three priority problems for Jared. Neurovascular assessment to assess and identify any impaired nerves in the limbs, , skin assessment for wound infections, Hemorrhage due to his hematocrit and hemoglobin resulting back very low this morning. 6. Describe in detail the steps of infection control precautions required for Jared. To minimize the spread of infection the nurse can implement effective hand washing techniques and standard, by using appropriate PPE’s. Monitor the blood cultures and administer antibiotics. 7. Develop a teaching plan specific to Jared’s needs. You are allowed to shower, but no baths until your incision has healed. Your dressing is waterproof and will protect your incision. Sit on a shower stool or chair when you shower to keep from falling. To relieve discomfort at night, get up and move around with your walker. Check the skin surrounding your incision daily for redness, swelling, tenderness or drainage. Avoid infection by washing your hands often. If an infection occurs, it will need to be treated immediately. So, call your doctor right away if you think you may have an infection. Avoid soaking your incision in water (no hot tubs, bath tubs, or swimming pools) until your doctor says it's okay. Sit in chairs that have armrests. The arms will make it easier for you to stand up and sit down. Don't sit for more than 30 - 45 minutes at one time

Sleep with a pillow under your ankle, not your knee. Be sure to change the position of your leg during the night. Take pain medications as prescribed by the provider upon discharge.

8. Identify three potential complications for Jared. Risk for infection Risk for Thromboembolism: DVT or PE Decreased wound healing

Step 6 In ClinPrep you will document ALL your assessment finding. You will document all actions you preformed above in Step 4. This will include mediation cards if you administer any meds....