Junetta Cooper Documentation and Guided Questions PDF

Preview

Summary

Download Junetta Cooper Documentation and Guided Questions PDF

Description

Pharmacology Scenario 1: Junetta Cooper Documentation Assignments 1. Document your assessment data of Junetta Cooper, including chest pain assessment (location, quality, severity, factors that make pain better/worse, associated symptoms: nausea, vomiting, or dizziness) and vital signs. After introducing myself to my patient, I washed my hands and asked her to verify her name and date of birth. Then I proceeded to check her vital signs; her respiration rate was 15 breaths/min., blood pressure 148/86, pain level 0/10, O2 sat. 96%, temp. 99 F and pulse 91. Patient then reported she was experiencing chest pain and tightness that she rated at a 7 out of 10 on the pain scale. She described the pain as feeling like “an elephant was sitting on my chest”. She was not able to state whether anything made the pain better or worse. Associated symptoms were elevated blood pressure of 156/92, increased pulse of 95 as well as increased respiration rate of 21 breaths/min. After checking that it was the correct medication three times 0.4 mg of sublingual nitroglycerin was administered. Respiration rate, blood pressure and pulse were reassessed and showed no change. Patient reported that she was still experiencing pain of 6/10. 2 mg of morphine was administered IV push for her pain. Vital signs were reassessed and still showed no change. Patient reported chest pain and tightness were still there with pain at a 6/10. Another 0.4 mg of sublingual nitroglycerin was administered 5 minutes after the first dose. Vital signs were reassessed, and blood pressure had decreased to 122/78, respirations were 12 breaths/min. and pulse 85. Patient states “I am not having any pain”. After checking that the patient was comfortable and didn’t need anything else, I performed hand hygiene and left the patient’s room to go document. 2. Document patient education that you provided related to medication(s) administered during this scenario. Patient was provided education on nitroglycerin which included informing her to take it when she is having chest pain, dose can be repeated every 5 minutes for a maximum of 3 tablets and to call 911 if the chest pain does not subside after the third dose. Patient was also educated on proper storage of nitroglycerin with is to store in a cool, dark place in the container the medication came in and to keep out of reach of children. She was also educated on the correct way to administer sublingual nitroglycerin which is to place the tablet under the tongue and let it dissolve; the tablets should not be crushed, chewed or swallowed. 3. Document medication(s) you administered during this scenario. I administered two doses of 0.4 mg sublingual nitroglycerin as was ordered by the physician PRN for acute chest pain. Patient’s pain subsided after second dose. I also administered 2 mg of morphine IV push as ordered by the physician PRN for pain between the two doses of nitroglycerin to lower her pain level. 4. Document additional patient education you provided to Junetta Cooper during this scenario. The education provided to the patient during was on nitroglycerin, including proper storage of the medication as well as the correct way to administer sublingual nitroglycerin and how that differs from the transdermal nitroglycerin patches that she was used to.

Pharmacology Scenario 1: Junetta Cooper Guided Reflection Questions Opening Questions How did the simulated experience of Junetta Cooper’s case make you feel? It was a surprisingly nerve-racking experience. I felt a great amount of responsibility caring for a patient where, if things got terribly serious, the decisions were up to me and her overall well-being was in my hands. Even though this was a simulated and online experience, it felt very real and elicited many of the feelings that I imagine would come out in a real-life situation. Tell me the actions you felt went well within this scenario. I feel that I was able to incorporate patient safety measures well in this scenario. I washed my hands frequently between various interaction with the patient, checked patient identification, and went through the appropriate steps of medication administration such as double checking the medication with the MAR, double checking the identity of the patient as well as checking for any allergies and assessing for side effects and therapeutic effects of the medication. Reflecting on Junetta Cooper’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 would organize the sequence of my assessment in a more streamline fashion. In the first round of the simulation I felt that my actions were disorganized, and I could have been more efficient with the order that I took vital signs as well as my pain assessment when she verbalized that she was having some discomfort. I would also time my patient education at a more appropriate time rather than randomly, toward the end of my time with her. Scenario Analysis Questions[1] PCC What priority problem(s) did you identify for Junetta Cooper? Priority problems for the patient were uncontrolled chest pain (angina), high blood pressure (Stage 1 hypertension), coronary artery disease and a suspected myocardial infarction. PCC

Identify Junetta Cooper’s risk factors specific to cardiovascular disease.

Patient has a 20-year history of hypertension, is over the age of 65 and she is also African American. These are risk factors for cardiovascular disease that apply to the patient. S/PCC

What potential problem could arise from sublingual nitroglycerin therapy, and what teaching should be included specific to this potential problem?

Patients may experience an intense headache right after the administration of sublingual nitroglycerin. It is important to inform the patient that this is a common side effect and to not be alarmed or concerned. Patients can take acetaminophen for the pain from the headache and it should subside within an hour. PCC/EBP Discuss the potential synergistic effect(s) of Junetta Cooper’s medication and identify the potential side effect this could cause. It is important to monitor blood pressure and heart rate because the combination of nitroglycerin and morphine can increase the risk of hypotension. Morphine can decrease heart rate and blood pressure

and nitroglycerin decreases preload and heart rate as well, inadvertently decreasing blood pressure. It is very important to monitor blood pressure as well as assess the patient for any dizziness, lightheadedness and orthostatic hypotension upon sitting and standing. T&C

What other interprofessional team members should be involved in Junetta Cooper’s care?

The patient’s primary health care provider, cardiologist and assistive personnel. Concluding Questions Describe how you would apply the knowledge and skills that you obtained in Junetta Cooper’s case to an actual patient care situation. I learned quite a few important lessons during this simulation including how the organization and efficiency of your assessment can greatly affect the quality of your care as well as just how important it is to make sure education specific to the patient is well incorporated throughout your time with them. These lessons will, without a doubt, apply to an actual patient care situation. I also feel that I understand how to take care of a patient presenting with similar symptoms and situation such as Junetta Cooper on a much deeper level. I feel confident that I could understand the correct vital signs to monitor and things to look out for, ways to assess pain properly as well as how to safely administer the ordered medications (especially sublingual nitroglycerin) and the patient education that needs to follow. Overall, it was a fun as well as highly education first vSim experience that I feel will benefit me in future face-to-face scenarios.

[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/...