Maternity-Brenda Patton Vsim DA and GRQ PDF

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Maternity guided reflection and documentation...

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V-sim #2 – Brenda Patton – Documentation and Guided Reflection Questions

Documentation

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Document your initial assessment data of Ms. Patton, including uterine activity (frequency and duration), fetal heart rate (FHR) activity (baseline FHR, long-term variability, accelerations, and decelerations), vaginal discharge, and maternal vital signs. o She had regular contractions of moderate intensity 4-5 minutes apart lasting 50 seconds. She rated her pain 2/10 between contractions. FHR: 145 bpm, regular. No decelerations. Clear vaginal discharge, fetus is in a longitudinal lie in vertex presentation. Vital signs: BP: 119/71, HR: 89, RR: 19, SpO2: 98%, Temp: 37C, no edema noted. 2. Document the medication(s) that you administered. -The pt was given 5,000,000 Units of Penicillin via IV piggyback

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3. Document Ms. Patton's pain during labor (severity during contractions, location, quality, interventions taken, and response to interventions) and the measures that were taken to promote her desire for a natural birth. o I asked the pt about her pain, she stated it was “not too bad” and rated the pain 2/10 between contractions. She said the pain was “everywhere”. When asked if she needed anything for the pain, she responded “no” that she wanted to have a natural birth. I used therapeutic communication to distract her from the contraction pain.

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4. Document your handoff report in the situation-background-assessment-recommendation (SBAR) format to communicate what further care Ms. Patton needs. o S-Brenda Patton is an 18-year-old female at 38 2/7 weeks gestation admitted to L&D unit for assessment. o B- Pt states that she thinks her water broke earlier this morning, Amnisure was positive. Group B strep test was taken at 36 weeks and was positive. The pt is taking penicillin IV piggyback. Patient has been educated on the med. o A- Vaginal exam reveals 50% effacement, 4cm dilated and fetus at -2 station. Mothers VS: BP: 119/71, HR: 89, RR: 20, SpO2: 97%, Temp: 37C FHR monitoring shows FHR 141 with no decelerations and occasional accelerations. Contractions approximately 4 minutes apart and lasting 50 seconds. Pt reported Pain 2/10 between contractions but refused pain medications as she wants a natural birth. o R-I would continue close monitoring of mother and fetus. Administer penicillin IV piggyback. Provide comfort measures to respect pt’s desires to have a natural birth & monitor pt vital signs, and contraction strength and duration.

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5. Document the informal patient education that you provided to Ms. Patton during this scenario regarding group B streptococcus and the patient's response to this teaching session. o I would have educated the patient about the positive GBS test. It is very important to treat the mother with antibiotics to prevent infection transferring to the fetus during birth. I educated the pt on the need for ABX and that they would not harm the fetus.

Guided Reflection Questions Opening Questions How did the simulated experience of Brenda Patton's case make you feel? a. I felt good about the care I provided during this vsim. I feel this was a great learning experience & I enjoyed it. Describe the actions you felt went well in this scenario. a. I believe that I did the appropriate assessments upon first seeing the patient. Assessment of the FHR and contractions went well during this scenario.

Scenario Analysis Questions* EBP What complications can occur if group B streptococcus is not treated? a. Upon delivery, the infection can transfer to the baby which can be life threatening. IF GBS is not treated, it could cause pneumonia, sepsis or meningitis in the fetus. PCC

What should be included in the priority teaching for Brenda Patton? a. Brenda needs to be educated about the positive group B strep test, effects it could have on the fetus, treatment and risks to the fetus if it went untreated.

T&C What key elements would you include in the handoff report for this patient? Consider the situation-background-assessment-recommendation (SBAR) format. a. I would include why the patient is there, what her pain and contractions are like at the current moment. FHR monitoring, It is also important for the

next nurse to know about the positive group B strep test and that the patient is currently receiving penicillin IV piggyback. S/QI Based on your experience with Brenda Patton's case, reflect on possible nursing actions for enhanced safety and quality improvement. I will be sure to assess for changes in the patient often, like changes in vitals and pain assessment. I also will make sure that the patient has been educated about everything that is going on, while also providing emotional support. I would also do a thorough postpartum assessment. Concluding Questions Reflecting on Brenda Patton's case, were there any actions you would do differently? Explain. -I would provide better education on GBS and the antibiotics being given. Describe how you would apply the knowledge and skills that you obtained in Brenda Patton's case to an actual patient care situation. In an actual patient scenario, I would make sure to educate my pt at appropriate times, like between contractions, when the pt can focus on what I am saying. During the contractions, I would try to accommodate the patient’s needs while providing emotional support to help the patient remain calm. I would practice different breathing exercises with my pt’s depending on which stage of labor they are in and whether they are pushing or not.

________________________________ *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/...