MS Mary Richards reflective questions PDF

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Pharmacology Scenario 5: Mary Richards Guided Reflection Questions

Opening Questions How did the simulated experience of Mary Richards’s case make you feel? This simulation mad me a little nervous in th fact that I felt like Mrs. Richard’s VS were more concerning to me than the simulation made it appear. Talk about what went well in the scenario. I felt as though I did a good job thouroughly assesing Mrs. Richards cardiac system. I also felt like I took the right precautions when administering her IV potassium by checking the IV site both before and after administration. Reflecting on Mary Richards’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? Knowing that Mrs. Richards has heart failure, and having access to her labs, I would have called the provider and discussed her orders about having IV potassium sooner. This could have saved more time in the beginning and potentially might have kept her from declining sooner.

Scenario Analysis Questions1 PCC/EBP/PCC What priority problem(s) did you identify for Mary Richards? Mrs. Richards primary concern was digoxin toxicity leading to her heart failure. PCC/EBP/PCC Are there any red flags noted when looking at the medications that Mary Richards is taking? Why or why not? Mrs. Richard’s is prescribed digoxin. Depending on the dose combined with her age, this could be a concern as older adults are more susceptile to digoxin toxicity with lower dose digoxin therapy. Amilodipine is an ace inhibitor which is also not recommended and could potentially cause renal impairement when prescribed with digoxin. Mrs. Richards furosemide may also be a potential risk with digoxin toxicity symptoms and should be carefully monitored. 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/

From vSim for Nursing | Pharmacology. © Wolters Kluwer.

PCC/EBP/PCC What are the potential problems that could arise if Mary Richards does not receive treatment immediately? What type of treatment would she benefit from? If digoxin tocity is not treated promptly, the effects could be fatal. By digoxin releaseing sodium thus resulting in intracellular calcium being increased, this will increased inotropy. Premature contractions and dysrhythmias may occur which could further lead to heart failure. Studies have shown that using activated charcoal can be used in patients who present with symptoms of digoxin tocity if they have ingested the digoxin dose within two hours. PCC/T &C/S

Discuss what should be taught to Mary Richards regarding her care at home. Mrs. Richards should be educated on the signs and symptoms of digoxin toxicity and should report to her HCP if she is experiencing any of the symptoms. Common symptoms of digoxin tocity include confusion, loss of appetite, NVD, palpitations, and vision changes.

T&C

What other interprofessional team members should be involved in Mary Richards’s care? The team members involved in Mrs. Richards care should be the nurse, the psychian, and the pharmacist.

Concluding Questions Describe how you would apply the knowledge and skills that you obtained in Mary Richards’s case to an actual patient care situation. If caring for a patient with digoxin tocity, I would be sure to do a thourough medication reconcilitation, be aware of the signs and symptoms of toxicity, know which lab values need to be closely monitored (potassium, B.U.N., and creatinine), know proper dosing, and alternative treatment options of digoxin toxicity.

From vSim for Nursing | Pharmacology. © Wolters Kluwer....