Sarah Lin v Sim Clinical Packet wk 12 PDF

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CONCEPT MAP WORKSHEET DESCRIBE DISEASE PROCESS AFFECTING PATIENT (INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS) Appendicitis o Pathophysiology:  Caused by obstruction of the appendiceal lumen from a variety of causes (inflammatory bowel disease, infections, more common during childhood and young adults, fecal stasis, or foreign bodies and neoplasms)  Obstruction causes an increase in pressure within the lumen o Risk factors:  Age: most often affects people between 15-30  Sex: more common in males than females  Family history o Causes  Abdominal pain  Nausea  Vomiting  Diarrhea or constipation

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DIAGNOSTIC TESTS (REASON FOR TEST AND RESULTS)

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CBC w/ differential Urinalysis (for differentiating appendicitis from urinary tract conditions) Liver and pancreatic function tests CT scanning Ultrasonography

ANTICIPATED PHYSICAL FINDINGS

PATIENT INFORMATION

Sarah Lin - 18 years old - Asian, female - Weight: 56 kg - Height: 165cm - Admitted: 03/23/2021 - Admitting DX: appendectomy due to appendicitis

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Abdominal pain Abdominal distention Nausea Vomiting Diarrhea or constipation Low grade fever, chills, anorexia, tachycardia, fetal position (decreases pain), guarding, grimacing, right lower quadrant tenderness due to appendectomy, normoactive bowel sounds

ANTICIPATED NURSING INTERVENTIONS 

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Assess pain o Monitoring effectiveness of medication o Progression of healing o Change in characteristics of pain (may indicate developing abscess or peritonitis) Encourage early ambulation o Stimulates peristalsis, passing of gas and reducing abdominal discomfort Watch closely for possible surgical complications o Continuing pain and fever may signal an abscess Provide nonpharmacologic interventions for pain o Refocus attention o Promote relaxation Keep at rest in semi-Fowler’s position o To lessen the pain Patient education o Wound care, incentive spirometer, and medication Continue to assess and monitor vital signs

vSim ISBAR ACTIVITY INTRODUCTION

STUDENT WORKSHEET 

Good morning, I’m Jonelle Wray a student nurse rotating on the surgical unit at 0800

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Sarah Lin 18 years old Asian-American, female Admitting DX: appendectomy due to appendicitis Patient presented in the ED 2 days ago Discontinued her IV antibiotics She will start on oral medications today Sarah presented in the ED 2 days ago with a 2-day history of nausea, vomiting, and increasing pain. She was taken to surgery that day and had an emergency open appendectomy for a ruptured appendix. She has been stable since arriving to the unit. Her parents have been here with her most of the time and are very helpful and supportive.

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Patient is AAOx3, appropriate for age. Vital signs performed: RR: 21 bpm (slightly elevated), HR: 99 bpm (radial, pulse is strong and regular), BP: 134/82 mmHg, T: 99 (tympanic, asked if she had any allergies), SpO2: 99% She needs to be reminded to use her incentive spirometer. Abdomen is soft, tender to touch. Bowel sounds are active. She has progressed to regular diet, and she’s eating small amounts. No nausea reported since post-op day 1. The abdominal dressing was changed by the surgery team early this morning. The incision is closed with staples; the edges are wellapproximated and only slightly redden with minimal serosanguinous drainage. Her sequential compression devices were discontinued, and her Jackson-Pratt drain was pulled this morning, A small amount of bleeding was present; no further bleeding is noted. This morning, she had her first small soft, brown stool since surgery Transition patient to oral antibiotics and pain medication. She last had pain medication 4 hours. I will need to provide discharge patient education on incision care, pain medication, and antibiotics, signs of postoperative infection, activity restrictions, and surgical follow-up

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

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

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RECOMMENDATION

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Any orders or recommendations you may have for this patient

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

Oxycodone Acetaminophen Levofloxacin

CLASSIFICATION:  Oxycodone: narcotic  Acetaminophen: analgesic  Levofloxacin: antibiotic PROTOTYPE:  Oxycodone Hydrochloride  Aspirin  Fluoroquinolones SAFE DOSE OR DOSE RANGE, SAFE ROUTE   

Oxycodone: at first 9mg every 12 hours with food. HCP may adjust dose as needed however; the dose is usually not more than 288mg per day. Acetaminophen: regular strength: 325-360 mg PO/RR q4hr PRN; not to exceed 3250 mg/day; under supervision of HCP, daily doses of up to 4g/day may be used Levofloxacin: 500mg PO/IV once daily for 7-14 days or 750 mg PO/IV once daily for 5 days

PURPOSE FOR TAKING THIS MEDICATION   

Oxycodone: severe pain Acetaminophen: fever Levofloxacin: antibiotic medication

PATIENT EDUCATION WHILE TAKING THIS MEDICATION   

Oxycodone: take with food, swallow the capsule, or tablet whole to avoid exposure to a potentially fatal overdose. Do not crush, chew, break, open, or dissolve. Side effects: confusion and orthostatic hypertension Acetaminophen: take exactly as directed on the prescription or package label. Do not take more often than directed, even if you still have fever or pain. Ask your doctor or pharmacist if you do not know how much medication to take or how often to take your medication. Side effects: rashes, nausea, and vomiting Levofloxacin: take with water, at the same time each day. Drink extra fluids to keep your kidneys working properly while taking this medicine. You may take levofloxacin tablets with or without food. Take oral solution (liquid) on an empty stomach, at least 1 hour before or 2 hours after a meal. Side effects: pain, swelling, diarrhea, and drowsiness

Clinical Worksheet Date: 03/26/2021 Initials: S.L.

Student Name: Jonelle Wray Diagnosis: appendectomy HCP: J. Doe due to appendicitis/ ruptured appendix

Isolation: NO

Fall Risk:

Age: 18

Consults:

M/F: F Length of Stay:

moderate

2 days Allergies:

risk

NKA

Transfer:

Code Status: full code

Assigned vSim: Sarah Lin IV Type: Critical Labs: WBC, Location protein test, Bilirubin : level, urinalysis Imaging: ultrasonography (pelvic Fluid/Rate: area), CT scan, abdomen MRi

Other Services:

Consults Needed:

N/A

Why is your patient in the hospital (Answer in your own words and include the History of present Illness)?:  Sarah Lin is 18-year-old female patient who had an emergency appendectomy. She is two days postoperative, and Sarah is expected to be discharged late this afternoon. We have discontinued her IV antibiotics after her morning dose. She will be getting oral medications today Health History/Comorbities (that relate to this hospitalization):  Patient presented in the ED 2-days ago with a 2-day history of nausea, vomiting, and increasing pain. She was taken to surgery that day and had an emergency open appendectomy for a ruptured appendix. She has been stable since arriving to the unit. Her parents have been here most of the time and are helpful and supportive

Shift Goals/ Patient Education Needs: 1. pain assessment and management 2.

safe medication administration

3.

postoperative care

Path to Discharge:  Inform the patient and the family about guidelines for pain assessment, including the frequency of reassessment. Make sure the patient and the family know to notify the HCP if pain isn’t maintained at or below the goal pain level  Teach the patient and family (if appropriate) to keep a current list of all medication. This list should include all prescription medications, OTC, or non-prescription medications,

herbal supplements, vitamins, and minerals. The patient should be familiar with the list and directions for the proper use of medications and understand any possible adverse effects and what to do should such effects occur  Encourage the patient and family or caregiver to ask questions about any medications that are prescribed, especially if it’s a newly prescribed drug. The patient shouldn’t take any medication without knowing its purpose. Tell patient that it’s acceptable to ask for written instructions about medications to use as a reference  Postoperative Path to Death or Injury:  An untreated ruptured appendix can lead to death – it is important for the patient to perform proper wound care to prevent any infection after appendectomy  Appendectomy – patient is at risk for infection and if patient does not take care of wound properly, or intake the proper nutrition to promote wound healing – necrosis and death follow in extreme cases

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

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

1.

Pain

Today?

2.

Fever

1.vitals

3.

Lower quadrant tenderness

2. education on postop wound care (to prevent wound infection) 4. Proper education on nutrition (which foods promote wound healing) (the patient has to be cautious of certain foods, high fiber: constipation, irritates abdomen, as well as high carb: increases cholesterol, not smart for someone trying to heal their wound, etc.) 5. Safe administration of medications during shift ** (very important) 6. Pain assessment

What Assessments will focus on for this patient? (How will I identify the above signs &Symptoms?) 1.

Pain assessment (pain management)

2.

Vitals (temperature, skin, HR and RR)

3.

Rebound tenderness, grimacing, facial expressions, use of pillow

Priorities for Managing the Patient’s Care Today 1. Pain assessment 2.

Fever

3.

Infection

4.

Medications

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

Risk for infection (improper postop care upon discharge)

2.

Acute pain due to surgical procedure

3.

Activity alteration due to RLQ tenderness

What aspects of the patient care can be Delegated and who can do it? - Getting the patient more pillows (UAP)

What nursing or medical interventions may prevent the above Alert or complications?

1.

Proper education on postop wound care (check on wound every 15min for color, exudate, swelling, etc)

2.

Administer medications as per ordered for pain (pain level should go down)

3.

Administer antibiotic medication for fever (fever should go down)

4.

Give patient more pillows, reposition patient ever so often (2hrs); ROM exercises Clinical Worksheet

Reflection Questions Paste your reflection questions in the box below

o Opening Questions - How did the simulated experience of Sara Lin’s case make you feel? It made me feel okay. We’ve been doing vSims for a couple of weeks so, I felt more confident when doing the simulation - Talk about what went well in the scenario. Patient education, pain management goals - Reflecting on Sara Lin’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? Nothing however, there is always room for improvement

o Scenario Analysis Questions* - EBP/S What priority problem(s) did you identify for Sara Lin? Infection, malnutrition, IBD, and deficient fluid volume less than body requirements Moderate pain, - EBP/S What should be included in Sara Lin’s education plan to assist with her pain control? Take medications as ordered, pillows for pain and position to help with pain - EBP/S What should be included in Sara Lin’s education plan related to postoperative incision care? Adequate wound care, post-op incision care entails: how to properly clean the wound, take care of it, being that the patient must have good nutrition; high fiber, low-carb to promote wound healing, also intake of fluids must be adequate - PCC/I In addition to the above education on pain management and incision care, what discharge teaching should be included specific to home antibiotic therapy (levofloxacin/Levaquin)? 1. Take prescribed pain medications on time and to try to stay ahead of pain, nonpharmacologic pain intervention 2. When showering to cover incision site with dry dressing, how to change the dressing, signs of infection (drainage, color, and odor) 3. Take the antibiotic with food 4. Avoid take antibiotic on empty stomach

o Concluding Questions - Describe how you would apply the knowledge and skills that you acquired in Sara Lin’s case to an actual patient care situation. After completing the vSim, I now know how to approach a patient with an appendectomy and adequately take care of them

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:

EADB EAD B EAD B

Total for category: Interpreting: Prioritizing Data: Making Sense of Data:

EADB EAD B

Total for category: Responding: Calm, Confident Manner: EAD B Clear Communication: EAD B Well-Planned Intervention/Flexibility: EAD B Being Skillful EADB 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...