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Brenda Patton Core vSim...

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Jennifer Mercer ADNAP 5 Maternity & Peds Simulation Guided Reflection Questions February 11, 2021 How did the simulated experience of Brenda Patton’s case make you feel? I felt nervous because it was timed but I think that it was a good first experience before going on site to do in person clinicals.

Describe the actions you felt went well in this scenario. I think that the medication administration with the antibiotic went well for me. I messed up on the head to toe a few times, so I feel like the medication was a better outcome for me.

What complications can occur if group B streptococcus is not treated? 

For the pregnant patient: o UTI o Uterine infection o Increased chances of:

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Premature rupture of the membranes

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Preterm labor

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Stillbirth

For the newborn: o Pneumonia o Sepsis o Meningitis

What should be included in the priority teaching for Brenda Patton? The most important teaching for the patient is going to be for the antibiotic that she is receiving. The patient should be informed that she tested positive for group B streptococcus (GBS) and hat it is a normal flora in her digestive system. The patient should be told that it is common for that

bacteria to occasionally get into the vagina to reassure her that she hasn’t done anything wrong in her pregnancy. The patient should be taught that the common treatment for GBS is penicillin given while in labor because when treated prior to labor, with oral antibiotics, it is not as effective. The patient should be aware that she is getting an initial large dose now of five million units in her IV and will also get half that dose, 2.5 million units, Q4H until she delivers her baby to ensure that baby doesn’t get the infection. The patient needs to be informed of what can happen to her baby if she doesn’t get an antibiotic so that she is aware of the consequences if she refuses. Patient should be made aware of common ASE with penicillin which include diarrhea and a yeast infection. Once patient is no longer on a clear liquid diet, yogurt can be offered to help restore normal flora.

What key elements would you include in the handoff report for this patient? Consider the situation-background-assessment-recommendation (SBAR) format. The oncoming nurse should be aware that there are additional orders to give PCN 2.5 million units IVPB Q4H until delivery. Keep continuous monitoring of O2 and FHR in place. Continue monitoring temperature, HR, & RR Q1H and after delivery temperature can be monitored Q2H. Head to toe assessments and BP are to be monitored Q4H. Continue reinforcing relaxation techniques and comfort to support natural childbirth. Once patient is no longer on a clear liquid diet, yogurt can be offered to help restore normal flora.

Based on your experience with Brenda Patton’s case, reflect on possible nursing actions for enhanced safety and quality improvement. Good communication between the health care team and with the patient are essential for safety and quality improvement.

Reflecting on Brenda Patton’s case, were there any actions you would do differently? Explain. 1. I should not have palpated the patient’s fundus of the uterus because the tone of the uterus was soft between contractions. 2. I performed a vaginal exam which was contraindicated due to the patient having ruptured membranes and the possibility of increased risk of infection. 3. There was a doctor’s order to perform a deep tendon reflex which I over-looked and was not done during the head to toe assessment.

Describe how you would apply the knowledge and skills that you obtained in Brenda Patton’s case to an actual patient care situation. With the simulation I learned that I need to do a better job of reviewing the doctors orders to make sure I have completed them all and I learned to only do what is need with the patient. The doctor, or oncoming nurse, is going to be unhappy about orders that haven’t been done and the patient is going to be unhappy if you are constantly messing with them, especially when they are in pain. In my LVN experience I have learned that once you have been on the job for a few months you get more efficient so that you are able to complete all your tasks while keeping your patient as happy as possible.

Group b strep infection. (2018, November). Retrieved February 11, 2021, from https://www.marchofdimes.org/complications/group-b-strepinfection.aspx#:~:text=Without%20treatment%2C%20infection%20during %20pregnancy,before%2037%20weeks%20of%20pregnancy Lowdermilk, D. L., Perry, S. E., Cashion, K., Alden, K. R., & Olshansky, E. F. (2020). Maternity & women's health care. St. Louis, MO: Elsevier. Wolters Kluwer. (n.d.). VSim for Nursing - Maternity - Brenda Patton (Core). Retrieved February 11, 2021, from https://thepoint.lww.com/Book/Show/504001#/CoursePointContent/Show/97fd9d69-2f38485d-98a0-38db007b67d6? forceView=False&viewMode=Student&productAssetId=97fd9d69-2f38-485d-98a038db007b67d6&behavior=Display&groupby=learningactivity&ts=1613080860079...