Situational Scenarios for Decision and Delegation QSEN PDF

Preview

Summary

Assighment...

Description

Prioritization/Delegation Scenarios Maternal-Newborn Care “What would you do Walk -Through” Review each scenario and answer the question after each description. Then after completing these 5 cases, answer the next set of questions at the end of the document. 1. Patient: Susan Right Age: 23; DOB 11/4/1995 Scenario: The health care provider has completed an assessment of the patient. You cared for her yesterday after delivery. She appears more confused than when you cared for her previously. The newborn is in the crib in the corner, sucking on her fist. Maternal Vital Signs are: Temp 100.9, HR 116, RR 32, BP 80/60, SPO2 85% on Room Air On your assessment, you note a boggy fundus, large clots, fundus remains boggy on massage. Saline lock is in Right hand. What is the nurse’s next actions? - Administer the nonbreather mask; O2 because her SPO2 is 85% - ask the pt when was the last time she void, if unable to void than request the order for straight catheter. If still boggy after the massage and void than notify the doctor. - ask the pt when she feed her infant and how she is feeding? 2. Patient: Emma Right Age: 1 day; DOB 11/13/19 Scenario: The newborn is in the crib in the corner of the mom’s room. Vital Signs are: Temp 36.2 C., HR 140, RR 34, BP 70/55, SPO2 95% Weight: 7lb 2oz. Admit Apgar 8 at 1 minute and 9 at 5 minutes On assessment, you note the vital signs are the same as what was given to you in the hand-off report. The baby is sucking on her fist and moving around. You attempt to obtain a feeding schedule from the mom, but she is not responding appropriately to your questions. What is the nurse’s next actions? - educated the pt that infant need to be feed by breastfeeding or formula. If pt still does not want to feed, check if there is any stored breast milk to feed the infant or discus with the pt about the bottle feed. Make sure that nurse educated the pt and understand why baby need to be feed. Source: QSEN website https://qsen.org/what-would-you-do-walk-through/

Establish the rapport builder so the mom can trust the nurse. Use therapeutic communication during the teaching. 3. Patient: Elizabeth Willyou Age: 24; DOB 3/24/1994 Scenario: Vital signs are: Temp 98.6, HR 80, RR 16, BP 116/80. On assessment the fundus is boggy with clots; the fundus firms with massage. Hgb is 8 from 11 on yesterday Hct is 28 from 32 yesterday You received from hand-off report that there was an order for a blood transfusion. You see the blood is sitting on the counter and it has been there for 20 minutes. What is the nurse’s next actions? -

The blood is still within a time so make sure you consent has been signed and explain the pt. about the procedure. Follow the producer for the blood transfusion.

4. Patient: JoAnna Train Age: 27; DOB 04/19/1991 Scenario: You are the nurse for the patient who is 39 weeks gestation, Gravida 2 Para 2. Vital Signs are: Temp 99.1, HR 88, BP 122/60. Her under pad is wet. You place the external fetal monitor and interpret the reading as contractions 8 minutes apart, irregular, FHR is 120-130, moderate variability. What is the nurse’s next actions? -

Attach the SPO2 Place the pt. on left-side laying position stop oxytocin to regulate the contraction Test the fluid to confirm if there is amniotic Continue to monitor

5. Patient: Rebecca Dowee Age 24: DOB 4/23/1994 Scenario: Source: QSEN website https://qsen.org/what-would-you-do-walk-through/

Vital signs are: Temp 98.6, HR 110, RR 28, BP 98/60. On assessment the fundus is boggy; she is diaphoretic. The patient is Muslim. Her husband is not present at the time of your assessment. Hgb is 8 from 11 on yesterday Hct is 28 from 32 yesterday What are the nurses next actions, while being culturally sensitive? -

Ask the pt when she void, if unable to void than order the catheter, massage the fundus Attach the SPO2 Make sure pt is understanding and educated the pt Do not make any assumption Build the trust

Source: QSEN website https://qsen.org/what-would-you-do-walk-through/

Decision/Delegation/Prioritization Activity “What Would You Do Walk-Through” 1. Which patient requires attention First and how might you accomplish this? - Patient: Susan Right Please explain the rationale for your decision: -

Our first priority is breathing. Pt Spo2 is 85% which is lower, and it is supposed to be 95-100%. Pt can experience the hypoxia Also, when palpating the fundus there was boggy even when massage. Boggy should not to palpate. She appears confuse so we need to check her LOC and need to check her postpartum blues.

2. Which patient will you see next, and how might you accomplish this BEST? - Patient: Emma Right Please explain the rationale for your decision? -

She is having a postpartum blues and she looks confuse. Her BP is low, and HR is higher than a normal. As a nurse it is very important to assess the pt psychosocial. She does not care about the baby and did not feed the baby. We need to check her mental health too.

3. Which patient will you see next? - JoAnna Train

Please explain the rationale for your decision? - her contraction is irregular, and it is in every 8 min. the contraction is supposed to be in every 10min for 2-3 times. We need to put her in left-side laying position and stop the oxytocin. 4. Which patient will you see next? - Elizabeth Willyou

Please explain the rationale for your decision? -

Pt fundus was firm when massage and her Hbg is normal. Blood transfusion was within a normal time.

Source: QSEN website https://qsen.org/what-would-you-do-walk-through/

5. Which patient will you see last? - Patient: Rebecca Dowee

Please explain the rationale for your decision? - pt Hgb is within a normal and sweat is common in postpartum. 6. Place yourself in this situation, with this patient assignment. Reflect on what your BEST course of action would be and how you might ensure patient-centered care. Please Explain: I will first asses the pt and see how they are doing after delivery. It is very important to see how they pt are coping with baby because after postpartum pt. might get postpartum blues. Always put the patient and do assessment. Make a rapport builder so that pt. can trust.

Source: QSEN website https://qsen.org/what-would-you-do-walk-through/

References London, M., Ladewig, P., Davidson, M., Ball, J., Bindler, R. & Cowen, K. (2017). Maternal & Child Nursing Care, (5th ed.). Boston: Pearson.

Source: QSEN website https://qsen.org/what-would-you-do-walk-through/...