Student Prep Concept Synthesis Family in Crisis Part Two PDF

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Department of Nursing STUDENT PREP for Concept Synthesis Simulation: Family in Crisis (Part Two) Name:

Date:

Instructions: 1. On the scheduled simulation session date, the student will wear the USD Nursing Clinical Uniform and Name ID Badge. 2. Bring a stethoscope, watch, black ink pen and your lap top computer. 3. Complete this prep worksheet PRIOR to the scheduled session and bring it to the session. Objectives for the Simulation Based Learning Experience: 1. Synthesize knowledge from multiple concepts when managing the care of family in situational crisis. 2. Collaborate with members of an interdisciplinary team to improve clinical judgment skills and patient outcomes. 3. Resolve personal conflicts and attitudes regarding belief systems and actions of dysfunctional family members. (Here is an update on the Peterson family) Tim is hospitalized on the rehabilitation unit recovering from the chest injury and surgical stabilization (fusion) of his T5-6 vertebrae with complete spinal cord lesion and once spinal shock subsided, paraplegia was permanent. Daughter, Holly (age 7) was killed in the accident and after the funeral the driver Anna (wife) was sent to an addiction treatment center (court order) because of driving under the influence of alcohol, cocaine and cannabinoids (THC). Anna was just discharged from the addiction treatment center this past week. Tim will be discharged home soon in care of his wife Anna. The healthcare team is working to improve Tim’s abilities for some self-care, wheelchair to bed transfers and bladder-bowel training. Read (it is an older journal article-but contains all the nursing care basics): Jones, T.S. (2005). A Bolt Out of The Blue-Dealing with the Aftermath of Spinal Cord Injury. Nursing Made Incredibly Easy. November/December, pp. 14-29 Complete this Preparation Worksheet: 1. Describe the features of complete spinal cord lesion verses incomplete lesion. a. Complete lesion: i. Complete loss of function below level of injury (motor and sensory), irreversible ii. Results in quadriplegia (C4-C6), Paraplegia (T6-L1) Student Prep –Concept Synthesis: Family in Crisis (Part 2)

2 b. Incomplete lesion: i. Partial loss below level of injury 1. Sensory and/or motor function, 2. Some neurotransmission can occur ii. Five main syndromes 1. Central cord syndrome 2. Anterior cord syndrome 3. Brown-Séquard syndrome 4. Cauda equina syndrome 5. SCI without radiographic 6. Abnormality 2. Compare contrast the types of shock that occur in persons with spinal cord injury Type of Shock Hypovolemic Shock Spinal Shock

Neurogenic Shock

What the nurse expects to see in the patient Tachycardia, hypotension, fluid volume replacement Temporary loss of all activity (motor, sensory, reflex) for 2-20 days up to 3 months Not able to determine extent of injury during this time Reflexes may return if lesion is incomplete Bradycardia* Peripheral vasodilation below injury Hypotension* Decreased cardiac output Distended neck veins

3. Based on the information on the update about Tim Peterson—what is the maximum function that he could regain during his rehabilitation period? a. Function above the level of injury, use of arms and hands

4. When thinking about a person with a spinal cord injury (SCI) and paraplegia, what is that person “at risk” for PHYSICALLY, and what interventions are used to prevent or decrease the likelihood of those problems? a. Cardiovascular system i. Hypertension 1. BP meds b. Pulmonary system i. Slowed heart rate 1. HR meds c. GI system i. Constipation 1. Laxatives Student Prep –Concept Synthesis: Family in Crisis (Part 2)

3 ii. Unable to recognize need to defecate 1. Constant checks d. GU system i. UTI 1. Straight catheterization 2. Bathroom schedule 3. Incontinent care 4. Stay away from uric acids 5. Decrease calcium e. Tissue Integrity i. Pressure ulcers 1. Reposition often 2. Nutrition – proteins ii. Wound care 1. Dressing changes 2. Debridement f. Neuromuscular system i. At risk of contractures 1. ROM exercises

5. What is that person “at risk” for EMOTIONALLY, and what interventions can be implemented to address these issues? a. Lifestyle i. At risk for impaired lifestyle 1. Help find creative ways to live a normal life 2. Encourage a decrease in alcohol b. Body Image i. At risk for poor body image 1. Support group 2. Encourage talking about feeling c. Economic Security i. Risk of feeling upset for not being able to work his old job 1. Help find a new job 2. Get set up with disability d. Coping i. Risk of ineffective coping 1. Recommend a support group 2. Help find ways to live a normal life e. Isolation i. Patient is at risk for isolation 1. Recommend a support group f. Vulnerability i. Patient is at risk for being taken advantage of or relying on others 1. Help patient find ways to live a normal life Student Prep –Concept Synthesis: Family in Crisis (Part 2)

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6. Family roles and relationships will change as a result of this accident and death of a child. What would the nurse anticipate to be the priority issues in the Peterson family dynamics? a. Coping with death of a child b. Repairing relationship with wife c. Forgiveness

Student Prep –Concept Synthesis: Family in Crisis (Part 2)...