Surgical Case Marilyn Hughes PDF

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Carline Celius Surgical Case 1: Marilyn Hughes Guided Reflection Questions 1. How did the scenario make you feel? I was a little frustrated with this scenario. I was confused on how to administer the medication order of morphine to the patient. I tried it many different ways. I had to reach out to my fellow classmates. I’ll keep trying to get 100% on the simulation. 2. How would you recognize that Marilyn Hughes’ condition was deteriorating? Her respirations, heart rate, bp all increased. She has pain without relief which increases even with passive movement. Her sensation in the leg decreased and her skin was sweaty and cool to touch. With compartment syndrome you have to look out for the 6 P’s: Pain, Paresthesia, Pallor, Paralysis, Poikilothermic, Pulselessness. 3. What interventions exist to alleviate compartment syndrome, and what assessments indicate improved perfusion to the extremity? 4. Perform neurovascular checks for the patient. Check and monitor the 6 P’s. Loosen the dressing around the limb so it can be less restrictive. We will also notify the physician. Feeling a pulse again, color coming back to the extremity. The limb is getting back to body temperature. 5. Why is it important to maintain the limb at heart level versus elevating it above heart level? We have ischemia going on so we don’t want to elevate above heart level to further decrease the arterial pressure resulting in even more ischemia. We want to keep the limb at heart level. 6. What could have happened in this scenario if Marilyn Hughes’ condition was not treated expediently? In severe cases a fasciotomy can be performed to relieve the pressure. Ultimately severe nerve damage to area would occur or tissue death. 7. What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format. Patients identity information, Why and how she was presented to us. Vitals signs back to stable. Pt was in excessive pain scaled at an 8. upon assessment, I found that the dressing was a bit tight, so I loosened it a little. I lowered her legs and gave pain meds PRN. Patients scaled her pain down to a five. Pedal pulses in the right leg but not the left leg. Physician is aware and is on the way to see the patient. Recommendation is to keep © Wolters Kluwer Health | Lippincott Williams & Wilkins

monitoring neurovascular checks, monitor patients pain level, follow up with physician. Also I would mark with a marker where I felt the pulse last if faint so the next nurse can find it.

8. What would you do differently if you were to repeat this scenario? How would your patient care change? Before I rushed under the pressure from the patient to give her pain medicine. I bypassed checking for allergies and even getting consent. When I repeated the simulation, I moved quickly and did what I needed to do first with the safety measures, I did an assessment, then read the orders. After all those steps then I provided the patient with the pain meds and called to inform the doctor.

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