VSIM-Eva Madison Guided Reflection PDF

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Allison Raz Eva Madison: Core Opening Questions How did the simulated experience of Eva Madison's case make you feel? I felt comfortable during this case because I felt that I knew what to do. I knew how to assess her and where the various commands were. I had only forgotten to educate Eva and her mother on her situation after giving her oral rehydration solution. Describe the actions you felt went well in this scenario. I felt everything went well, I knew which vitals to take and when and I knew to assess her mucus membranes because of the chance of dehydration because of gastroenteritis. I would only need to remind myself to give patient and parent teaching because it is the only step that I forget in these simulations.

Scenario Analysis Questions* EBP

What priority problem did you identify for Eva Madison?

I identified her risk for dehydration related to several days of vomiting as the priority problem. EBP What complications might Eva Madison face if her symptoms are not recognized and actions are not initiated in a timely manner? She may become further dehydrated, which may cause her to go into hypovolemic shock. Her infection may also develop into sepsis and her condition could worsen significantly if actions were not taken. PCC What actions should be implemented to decrease anxiety in Eva Madison and her mother? I would make sure to ensure her that gastroenteritis is a very common and very treatable illness in children. I would explain that the biggest worry with gastroenteritis is dehydration caused by prolonged vomiting and diarrhea. I would then explain that Eva’s mild dehydration can be treated with oral rehydration solution and that once we treat the underlying cause of her gastroenteritis Eva will recover well. The most important part is making sure Eva’s mother is informed on Eva’s condition and that it is treatable with medication and fluids. PCC Describe age-appropriate strategies to empower Eva Madison and her mother in all aspects of the health care process. I would make sure to explain in age-appropriate words what I would be doing to Eva and how it would make her feel better. I would explain that she caught a stomach bug that makes her vomit, so we have to give her a special drink that will make her feel better.

PCC/S What should you teach Eva Madison and her mother about home care of a patient with gastroenteritis? I would make sure to teach her mother to slowly reintegrate normal foods into her diet after having gastroenteritis. I would also make sure that she knows to give her the oral rehydration solution so Eva can stay adequately hydrated. Her diet must include fresh fruits and vegetables, meats with less fat, and complex carbohydrates when she is ready to start eating. Sugary drinks should be avoided when she comes home. T&C What role do you feel Eva Madison's mother has as a member of her health care team? (Explain your answer.) Eva’s mother has a very important role in that she knows Eva the best. She knows what her baseline is like and how she generally acts. She is also the first one to see if Eva is vomiting or has diarrhea. She is the basic informant to the rest of the healthcare team as to how Eva’s condition progressed until she was hospitalized. She will also be the one to take care of Eva when she is done in the hospital, so it is important that she is informed on Eva’s home treatment and diet while recovering from gastroenteritis. T&C/I What key elements would you include in the handoff report for this patient? Consider the situation-background-assessment-recommendation (SBAR) format. Eva Madison is a 5-year-old female that has been vomiting for several days. She states that she feels the need to throw up but did not vomit during my shift. Mucus membranes were pink and moist, vital signs were: HR 112, BP 134/92, Respiration 18, SpO2 97%, temp 100 F, and a pain of 0 on the FACES scale. I contacted her physician and gave 5mL of oral rehydration solution as prescribed and took a stool sample. Physician asked to be contacted after results came in. I recommend continuing to monitor her for signs of worsening dehydration.

Concluding Questions Reflecting on Eva Madison's case, were there any actions you would do differently? If so, what were these actions, and why would you do them differently? I would have made sure to educate Eva and her mother more on Eva’s care. I keep forgetting to educate them during the simulations because I pass over them in the communications prompts. I would make sure to educate Eva and her mother after I have given her oral rehydration fluids and make sure they understand Eva’s diet after being able to return home. Describe how you would apply the knowledge and skills that you obtained in Eva Madison's case to an actual patient care situation. I would know how to assess a child that has signs of gastroenteritis. I would make sure to check for signs of dehydration and ensure that she would be adequately hydrated. I would also make sure to inform the parent on gastroenteritis and what their child’s diet should be after they are able to go home.

Eva Madison: Complex Opening Questions How did the simulated experience of Eva Madison's case make you feel? I felt a bit more nervous during this case as opposed to the core case, but when I actually started assessing and treating her I felt very comfortable. I felt that I understood what to do and how to assess her. Describe the actions you felt went well in this scenario. I thought everything went well in this scenario. I first assessed her stomach and mucus membranes then took her vital signs. I recognized that she was tachycardic and that her BP was low so I contacted her physician. Her doctor then prescribed D5 ½ NS at 62mL/hr to treat her hypovolemia. I explained to her mother that Eva was dehydrated because of her vomiting for several days and that I took a urine and stool sample to have her checked for infection and parasites to see what the cause of her gastroenteritis was.

Scenario Analysis Questions* EBP List in order of priority your initial nursing actions identified for Eva Madison based on physical findings and family interaction. I found her respirations, blood pressure, and heart rate to be alarming and thought it might be because of hypovolemia related to her vomiting for several days. I contacted her doctor so that she could get some fluids to replace her lost ones. EBP When initiating a fluid bolus for a dehydrated child, what type of fluid should be given and why? Normal saline should be given at first until it is known if she has any electrolyte imbalance. Isotonic solutions should be given because they most adequately hydrate a dehydrated patient. EBP What complications might Eva Madison face if her symptoms are not recognized and treated in a timely manner? She may develop hypovolemic shock from severe dehydration if she is not treated in a timely manner. Her blood pressure would fall until circulatory collapse occurred. PCC What measures should be initiated to decrease anxiety in Eva Madison's mother while simultaneously caring for Eva? I would make sure that Eva’s mother was always informed of Eva’s condition. I would explain to her that dehydration is very treatable with IV fluids and that Eva will get the best care that we can give her. S/QI Reflect on ways to improve safety and quality of care based on your experience with Eva Madison's case.

I would make sure to monitor her I&O’s and continue to monitor her blood pressure, heart rate, and respiration rate. S/QI

What infection control measures should be taken in this case and why?

Contact precautions should be taken in case she has a disease that could be caught by other patients. T&C/I What key elements would you include in the handoff report for this patient? Consider the situation-background-assessment-recommendation (SBAR) format. Eva Madison is a 5-year-old female that came into the ED with vomiting and diarrhea for 3 days, she was unable to keep fluids down and had no urine output for 12 hours. Patient is dehydrated and has history of gastroenteritis. She was given normal saline bolus IV in the ED before going to the peds floor. Patients weight is 20.5kg, B/p 80/64, pulse 185, temp 99 F, O2 96%, RR 31. Patient is pale and has dry mucus membranes, complains of stomach pain. Provider ordered D5 ½ NS IV at a rate of 62ml/hr, strict I&Os, check weight daily and repeat CBC in the morning.

Concluding Questions Reflecting on Eva Madison's case, were there any actions you would do differently? If so, what were these actions, and why would you do them differently? I would make sure to reassess her breathing after giving her D5 ½ NS to see if her condition has improved. Describe how you would apply the knowledge and skills that you obtained in Eva Madison's case to an actual patient care situation. I would know how to assess a patient with presumed dehydration and know how to identify the signs of dehydration in children....