VSIM Vincent Brody reflection questions PDF

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Medical Case 3: Vincent Brody Guided Reflection Questions 1. How did the scenario make you feel? I was interested in seeing what would happen in the scenario. Also, I was a little nervous when Mr. Brody developed a pneumothorax. 2. When a patient develops a rapid onset of shortness of breath, what are the nurse’s immediate priorities? The priority is assessing the patient’s airway, breathing, and circulation. Providing maximal oxygenation and adjusting the position of the patient to semi-fowlers (which I forgot to do) to allow optimal air exchange. 3. What assessment findings would indicate that the patient’s condition is worsening? A drop in SpO2, and signs of confusion, dizziness, and cyanosis around the lips and nails. Also, the patient may report shortness of breath and tightness of the chest. 4. Review Vincent Brody’s laboratory results. Which results are abnormal? Discuss how these results relate to his clinical presentation and chronic disease process. Brody’s ABGs before the chest tube insertion were pH: 7.33 (below range) , PaCO3: 55mmHg (below range), HCO3: 22mEq/L, PaO2: 78 mmg. His hematocrit was 49% which was elevated due to his COPD. Post chest tube insertions the ABGs were: pH: 7.35, PaCO2: 51mmHg, HCO3: 29mEq/L, PaO2: 85mmHg. The pulmonary and renal systems have compensated each other to reverse the respiratory acidosis and return the pH back to normal. 5. What are safety considerations when caring for a patient with a chest tube? Continuous assessment of the surgical wound for any drainage, and check for change in color/temperature of the skin. Monitoring vital signs for any changes is important. Also, checking the tubing is it’s dislodged or kinked. 6. What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format. S- Vincent Brody is a 67-year-old male admitted for exacerbation of his COPD B- He’s maintaining O2 saturation at 94% on 2L/min of O2 via nasal cannula. Has an IV of NaCl in 5% dextrose and normal saline infusing at 100ml/hr in his right arm. He continuous to have a productive cough. During the last year he has had 2 exacerbations of his COPD. He has a 50 year Hx of smoking 2 packs a day. He has a barrel chest and clubbed fingers.

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A- Pt. was given albuterol 2.5mg in 3ml normal saline via nebulizer every 20 min x 3 doses. Symptoms didn’t improve, pt. complained of chest pain and difficulty breathing, assessed and sign of pneumothorax was present. Provider put a chest tube in place. R- Continue monitoring/reassessing pt’s vitals and chest tube. Make time for patient ed. and documentation. Notify provider of any changes. 7. What patient teaching priorities would be important in the patient experiencing an acute exacerbation of COPD? Teach the patient deep breathing techniques, proper nutrition, rest, and smoking cessation. 8. For a patient with COPD who is stable, what resources would you recommend? Reaching out to support groups and reach out to the provider for more information on COPD management. 9. What would you do differently if you were to repeat this scenario? How would your patient care change? I should have elevated the head of the bed to improve the pt’s breathing and assessed lung sounds more often. I would try to provide focused pt. care.

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