What follow-up assessment priorities should be done post-allergic reaction? List them and tell why each is pertinent to perform

NURS 4581 ADULTS WITH COMPLEX NEEDS     WEBSITE   Lippincott the point Login:  Michaeltwilliams@mavs.uta.edu Password:  Joe0922!   Click on the book: Hinkle & Cheever: Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, Fourteenth Edition Then click on the VSIMS tab   Clinical Make-up Assignment for Absence This assignment is due no later than 2359 Tuesday, July 16, 2019. Please save as a word document and send as an attachment via. Disregard of this assignment will result in a clinical grade of “F”.   The purpose of this assignment is to help you develop critical thinking skills that would be required in the clinical setting.  The responses you provide to the debriefing questions are to be in-depth and show evidence that you have used a variety of different sources when developing your answers. Answers must be in your own words meaning do not cut and paste from your references. Please submit the assignment in a thoughtful, scholarly format (complete sentences), and cite references used.   Do not seek help from your peers to complete this project as this is independent study and must be completed by you and you alone. This will be sent through Safe Assign to check for plagiarism.  If found, you will be reported to the office of Student Conduct and if found to have copied another’s work you will receive an “F” for clinical which is a course failure.

1. For the following vSim scenarios: Complete the pretest, obtain a 95% on the vSim itself, obtain 100% on the posttest, and complete the attached debriefing questions for all of the following vSims which are located in thepoint.lww.com, Hinkle & Cheever: Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 13th Edition.

Kenneth Bronson Stan Checketts Carl Shapiro Vernon Watkins   Debriefing Questions for Kenneth Bronson

1. How did the scenario make you feel and why? What did you learn from this experience that may help you with future patient care?

 

2. What signs and symptoms led you to the conclusion that Kenneth Bronson was experiencing an allergic reaction? Which additional S & S may have been present for the type of allergic reaction he had?

 

3. List the differences between mild, moderate, and severe anaphylactic reactions.

 

4. What follow-up assessment priorities should be done post-allergic reaction? List them and tell why each is pertinent to perform.

 

5. What further needs does Kenneth Bronson have at the end of the scenario that future nursing care should address?

 

6. Write a thorough and accurate SBAR (situation, background, assessment, recommendation) formatted shift change report on this patient.

 

7. What did you do differently when you repeated this scenario? How did your patient care change?

      Debriefing Questions for Stan Checketts

1. How did the scenario make you feel and why? What did you learn from this experience that may help you with future patient care?

 

2. When reflecting on the care of Stan Checketts, what are signs and symptoms you can assess for in the next patient who might be at risk of dehydration? Discuss two situations that may cause dehydration and the pathophysiology of these conditions.

 

3. What are the signs and symptoms of hypovolemic shock? Discuss two situations that may cause hypovolemic shock and the pathophysiology of these conditions.

 

4. In evaluating Stan Checketts’ laboratory values, what, if any, abnormalities did you find? List them and state why you believe each is abnormal.

 

5. Stan Checketts had a nasogastric (NG) tube inserted for gastric decompression. What are the preferred methods for confirming placement of the NG tube? What could be some of the potential complications of not confirming placement using current evidence-based practice?

 

6. Write a thorough and accurate SBAR (situation, background, assessment, recommendation) formatted change of shift report on this patient.

 

7. What did you do differently when you repeated this scenario? How did your patient care change?

      Debriefing Questions for Carl Shapiro  

1. How did the scenario make you feel and why? What did you learn from this experience that may help you with future patient care?

 

2. List the possible causes of ventricular fibrillation and explain the contributing pathology for each cause?

 

3. What is the difference between synchronized and asynchronized defibrillation and what dysthymias may be treated with each type of defibrillation? List the safety precautions that must be implemented during defibrillation and the rationale for each.

 

4. When performing CPR on Carl Shapiro, list the quality indicators that would indicate that you are performing resuscitation correctly? If he would have had return of spontaneous circulation (ROSC), what would be your next interventions and why?

 

5. If Carl Shapiro’s family members had been present at the bedside and witnessed the arrest, describe what you could have done to support them during this crisis.

 

6. Write a thorough and accurate SBAR (situation, background, assessment, recommendation) formatted change of shift report on this patient.

 

7. What did you do differently when you repeated this scenario? How did your patient care change?

        Debriefing Questions for Vernon Watkins

1. How did the scenario make you feel and why? What did you learn from this experience that may help you with future patient care?

 

2. List ALL of the various oxygen therapy modalities available for use in the hospital setting and in what situation(s) each would be appropriate to use and why. Which one did you select for Vernon Watkins, including why you chose the particular oxygen device, rate, and flow.

 

3. Examine Vernon Watkins’ arterial blood gas (ABG) analysis results and provide your interpretation of them and explain what caused each of the abnormal results.

 

4. What is a heparin nomogram and why should we use one when administering heparin intravenously via continuous infusion? What are important lab/diagnostic values to monitor? What assessment findings may indicate the Heparin gtt needs to be discontinued?

 

5. Explain why Vernon Watkins may be at risk for right ventricular failure as a complication of his pulmonary embolism (PE).

 

6. Write a thorough and accurate SBAR (situation, background, assessment, recommendation) formatted shift change report on this patient.

 

7. What did you do differently when you repeated this scenario? How did your patient care change?

 

1. The Following is a case study on John Thomas. Please review each stage and answer the questions.

STAGE 1: John Thomas is a 64-year-old Caucasian male who presents to the emergency room with a two-day history of intermittent substernal chest pressure associated with shortness of breath and diaphoresis.  The pain had originally awoken Mr. Thomas from sleep 2 nights ago and has been intermittently relieved with some sublingual nitroglycerin tablets that he had received from his physician 3 years ago.  The pain increases with exertion, but now is constant.  He rates the pain a “7” on a scale of 1 to 10. Past Medical History:  HTN, Type 2 DM Home Medications:     Lopressor (metoprolol) 50 mg PO daily Lasix 40 mg PO daily ASA 325 mg PO daily Glucophage 50 mg PO BID Vital Signs:  T-98.9 (O)          P= 110             R=32               BP= 90/60       SpO₂=86% on RA Physical Exam: Neuro:             Anxious, but alert and oriented x3 Pulm:               Bilateral rales, labored CV:                 RRR; S₁, S₂, S₃; tachycardic; PMI displaced laterally ABD:              Active bowel sounds; soft/non-tender; liver enlarged EXT:               2+ lower extremity edema; 1+ peripheral pulses INTEG:           Poor capillary refill; nail beds cyanotic; skin is diaphoretic Lab Results: Na= 133;         K=5.0;             C1=100;          CO₂=22;          BUN=29;        Cr=1.8; Glucose=183            Hgb=9.2;         Hct=27.6;        WBC=11.2;     Plt=203           BNP=788 CPK=2900;     CKMB=432%;                        LDH=972;       Troponin=6 Diagnostic Tests: 12 lead ECG; Sinus tachycardia with left ventricular hypertrophy and ST elevation in leads V₁, V₂, V₃, & V₄ CXR:   Increased vascular markings in both lungs   Critical thinking exercises

1. List your primary medical and nursing diagnoses for this patient.
2. What area of the left ventricle is affected by this MI?
3. What is your rationale for EACH of the abnormal physical assessment parameters, the abnormal laboratory results, and the abnormal diagnostic tests?
4. What are your anticipated nursing interventions for this patient?

STAGE 2: Mr. Thomas is admitted to the CCU with a diagnosis of Acute MI with acute decompensated heart failure.  The following orders are obtained: Vital Signs q1h Continuous ECG monitor Bedrest Foley catheter Nitroglycerin IV infusion @ 10 mcg/min Dobutamine 2mcg/kg/min Heparin IV infusion @ 1000 units/hr PTT q6h and call results if <60 or > 90 CK isoenzymes q8h x3 Troponin level q12h x2 O₂ at 2 1iters/min per NC—titrate for SpO₂>91% Lopressor 25 mg PO BID Lasix 40mg IV q6h Ambien 5 mg PO qHS PRN sleep

 

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