Henry Williams Reflection Questions

Henry Williams, Part 1 Guided Reflection Questions Opening Questions How did the simulated experience of Henry Williams’s case make you feel? I felt that I learned more about medications for COPD and the priority of administering them. I also felt sad that chronic diseases such as these can make people fall into depression they would likely otherwise not experience. What nursing actions did you feel were appropriate within this scenario? I believe we performed all orders in a reasonable time and provided further therapeutic communication to determine how severe his depression was and if he has any suicide ideation. Scenario Analysis Questions* What priority problem did you identify for Henry Williams? Exacerbated COPD with SOB, barrel chest, labored breathing, and accessory muscle use. He also has history of type 2 diabetes which is not well managed and depression with former suicide attempt. What is the rationale for recognizing Henry Williams’s shortness of breath and for initiating actions in a timely manner? Using the ABC’s of care, airway and breathing are the first two priorities for this patient. We would first administer O2 at 2 liters via nasal cannula and if SpO2 does not increase, we switch to non-rebreather mask at 4 liters. It is important to administer the Solumedrol IV stat to act quickly in the patient’s blood stream followed by the order of albuterol. What is the rationale for recognizing Henry Williams’s anxiety and concern for his wife and for initiating actions in a timely manner? In this campus simulation, we did not have an experience or a story line for his wife. I would imagine this would be regarding his health and depression. We would want to be sympathetic and provide education to the wife as to what we are doing for him. What teaching strategies and information should be included during Henry Williams’s visit to the clinic? We want to provide education about his existing conditions, how to prevent exacerbation, and when to see a physician. We also want to discuss medication compliance and refer him to help for his mental health. What appropriate assessments were made to help you decide what interventions Henry Williams needed? We needed to do a respiratory assessment including listening to his lungs, obtaining SpO2 and administering oxygen per orders. Based on the consistent shortness of breath, we administered medications per physician’s orders and called to report status. What was the relevance of the nursing communication with Henry Williams’s daughter-in-law, Betty? There was no communication with his daughter-in-law, but in the pre-sim information, it mentions that she reports Henry being depressed with lack of appetite. We would want to let her know that we will perform a depression and nutrition screening and thank her for letting us know. What health care team members and services may play a role in Henry Williams’s care and why? Admitting physician, nurse, respiratory therapy, nutrition, physical therapy, primary care physician. These are all members of his health care team that have specific roles to improve his condition. What actions should take place to improve Henry Williams’s quality of care? To improve his quality of care, the nurse should provide comfort measures and therapeutic communication. How do you think Henry and Ertha Williams will be coping 1 month after the scenario? Henry and his wife should be checked up on after a month to see if they are following the education and if there is any improvement in Henry’s mental state. If the wife has memory issues, she may not remember important information from his clinic visit. Henry will have to bear both health burdens and is at risk for further chronic depression. Concluding Questions Reflecting on Henry Williams’s case, were there any actions you would do differently? If so, what were these actions, and why would you have done them differently? If we were to re-do this scenario, I would have us administer the Solumedrol first as indicated by the order “stat.” We realized this after the simulation and gave albuterol beforehand. While this helped the patient, it wasn’t the best practice. How would you apply the knowledge and skills that you obtained in Henry Williams’s case to an actual patient care situation? In a real patient situation, I now know what meds to anticipate giving and I understand the importance of keeping the SpO2 up but not overloading them with oxygen. In patients with COPD, giving too much oxygen directly at one time can cause hypoxic injury during exacerbations of COPD.