Guided Reflection Questions - Olivia Jones (Complex)

Maternity Case 2: Olivia Jones (Complex) Guided Reflection Questions Opening Questions How did the simulated experience of Olivia Jones’s case make you feel? Nervous as it was my first vSim and I did not know what to expect Describe the actions you felt went well in this scenario. I feel that the physical assessment and the patient education went well in this simulation. I was interesting to see the difference in breathing pattern between the patient being in a sitting position and lying back. Scenario Analysis Questions* EBP What are the indications that Olivia Jones’s preeclampsia has progressed? • • • • • PCC • PCC/I • T&C Results of LFT's, electrolytes, low platelets Current vital signs, Bilateral lower extremities +3 pitting edema Clonus +4 deep tendon reflexes Worsening epigastric pain and headache What should the priority teaching for Olivia Jones include? Priority teaching should include teaching Mrs. Jones to be mindful of the signs of worsening preeclampsia, in other words, teaching or reinforcing education about the condition, its signs, symptoms, treatment, and prognosis Olivia Jones was placed on magnesium sulfate for treatment of her preeclampsia. What are the indications for this drug, and what should be taught to the patient regarding side effects? Magnesium sulfate is used for the prevention of seizures in patients with severe preeclampsia and preterm labor. Mrs. Jones should be educated about the side effects of this medication, such as confusion, shortness of breath, nausea, dizziness, and dysrhythmia. What key elements would you include in the handoff report for this patient? Consider the situation-background-assessment-recommendation (SBAR) format. * The Scenario Analysis Questions are correlated to the Quality and Safety Education for Nurses (QSEN) competencies: Patient-Centered Care (PCC), Teamwork and Collaboration (T&C), Evidence-Based Practice (EBP), Quality Improvement (QI), Safety (S), and Informatics (I). Find more information at: http://qsen.org/ • S Olivia Jones, a 23-year-old African American female, G1P0 at 36 weeks of gestation, was admitted to L&D for monitoring and surveillance. No previous health problems and pregnancy was normal until prenatal visit at 30 weeks. The patient's current status is Heart rate: 103. Pulse: Present. Blood pressure: 168/100 mm Hg. Respiration: 22. Conscious state: Appropriate. SpO2: 96%. Temp: 99 F (37 C). EFM: Baseline. Fetal heart rate: 151. The patient is complaining of pain of 4 out of 10 in the upper center of the stomach and under the right breast and headache across her forehead of 5 out of 10. Patient denies medication for pain at this time. There are crackles at both bases. There is a moderate to severe pitting edema graded to +3. The deep tendon reflexes were very brisk, hyperreflexive, and with clonus. Graded to +4. Patient reports blurred vision and seeing spots. Patient has an indwelling urinary catheter placed and is currently on a nonrebreathing mask with 100% oxygen at 10L as ordered. What safety measures should be initiated while Olivia Jones is in the hospital? • • S/QI • Seizure precautions: Pad bed rails, have oxygen and suction at the bedside, never leave a patient unattended during a seizure. Keep the lights dimmed, reduce outside stimuli, and continue to monitor the patient's blood pressure. Fall risk: Activate bed alarm, place fall mats, place call light at patient's reach, educate patient on asking for help to get out on in bed. Based on your experience with Olivia Jones’s case, reflect on possible nursing actions for enhanced safety and quality improvement. I think that when it comes to clinical nursing action, this simulation was spot on. Concluding Questions Reflecting on Olivia Jones’s case, were there any actions you would do differently? Explain. • I would definitely pay more attention to the orders in the patient’s chart, which is something I missed on my first simulation Describe how you would apply the knowledge and skills that you obtained in Olivia Jones’s case to an actual patient care situation. • Like I mentioned before I would pay more attention to the orders in the patient’s chart, as it will contain standing orders that might be needed at any certain time. It is important to know as much as possible your patient’s medical history in order to provide the best care possible.