Maternity Case Brenda Patton

Maternity Case: Brenda Patton Guided Reflection Questions Opening Questions How did the simulated experience of Brenda Patton’s case make you feel? The simulated experience of Brena Patton’s case was pretty straight forward. Describe the actions you felt went well in this scenario. The actions that I felt went well in this scenario was assessing the patient, asking her for her pain level, gave comfort measures, recognizing she had pain and tried to make her as comfortable as possible. I also was able to educate her and make her and her significant other less anxious. I was able to administer her medications easily. Scenario Analysis Questions1 EBP What complications can occur if group B streptococcus is not treated? The complications can occur if group B streptococcus is not treated include: skin infection, infection of the bloodstream, pneumonia, bone and joint infections, endocarditis, and meningitis. PCC What should be included in the priority teaching for Brenda Patton? -“We can see that you are in active labor. We will be monitoring you and will do some diagnostic tests to make sure everything is fine with you and your baby.” -Explain that she had a ruptured membrane and what this includes. - Her results came back as GBS positive. Group B Streptococcal continues to be one of the leading infections of infant mortality abd morbidity in the US. The primary risk factor is maternal intrapartum colonization, and your screening revealed that you were positive. Prophylactically we will give you Penicillin to reduce the chances of the baby contracting the infection. -Vital signs within normal range. -Patient received education regarding that the medication would not harm the fetus which allowed her to comfortably give me permission to administer her the medication for her condition. T&C 1 What key elements would you include in the handoff report for this patient? Consider the situation-background-assessment-recommendation (SBAR) format. -Her History: Brenda Patton, an 18-year old Caucasian female, G1P0 at 38 2/7 weeks of gestation is admitted to the labor and birthing unit for labor assessment. She states her water may have broken earlier this morning and she thinks she is in labor. AmniSure was +. Vaginal exam reveals 50% effacement of cervix, cervical dilation 4 cm, and fetus at -2 station. Her boyfriend is present and Ms. Patton’s mother was called earlier by Ms. Patton to inform her of her admission. The provider has been notified and prenatal records have been pulled. The lab report indicates that the patient’s group B strep vaginorectal cultyre taken at 36 weeks was positive. The patient wishes to have a natural birth without medication. Admission intrapartum orders have been initiated, initial labs have been drawen, and a saline lock has been placed. -Ms. Patton’s vital signs: HR: 88, Pulse: Present, BP 117/70 mm Hg, Respirations: 20, normal breathing and chest moving equally. Ms. Patton is in an appropriate conscious state, and her SpO2 is 97%. Her temperature is 99 F. EFM showed baseline, and fetal heart rate was 141. -Assessment: No obvious airway obstruction and there is normal elasticity of the skin. Her color is normal and she is not sweating. Next I examined Ms. Patton’s chest. She is breathing at 20 breaths per minute and her chest moving equally. Normal elasticity of the skin and skin color is normal. She is not sweating. Ms. Patton’s arms were normal elasticity and her skin color was normal and she was not sweating. There was nothing else to examine on her arms. Ms. Patton’s abdomen and pelvis were examined next. Leopold’s maneuvers were performed and the fetus is in longitudinal lie, in vertex presentation. Nothing to be examined on Ms. Patton’s legs. No pitting edema and her deep tendon reflexes were normal, 2+. -Medication: Ms. Patton received Penicillin 5 million units IVPB (piggyback). Promethazine 12.5 mg IVPB (piggyback) every 4 hours PRN (for nausea/vomiting). -Education: Patient was educated. See question above. S/QI Based on your experience with Brenda Patton’s case, reflect on possible nursing actions for enhanced safety and quality improvement. Educating her about her meds she was receiving, the education about the equipment we were using on her (pulse ox, BP device, fetal monitor), advised her of position changes every hour, educated her about her ruptured membranes, made sure to do her head to toe assessment, handled her pain with comfort measures, asking her her name and date of birth and any allergies, etc. Concluding Questions Reflecting on Brenda Patton’s case, were there any actions you would do differently? Explain. I would start off by doing my head to toe assessment and taking her vital signs right after I washed my hands, introduced myself, and identified patient. I didn’t do that the first time and that’s why I missed a lot of the simulation. I went straight to administering her medication because she kept moaning and I wanted her to be comfortable. But after the first simulation and the explanation behind it, I understand the assessment is important to do first. Another thing I struggled with was that there was a PRN order for nausea/vomitting but she didn’t want any medication because she wanted a natural birth so it was a little confusing with if we should administer it or not. Describe how you would apply the knowledge and skills that you obtained in Brenda Patton’s case to an actual patient care situation. I would apply the knowledge and skills that I obtained in Brenda Patton’s case to an actual patient care situation by making sure that I completed the same steps I did in the vSim. This includes starting off by arriving at the patient’s side, introducing myself, washing my hands, and identifying the patient as well as asking the patient if they had any allergies. I would ask the patient how her pain is and the start my head to toe assessment. I would then administer her medications, as well as educating her and providing comfort measures.