Vincent Brody Virtual Simulation

Vincent Brody Virtual Simulation Documentation Assignment 1. Document your focused respiratory assessment for Vincent Brody. a. My focused respiratory assessment for Mr. Vincent Brody found on inspection and auscultation that the chest was moving normally on both sides and there were a few audible wheezes. Additional focused assessment found he has a respiration rate of 19 and SpO2 of 94%. Upon Mr. Brody, developing a left-sided pneumothorax, auscultation showed that he was experiencing reduced breath sounds on the left side by maintaining breath sounds on the right side. His SpO2 began to drop and his respiration rate began to increase. Administration of morphine and use of the non-rebreather brought his oxygen saturation back up into the high 90%’s and lowered his respiratory rate to the low 20’s. 2. Identify and document key nursing diagnoses for Vincent Brody. a. Impaired gas exchange related to COPD b. Ineffective breathing pattern related to Tachypnea c. Risk of infection related to chest tube insertion 3. Document pain management interventions and Vincent Brody’s response to therapy. a. Mr. Brody did not report any pain upon assessment throughout the simulation. He was not responsive to initial orders and administration of 2.5mg Albuterol nebulizer as evidenced by his coughing attack, chest pain, and left pneumothorax. New orders were given and Mr. Brody was administered 2mg of Morphine IVP prior to placement of chest tube. Mr. Brody was responsive to the placement of the chest tube as evidenced by improvement in breath sounds, increase in SpO2, and decrease in respiration rate. 4. Document your phone call to the provider, including the significant changes exhibited by Vincent Brody that triggered the need to notify the provider. a. I would utilize the SBAR model in all my communication with providers in order to streamline communication: i. Situation: Mr. Brody is a 67-year-old male that has COPD and was admitted for exacerbated COPD symptoms. ii. Background: Mr. Brody has a 50-year history of smoking 2 packs a day. Over the last year he has had two incidents of COPD symptom exacerbations. iii. Assessment: Mr. Brody did not report any pain upon assessment throughout the simulation. On inspection and auscultation the chest was moving normally on both sides and there were a few audible wheezes. Additional focused assessment found he has a respiration rate of 19 and SpO2 of 94%. He was not responsive to initial orders and administration of 2.5mg Albuterol nebulizer as evidenced by his coughing attack, chest pain, decrease in SpO2, increase in respiration rate, and left pneumothorax. iv. Recommendation:It is my recommendation that we insert a chest tube to help alleviate the left pneumothorax and decrease his respiration rate. In addition I recommend we provide 10L oxygen through a non-rebreather to help improve his SpO2. 5. Document key assessments you would monitor for a chest tube (insertion site, dressing, suction level, drainage, fluctuation, air leak). a. When monitoring a chest tube there are a few key elements you want to assess to ensure patient safety. At the insertion site you want to ensure that a sterile dressing is dry and intact w/o any drainage holes visible of fluid leaking. It is important to check for subcutaneous emphysema. The chest tube should be changed 24 hours after initial insertion then every 48 hours. As a nurse we want to provide suction every 1-4 hours and notify the provider if drainage exceeds more than 70 mL/hr, increases suddenly, or becomes bright red. Additional monitoring to ensure patency of the tube as well as any air leaks are important and should be reported to the provider. 6. Referring to your feedback log, document the nursing care you provided. a. I started by introducing myself, washing my hands, and identifying the patient for patient safety. I asked about allergies, confirmed consent, and assessed IV site before administering albuterol per order. I then checked patients vitals, pain level, and focused respiratory system assessment. Additionally I attach Mr. Brody to a 3 - lead EKG and noninvasive blood pressure (NIBP) measurement cuff to allow for continuous monitoring of his heart and BP. b. Upon Mr. Brody developed a left pneumothorax, I assessed patients lungs, provided pt with 100% oxygen from a non-rebreathing mask, and contacted HCP for new orders. I obtained informed consent and then per new orders I then slowly administered 2mg Morphine IVP, inserted chest tube, and obtained chest x-ray. I provided patient education around treatment and completed a patient handoff. Guided Reflection Questions 1. How did the scenario make you feel? a. The scenario gave me mixed feelings. On one hand it was helpful to see that I was able to identify and complete the needed nursing interventions. On the other hand there was a level of frustration that resulted in knowing the appropriate steps but in this virtual environment having to wait for the scenario to play out. 2. When a patient develops a rapid onset of shortness of breath, what are the nurse’s immediate priorities? a. Paramount is assessing and establishing a patent patient airway and breathing pattern. This can be done by auscultating the lungs, determining the SpO2, sitting the patient upright, and supplemental oxygen if needed. Assessment data and current patient status should than be communicated through SBAR to the provider to determine if additional intervention and/or treatment is needed. 3. What assessment findings would indicate that the patient’s condition is worsening? a. In Mr. Brody’s situations the indicators that his condition was worsening were first and foremost his complaining of chest tightness and shortness of breath. Additionally diminished breath sounds, wheezing, and low oxygen saturation were indicators of a worsening condition. His ABG lab results also indicated some abnormal findings. Other signs that can indicate a worsening respiratory condition in patients may be a fever, confusion, increase in mucus, and cyanosis. 4. Review Vincent Brody’s laboratory results. Which results are abnormal? Discuss how these results relate to his clinical presentation and chronic disease process. HCO3-, PCO2, and Base Excess: Suggest Respiratory Alkalosis SaO2: indicative a low arterial blood oxygen saturation PO2 & HCT: common in pt w/ COPD a. 5. What are safety considerations when caring for a patient with a chest tube? a. When monitoring a chest tube there are a few key elements you want to assess to ensure patient safety, in addition to regularly monitoring the patients respiration rate, breath sounds, and oxygen saturation. At the insertion site you want to ensure that a sterile dressing is dry and intact w/o any drainage holes visible of fluid leaking. It is important to check for subcutaneous emphysema. The chest tube should be changed 24 hours after initial insertion then every 48 hours. As a nurse we want to provide suction every 1-4 hours and notify the provider if drainage exceeds more than 70 mL/hr, increases suddenly, or becomes bright red. Additional monitoring to ensure patency of the tube as well as any air leaks are important and should be reported to the provider. 6. What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format. a. Situation: Mr. Brody is a 67-year-old male that has COPD and was admitted for exacerbated COPD symptoms. He developed a left-sided pneumothorax. The provider was contacted and new orders were given. 2mg of morphine IVP was administered, 10L oxygen via non-rebreather, a chest x-ray taken, and chest tube placed. Mr. Brody was responsive to these interventions and his oxygen saturation and respiratory rate improved. b. Background: Mr. Brody has a 50-year history of smoking 2 packs a day. Over the last year he has had two incidents of COPD symptom exacerbations. c. Assessment: Mr. Brody did not report any pain upon assessment throughout the simulation. On inspection and auscultation the chest was moving normally on both sides and there were a few audible wheezes. Additional focused assessment found he has a respiration rate of 19 and SpO2 of 94%. He was not responsive to initial orders and administration of 2.5mg Albuterol nebulizer as evidenced by his coughing attack, chest pain, decrease in SpO2, increase in respiration rate, and left pneumothorax. d. Recommendation: Continued monitoring of Mr. Brody’s respiration rate, oxygen saturation, and chest tube are recommended until symptoms subside and labs are within normal range. 7. What patient teaching priorities would be important in the patient experiencing an acute exacerbation of COPD? a. Breathing exercises along with lifestyle changes around smoking cessation, diet & exercise, and medication compliance are all important teaching and educational topics for patients experiencing an acute exacerbation of COPD. 8. For a patient with COPD who is stable, what resources would you recommend? a. As mentioned before once a patient with COPD is stable further focus on smoking cessation programs is vital. 9. What would you do differently if you were to repeat this scenario? How would your patient care change? a. I would have thought more about what exacerbated COPD presents like in the patient population. In addition I would have done more research around treatment options and planned effectively to utilize these interventions.