Surgical Scenario 4 Vernon Watkins

Surgical Scenario 4 Vernon Watkins Guided Reflections Questions 1) How did the scenario make you feel? - At first, I get anxious because I want to do everything perfect to help the patient. As I read more about how to solve or help prevent a problem, the better I feel about caring for a patient. 2) Discuss your use of adjunct oxygen therapy for this patient, including why you chose a particular oxygen device, rate, and flow. - At times I do have difÏculty choosing oxygen device, rate, and flow but I try to go by patient’s condition and SPo2 reading. If there is no improvement then device, rate, and flow must be adjusted. 3) Discuss Vernon Watkins’ arterial blood gas (ABG) analysis result and explain what caused this result. - Mr. Watkins results were from respiratory alkalosis which may have occurred due to mild hypoxemia from hyperventilating. 4) What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format. - (S) Vernon Watkins is a 69-year-old male patient, postop from an emergency hemicolectomy - (B) Mr. Watkins came into ED 4 days ago with complaint of nausea, vomiting, and severe abdominal pain and was admitted for emergent surgery for bowel perforation. He underwent a hemicolectomy. He has a midline abdominal incision without redness, swelling, or drainage. He is tolerating a soft diet without nausea or vomiting. Bowel sounds are present in all four abdominal quadrants. He had a bowel movement yesterday. Last urinary output was 400 ml at 6 a.m. He is reluctant to use the incentive spirometer, but his wife encourages him to do his deep breathing. Abdominal pain has been controlled with morphine. He has refused to ambulate this morning because of fatigue and a sore leg. - (A) Oxygenation given through non-rebreathing to maintain SpO2 above 92%, Arterial Blood Gas and Venous blood test taken, CT scan, ECG monitoring all ordered. Closely monitored, patient was complaining of difÏculty breathing and started hyperventilating triggering respiratory alkalosis. Elevated head of bed to assist in comfort and breathing, heparin given as ordered. - (R) Postoperative patients are at risk for complications such as atelectasis, pneumonia, deep vein thrombosis, pulmonary embolism, constipation, paralytic ileus, and wound infection. This patient’s pulmonary embolism (PE) is most likely the result of deep vein thrombosis related to surgery and decreased mobility. PE is a life-threatening medical emergency. Signs and symptoms range from dyspnea, pleuritic chest pain, and tachynpnea to shock and syncope. The immediate objectives are to establish a diagnosis, administer anticoagulation, and stabilize the cardiopulmonary system. 5) Discuss the use of a heparin nomogram (guideline for heparin titration) and safety related to this intervention. - Heparin nomogram/guideline is an adjustment of heparin dosages that standardized therapy used for each patient which also helped to reduce the time it took to reach and maintain a therapeutic APTT result. Each patient must be closely monitored with head to toe assessments and laboratory test due its increased risk of bleeding. 6) Discuss why Vernon Watkins may be at risk for right ventricular failure as a complication of his pulmonary embolism (PE). - According to Brunner & Suddarth's 14th ed. Textbook of Medical-Surgical Nursing, a sudden increase in pulmonary resistance increases the work of the right ventricle, which can cause acute right-sided heart failure. 7) Discuss how you would communicate with the patient in acute respiratory distress in this emergency situation and what effective communication techniques you would use. - Keeping patient calm and comfortable to keep anxiety down to a minimal because he is already having trouble breathing. Allowing the patient to take part in his plan of care allows him to stay informed without surprises. Think about tone of your voice and your body posture to help maintain a good rapport with patient. Be reassuring and use openended questions. 8) Consider what would have happened if Vernon Watkins’ family members had been present at the bedside and describe how you would have supported them during this acute episode. - Continue to keep family and patient informed and connected in the plan of care for patient. Allow them to ask questions and answer certain questions to your best ability, keep them calm and as comfortable as possible throughout process. 9) What would you do differently if you were to repeat this scenario? How would your patient care change? - I would of attached the ECG earlier and pushed the morphine slowly.