RLE Simulation Scenario For Clinical Practice: (Care of Patients With Alterations in Oxygenation)

RLE Simulation Scenario for Clinical Practice: (Care of patients with alterations in Oxygenation)
Anna Maria B. 35-year-old was admitted to the hospital for shortness of breath,
weakness, productive cough, chest pains and epigastric discomfort. Vital signs upon
admission were:
 Temperature- 38 o C
 Pulse- 105 Beats/min irregular and weak
 Respiration- 30 bpm
 BP100/60 mmHg.
She had been experiencing discomfort for 1 week prior to admission. She was given
orders for bed rest and a low salt, low fat diet. Upon assessment the nurse found out
significant findings such as:
 Pale nail beds and conjunctiva
 Rales on both lower lung fields and reduced lung excursion and increased
fremitus
 Skin was flushed and warm with dryness
 No lesions noted
Anna reported:
 Poor appetite for 1 month now and vomiting episode every now and then
following abdominal pains 2-3 hours after meals and at night.
 She drinks 1 glass of water every meal time to avoid going to the bathroom
frequently.
 Her stools appear soft and dark brown in color; No pain upon defecation noted.
 She lacks sleep and appears haggard owing to her discomfort and cough.
 She is still able to do ADLs but reports fatigue and weakness often in the day.
When asked about her health history and practices:
 She reported having frequent sore throat which she thinks comes from excessive
intake of salty and hot food.
 She has heredo-familial diseases such as hypertension and CAD.
 She smokes 1 pack of cigarette per day
 She occasionally drinks
 She self-medicate using NSAIDS for Gout
When she feels sick, she manages her discomforts with herbal supplements sold to her
by officemates in the auditing office. Her present hospitalization is affecting her role as
breadwinner for her family.
She verbalizes:
 “What is going to happen to us now that I am in the hospital? I feel so bad about
not being healthy but I know God has a purpose for everything.”
Her husband often visits her in the hospital after attending to their two kids in
elementary school.
Upon reading the patient’s chart, the admitting orders are as follow:
 Pls admit to Medical Ward.
 Secure consent for admission
 On NPO temporarily
 Monitor O2 Sat
 IVF: Plain NSS 1 L at 20 gtts/min
To follow: D5Lr 1 L at 30 gtts/min
 Lab
 Endoscopy
 Chest X ray
 CBC
 Lipid Profile
 Urinalysis
 Fecalysis
 Meds
 Paracetamol 500 mg. tab every 6 hours PRN for fever.
 Iron supplement 1 cap. OD
 Esomeprazole 40 mg tab OD
 Amoxicillin 1 gm BID
 Clarithromycin 500 mg BID
 Irbesartan 300 mg OD
 O2 inhalation via cannula at 4-5 liters/min
 Watch for episode of bleeding
 Refer accordingly
DR: Joanna Marie De Guzman RN MD
Laboratory exams for Ann revealed the following:
Chest X ray CBC Lipid profile

 Lung Blood Type: A+ Total Cholesterol 300
consolidation, WBC 18,000/ mm3* mg/dl*
bilateral RBC 3 x 106/Ul* HDL 40 mg/dl*
lung fields. Hgb 8.5 g/dl* LDL 250 mg/dl*
 Heart appears Hct 40 %* Triglycerides 180 mg/dl*
normal WBC Differential
Neutrophils 52%
Lymphocytes 42%*
Monocytes 2%*
Eosinophils 2%
Basophils 1%
PlateletCount
200,000/mm3
Endoscopy Urinalysis Fecalysis
Bleeding ulcer noted below Appearance: clear Color: dark
pyloric junction measuring Color: dark brown
3x4 yellow Consistency: soft-
cm. superficial gastric Odor: formed
irritations aromatic Occult Blood: positive
on mucosa noted. pH: 5.0 Pus:
Protein: negative
negative Ova and Parasites:
Sp. Gravity: 1.005 none seen
Glucose:
negative
Casts: none
WBC: 1-2
RBC: 0-1
Day 2.
 On soft diet
 For H pylori test
 Regulate O2 @ 3 liters per min
 Continue meds
 Continue 02 sat monitoring
 Watch for signs of bleeding
Day 3
 Discontinue o2
 BLAND diet
 Continue meds
Day 4
 For discharge
 Home meds
 Iron supplement 500mg 1 cap OD for 3 months
 Esomeprazole 40 mg tab OD for 1 week
 Clarithromycin 500 mg BID for 1 week
Final Diagnosis: Peptic Ulcer Disease
Follow up Check Up: Sept 20, 2020

Learning Activities:
Reminders: Print the worksheet to answer or answer directly on the worksheet
1. Fill-up the needed data based on the given scenario/case

2. Document the assessment data using BLUE pen for normal findings and RED
for abnormal findings under Review of Systems (ROS)
3. Create a concept map/ case study integrating all the concepts (Disease
process/pathophysiology, signs and symptoms, possible risk factors diagnostic
test, medical diagnosis, pharmacology, at least 3 nursing diagnosis, expected
outcomes, nursing interventions). Fill up also the additional learning worksheet
tables/charting.
4. For documentation use FDAR based on data presented
5. Make drug study using the format below.
Critical Thinking Exercises
Answer the following Critical Thinking Question: Use the space provided below.
1. What will be your focused physical assessment priorities before you start your care for Anna
(10 points)
2. Interpret the diagnostic lab test results for case Correlate the significant diagnostic tests an
PA finding with the pathophysiology of the condition. (10 points)
3. Assuming that Anna was transfused with 1 bag of PRBC, what is the role of this intervention
and your nursing responsibilities for its administration? (10 points)
4. What position and diet modifications will be advised for her to help manage her symptoms?
(10 points)
Answer
1.
2.
3.
4.
Clinical Reasoning
1. What possible COMPLICATIONS do you anticipate?
2. What ASSESSMENT do you need to identify & respond to if this complication develops?
3. What EDUCATIONAL OPPORTUNITIES have you identified for your client?

Name of STUDENT: __________________________________________ Section/Group:
___________
Date: _____________ Institution: ___________________________ Area: _________________
A. Application of the nursing process: Assessment findings of all other areas must be
filled-up using fictional data BUT should be within the scope of the case scenario
given.
1
FILL-UP data completely (Put N/A if not applicable) while receiving endorsement
from staff
In compliance with the Data Privacy Act, Personal Data are NOT ALLOWED in this
worksheet.
Patient’s Case : _______________________________________ Age: _____ Sex: _____

Room/Bed#: _______ Doctor/s :
_________________________________________________________________________
________ Diagnosis : _____________________________________________ Activity
Restriction: ___________________ Chief complaint:
_____________________________________________ Diet:
_______________________________ Brief History (Part of #2: Assessment)
Present Illness:
_________________________________________________________________________
__
Past Med/Sur:
_________________________________________________________________________
__
Family:
_________________________________________________________________________
__
OB-Gyne :
_________________________________________________________________________
__
Personal/Social:
_________________________________________________________________________
__
Previous Nursing Diagnoses:
2
ASSESS THE PATIENT (Initial/Focus/General): Use BLUE for normal findings and RED
for ABNORMAL FINDINGS
Assessment Findings
Skin
Head, Eyes, Ears, Nose,
Throat
Neck
Breast
Respiratory
Cardiovascular
Gastrointestinal
Urinary
Genital
Peripheral / Vascular
Musculoskeletal
Neurologic
Hematologic
Endocrine
Psychiatric
3
Drug study
Dose
Drug Frequency Classification Mechanism Nursing
Time of of responsibilities
Administration action
4
IV Line
IV Line hooked
IV Level received
IV rate per hour
IV level to endorse
5
Nursing Care Plan
Cues/evidences Nursing Planning Nursing Rationale

Diagnosis Interventions
1.
2.
3.
6 F-D-A-R Charting
FOCUS /Nursing
Diagnosis DATA ACTION RESPONSE
Evaluation
Discharge Planning:
Fully Met
Partially Met
Unmet
B. Communication:
Using ISBAR as a model for structured clinical communication and ensure accurate
handover of information between shifts, write down your end of the shift report for
the incoming nurse/student nurse guided by the following questions:
1. Identify: Identify yourself, who you are talking to and who you are talking about
2. Situation: What is the current situation, concerns, observations
3. Background: What is the relevant background information? This helps you set
the scenario to interpret the situation accurately Risk Pathophysiology Signs Dx
Med Dx Phar m ND Exc Inter
4. Assessment: What do you think the problem is? This requires the interpretation
of the situation and background information to make an educated conclusion
about what is going on
5. Recommendation: What do you need them to do? What do you recommend
should be done to correct the current situation?
1. Identify:
2. Situation:
3. Background:
4. Assessment:
5.
Recommendati
on:
Use the Diagram below as your guide

C. Learning Insights/ Reflective Journaling:

RLE Simulation Scenario For Clinical Practice: (Care of Patients With Alterations in Oxygenation)

Uploaded by

Copyright:

Available Formats

RLE Simulation Scenario For Clinical Practice: (Care of Patients With Alterations in Oxygenation)

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

RLE Simulation Scenario For Clinical Practice: (Care of Patients With Alterations in Oxygenation)

Uploaded by

Copyright:

Available Formats

RLE Simulation Scenario for Clinical Practice: (Care of patients with alterations in Oxygenation)

Laboratory exams for Ann revealed the following:

Chest X ray CBC Lipid profile

Final Diagnosis: Peptic Ulcer Disease

Follow up Check Up: Sept 20, 2020

Reminders: Print the worksheet to answer or answer directly on the worksheet

1. Fill-up the needed data based on the given scenario/case

Critical Thinking Exercises

1. What possible COMPLICATIONS do you anticipate?

3. What EDUCATIONAL OPPORTUNITIES have you identified for your client?

Date: _ Institution: _ Area: ___

Patient’s Case : _____________________________________ Age: _ Sex: ___

Cues/evidences Nursing Planning Nursing Rationale

Use the Diagram below as your guide

You might also like