Question

Simulation

This is Becky, the nurse in the emergency Department. I am caring for Robert jones a 60-year-old African- American male. We admitted him at at 4:30   this morning. He reported increased shortness of breath and weakness.    His vitals were: blood pressure 80 over 62, R 30 pulse 164 and in a-fib. We gave him a 1000 milliliter bolus of sodium chloride to bring his blood pressure. He was recently in the hospital for atrial fibrillation and stage three   ulceration. He is been on home antibiotics. Past medical history includes chronic renal failure, type two diabetes, peripheral vascular disease, coronary   artery disease, and atrial fibrillation. The client’s social history includes smoking one pack of cigarettes per day and consumes three to five alcoholic drinks per week. He has difficulty adhering to his diabetic management plan. Laboratory findings include sodium 128 potassium 5.1, BUN, creatinine of 3.0 total bilirubin of 2.8 globular filtration rate 45 calcium 8.7 digoxin level 0.6. His WBC is 16.1 hemoglobin 9.3, and hematocrit 28.2 his chest x-ray findings include: right lung opacities greater than left lung. His ECG revealed atrial fibrillation. The client currently has a 20 gauge in the left forearm with IV fluids of .9%sodiumchloride at 100milliliters per hour. He is on 2 liters of 2 nasal cannula and his 02 sat is 91%. He is resting in bed now. I’ll bring him up to the telemetry unit in a few minutes.

Question

1. Reflect on ethical dilemmas uncovered during scenario.

2. Discuss cultural considerations.

3. Discuss educational needs of the client who has multiple disease processes.

4. Describe an “Aha” moment you experienced during the simulation. What are some of the aspects of the client’s care that you did not feel they were prepared for?

Answer 1

1.Here the patient is suffering from several disease like CAD,PVD, Hypotension, Tachycardia, AF, Right lung opacification,etc. Here the patient is receiving 0.9% of NACL at 100 ml per hour and 2 liters of oxygen only. Atrial fibrillation is a life threatening condition if it turns to ventricular tachycardia. The creatinine level is high,GFR also very low and potassium level is high, this is also a serious condition which shows acute renal failure. So the AF and ARF should be treated first. Here the patient getting fluid therapy despite the patient is on renal failure.

2.The African-Americans traditionally believed that spirits dwelled in their surrounding nature.They also generally believed that a spiritual life source existed after death and that ancestors in this spiritual realm could then mediate between the supreme Creator and the living. So the healthcare worker should give maximum freedom in his spiritual views. The other problem is that racism. It should be avoided completely.

3.As the patient have the history of CAD,PVD ,he should quit smoking and alcohol consumption strictly. These habits will put him under high risk. The dietary management is also very important. He should avoid fast food and concentrate on fibre rich diet like vegetables. He should take the prescribed medicines as per the physicians order.

4.The 'aha ' moment is that when she says that she will bring him to the telemetry unit despite of all his present problems.