VSIM RED YODER part 1 Guided Reflection Sherman “Red” Yoder, Part 1 & 2 (answered) Sherman “Red” Yoder, Part 1 & 2 (answered) Guided Reflection Questions Opening Questions 1. How did the s... imulated experience of Red Yoder’s case make you feel? The home assessment was a new simulation for me. In this scenario the regular head to toe assessment wasn’t necessary, but it never hurts to get a full picture of the patient. This simulation provided extensive practice with asking questions and gaining a health picture for this patient. I thought that it was difficult to ask the questions without the form in from of me to go by. 2. What nursing actions did you feel were appropriate within this scenario? This simulation provided extensive practice with asking questions and gaining a health picture for this patient. The nurse needed to assess the patient, identify concerns and plan care for the patient. Discussing Red’s understanding of his diagnosis of diabetes and the necessity to stick to the correct insulin routine, diet and exercise and discussing his sleep and alcohol use patterns were all appropriate.Assessing his foot ulcer and evaluating Red’s ability to care for the wound and the availability of family support was also important. Scenario Analysis Questions* 3. EBP What are the priority nursing actions for Red Yoder based on physical findings and social andfamily interaction? Educating Red on how alcohol use can affect diabetes outcomes is important. Addressing adherence to a diabetic diet and staying hydrated was important and was also acknowledging and addressing his daughter’s concerns regarding Red’s care in this aspect, as she is the one who brings his groceries. It is important for diabetics with wounds to stay hydrated and eat nutritious foods to promote healing and fight infection. Correct Insulin administration and scheduling is important to maintain blood sugars in diabetics. 4. EBP What potential problems can you identify for Red Yoder? The patient could potentially have his foot amputated if his wound isn’t maintained and assessedfor proper healing. He could get also develop a bone infection or other systemic infection causing the need for prolonged hospitalization.5. S/QI For the following Safety/Quality Improvement measures, what nursing actions should be takenduring Red Yoder’s case? Safety/Quality Improvement Measures Nursing Actions Assessment of patient’s ability to self-administer his insulin Teach and then have Red demonstrate proper administration of insulin Assessment of patient’s ability to monitor blood glucose Demonstrate the correct process and then have Red re-teach back to the nurse. Safety issues related to needle disposal Teach the patient about the importance and possibly provide the patient with an appropriate receptacle. 6. PCC/I What appropriate assessments were made to help you decide what interventions Red Yoderneeded? Skin assessment Health and education assessment- Diet, wound care, diabetes knowledge Sleep Routine Alcohol Usage Wound assessment Vitals assessment 7. T&C Why is it important to include Red Yoder’s family as members of his health care team? It is difficult for Red to assess the bottoms of his feet on his own, he is going to need some support from his family. His family also provides support with groceries and getting to his doctor appointments, so making sure they understand the plan of care with give Red more accountability in his health routine. Concluding Questions 1. Reflecting on Red Yoder’s case, were there any actions you would do differently? If so, what were theseactions, and why would you do them differently? I completed the simulation twice. During the first simulation I was confused as to where I find the answers to the alcohol and sleep assessments, so I completed the questions based on what little information I had of Red. I then realized there were options to have the conversation with the patient in the communication controls. Secondly, I realized there were multiple ways to ask the same question, and some were better than others. If I completed it again, I would pay closer attention to the way questions were asked.2. How would you apply the knowledge and skills that you obtained in Red Yoder’s case to an actual patientcare situation? In real life, I would try to have a natural conversation with the patient. Asking questions directly from some of the assessment tools available to nurses can be difficult and feel very unnatural. The information is very personal and people tend to guard the truth when they think they are being judged based on their answers. And questionnaires about alcohol use elicit a defensive response in people who drink. Having an open conversation and remaining unbiased is important. Remembering the phrasing of a question can make a huge difference when using these tools.Safety/Quality Improvement Measures Nursing Actions Sherman “Red” Yoder, Part 2 Guided Reflection Questions Opening Questions 1. How did the simulated experience of Red Yoder’s case make you feel? - I think it was a great experience to assess a patient as an emergency triage nurse. Assessing the same patient again but with different problem this time and evaluating his wound care interventions was a good change. I also enjoyed asking questions regarding CAM assessment. 2. What nursing actions did you feel were appropriate within this scenario? - I feel all nursing actions were appropriate for this scenario. Administration of medication, taking vitals, assessing the wound, completing CAM and SPICES assessment tools, communicating with a family member, calling ICU and provider were all necessary actions. Scenario Analysis Questions* 1. PCC What is the correlation between Red Yoder’s open foot wound, the diagnostic findings, and treatment modalities including fluid bolus, insulin, and antibiotic therapy? - A wound culture and sensitivity test was ordered for Red to identify the bacterial microorganisms in the wound. His diagnostic findings also suggested high white blood cells (12,000) which suggests an infection from a diabetic foot ulcer. Red was ordered to start antibiotic therapy to treat Red’s foot wound and prevent further infection from spreading. Red has type 2 diabetes which could cause nerve damage and numbness in his foot. Insulin would help control the diabetes and fluid bolus would help red to stay hydrated and promote wound healing. Fluid bolus will help to prevent the patient from being hypovolemic and tachycardia. 2. PCC What potential problems can you identify for Red Yoder if his symptoms are not managed in a timely manner? - If the infection gets worse and his foot gets necrotic, his foot might need to be amputated. If the systemic infection is not controlled, he could possibly go into septic shock. 3. S/QI For the following Safety/Quality Improvement measures, what nursing actions should be taken during Red Yoder’s case?Medication administration - Prepare and administer medications, using rights of medication administration - Assess IV site for infiltration or extravasation - Review pertinent data prior to medication administration (e.g., contraindications, lab results, allergies, potential interactions) - Administer and document medications given by parenteral routes - Participate in medication reconciliation process - Assess pt’s response to the meds Supportive care - Educate pt about diabetes and its complications - Reposition pt to semi-fowler to promote lung expansion to aid in breathing - Using CAM method, assess his confusion - Educate judy and Red on delirium - Provide education on foot sore, wound care, medications, and sepsis - Assess sensation in lower extremities - Perform focused neurological exam - Administer insulin as ordered - Monitor vital signs - Apply nasal cannula to bring o2 back up to greater than 94 Safety issues related to infection control - Pt is at fall risk due to delirium and should be assess using morse fall risk scale - To control the infection, his lab values should be monitored along with vitals (sp02, BP) - His blood sugar should be checked frequently and administer insulin accordingly - Maintain contact isolation as pt is positive for staph4. PCC/I What appropriate assessments were made to help you decide what interventions Red Yoder needed? - Completing the Confusion Assessment Method (CAM) was important to investigate Red’s delirium - SPICES was useful to identify red’s aging pattern - Assessing Red’s wound to find that the wound is about 1 inch , and 5 millimeters deep with white margins, foul odor, and opaque drainage. - Assessing the sensation in the right foot. - Assessing the vital signs. - Assessing the pain level. 5. QI/EBP In your situation-background-assessment-recommendation (SBAR) report to the provider, what would you request? - In my SBAR report, I would request an immediate transfer to the intensive care unit. I would also request MD to review his antibiotic. I would raise concern about his delirium. 6. T&C In addition to the health care team, who should be involved in discussions about Red Yoder's treatment? - It is important to communicate with the daughter-in-law Judy, as the primary source of information. She is a caregiver for Red and with him being confused she can help the nurse evaluate and assess Red’s situation better. Furthermore, the home health nurse should be involved in the care at home for wound care, and focused assessments. Concluding Questions 7. Reflecting on Red Yoder’s case, were there any actions you would do differently? If so, what were theseactions, and why would you do them differently? - The vsim stated that pt was lethargic, and he was confused. That puts the pt at high fall risk, i would use Morse fall risk scale to assess his risk. There was no option for this. I would also try to go in order by focusing on his ABC’s first, and then the rest. 8. 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