Question

To start, thank you to whoever can help me clear this up a little better! I have a simulation to prepare for in Nursing in which I care for this hypothetical patient and I wanted to make sure I have all my priorities straight. I was given a hypothetical patient with the below characteristics, and my question is what are my priorities with this patient as a senior nursing student and challenges might I expect to be thrown at me during my simulation?

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Patient Name: W.H.

Patient information: 80 year old Caucasian male; thinning gray hair.

Environment/setting: Medical Unit

Vital signs: T: 37.5 C (99.5 F) P: 92, regular R: 22 BP: 118/70 O2 Sat: 91%

CLINICAL CASE INFORMATION:

Surgical History: Multiple extractions of teeth in the last few years (has a partial plate on bottom and some teeth on top).

Medical History: CHF, Atrial Fibrillation (rate controlled), COPD, Hypertension, Hypothyroidism, and Hyperlipidemia.

Social History: Tobacco use (50 pack years). Widowed, lives alone. Retired, sometimes volunteers at the library – has not been able to for the past few weeks due to health problems. Has 3 daughters: Lynn, Devon, and Kristy. Lynn is a teacher and single mother with one child. She lives in the same town 5 minutes away and calls her father daily. They go out to lunch on Saturdays. Devon is a nurse who has 8 children. Kristy is estranged. He lives alone and speaks frequently of his late wife of 55 years. He has been visited from 2 of his 3 daughters and many grandchildren. W.H. is considering getting a pet to help decrease the feeling of being alone in an empty house. He enjoys talking about current events and frequently watches various news channels on TV.

MEDICATIONS & ALLERGIES (MAR)

Allergies: Sulfa drugs

Current Meds:

Furosemide 40 mg in 4 ml IVP bid. Lisinopril 10 mg po daily, hold if systolic <90. Aspirin Enteric coated 81mg po daily. Multi vit 1 tab po daily. Docusate 100 mg po daily. Levothyroxine 75mcg po daily, administer 30 min prior to A.M. meal. Oxygen 2L via nasal cannula. Spiriva 10mcg 1 inhalation daily. Carvedilol 6.25mg po q12h, hold if heart rate <60 or systolic <90. Saline flush 3ml q8h. K-Dur 20mEq po bid. Coumadin po HS per MAR instructions. Lanoxin 0.25 mg po daily, check apical pulse prior to administration. Azithromycin 250 mg po daily.

ROLES AND RESPONSIBILITIES:

1. Patient - manikin with voice or standardized patient w/ foley prosthesis

2. Incoming nurse - Comes in at 7am. Listens to reports, goes to patient room, performs primary assessment and management of patient condition.

3. Nurse orientee - assigned to assist primary RN as needed; may perform any tasks as assigned.

4. Lynn - Patient's daughter.

REPORT FROM OUTGOING NURSE:

W.H. is an 80-year-old male patient admitted to the medical unit two days ago with a primary diagnosis of exacerbation of CHF. He presented to his PCP with a two week history of weakness, shortness of breath, and difficulty ambulating more than ten feet. He reported he had been unable to get out of bed for two days prior to seeing PCP. Compared to his visit one month ago, he has gained 11 pounds. He reports that he rarely uses oxygen at home but has been using it continuously for the past two days prior to seeing PCP.

It is day three of his admission. He is alert and oriented to person, place and time; resting at 45 degrees. His RR are 38 bpm with bathroom ambulation. He has been encouraged to use his urinal for energy conservation. Mr. Hampton has tried but is getting frustrated because he spills it frequently. A Foley catheter may be beneficial. Also patient has bilateral coarse crackles with a frequently productive cough and clear sputum. He has +3 pitting edema bilaterally of feet and ankles making it impossible to apply the ordered anti-embolism stockings. Pedal pulses + with Doppler. He has positive bowel sounds and is requesting breakfast.

EXPECTED OUTCOMES:

1. Nurse receives report from previous shift - notes patient status

2. Nurse obtains or appropriately delegates vital signs; performs physical assessment

3. Nurse notes any abnormal findings and takes appropriate action if necessary

4. Nurse or designee administers medications as scheduled/needed

5. Nurse or designee performs patient care/tasks as needed

6. Nurse reassesses patient and takes action based on findings

7. Nurse engages in therapeutic communication/education with patient, family, and/or friends

8. Patient's needs are addressed and met.

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Answer 1

Senior nursing students have a dual responsibility in nursing education and patient care. she can do for caring this patient with
-Helping incoming nurses in performing a primary assessment and observe and learn the procedure from them.
-Making the patient comfortable at bed with the correct position
-Providing routine basic care
-Monitoring vital signs and reporting in the chart.
-Provide foley care and measure urine output and record it.
-Providing education for the patient in a deep breathing exercise, coughing exercise
-Have always teamwork to avoid medical error
-Have rapport communication with patient and family
-Respect the senior staffs
-Write a diet chart and distribution of diet
-Learn medication administration from senior staff and never administer medication alone.
-assist patients with ambulation and rehabilitation
-Provide counseling to family and patient
-Supervise junior student nurses for improving knowledge and skills in basic patient care.