Question

SCENARIO OVERVIEW:
Cynthia Bennet is a 34-year-old African American female with a history of type 1 diabetes mellitus, end-stage renal disease, and hemodialysis. Early on Monday morning, she was admitted to the emergency department for a fever of unknown origin.
She was subsequently admitted to the medical-surgical unit for further evaluation and treatment of a urinary tract infection (UTI). The scenario takes place on Monday at 1300 after Cynthia has returned from hemodialysis.
The dialysis nurse has just started the first dose of IV ampicillin.

REVIEW AND COMPLETE PRIOR TO THE START OF PRE-BRIEFING:
In order to prepare for the simulation, you should complete your assigned reading for the course. In addition, you should be prepared to complete and document a thorough nursing assessment along with completing the following skills:
 Anaphylactic reactions
 Endocrine, urinary, and renal system alterations
Please keep in mind you will also be required to recognize a variety of signs and symptoms linked to abnormalities in these skills.
Therefore, in order to prepare for the simulation, you are required to complete the pre-briefing questions below and submit to the faculty facilitating the simulation prior to the start of pre-briefing. If you do not complete the pre-briefing questions below and submit to faculty facilitating the simulation prior to the start of pre-briefing, you will not be permitted to participate in the simulation.

1. List three signs and symptoms from each of the following body systems that occur during an anaphylactic reaction: Respiratory, Cardiovascular, Gastrointestinal, and Dermatological.
2. What is the nurse’s role in providing family-centered care during and after a crisis?
3. Explain the collaborative role of the nurse, and priority nursing interventions when caring for a patient undergoing hemodialysis.

Answer 1

1.Signs and symptoms of Anaphylactic reaction

Respiratory :

• Bronchial spasm
• Laryngeal edema
• Dyspnea

1. Cardiovascular

• Hypotension
• Tachycardia
• Cyanosis

Gastrointestinal

• Diarrhoea
• Nausea
• Vomiting

Dermatological

• Pruritis
• Skin rash
• Urticaria

Family centered care

• Inform the family regarding anaphlactic reaction
• Provide reassurance
• Participate while decision making during treatment

After crisis

• Teach family about specific allergen which caused anaphylaxis .

Nurses role and intervention during hemodialysis

• Explain procedure to the patient and provide reassurance
• Weigh before and after procedure
• Asses the patency of the venous access site
• Check thrill or vibration should be palpable and bruit should be audible with a stethascope unless immediately informed to dialysis technician and nephrologist
• Monitor vital sign every 15minutes during procedure :assess for hypotension and hemorrhage
• Provide back care to promote comfort
• asses electrolyte imbalance
• Assess signs and symptoms of fluid overload such as hypertension, dyspnea and hyperkalemia
• Observe muscle cramp present
• Administer erythropoietinfor correction of anemia as per doctors order