Learner Response Summary

Successful
Scenario: Assessment of the Post-Operative Patient (026)
Started On November 22, 2023

How do you respond to this report?

Your Choices:
- Clarify report

Patient arrived. What is the priority?

Your Choices:
- Assess patient first

Which option best describes what you heard during auscultation?

Your Choices:
- Diminished sounds in the bases

What was Lena’s calculated apical rate?

Your Choices:
- 90

What vitals would you act on?

Your Choices:
- SpO2 92

What intervention would be most appropriate?

Your Choices:
- Deep breathing / Incentive spirometry

Document your admission of Lena and the assessment findings using a narrative note style.

Your Response:
Received pt at (time) awake and A+Ox3 post-RT knee arthroplasty. Denies any pain on admission. Chest clear with
diminished A/E to the bases bilaterally, no WOB or dyspnea. Skin warm, dry and well perfused, cap refill brisk. S1 and S2
heard, no murmurs noted. Abdomen soft, not distended or tender, bowel sounds present x4. No nausea/vomiting. Pedal
pulse palpable in left foot, right foot pulse heard by doppler. CSM WDL and equal in both feet/legs. RT knee dressing dry
and intact, showing some serosanguinous drainage. Hemovac drain in situ, and drained about 30-50mls of
serosanguinous drainage. Foley catheter in situ and draining light straw-coloured urine. 18 gauge PIV insitu in the LT
forearm running RL at 125ml/hr. PIV site soft, no signs of phlebitis or infiltration. Education provided to pt re. incentive
spirometry and was instructed to use it 3x per hour when awake. Pt appears comfortable resting in bed, PCA pump
remote and call bell within reach. All needs met at this time. (Nurse signature)

How do you proceed with Lena's concern about pain medication?

Your Choices:
- Assess pain using a numerical pain scale (0-10)

When considering a patient using a PCA pump, what health teaching would you provide related to pain, dosing and
potential side effects of the medication?

Your Response:
The PCA pump is specifically programmed to limit the doses to a certain amount per hour, so it would be virtually
impossible to overdose. Once that limit is met, it will not allow any more of the medication to be administered before the
time limit has been reached.
It is also important to treat your pain when it's lower, so your pain doesn't reach an intolerable level. This means pressing
the button for more medication when your pain exceeds a 3/10. It's important to not wait until your pain is excruciating
to administer the medication because then you're trying to play catch up with your pain, which is uncomfortable for you,
and has been shown to prolong recovery when pain is not well managed.

What would you do next after explaining the PCA pump use?

Your Choices:
- Ask Lena to restate the information about PCA pump

When should you return to check on Lena?

Your Choices:
- 15-30 min

Document on your latest interaction with Lena.

Your Response:
Pt reported 7/10 pain to RT knee. Pt expressed apprehension about using PCA pump. Further teaching re. narcotics and
PCA pump use reviewed and discussed, all questions addressed. Pt expressed understanding and was able to teach
back the information about PCA pump usage. Pt administered a dose herself at (time). PCA pump remote and call bell
within reach. (Nurse signature).

List the cues Lena has presented in the previous interaction.

Your Response:
- Itchiness to the neck and chest
- hives
- nausea and abdominal discomfort
- tachycardia
- restless

What do the cues suggest/infer?

Your Choices:
- Allergic reaction

What is your next action in response to Lena's allergic reaction?

Your Choices:
- Remove the Morphine and call the MRP

Prepare SBAR

Your Response:
Hi I'm (name) calling from the med-surg unit regarding Lena Futris, the 56-year-old female post-op RT knee arthroplasty.
She has just come back to the unit, and started her morphine via PCA pump about 2 hours ago, but hasn't really been
using it until about 20 minutes ago. Since delivering a dose at that time, she has developed some itchiness and hives on
her neck and chest, some abdominal discomfort and nausea, and tachycardia. She is alert and talking, and is having no
difficulty breathing. I've disconnected her from the pump, but would you mind coming to reassess her, and maybe
discuss with her some alternative pain management options?

What might be contributing to Lena feeling so dizzy? Answer - all apply.

Your Choices:
- Lying supine
- Hypovolemia
- Analgesic
- Fatigue
- Pain
- Dehydration

Can you describe in one or two sentences how you felt after playing the virtual game?

Your Response:
I felt comfortable with the post-operative care.
It was a good reminder of PCA pump considerations.

What were you proud of? What went well during the game and why do you think it went well?

Your Response:
I felt quite comfortable with my assessment skills, both in knowing what assessments to complete and how to
do/interpret them. Especially when it came to the portion of the simulation when the patient was experiencing an allergic
reaction, I was able to identify the reaction, and assess the patient, and also was familiar with what actions to take next
(stopping the infusion and calling the MRP).

What challenged you during the game? What was the most difficult decision point and why was it difficult for you?

Your Response:
Nothing was particularly difficult, but I did need a refresher on the use of PCA pumps. I had a general understanding that
it was patient-led pain management, but since I do not have any recent experience with these pumps, I was unfamiliar
with the specifics of how they work and what nursing considerations need to be recognized. After reviewing the
textbook, I felt more prepared for the simulation.

Were you satisfied with your ability to care for Lena Futris? If a similar situation arose in the future, what would you
take away from this simulation to incorporate into your clinical practice?

Your Response:
I was satisfied with my care for Lena. In the future, I feel that I will be more comfortable providing safe care for those
with PCA pumps and will use the practice from the simulation on health teaching to be able to provide thorough patient
education on the pumps as needed.

What were your key learning points regarding post-opertaive assessment?

Your Response:
1. I was able to identify what health assessments were needed and prioritized them to best evaluate the patient.
2. I was able to interpret the results of these assessments and recognize that the patient was having an adverse effect of
the medication (allergic reaction).
3. When I recognized the patient was having an allergic reaction, I was able to prioritize the appropriate actions to take
(i.e. disconnect the morphine infusion first, and then contact the MRP).
4. When the patient was feeling some dizziness from sitting up in bed, I was able to identify that based on her risk
factors of orthostatic hypotension (as stated above), she was at risk for falls, and provided teaching (sitting up slowly,
taking breaks sitting before standing) and offered help in transferring and ambulating.

What would you do differently next time?

Your Response:
I do not really see any areas in which I would do anything differently in the simulation, but in a real-life situation, I would
probably want to include the patient more in their care and provide more opportunities for the patient to be an active
member in their care. I would also like to be able to spend more time doing health teaching, as I feel that the patient
could have still used more education.

Is there anything else you would like to discuss?

Your Response:
I believe I have covered the important topics.

Session ID: 791970