Nursing Concepts of safety, assessment, and communications Project description SIMULATION: CONCEPTS OF SAFETY, ASSESSMENT AND COMMUNICATION HISTORY (0700 Report): Mrs. Kay Thomas is a 61 year old female who was admitted two days ago by Dr. Cohen for an abdominal mass. Dr. Cohen did a colectomy two days ago and she was diagnosed with colon cancer. We are now waiting for the pathology report which should come back sometime today. She is 5’8” tall and weighs 170 lbs. She denies any allergies. She is oriented x4, PERRLA, and moves all extremities. She has a regular heart rhythm and rate, equal and clear breathe sounds throughout, and abdomen is soft, nontender with just a few upper quad bowel sounds noted. The doctors made rounds early and discontinued several things. She received her clear liquid tray for breakfast. She complains of mild incisional pain and requests pain medication. She has IV fluids infusing into a right antecubital site as well as a large abdominal incision approximated with staples and open to air. Her husband plans to arrive later this morning. The vital signs from 0500 are BP 136/86, pulse 100, resp. 16, temp 100.3, SpO2 95%. HEALTHCARE PROVIDER’S ORDERS (as of 0600 today): • Clear liquid diet, advance as tolerated • Intake and output • D/C IVF and saline lock when tolerating po • Vital signs per routine • Ambulate in halls • Incision open to air • Lovenox (enoxaparin sodium ) 40 mg Subcu every day • D/C oxygen • D/C Cefazolin 1gram IVPB every 6 hours after 1400 dose • D/C PCA • D/C NGT • D/C Foley • Hydromorphone hydrochloride 2mg IVP every 2 hours prn severe pain • Vicodin 2 tabs (5/500 hydrocodone/acetaminophen) po every 4 hours prn pain when tolerates po well • Notify healthcare provider for: SBP < 100, HR >120, Temp. >100.5, urine output < 30 ml/hr., SpO2 < 94% Dr. Mathis (intern) CLINICAL OUTCOMES: On completion of the simulation the student will: 1. Practice patient safety measures. 2. Perform a complete head to toe assessment. 3. Demonstrate the use of critical thinking in assessments and interventions. 4. Implement SBAR reporting to healthcare providers and professional patient communication. FOR YOUR PREPARATION: • Read QSEN’s competency of safety at http://qsen.org/competencies/pre-licensure-ksas/#safety • Review “Administering Medications Safely” in your Foundations of Nursing Practice text page 492-514 and 527-536. • Review and practice the adult baseline head to toe physical assessment. • Review the chart for Mrs. Thomas and be familiar with all medications and lab values. • Complete drug cards for Cefazolin, Dilaudid, and Vicodin and bring these to the simulation experience. • Read about the nursing care of a hospitalized postoperative patient in med/surg text page 468-481. QUESTIONS TO PREPARE FOR THE SIMULATED CLINICAL EXPERIENCE: 1. Identify three areas of concern regarding Mrs. Thomas’ safety as well as what should be done to protect her. 2. Identify potential postoperative abdominal surgery complications. Include assessment findings, diagnostic evaluation, and nursing measures designed to prevent these complications from occurring. 3. How do you evaluate if a postoperative patient is tolerating oral fluids well? 4. What are your top three nursing diagnoses and interventions for Mrs. Thomas and why?