Surgical Case 4: Vernon Watkins
Guided Reflection Questions
1.How did the scenario make you feel? The scenario made me feel a sense of urgency due to Mr. Watkins condition signs and symptoms.
2.Discuss your use of adjunct oxygen therapy for this patient, including why you chose a particular oxygen device, rate, and flow. I chose a non-rebreather mask (High Flow) 02 due to the Pt complaint, condition, and clinical findings, and the Dr standing orders. 2.Discuss Vernon Watkins’ arterial blood gas (ABG) analysis result and explain what caused this result. Mr. Watkin’s ABG showed respiratory alkalosis PaC02 32 and mild hypoxemia Pa02 of 74. Mr. Watkin’s respiratory alkalosis was most likely due to a fast respiratory rate that was being caused by his body trying to compensate for the hypoxemia from the PE. 3.Discuss the use of a heparin nomogram (guideline for heparin titration) and safety related to this intervention.
The Dr ordered a bolus or loading dose of Heparin for Mr. Watkins to reduce the possibility of further coagulation causing more clots to form. The nomogram uses the Pt weight and PTT to determine a therapeutic range for the Pt. The Heparin dose calculation should be verified by two nurses for Pt safety. 4.What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format.
S- Pt is post op hemicolectomy Pt. Upon assessment Pt began complaining of difficulty in
breathing.
B- Pt was diagnosed with PE and is currently on a 1440 units/hour heparin infusion. Pt is on high flow 02 via non rebreather mask.
A-Pt symptoms have improved however, are not completely resolved and pt vital signs seem to be stable for now.
R- It is recommended that the Pt be under close observation for changes in his condition
and for further orders for the Dr. © Wolters Kluwer Health | Lippincott Williams & Wilkins
Guided Reflection Questions
1.How did the scenario make you feel? The scenario made me feel a sense of urgency due to Mr. Watkins condition signs and symptoms.
2.Discuss your use of adjunct oxygen therapy for this patient, including why you chose a particular oxygen device, rate, and flow. I chose a non-rebreather mask (High Flow) 02 due to the Pt complaint, condition, and clinical findings, and the Dr standing orders. 2.Discuss Vernon Watkins’ arterial blood gas (ABG) analysis result and explain what caused this result. Mr. Watkin’s ABG showed respiratory alkalosis PaC02 32 and mild hypoxemia Pa02 of 74. Mr. Watkin’s respiratory alkalosis was most likely due to a fast respiratory rate that was being caused by his body trying to compensate for the hypoxemia from the PE. 3.Discuss the use of a heparin nomogram (guideline for heparin titration) and safety related to this intervention.
The Dr ordered a bolus or loading dose of Heparin for Mr. Watkins to reduce the possibility of further coagulation causing more clots to form. The nomogram uses the Pt weight and PTT to determine a therapeutic range for the Pt. The Heparin dose calculation should be verified by two nurses for Pt safety. 4.What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format.
S- Pt is post op hemicolectomy Pt. Upon assessment Pt began complaining of difficulty in
breathing.
B- Pt was diagnosed with PE and is currently on a 1440 units/hour heparin infusion. Pt is on high flow 02 via non rebreather mask.
A-Pt symptoms have improved however, are not completely resolved and pt vital signs seem to be stable for now.
R- It is recommended that the Pt be under close observation for changes in his condition
and for further orders for the Dr. © Wolters Kluwer Health | Lippincott Williams & Wilkins
