VERNON WATKINS: GUIDED REFLECTION QUESTIONS
Guided Reflection Questions
1. How did the scenario make you feel?
Not really knowing what to expect from this scenario made me a little nervous. I have
gained quite a bit of confidence throughout each simulation though and was confident
that I could systematically work through the process and have a successful outcome.
2. Discuss your use of adjunct oxygen therapy for this patient, including why you chose
a particular oxygen device, rate, and flow.
The physician orders stated continuous oxygen for the patient to maintain a 02
saturation of 92% or more. I placed the pulse oximeter on the patient and his O2
saturation was 95%. As the patient’s oxygen saturation was only slightly decreased from
normal and above 92%, I chose to apply a nasal cannula versus a mask. The average
oxygen flow via nasal cannula is 1 – 6 L/min. Only needing to maintain the patient’s
current oxygen level meant he would not require a high oxygen flow rate.
3. Discuss Vernon Watkins’ arterial blood gas (ABG) analysis result and explain what
caused this result.
Mr. Watkins’ arterial blood gas analysis showed the follow abnormal results: pH was
elevated at 7.50, HCO3- was low at 20.9, PCO2 was low at 25, PO2 was low at 68, and
SaO2 was low at 92.
A pH level of 7.50 showed a state of alkalosis.
A decreased HCO3- showed a state of
acidosis.
A PCO2 of 25 indicated the cause of the patients’ issue was respiratory.
His PO2 and SaO2 both being low were further indications of a respiratory issue.
Mr. Watkins had respiratory alkalosis brought on by hyperventilation, as indicated by his
increased respiratory rate of 24 breaths per minute, causing his lungs to blow off more
carbon dioxide that his body had available. The hyperventilation was caused by
hypoxemia, indicated by his declining O2 saturation throughout the simulation. Both
conditions were the result of the pulmonary embolism he was experiencing.
4. Discuss the use of a heparin nomogram (guideline for heparin titration) and
safety related to this intervention.
A heparin nomogram is a guideline nurses use for heparin therapy and titration. The first
step is for the doctor to determine if the indication for the use of heparin justifies a
gradual or rapid heparin nomogram. Based on the patient’s chest CT scan showing a PE,
the patient would meet the criteria for the rapid infusion. According to the protocol for
rapid infusion, the bolus dose is 80 units/kg and the initial infusion rate is 18 units/kg/hr.
Guided Reflection Questions
1. How did the scenario make you feel?
Not really knowing what to expect from this scenario made me a little nervous. I have
gained quite a bit of confidence throughout each simulation though and was confident
that I could systematically work through the process and have a successful outcome.
2. Discuss your use of adjunct oxygen therapy for this patient, including why you chose
a particular oxygen device, rate, and flow.
The physician orders stated continuous oxygen for the patient to maintain a 02
saturation of 92% or more. I placed the pulse oximeter on the patient and his O2
saturation was 95%. As the patient’s oxygen saturation was only slightly decreased from
normal and above 92%, I chose to apply a nasal cannula versus a mask. The average
oxygen flow via nasal cannula is 1 – 6 L/min. Only needing to maintain the patient’s
current oxygen level meant he would not require a high oxygen flow rate.
3. Discuss Vernon Watkins’ arterial blood gas (ABG) analysis result and explain what
caused this result.
Mr. Watkins’ arterial blood gas analysis showed the follow abnormal results: pH was
elevated at 7.50, HCO3- was low at 20.9, PCO2 was low at 25, PO2 was low at 68, and
SaO2 was low at 92.
A pH level of 7.50 showed a state of alkalosis.
A decreased HCO3- showed a state of
acidosis.
A PCO2 of 25 indicated the cause of the patients’ issue was respiratory.
His PO2 and SaO2 both being low were further indications of a respiratory issue.
Mr. Watkins had respiratory alkalosis brought on by hyperventilation, as indicated by his
increased respiratory rate of 24 breaths per minute, causing his lungs to blow off more
carbon dioxide that his body had available. The hyperventilation was caused by
hypoxemia, indicated by his declining O2 saturation throughout the simulation. Both
conditions were the result of the pulmonary embolism he was experiencing.
4. Discuss the use of a heparin nomogram (guideline for heparin titration) and
safety related to this intervention.
A heparin nomogram is a guideline nurses use for heparin therapy and titration. The first
step is for the doctor to determine if the indication for the use of heparin justifies a
gradual or rapid heparin nomogram. Based on the patient’s chest CT scan showing a PE,
the patient would meet the criteria for the rapid infusion. According to the protocol for
rapid infusion, the bolus dose is 80 units/kg and the initial infusion rate is 18 units/kg/hr.
