Simulation Pre-Case Review
Student Name: Ebony S Davis Date: 2/9/2020
Simulation Name: K. Peterson Simulation Date: 2/10/2010
K. Peterson Age: 35 Weight: 171 kg Height: 175 cm
Case Objectives
• Designs an individualized plan of care for the nursing management of a postoperative laparoscopic adjustable
gastric banding patient who experiences chest pain (CREATING)
• Prioritizes the implementation and approach to the nursing care of the postoperative laparoscopic adjustable
gastric banding patient who experiences chest pain (APPLYING)
• Evaluates the patient’s response to interventions and modifies the nursing care as appropriate
(EVALUATING)
Synopsis
35-year-old individual who is post-operative day 1 after undergoing an elective laparoscopic adjustable gastric banding
procedure for morbid obesity. The scenario takes place on the second day of admission.
Patient History
Past Medical History:
• No significant medical history other than morbid obesity
Allergies:
• No known allergies
Medications:
• None
Code Status:
• Full code
Social/Family History:
• Client has been married for eight years and has a 4-year-old boy and 2-year-old girl. Denies any smoking or illicit
drug use. Reports drinks a beer no more than 3 a week
Admitting Diagnosis: Morbid Obesity
Pathophysiology: Obesity is an excess of adipose tissue on the body This excess can lead to many conditions such as
diabetes and leads to a greater risk of developing more life-threating conditions such as cancer.
Risk Factors: Genetic factors, activity level (sedentary lifestyle), eating habits (What you eat, time you eat and liquids you
consume), stress, anxiety, sleep habits, medical conditions such as Cushing’s syndrome, medications
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, Questions:
1. Discuss the etiology and pathophysiology of morbid obesity. Discuss the current accepted diagnostic criteria for
morbid obesity.
Morbid obesity is excessive fat is stored in the body and the consumed calories aren’t being used for energy.
Instead it is being used in storage.
2. Discuss laparoscopic adjustable gastric banding for morbid obesity. Differentiate the method of weight loss,
anatomic changes, advantages and the risks.
Weight loss surgery: small incision in the upper abdominal area. An adjustable band is placed at the top of the
stomach and it creates a small stomach pouch. The pouch helps to decrease the amount of food it takes, creating
a filling sensation. In addition to a 40-60 percent weight loss, it is easily reversible, non-invasive, digestion and
absorption aren’t affected. Risk factors include bleeding, infection, blood clots, slipping of the band, puncturing
the stomach, food not going into the stomach, and food intolerance. Health risk factors include cardiovascular
problems, diabetes, osteoarthritis, metabolic syndrome, GERD, gallstones, and psychosocial problems.
3. Identify the components necessary to include in the nursing assessment of the obese patient.
Height, weight, waist circumference, blood pressure, heart rate. I would also check respirations during this time
because of medications he is subscribed can cause respiratory depression. Check for heart abnormalities as well
as lungs by auscultating as well as asking patient questions about medical history. Check thyroid.
4. Identify the modifications to the care environment that may be necessary for the morbidly obese patient
undergoing surgical treatment.
Larger beds, larger scale, bigger blood pressure cuffs, the ceiling sign, bigger gowns, bigger wheelchair, railings
up (3).
5. How will the nursing management strategy need to be adapted to care for the morbidly obese patient?
Team nursing would be supportive way to start an assessment on someone whose obese. In addition to the
modifications above, teach deep breathing (tell them to do it during every commercial and the incentive
spirometer every hour by setting an alarm clock.
6. When a patient complains of chest pain, what is the appropriate response of the nurse?
The nurse should ask the patient about his pain using scale of 0-10; How long has it been happening, the quality
of the pain (i.e. dull, sharp), what activities make it better/worse, location of pain/other pain areas. Check MAR to
see when the last medication was given and administer medications accordingly. Notify the healthcare provider
immediately and notate the record of findings as well as any medications given.
7. Identify the nursing management of a patient experiencing chest pain.
Administer oxygen through a nasal canula; provide the patient with nitroglycerin with a prescription to relax the
coronary arteries as well as any other orders listed for pain; continue to monitor BP and ECG 12 lead
8. Discuss the medical management of chest pain, including how the various therapies relieve chest pain.
blood thinners (heparin), nitroglycerin tabs, aspirin, thrombolytic drugs,acid suppressing medications, and
antidepressants for chest pain relief. Angioplasty and stent placements as well as bypass surgery can be done to
treat chest pain
9. Do chest pain and angina mean the same thing? Discuss your answer.
Angina occurs when the heart doesn’t get enough oxygen rich blood and can be displayed by a feeling of chest
tightening, pressure or squeezing in the chest (also can radiate to other areas). Chest pain is a stabbing, pricking,
or sharp pain that is localized.
Nursing Management of your client (What will you do?):
Educate patient of the procedure, educate patient on the importance of lifestyle changes, monitor vitals signs before and
after surgery, assess pain level
Diagnostic Tests:
Test Name Purpose Nursing Considerations
CBC Assess RBC, WBC, and platelets Determine if patient is at risk for
infections or have an infection
BMP Measure kidney function, blood sugar, Determine diet and any medications to
This study source was downloaded by 100000840858457 from CourseHero.com on 02-26-2022 20:03:58 GMT -06:00 2
https://www.coursehero.com/file/56819148/E-Davis-Peterson-Student-Prepwork-2102020docx/
Student Name: Ebony S Davis Date: 2/9/2020
Simulation Name: K. Peterson Simulation Date: 2/10/2010
K. Peterson Age: 35 Weight: 171 kg Height: 175 cm
Case Objectives
• Designs an individualized plan of care for the nursing management of a postoperative laparoscopic adjustable
gastric banding patient who experiences chest pain (CREATING)
• Prioritizes the implementation and approach to the nursing care of the postoperative laparoscopic adjustable
gastric banding patient who experiences chest pain (APPLYING)
• Evaluates the patient’s response to interventions and modifies the nursing care as appropriate
(EVALUATING)
Synopsis
35-year-old individual who is post-operative day 1 after undergoing an elective laparoscopic adjustable gastric banding
procedure for morbid obesity. The scenario takes place on the second day of admission.
Patient History
Past Medical History:
• No significant medical history other than morbid obesity
Allergies:
• No known allergies
Medications:
• None
Code Status:
• Full code
Social/Family History:
• Client has been married for eight years and has a 4-year-old boy and 2-year-old girl. Denies any smoking or illicit
drug use. Reports drinks a beer no more than 3 a week
Admitting Diagnosis: Morbid Obesity
Pathophysiology: Obesity is an excess of adipose tissue on the body This excess can lead to many conditions such as
diabetes and leads to a greater risk of developing more life-threating conditions such as cancer.
Risk Factors: Genetic factors, activity level (sedentary lifestyle), eating habits (What you eat, time you eat and liquids you
consume), stress, anxiety, sleep habits, medical conditions such as Cushing’s syndrome, medications
This study source was downloaded by 100000840858457 from CourseHero.com on 02-26-2022 20:03:58 GMT -06:00 1
https://www.coursehero.com/file/56819148/E-Davis-Peterson-Student-Prepwork-2102020docx/
, Questions:
1. Discuss the etiology and pathophysiology of morbid obesity. Discuss the current accepted diagnostic criteria for
morbid obesity.
Morbid obesity is excessive fat is stored in the body and the consumed calories aren’t being used for energy.
Instead it is being used in storage.
2. Discuss laparoscopic adjustable gastric banding for morbid obesity. Differentiate the method of weight loss,
anatomic changes, advantages and the risks.
Weight loss surgery: small incision in the upper abdominal area. An adjustable band is placed at the top of the
stomach and it creates a small stomach pouch. The pouch helps to decrease the amount of food it takes, creating
a filling sensation. In addition to a 40-60 percent weight loss, it is easily reversible, non-invasive, digestion and
absorption aren’t affected. Risk factors include bleeding, infection, blood clots, slipping of the band, puncturing
the stomach, food not going into the stomach, and food intolerance. Health risk factors include cardiovascular
problems, diabetes, osteoarthritis, metabolic syndrome, GERD, gallstones, and psychosocial problems.
3. Identify the components necessary to include in the nursing assessment of the obese patient.
Height, weight, waist circumference, blood pressure, heart rate. I would also check respirations during this time
because of medications he is subscribed can cause respiratory depression. Check for heart abnormalities as well
as lungs by auscultating as well as asking patient questions about medical history. Check thyroid.
4. Identify the modifications to the care environment that may be necessary for the morbidly obese patient
undergoing surgical treatment.
Larger beds, larger scale, bigger blood pressure cuffs, the ceiling sign, bigger gowns, bigger wheelchair, railings
up (3).
5. How will the nursing management strategy need to be adapted to care for the morbidly obese patient?
Team nursing would be supportive way to start an assessment on someone whose obese. In addition to the
modifications above, teach deep breathing (tell them to do it during every commercial and the incentive
spirometer every hour by setting an alarm clock.
6. When a patient complains of chest pain, what is the appropriate response of the nurse?
The nurse should ask the patient about his pain using scale of 0-10; How long has it been happening, the quality
of the pain (i.e. dull, sharp), what activities make it better/worse, location of pain/other pain areas. Check MAR to
see when the last medication was given and administer medications accordingly. Notify the healthcare provider
immediately and notate the record of findings as well as any medications given.
7. Identify the nursing management of a patient experiencing chest pain.
Administer oxygen through a nasal canula; provide the patient with nitroglycerin with a prescription to relax the
coronary arteries as well as any other orders listed for pain; continue to monitor BP and ECG 12 lead
8. Discuss the medical management of chest pain, including how the various therapies relieve chest pain.
blood thinners (heparin), nitroglycerin tabs, aspirin, thrombolytic drugs,acid suppressing medications, and
antidepressants for chest pain relief. Angioplasty and stent placements as well as bypass surgery can be done to
treat chest pain
9. Do chest pain and angina mean the same thing? Discuss your answer.
Angina occurs when the heart doesn’t get enough oxygen rich blood and can be displayed by a feeling of chest
tightening, pressure or squeezing in the chest (also can radiate to other areas). Chest pain is a stabbing, pricking,
or sharp pain that is localized.
Nursing Management of your client (What will you do?):
Educate patient of the procedure, educate patient on the importance of lifestyle changes, monitor vitals signs before and
after surgery, assess pain level
Diagnostic Tests:
Test Name Purpose Nursing Considerations
CBC Assess RBC, WBC, and platelets Determine if patient is at risk for
infections or have an infection
BMP Measure kidney function, blood sugar, Determine diet and any medications to
This study source was downloaded by 100000840858457 from CourseHero.com on 02-26-2022 20:03:58 GMT -06:00 2
https://www.coursehero.com/file/56819148/E-Davis-Peterson-Student-Prepwork-2102020docx/
