Welcome to your Nancy Gilbert Virtual Simulation:
Please go through each slide and answer the questions below that correlates with the slides.
1. Complete Pre-brief Questions Slides 5, 6, 7:
a. Patients can communicate their needs or responses to nurses by using a white board,
pen and paper, or pointing to pictures. If they have access to an ipad, they can also
use that.
b. Three nursing interventions when treating someone with MRSA are
i. Administer medications such as antibiotics
ii. Perform proper hand hygiene
iii. Follow contact precautions and wear a mask if there is a respiratory infection
c. I would anticipate a patient with a tracheostomy to have electrolyte imbalances
from suctioning.
d. This patient would be immune compromised because of the open trach. It is a portal
for infection if not properly cared for.
e. Patients with tracheostomies need to be monitored when eating or drinking. If they
have difficulty swallowing, they are at risk for aspiration. Their diets are also modified,
and they need to take in more liquids to thin secretions.
f. Patients with a trach can be given liquid medications or inhaled medications. They
can also be given injections.
2. In a few words please describe each review of systems in your own words Slides 12-16:
a. ENT: Patient has permanent tracheostomy and reports no changes in tracheostomy
or stoma. Cranial nerves intact. Buccal mucosa dry. Lips dry and cracked.
b. Endocrine: Postmenopausal. HX miscarriage age 26.
c. Integumentary: Skin intact, peristomal skin intact. Dry skin in the winter
d. Psychological family/support: has husband, writes for communication
e. Respiratory: hx laryngeal cancer resulting in total laryngectomy and permanent
tracheostomy. HX smoking and secondhand smoking. Recent cough and dyspnea on
exertion. Pain with breathing. Rhonchi upper loads bilaterally. Diminished breath
sounds lower lobes bilaterally.
f. Cardiovascular: recent onset of fatigue, pulses normal and equal bilaterally, AP 84
g. Neurological: A + O x4. No deficits noted
h. GI, GU, I & O: regular soft diet tolerated well. uses magnesium hydroxide when
constipated. Abdomen flat, bowel sounds x 4 quadrants.
i. Dietary history: regular soft diet. Intolerant of spicy food
3. Slides 21
a. Other than suctioning, we will need a spare tracheostomy tube, scissors, tape,
lubricant, oxygen equipment, sterile water and bowl, obturator
b. Since patient has no problems with hearing, I will ask her questions and wait for her
to respond how she chooses, whether by writing her answers or mouthing words.
4. PPE Slides 24
a. PPE needed includes gown, mask, and gloves, and eyewear
b. On: gown, mask, eye, gloves
c. Off: gloves, eye, gown, mask
Please go through each slide and answer the questions below that correlates with the slides.
1. Complete Pre-brief Questions Slides 5, 6, 7:
a. Patients can communicate their needs or responses to nurses by using a white board,
pen and paper, or pointing to pictures. If they have access to an ipad, they can also
use that.
b. Three nursing interventions when treating someone with MRSA are
i. Administer medications such as antibiotics
ii. Perform proper hand hygiene
iii. Follow contact precautions and wear a mask if there is a respiratory infection
c. I would anticipate a patient with a tracheostomy to have electrolyte imbalances
from suctioning.
d. This patient would be immune compromised because of the open trach. It is a portal
for infection if not properly cared for.
e. Patients with tracheostomies need to be monitored when eating or drinking. If they
have difficulty swallowing, they are at risk for aspiration. Their diets are also modified,
and they need to take in more liquids to thin secretions.
f. Patients with a trach can be given liquid medications or inhaled medications. They
can also be given injections.
2. In a few words please describe each review of systems in your own words Slides 12-16:
a. ENT: Patient has permanent tracheostomy and reports no changes in tracheostomy
or stoma. Cranial nerves intact. Buccal mucosa dry. Lips dry and cracked.
b. Endocrine: Postmenopausal. HX miscarriage age 26.
c. Integumentary: Skin intact, peristomal skin intact. Dry skin in the winter
d. Psychological family/support: has husband, writes for communication
e. Respiratory: hx laryngeal cancer resulting in total laryngectomy and permanent
tracheostomy. HX smoking and secondhand smoking. Recent cough and dyspnea on
exertion. Pain with breathing. Rhonchi upper loads bilaterally. Diminished breath
sounds lower lobes bilaterally.
f. Cardiovascular: recent onset of fatigue, pulses normal and equal bilaterally, AP 84
g. Neurological: A + O x4. No deficits noted
h. GI, GU, I & O: regular soft diet tolerated well. uses magnesium hydroxide when
constipated. Abdomen flat, bowel sounds x 4 quadrants.
i. Dietary history: regular soft diet. Intolerant of spicy food
3. Slides 21
a. Other than suctioning, we will need a spare tracheostomy tube, scissors, tape,
lubricant, oxygen equipment, sterile water and bowl, obturator
b. Since patient has no problems with hearing, I will ask her questions and wait for her
to respond how she chooses, whether by writing her answers or mouthing words.
4. PPE Slides 24
a. PPE needed includes gown, mask, and gloves, and eyewear
b. On: gown, mask, eye, gloves
c. Off: gloves, eye, gown, mask
