SURGICAL CASE
Surgical Case 0404 VERNON
Vernon Watkins WATKINS
lOMoARcPSD|596 76
Medical-Surgical Nursing
Surgical Case 4: Vernon
WatkinsGuided Reflection
Questions
• How did the scenario make you feel?
At the beginning I felt very anxious because the patient was reporting a respiratory distress so it
was verychallenging. I had to do it several times.
• Discuss your use of adjunct oxygen therapy for this patient, including why you chose a particular
oxygen device, rate, and flow.
Oxygen administration was a challenge as well because I was not so sure on which kind of oxygen
supply to choose, I chose a nasal cannula and deliver a 6ml oxygen in order to maintain the patient
oxygen saturation at 92% due to the patient complaint, condition, and clinical findings, and the Dr
standing orders.
• Discuss Vernon Watkins’ arterial blood gas (ABG) analysis result and explain what caused this result.
• He had respiratory alkalosis
Mr. Watkin’s ABG’s showed respiratory alkalosis most likely due to a fast respiratory rate that
was being caused by his body trying to compensate for the hypoxemia from the pulmonary
embolism..
• Mild hypoxemia .
He had trouble maintaining his oxygen saturations at 92% therefore his condition of
hypoxemia. Respiratory alkalosis was the result of the respirations per minute which were
24. This caused him to blow off too much carbon dioxide.
• He was hyperventilating that’s why he complained that he could not breath. This caused his
carbondioxide to drop.
• Discuss the use of a heparin nomogram (guideline for heparin titration) and safety related to this
intervention.
Providers order a heparin therapy anticoagulation target, and nurses use a clinical algorithm to guide
care. Nurses obtain baseline labs, calculate and administer initial bolus dose, order and evaluate
anticoagulation labs, and titrate heparin to therapeutic goal based on clinical algorithm and patient
presentation. Heparin requires close monitoring because of its narrow therapeutic index and
increased risk for bleeding. Monitoring includes head-to-toe patient assessments for potential side
effects and laboratory monitoring.
• What key elements would you include in the handoff report for this patient? Consider the SBAR
(situation, background, assessment, recommendation) format.
S: Mr. Watkins is a 69 year old patient who underwent a hemicolectomy.
B: He presented to the Emergency room 4 days ago with complaints of nausea, vomiting, and
severe abdominal pain admitted for emergent surgery for bowel perforation He has a midline
abdominal incision, tolerating a soft diet without nausea or vomiting. Abdominal pain has been
controlled with morphine. He has refused to ambulate this morning because of fatigue and a sore
leg. Patient complains about a pain in his right leg that goes worst every time he moves it,
Surgical Case 0404 VERNON
Vernon Watkins WATKINS
lOMoARcPSD|596 76
Medical-Surgical Nursing
Surgical Case 4: Vernon
WatkinsGuided Reflection
Questions
• How did the scenario make you feel?
At the beginning I felt very anxious because the patient was reporting a respiratory distress so it
was verychallenging. I had to do it several times.
• Discuss your use of adjunct oxygen therapy for this patient, including why you chose a particular
oxygen device, rate, and flow.
Oxygen administration was a challenge as well because I was not so sure on which kind of oxygen
supply to choose, I chose a nasal cannula and deliver a 6ml oxygen in order to maintain the patient
oxygen saturation at 92% due to the patient complaint, condition, and clinical findings, and the Dr
standing orders.
• Discuss Vernon Watkins’ arterial blood gas (ABG) analysis result and explain what caused this result.
• He had respiratory alkalosis
Mr. Watkin’s ABG’s showed respiratory alkalosis most likely due to a fast respiratory rate that
was being caused by his body trying to compensate for the hypoxemia from the pulmonary
embolism..
• Mild hypoxemia .
He had trouble maintaining his oxygen saturations at 92% therefore his condition of
hypoxemia. Respiratory alkalosis was the result of the respirations per minute which were
24. This caused him to blow off too much carbon dioxide.
• He was hyperventilating that’s why he complained that he could not breath. This caused his
carbondioxide to drop.
• Discuss the use of a heparin nomogram (guideline for heparin titration) and safety related to this
intervention.
Providers order a heparin therapy anticoagulation target, and nurses use a clinical algorithm to guide
care. Nurses obtain baseline labs, calculate and administer initial bolus dose, order and evaluate
anticoagulation labs, and titrate heparin to therapeutic goal based on clinical algorithm and patient
presentation. Heparin requires close monitoring because of its narrow therapeutic index and
increased risk for bleeding. Monitoring includes head-to-toe patient assessments for potential side
effects and laboratory monitoring.
• What key elements would you include in the handoff report for this patient? Consider the SBAR
(situation, background, assessment, recommendation) format.
S: Mr. Watkins is a 69 year old patient who underwent a hemicolectomy.
B: He presented to the Emergency room 4 days ago with complaints of nausea, vomiting, and
severe abdominal pain admitted for emergent surgery for bowel perforation He has a midline
abdominal incision, tolerating a soft diet without nausea or vomiting. Abdominal pain has been
controlled with morphine. He has refused to ambulate this morning because of fatigue and a sore
leg. Patient complains about a pain in his right leg that goes worst every time he moves it,
