CNCL 700Sherman Red Yoder - All Parts./ attempted score A+

Sherman “Red” Yoder – Part A Part 1: Plan of Care Concept Map (adapted from vSim template) Simulation Patient Overview • Client summary: presentation, medical history and background, physical assessment findings, medications, diagnostics • brief summary of pathophysiology and rationale for clinical manifestations Red is an 80-year-old male who lives alone, 20 miles from the nearest city. The patient has previously been diagnosed with type 2 diabetes (six months ago) and has recently began taking insulin. The nurse came to Reds’ house to assess and evaluate a wound that was caused by wearing shoes that were too tight. The toe was injured about three weeks ago. It is plausible that Red has developed peripheral neuropathy which is typically caused by diabetes. This causes loss of sensation and numbness to the extremities. In Reds’ case, he might have not felt in the injury on his toe and that is why he did not address it immediately. Red also lives alone so there was no was else in the household to bring his attention to the injured toe. The Assessment Anticipated Physical Assessment Findings • additional focused assessment • relevant cues (S&S) • cues indicating need for immediate concern and rationale Anticipated Diagnostic Tests • relevant cues (abnormal findings) • additional tests to consider Peripheral neuropathy – numbness and loss of Abnormal Values sensation in the feet Part A: No diagnostic tests Right toe wound Additional tests to consider – monitoring of blood glucose x 4 times a day. Plan Anticipated Care Priorities Anticipated Nursing Interventions Monitor blood glucose levels and adhere to medication. Wound dressing. Educate patient on: the importance of monitoring his blood glucose after meals, and adhering to the sliding scale dosage, daily inspection of feet with help of mirrors and family, how to apply wound dressings on his right toe to prevent further complications, information on diet and nutrition. Feet inspection. Great importance must be placed on footcare. Diet and nutrition information. Sleep education. Assess independence in ADLs. ISBAR Worksheet (adapted from vSim) ISBAR Student Notes Introduction • Your name, position (Nursing student), unit you are working on • What is the purpose of this communication? Hello, my name is Ronit Patel. I am student RN with a home health agency. I will be giving you a report on Red Yoder. Situation • What is happening at the moment? • Patient’s name, age, specific reason for visit/admission Red Yoder is an 80-year-old male that is being seen at home for a right toe wound. Background • What are the issues that led up to this situation? • Patient’s primary diagnosis, date of admission, current orders The patient was diagnosed with type two diabetes six months ago. He has recently began taking insulin. Red suffered an injury to his toe three weeks ago. Up till now, he has been wearing tight shoes which progressively made his injury worse. No current orders. Assessment • What do you believe the problem is? • Current pertinent assessment data using head to toe or focused assessment approach, • Pertinent diagnostics • Vital signs The issue with the patient is the lack of knowledge regarding the disease, as well as non- adherence to treatment. Recommendation • What should be done to correct this situation? • Any orders or recommendations you have for this patient I would recommend that the patient be connected with a diabetes education, a dietician, and be a participant for a sleep study. The patient also might need assistance with ADLs so an OT/PT assessment might also benefit the patient. Guided Reflection Questions 1. How did the simulated experience of Red Yoder’s case make you feel? I felt comfortable in this simulation because it felt like a very real scenario that could take place in the community. I have also had patients with peripheral neuropathy in the past so I was able to draw from that experience to help me in this simulation. 2. What nursing actions did you feel were appropriate within this scenario? The nursing actions that I felt were appropriate in this scenario was the evaluation of Red’s knowledge about diabetes, and how much he adheres to checking his blood sugar and taking medications. Another important nursing action was providing the patient with education regarding diabetes, wound and foot care, medication, sleep, etc. 3. EBP What are the priority nursing actions for Red Yoder based on physical findings and social and family interaction? Based on physical findings and social and family interaction, the priority nursing actions for Red Yoder would be patient education. I believe that the foundation of the problems that Red experienced are based on not having enough information about the disease process, and being unable/not willing to take care of himself. If we prioritize teaching and educating the patient and provide guidance on how can he better take care of himself and his disease, then he is more likely to succeed and less likely to be re-admitted for diabetes related issues. 4. EBP What potential problems can you identify for Red Yoder? The potential problems that I can identify with Red Yoder relate to his non-adherence to self-care and medications. If Red continues to neglect his health then potential problems could be worsening of his wound, and maybe even an infection. The patient also has problems with sleep so without the proper rest, the patient’s body can breakdown, and be prone to other infections. 5. S/QI For the following Safety/Quality Improvement measures, what nursing actions should be taken during Red Yoder’s case? Safety/Quality Improvement Measures Nursing Actions Assessment of patient’s ability to self-administer his insulin Ask the patient if he knows how to self- administer insulin. If he states yes, ask him to demonstrate how he would self-administer insulin. Assessment of patient’s ability to monitor blood glucose Ask the patient if he knows how check his blood sugar. If he states yes, ask him to demonstrate how he checks his blood sugar as well as how often and at what times. Safety issues related to needle disposal Provide patient with a sharps container and instruct the patient on how to properly dispose of his used needles. 6. PCC/I What appropriate assessments were made to help you decide what interventions Red Yoder needed? The assessments that helped in determining the appropriate interventions was evaluating Reds’ ability to take care of himself as well the family’s input on Red’s habits and behaviours. Assessment of the wound also helped in determining the type of care Red will need in order to prevent infection and promote healing. 7. T&C Why is it important to include Red Yoder’s family as members of his health care team? The inclusion of Red’s family is vital to this simulation because they are able to provide more information on Red’s eating and drinking habits. The family is also extremely supportive of Red and they want to see him get better, therefore, we should involve them in his care because they will provide him with emotional support and encouragement. 8. Reflecting on Red Yoder’s case, were there any actions you would do differently? If so, what were these actions, and why would you do them differently? If I had a change to repeat this simulation, I would focus more on speaking to the family members as well as they might have been able to provide additional information. 9. How would you apply the knowledge and skills that you obtained in Red Yoder’s case to an actual patient care situation? I would apply the knowledge and skills I gained from this simulation by conducting thorough and detailed assessments that include both the patient and the family member. It is important to look at the patient as a whole and see if they have any support systems that we can involve in the care of the patient. I also learned that education is extremely important as many patients will not have sufficient information about the disease and will not be able to take care of themselves. Sherman “Red” Yoder – Part B Part 1: Plan of Care Concept Map (adapted from vSim template) • brief summary of pathophysiology and rationale for clinical manifestations Red is being seen for a pressure ulcer on his right toe that developed around five weeks ago. It is likely that the patient continued to not adhere to his medication routine as well as his foot care routine. The patient is being treated at home with the use of an oral antibiotic and a wet to damp saline dressing daily. Red is being admitted due to a possible wound infection. The ER orders for this patient are an IV bolus of normal saline 500ml, a lab order for the following blood work: CBC, electrolytes, BUN and creatinine, blood culture x 2, and serum lactate. The patient’s oxygen levels are to stay above 94%, if they drop below that, administer oxygen via nasal canula. If the patient is retaining fluid and is unable to void, insert urinary catheter to continuous drainage. Patient requires continuous ECG and SpO2 monitoring, as well as capillary blood glucose monitoring in order to give insulin on a sliding scale. The patient is placed on IV antibiotic Ceftazidime 1 gram IV every 8 hours. The Assessment Anticipated Physical Assessment Findings • additional focused assessment • relevant cues (S&S) • cues indicating need for immediate concern and rationale Anticipated Diagnostic Tests • relevant cues (abnormal findings) • additional tests to consider Abnormal Values Right toe ulcer Distended bladder (need for urinary catheter) Potential polyuria, polydipsia, and polyphagia due to increased glucose levels. Blood Glucose: 210 Serum Lactate: 4 White blood cells: 12000 Red blood cells: 4.2 Hemoglobin: 10.5 Would culture: Staphylococcus positive Additional tests to consider – monitoring of blood glucose x 4 times a day. Plan Anticipated Care Priorities Anticipated Nursing Interventions Monitor blood glucose levels and adhere to medication. Wound dressing. Feet inspection. Diet and nutrition information. Intake/output monitoring Educate patient on: the importance of monitoring his blood glucose after meals, and adhering to the sliding scale dosage, daily inspection of feet with help of mirrors and family, how to apply wound dressings on his right toe to prevent further complications, information on diet and nutrition. Great importance must be placed on footcare. Assess independence in ADLs. Insert urinary catheter if patient is retaining fluid Part 1: Medication Worksheet (one per medication) (adapted from vSim template) Medication Classification cefTAZidime Antibiotic Dose - PO, IV, IM.SC or most common route Adults and children age 12 and older: 1 to 2 g IV or IM every 8 to 12 hours. Route and dosage are determined by susceptibility of the organism, severity of infection, and condition of patient. Give up to 6 g daily in life-threatening infections. Drug calculations: how supplied, how to reconstitute, volume for required dose, drip rate N/A Purpose/Main Drug Actions Inhibits cell-wall synthesis, promoting osmotic instabili