Surgical Case 1: Marilyn Hughes
Guided Reflection Questions
1. How did the scenario make you feel?
I felt pretty confident in this scenario and it was a very focused assessment because it
was post op and I think I did a job well done. I felt like this was a helpful review on
compartment syndrome.
2. How would you recognize that Marilyn Hughes’ condition was deteriorating?
I knew she was deteriorating because her vitals were high and pain level was
worsening even after she has received morphine an hour ago. She had no distal pulse,
sweating, and not being able to mover her toes were clear indications I need to call
the dr immediately.
3. What interventions exist to alleviate compartment syndrome, and what assessments
indicate improved perfusion to the extremity?
After I assessed her, her dressing was too tight so I loosened the dressing in hopes that
she would start feeling better and the pressure would be relieved. I also, lowered her
leg at heart level to increase with circulation. She didn’t have a pedal pulse and her
cap refill was decreased. I could have applied ice as well. If the color would have
come back to normal that would have been an indication of improved perfusion to
extremity as well.
4. Why is it important to maintain the limb at heart level versus elevating it above heart
level?
When Marilyn leg is at hear level, arterial perfusion is being maintained preventing
further fluid accumulation in the leg. If the leg is elevated, then it will cause more
pressure and blocking of perfusion.
5. What could have happened in this scenario if Marilyn Hughes’ condition was not treated
expediently?
If Marilyn wasn’t properly treated, it could have ended up with a leg amputation
because of the compromised blood flow and damage.
6. What key elements would you include in the handoff report for this patient? Consider
the SBAR (situation, background, assessment, recommendation) format.
Situation: Marilyn Hughes, 45, female c/o pain 8/10 post op. She was given morphine
at 1415. Bandage was too tight and has been loosened and leg placed at heart level. Pt
still complaining of pain.
Background: fell on icy stairs and fractured her left mid-shaft tibia-fibula. She went to
have an ORIF and returned @1345 with below knee ace splint dressing, Adm Dx Lower
Leg Fracture, Admitted on 07/02/20, Orders: Admit to surgical floor following surgery,
Diet: liquids advance to regular as tolerated, Activity: no weight bearing on left leg
postop, vital signs including neurovascular checks to left lower extremity every 2
hours, IV: lactated ringer's solution @ 75mL/hr, elevate left leg, Meds: morphine
sulfate 4-6 mg IV push every 4 hours prn pain
© Wolters Kluwer Health | Lippincott Williams & Wilkins
This study source was downloaded by 100000838401522 from CourseHero.com on 04-28-2022 05:32:11 GMT -05:00
https://www.coursehero.com/file/64554920/Marilyn-Hughes-Guided-Reflection-docx/
Guided Reflection Questions
1. How did the scenario make you feel?
I felt pretty confident in this scenario and it was a very focused assessment because it
was post op and I think I did a job well done. I felt like this was a helpful review on
compartment syndrome.
2. How would you recognize that Marilyn Hughes’ condition was deteriorating?
I knew she was deteriorating because her vitals were high and pain level was
worsening even after she has received morphine an hour ago. She had no distal pulse,
sweating, and not being able to mover her toes were clear indications I need to call
the dr immediately.
3. What interventions exist to alleviate compartment syndrome, and what assessments
indicate improved perfusion to the extremity?
After I assessed her, her dressing was too tight so I loosened the dressing in hopes that
she would start feeling better and the pressure would be relieved. I also, lowered her
leg at heart level to increase with circulation. She didn’t have a pedal pulse and her
cap refill was decreased. I could have applied ice as well. If the color would have
come back to normal that would have been an indication of improved perfusion to
extremity as well.
4. Why is it important to maintain the limb at heart level versus elevating it above heart
level?
When Marilyn leg is at hear level, arterial perfusion is being maintained preventing
further fluid accumulation in the leg. If the leg is elevated, then it will cause more
pressure and blocking of perfusion.
5. What could have happened in this scenario if Marilyn Hughes’ condition was not treated
expediently?
If Marilyn wasn’t properly treated, it could have ended up with a leg amputation
because of the compromised blood flow and damage.
6. What key elements would you include in the handoff report for this patient? Consider
the SBAR (situation, background, assessment, recommendation) format.
Situation: Marilyn Hughes, 45, female c/o pain 8/10 post op. She was given morphine
at 1415. Bandage was too tight and has been loosened and leg placed at heart level. Pt
still complaining of pain.
Background: fell on icy stairs and fractured her left mid-shaft tibia-fibula. She went to
have an ORIF and returned @1345 with below knee ace splint dressing, Adm Dx Lower
Leg Fracture, Admitted on 07/02/20, Orders: Admit to surgical floor following surgery,
Diet: liquids advance to regular as tolerated, Activity: no weight bearing on left leg
postop, vital signs including neurovascular checks to left lower extremity every 2
hours, IV: lactated ringer's solution @ 75mL/hr, elevate left leg, Meds: morphine
sulfate 4-6 mg IV push every 4 hours prn pain
© Wolters Kluwer Health | Lippincott Williams & Wilkins
This study source was downloaded by 100000838401522 from CourseHero.com on 04-28-2022 05:32:11 GMT -05:00
https://www.coursehero.com/file/64554920/Marilyn-Hughes-Guided-Reflection-docx/
