Surgical Case 1: Marilyn Hughes
Kourtney Chaney
Guided Reflection Questions
1. How did the scenario make you feel?
a. This scenario was one we’ve discussed a lot in adult health. Compartment
syndrome could become a potential post-op complication and we should
assess for and quickly recognize this as nurses. I was mostly prepared for this
vSim due to learning about it prior to this activity.
2. How would you recognize that Marilyn Hughes’ condition was deteriorating?
a. She would exhibit signs of increased pain such as an increase in blood
pressure, heart rate, and respirations. She might also complain of persistent,
unrelieved pain after adequate medication administration. Worst case
scenario, her lower left leg might also become cyanotic with loss of feeling.
3. What interventions exist to alleviate compartment syndrome, and what
assessments indicate improved perfusion to the extremity?
a. Lower leg to heart level and loosen dressing to improve tissue perfusion.
b. Return of color to the toes, decreased capillary refill, and present pedal
pulses would indicate improved perfusion to the extremity.
4. Why is it important to maintain the limb at heart level versus elevating it above
heart level?
a. Lowering the limb to the same level as the heart improves arterial tissue
perfusion and prevents further fluid accumulation in the affected
extremity.
5. What could have happened in this scenario if Marilyn Hughes’ condition was not
treated expediently?
a. The patient could have lost more feeling in her lower left leg, which could lead
to excessive ischemia. Marilyn could eventually lose her toes, foot or even her
whole leg if the issue wasn’t resolved.
6. What key elements would you include in the handoff report for this patient?
Consider the SBAR (situation, background, assessment, recommendation) format.
a. S: 45-year-old female who suffered a left mid-shaft tibia-fibula fracture from
slipping on icy stairs. She was taken to surgery for an ORIF and has returned
with a below-the-knee ace /splint dressing.
b. B: Full code. Clear diet, advance as tolerated. Patient is bedrest until she
works with physical therapy. No known allergies.
c. A: Skin intact and free of lesions. Neurological assessment performed, person
alert and oriented x4. Vitals to be taken every 30 minutes. Last VS were: temp:
99F, RR: 21, HR:105, BP:158/81, O2: 98% on room air. IV site intact and dry. She
has lactated ringers at 75ml/hr. Patient states pain is 7/10. She was given
morphine IV 6mg at 1415. She developed severe pain in her left lower
extremity for the past hour after returning from surgery. She had absent pedal
pulse in the left foot and numbness in that extremity. Her leg was lowered on
the bed and the dressing was loosened. This improved her pain and resulted in
increased perfusion to her left foot. Patient states pain is now 4/10 after
morphine injection.
Kourtney Chaney
Guided Reflection Questions
1. How did the scenario make you feel?
a. This scenario was one we’ve discussed a lot in adult health. Compartment
syndrome could become a potential post-op complication and we should
assess for and quickly recognize this as nurses. I was mostly prepared for this
vSim due to learning about it prior to this activity.
2. How would you recognize that Marilyn Hughes’ condition was deteriorating?
a. She would exhibit signs of increased pain such as an increase in blood
pressure, heart rate, and respirations. She might also complain of persistent,
unrelieved pain after adequate medication administration. Worst case
scenario, her lower left leg might also become cyanotic with loss of feeling.
3. What interventions exist to alleviate compartment syndrome, and what
assessments indicate improved perfusion to the extremity?
a. Lower leg to heart level and loosen dressing to improve tissue perfusion.
b. Return of color to the toes, decreased capillary refill, and present pedal
pulses would indicate improved perfusion to the extremity.
4. Why is it important to maintain the limb at heart level versus elevating it above
heart level?
a. Lowering the limb to the same level as the heart improves arterial tissue
perfusion and prevents further fluid accumulation in the affected
extremity.
5. What could have happened in this scenario if Marilyn Hughes’ condition was not
treated expediently?
a. The patient could have lost more feeling in her lower left leg, which could lead
to excessive ischemia. Marilyn could eventually lose her toes, foot or even her
whole leg if the issue wasn’t resolved.
6. What key elements would you include in the handoff report for this patient?
Consider the SBAR (situation, background, assessment, recommendation) format.
a. S: 45-year-old female who suffered a left mid-shaft tibia-fibula fracture from
slipping on icy stairs. She was taken to surgery for an ORIF and has returned
with a below-the-knee ace /splint dressing.
b. B: Full code. Clear diet, advance as tolerated. Patient is bedrest until she
works with physical therapy. No known allergies.
c. A: Skin intact and free of lesions. Neurological assessment performed, person
alert and oriented x4. Vitals to be taken every 30 minutes. Last VS were: temp:
99F, RR: 21, HR:105, BP:158/81, O2: 98% on room air. IV site intact and dry. She
has lactated ringers at 75ml/hr. Patient states pain is 7/10. She was given
morphine IV 6mg at 1415. She developed severe pain in her left lower
extremity for the past hour after returning from surgery. She had absent pedal
pulse in the left foot and numbness in that extremity. Her leg was lowered on
the bed and the dressing was loosened. This improved her pain and resulted in
increased perfusion to her left foot. Patient states pain is now 4/10 after
morphine injection.
