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  • Maternity Case 7: Carla Hernandez (Core) : Guided Reflection Questions

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    Dai Nguyen
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    373 views2 pages

    Maternity Case 7: Carla Hernandez (Core) : Guided Reflection Questions

    Uploaded by

    Dai Nguyen

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 2

    Maternity Case 7: Carla Hernandez (Core)

    Guided Reflection Questions

    Opening Questions
    How did the simulated experience of Carla Hernandez’s case make you feel?

    The simulated experience made me felt a little nervous at first. That was the first time I took care for
    someone who had umbilical cord compression so I did not realize what to do next when I entered the
    room even though I have learnt the priority interventions for this specific case.

    Describe the actions you felt went well in this scenario.

    For the second time, I did smoothly throughout the scenario. I communicated with the patient, assessed
    her vital signs, recognized that there was something wrong with the mom and fetal which is late
    deceleration shown on the EFM. I gave 10L oxygen via nonrebreathing mask, turned the patient into
    Trendelenburg position, started a bolus of 500 ml of lactated Ringer based on the physician’s order. I
    contacted with the charge nurse, provider, surgery unit, NICU, and anesthesia care team for her.

    Scenario Analysis Questions1


    EBP Consider the emergent nature of umbilical cord prolapse. What nursing actions should be
    initiated immediately? Why?

    I should immediately relieve umbilical cord pressure using a gloved hand. Repositioning the
    mother to Trendelenburg position, or knee-chest position. The mother should also be educated
    about the situation so that she does not become so anxious of frightened. The baby’s heart rate
    should be continuously monitored, to watch out for fetal hypoxia. The mom should also be
    provided the oxygen.

    PCC What is the priority need for Carla Hernandez at this time?

    The priority need for Carla Hernandez at this time would be prepared for an emergency C-
    section. After initial intervention include relieving pressure so that the situation would not get
    worse, then prepare her for surgery by educating and calming the mother and family, witnessing
    the signed consent for the surgery, calling surgery, calling anesthesia, and calling the NICU.

    1
    The Scenario Analysis Questions are correlated to the Quality and Safety Education for Nurses (QSEN)
    competencies: Patient-Centered Care (PCC), Teamwork and Collaboration (T&C), Evidence-Based Practice (EBP),
    Quality Improvement (QI), Safety (S), and Informatics (I). Find more information at: http://qsen.org/

    From vSim for Nursing | Maternity. © Wolters Kluwer Health.


    T&C What key elements would you include in the handoff report for this patient? Consider the
    situation-background-assessment-recommendation (SBAR) format.

    S: Carla Hernandez is 32 yo Hispanic female, G2P1 (L1), at 39 5/7 weeks of gestation, has
    prolapsed umbilical cord and is being prepared for an emergency C-section.

    B: Hernandez is at 39 5/7 weeks gestation and is a G2P1 with no known allergies. She was
    admitted to the L&D in active labor at 0600. The provider performed the artificial rupture of
    membranes before the prolapsed umbilical cord occurred. She is currently on 125 ml/hr
    Lactated Ringers.

    A: HR: 89, RR: 16, O2: 97, T 37C, BP: 136/81. She reports pain 2/10 in between contractions. The
    fetal heart is low at 71 bpm and shows late deceleration. Physical head-to-toe examination was
    performed and nothing to find on the exam. No pitting edema on the legs. IV sites was assessed
    and there is no redness, swelling, infiltration, bleeding, or drainage; the dressing was dry and
    intact. Breath sound was clear bilaterally. The surgical team, anesthesia, NICU, and provider
    have all been called.

    R: I recommend Hernandez and baby continue to be monitored and prepared for emergency C-
    section.

    S/QI/I Based on your experience with Carla Hernandez’s case, reflect on possible nursing actions for
    enhanced safety and quality improvement.

    Repositioning of the patient, manually relieving pressure of the umbilical cord, educating the
    mother and the family, providing comfort and support to both the mother and her family,
    communicating with the health care team so the birth can go as smoothly as possible.

    Concluding Questions
    Reflecting on Carla Hernandez’s case, were there any actions you would do differently? Explain.

    I would palpate the fundus and massaged the fundus when she was in Trendelenburg position rather
    than lying flat. I would have helped Carla into the Trendelenburg position sooner.

    Describe how you would apply the knowledge and skills that you obtained in Carla Hernandez’s case to
    an actual patient care situation.

    I will know what to do if a patient is experiencing a prolapsed umbilical cord. I will know the signs to look
    out for and then how to implement the intervention to make sure both mother and baby are safe

    From vSim for Nursing | Maternity. © Wolters Kluwer Health.

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