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    Medical Case 3: Vincent Brody: Guided Reflection Questions

    Uploaded by

    api-546220765

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 3

    Medical Case 3: Vincent Brody

    Guided Reflection Questions

    1. How did the scenario make you feel?

    This scenario made me a little nervous the first time because I wasn’t really sure what
    steps to take being that I personally never had a patient who was experiencing an
    exacerbation of COPD. The second time around I felt more confident and did better.
    Airway clearance and patency is a crucial part of life so I think that’s what made this
    scenario so intimidating.

    2. When a patient develops a rapid onset of shortness of breath, what are the nurse’s
    immediate priorities?

    The immediate priorities of the nurse include assessing the patients airway, breathing,
    and circulation (ABC’s), providing oxygen if needed, listening to the lungs and breath
    sounds for adventitious sounds such as wheezes, or crackles. And contacting the
    provider for further assessment on how they want you to handle the situation.

    3. What assessment findings would indicate that the patient’s condition is worsening?

    The assessment findings that would indicate the patient’s condition is worsening would
    include no improvement in the patients SP02 levels and changes in the patients Arterial
    Blood Gases Results.

    4. Review Vincent Brody’s laboratory results. Which results are abnormal? Discuss how
    these results relate to his clinical presentation and chronic disease process.

    I don’t remember what the HC03 or the PC02 were and I wasn’t able or I don’t know
    how to go back and look at those. However, I believe they were both abnormal. Which
    makes since for a patient with COPD. Since PC02 has to deal with the level of carbon
    monoxide in the body and HC03 has to deal with the metabolic and kidneys ability to
    maintain or get rid of bicarbonate in the body. COPD patients have difficulty getting rid
    of CO2 because of their weakened alveoli.

    5. What are safety considerations when caring for a patient with a chest tube?

    Some safety concerns when caring for a patient with a chest tube include assessing the
    patients respiratory status and monitoring for any deteriorations, assessing the chest
    tube and drainage system for patency, monitoring the chest tube site for any

    © Wolters Kluwer Health | Lippincott Williams & Wilkins


    signs/symptoms of infection, encouraging the patient to take part in ambulation
    exercises, and making sure the tubing is within their reach so they don’t pull it out.

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

    The patient presented to the hospital with an exacerbation of COPD. The patient has a
    history of smoking 2 packs of cigarettes per day. His oxygen saturation had dropped and
    he was placed on oxygen via nasal cannula. However, his oxygen saturation levels did
    not improve. The patient received Potassium Chloride in 5% dextrose and normal saline
    at 100ml/hr. via IV on his right hand. He also received Albuterol via nebulizer 2.5 mg in
    3ml of normal saline. There were bilateral wheezes upon auscultation of the lungs, an
    increased RR, HR, and BP. I took an ABG and results showed respiratory distress. I
    contacted the physician who ordered an insertion of a chest tube with X-Ray’s before
    and after insertion along with 2mg of Morphine via IV before the insertion of the chest
    tube. The patient improved after the insertion of the chest tube. The dressing is clean,
    dry, and intact. There are no signs of any air leaks. The patients current status is ECG:
    Sinus rhythm. Heart rate: 98. Pulse: Present. Blood pressure: 112/72 mm Hg.
    Respiration: 19. Conscious state: Appropriate. SpO2: 94%. Temp: 99 F (37 C). I
    recommend continued monitoring of the dressing and insertion site along with patients
    respiratory status and vitals.

    7. What patient teaching priorities would be important in the patient experiencing an


    acute exacerbation of COPD?

    Some patient teaching priorities for a patient experiencing an acute exacerbation of


    COPD would include knowing what can cause an exacerbation, signs and symptoms of
    an exacerbation, how to prevent exacerbations, and how serious is the exacerbation.
    Along with taking your medications as prescribed, smoking cessation, exercising, and
    eating a healthy and well balanced diet.

    8. For a patient with COPD who is stable, what resources would you recommend?

    An important resource for this patient would be a program that promotes smoking
    cessation. As well as a pulmonary rehabilitation program that he can attend. It is
    important that he stop smoking so he can promote lung function and decrease the
    likelihood of having a COPD exacerbation.

    9. What would you do differently if you were to repeat this scenario? How would your
    patient care change?

    If I were to do things differently I would brush up on how to treat a patient who is


    experiencing a COPD exacerbation. The pretest was helpful but actually treating a

    © Wolters Kluwer Health | Lippincott Williams & Wilkins


    patient with COPD versus just knowing what COPD is and the signs and symptoms that
    go along with it. Along with staying on track during the scenario as well because I lost
    my place a couple of times and wasn’t sure what to do next. There were a lot more
    steps to follow during this simulation than the others.

    © Wolters Kluwer Health | Lippincott Williams & Wilkins

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