Surgical Case 3: Doris Bowman Guided Reflection Questions
Surgical Case 3: Doris Bowman
Guided Reflection Questions
1.How did the scenario make you feel?
At first the scenario was overwhelming and a littl
...
Surgical Case 3: Doris Bowman Guided Reflection Questions
Surgical Case 3: Doris Bowman
Guided Reflection Questions
1.How did the scenario make you feel?
At first the scenario was overwhelming and a little bit stressful, because when Doris stopped
breathing, I was not exactly sure what to do. Not because I was lacking knowledge but because I
panicked. After, I realized that she was experiencing respiratory failure, I got myself together
and I was able to help her through ventilation and medication administration. I treat those
scenarios very seriously, and I act as if it was a real patient, and that is a reason I get anxious and
overwhelmed sometimes. It is because I want to be a good nurse. (As we all do)
2. What further intervention would have been required if naloxone hydrochloride (Narcan) had
not been effective in this case?
I would provide high level of oxygen and if Doris’s pulse was absent along with respirations,
the CPR would be needed.
3. Discuss readiness for discharge from PACU criteria.
To be discharged from PACU the patient must be awake and able to respond to verbal
commands. The patient must be able to breath deeply and cough. Patient’s blood pressure should
be (+) or (-) >20-35mmHg of the pre-anesthetic level. According to the article Standards of Post
Anesthesia Nursing Practice “Patients with a systolic blood pressure 200mmHg, or exhibiting a
blood pressure other than their baseline pre-anesthetic blood pressure, must be evaluated by an
anesthesiologist prior to discharge.” (2001)
Also, before discharge from PACU the patient’s SpO2 level must meet or exceeds the
anesthesiologist's parameters on supplemental 02 or room air.4. What key elements would you include in the handoff report for this patient? Consider the
SBAR (situation, background, assessment, recommendation) format.
Doris Bowman is a 39 years old woman who had hysterectomy with bilat salpingooopherectomy done under general anesthesia. There were no complications during procedure
and the patient tolerated it well. Patient complained of pain which she rated 6 on scale of 0-
10, so the morphine was administered as ordered. After administration of the medication the
patient’s respirations have dropped to 5 breaths per minute and patient was unconscious.
Patient was ventilated at rate of 12 breaths per minute and 10 L of oxygen and received
naloxone to reverse the side effects of morphine. Patient’s condition returned to normal
within few minutes of administration of the medication. Patient has potassium chloride in 5%
dextrose and NS running in right arm. The abdominal incision is dry with no signs of
abnormal bleeding.
5. What further complications could have occurred if the respiratory depression had not
resolved?
Patient’s hypoventilation could have lead to increase of CO2 and respiratory acidosis and
hypoxemia. Respiratory depression can lead to pulmonary hypertension, heart failure, brain
damage, respiratory arrest, coma and even death.
6. If Doris Bowman’s family members had been present during the scenario, describe how you
would support them when her condition deteriorated.
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