Guided Reflection Questions
Opening Questions
How did the simulated experience of Sabina Vasquez’s case make you feel? As any other
VSIM, Sabina made me feel uncomfortable. Sabina adds another level of complexity,
wh
...
Guided Reflection Questions
Opening Questions
How did the simulated experience of Sabina Vasquez’s case make you feel? As any other
VSIM, Sabina made me feel uncomfortable. Sabina adds another level of complexity,
where a child comes in with respiratory disease, already has a condition that can amplify
possible problems. I think Sabina is an excellent introduction to a real-life patient
scenario. They most likely have multiple issues wrong with them and the nurse has to
think of how disease processes will interact and how will that apply to the patient. Sabina
had two inflammatory disease, pneumonia as an acute infection, and asthma as chronic
inflammatory condition.
Describe the actions you felt went well in this scenario. I feel like I followed through the
orders correctly and efficiently. I recognized that Sabina was in distress, and she needed
another dose of albuterol. I contacted the doctor to deal with the problem at hand, and I
had no problem picking what medication was the priority. Albuterol took the first place,
to alleviate girls bronhospasm, then I proceeded with medication to treat the fever and
antibiotics. Even though this is not available in this simulation, one of my first thoughts
was a need for an interpreter. I knew that we should provide them with appropriate
language services in case they weren’t comfortable with english.
Scenario Analysis Questions[*]
EBP List in order of priority your initial nursing actions for Sabina Vasquez based on
physical findings and family interaction. 1) Elevate the head of the bed to provide a
position of comfort and to relieve respiratory distress, 2) increase oxygen to 4 L
via a nasal cannula, 3) administer albuterol, 4) notify the primary care provider.
EBP What complications might Sabina Vasquez face if her symptoms are not
recognized and if care is not initiated in a timely manner? Acute pneumonia may
progress to severe hypoxia leading to respiratory failure and possible death.
PCC What actions should be taken to ensure the delivery of appropriate information to
Sabina Vasquez’s mother? Because sabina’s mother has limited English, a trained,
approved interpreter is legally required to assist with communication.
PCC Recognizing the acuity of the situation, how would you include Sabina Vasquez
and her mother in the decision-making process? Discussion should include the
following: the importance of recognizing communication barriers; the use of eye
contact, simple statements, and hand gestures, the use of therapeutic touch by
both the nurse and mother, and the encouragement of the mother’s active support
and engagement in providing care for Sabina as appropriate.
S/QI Reflect on ways to improve safety and quality of care based on your experience
with Sabina Vasquez’s case. Possible areas for improvement include medication
administration and drug calculations (right of medication administration to include
oxygen), patient/family teaching (using an interpreter, discussing medication
administration to include timing, providing information on side effects, educating
on triggers, recognizing signs and symptoms, and providing written instruction in
Spanish), and equipment use (demonstration of appropriate use of medication
delivery devices to include nebulizer and intravenous (IV) piggyback and
appropriate documentation).
T&C/I What key elements would you include in the handoff report for this patient?
Consider the situation-background-assessment-recommendation (SBAR) format.
S: Sabina Vasquez, 5 year old, Hispanic girl came in with her mother to the ER
with pneumonia. She has a history asthma and has had several episodes requiring
use of an albuterol inhaler at home.
B: Sabina’s mother reports her daughter had an upper airway infection for a
couple of days, and today she developed 39 C fever; therefore, she brought her in.
She is now on 4L/min humidified nasal cannula. She got a 380 mL bolus of NS and
albuterol at 1700. When I saw her at 1900, she had: difficulty breathing,
unproductive cough, and some wheezing. Along with reduce breath sounds at the
right lung base, SpO2 92% respiration rate 29/min, and temperature 39.1C;
We got an extra dose of 2.5 mg albuterol nebulizer to ease the bronchospasm
from the provider; 240 mL of acetaminophen for the fever; piggyback infusion of
475 mg of cefuroxime IV for pneumonia; also a 190-mg oral dose of azithromycin
for pneumonia. An intravenous injection of D5 1/2NS is infusing at 61mL/hr.
A: I believe sabinas airway is hyperactive during illness due to increased
inflammation caused by pneumonia.
R: Sabina’s airway should be monitored carefully, and the mother should be
encouraged to call for help if she sees and hears any complaint of dyspnea so that
we can manage asthma and pneumonia efficiently. Monitor for signs and
symptoms of antibiotic hypersensitivity. There are two antibiotics ordered for
treatment of pneumonia, that should be discussed and reinforced with Sabina’s
mother, so that she will receive a full treatment after she is discharged home.
QI As you begin to think about discharge planning for Sabina Vasquez and her
family, what teaching needs to be provided? Students should incorporate the asthma
action plan during patient and family teaching on signs and symptoms, asthma
triggers, and the effect of the chronic illness on the family.
Concluding Questions
Reflecting on Sabina Vasquez’s case, were there any actions you would do differently? If so,
what were these actions, and why would you do them differently? According to VSIM grading,
there wasn’t much I should do differently, but in real life, I would add a lot more
education for Sabina’s mother. After Sabina gets her albuterol and we monitor her for
improvement I think it’s a good timing to begin talking about asthma action plan,and
explain why is she having this difficulty breathing because of the pneumonia as well.
This way we can lower Sabinas mother stress, therefore indirectly Sabina will fell more
comfortable with mom that is less anxious. I believe that as a practicing nurse you
should be talking to the patient in simple terms what are you doing to them. For example,
in the VSIM, medication administration is quiet, and the nurse does not give any
information about what she is giving to Sabina. This is again a goof time for teaching,
and keeping the mother involved and informed.
Describe how you would apply the knowledge and skills obtained in Sabina Vasquez’s case to
an actual patient care situation. This scenario was great review of pneumonia and asthma.
In my clinical rotation in the school district, I am now aware that the nurse should have
an asthma action plan in case a child needs an inhaler. The review of the medication and
inhalers will help me look for proper use of them in the nurse’s office to ensure adequate
administration. Sabina’s case also made me think about the cultural aspect of nursing,
that use of bilingual pamphlets can increase compliance with new medication.
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