VSIM__Carla_Hernandez./VSIM__Carla_Hernandez. | Exams Nursing | Docsity (2024)

Download VSIM__Carla_Hernandez./VSIM__Carla_Hernandez. and more Exams Nursing in PDF only on Docsity! Paula Zelinsky- VSIM- Carla Hernandez  Due Tuesday by 11:59pm---Submitting a text entry box, a media recording, or a file upload  Available Sep 26 at 12:01am - Oct 10 at 11:59pm 15 days  This is a MULTI-Phase Assignment- This assignment counts towards CLINICAL TIME. Satisfactory completion isREQUIRED to pass the clinical portion of the course. 1. Watch the simulation (vSim) as assigned through your Course Point Plus account. You must reach the required benchmark to earn credit for clinical time. Carla Hernandez 2. Create a CONCEPT map using the 8 basic needs criteria for this scenario. The concept map templates for the map is located in the Resources tab. 3. Submit an AUDIO file- (MP3 format created using Audacity- see Resource Tab) - explaining your map and how you "analyzed" it. Explain "why" you placed the data under a specific concept, how it relates to the patient's condition, and explain interactions between any linked concepts. Failure to complete results in a clinical course failure. Rubric CONCEPT Map Rubric CONCEPT Map Rubric Criteria Ratings Pts This criterion is linked to a Learning Outcome Lists the primary/admitting problem in the center of the map and lists the priority assessments 2.0 pts SATISFACTORY 0.0 pts UNSATISFACTORY - is missing 1 or more critical problem or priority assessments 2.0 pts This criterion is linked to a Learning Outcome Identifies appropriate assessment data (cluster clues) and places data under appropriate CONCEPT 5.0 pts SATISFACTORY - places all appropriate assessment data under the corresponding 8 basic needs 3.0 pts MARGINAL- missed 1 key clues in assessment data under the 8 basic needs 0.0 pts UNSATISFACTORY- missed 2 or more assessment findings or did not place data under correct CONCEPTS; map reveals student has no grasp of how to document assessments in relation to the 8 basic needs 5.0 pts This criterion is linked to a Learning OutcomeIncludes medications and laboratory results under appropriate CONCEPT 3.0 pts SATISFACTORY 2.0 pts MARGINAL - missed 1 med and/or lab in assessment findings/history under appropriate CONCEPT 0.0 pts UNSATISFACTORY - missed 2 or more meds and/or labs under the correct CONCEPT 3.0 pts This criterion is linked to a Learning OutcomeIncludes Erikson's stage of development 1.0 pts SATISFACTORY - includes correct stage under correct CONCEPT 0.0 pts UNSATISFACTORY - does not include stage or is incorrect stage or is under incorrect CONCEPT 1.0 pts This criterion is linked to a Learning Outcome Shows correlation/connection between CONCEPTS 2.0 pts SATISFACTORY - map shows connections between CONCEPTS via colored lines/shapes, etc. Map fully demonstrates all appropriate connections. 0.0 pts UNSATISFACTORY - map is missing connections between CONCEPTS; or lines/shapes/colors are not utilized to show connections 2.0 pts Paula Zelinsky- VSIM- Carla Hernandez CONCEPT Map Rubric Criteria Ratings Pts This criterion is linked to a Learning Outcome Nursing Diagnosis listed according to R/T and AEB criteria for all 8 concepts 4.0 pts SATISFACTORY 2.0 pts MARGINAL - lists nursing diagnosis but does not include R/T and AEB criteria for each diagnosis 0.0 pts UNSATISFACTORY - 2 or more are incorrect and/or missing 4.0 pts This criterion is linked to a Learning Outcome Nursing Diagnosis are prioritized according to Maslow's hierarchy on the map 3.0 pts SATISFACTORY 0.0 pts UNSATISFACTORY - diagnoses are not numbered or are not prioritized according to Maslow 3.0 pts This criterion is linked to a Learning Outcome Late Submission- # points deducted as per policy 0.0 pts 0.0 pts UNSATISFACTORY - LATE SUBMISSION 0.0 pts Total Points: 20.0 Patient Introduction Carla Hernandez is a 32-year-old Hispanic female, G2P1 (L1), at 39 5/7 weeks of gestation. She was admitted to labor and delivery in active labor at 0600 hours today, accompanied by her husband Earl. To progress the delivery, artificial rupture of membranes was performed by the provider a few minutes ago. The provider has just left the room to make rounds. Suddenly, the fetal heart rate drops dramatically, and you discover that the umbilical cord is prolapsed. You are ready to handle this situation with another nurse who is also present in the room. Paula Zelinsky- VSIM- Carla Hernandezxe Topic: OB Week 2General Quest X | [J CoursePoint Plus: Ricci, Kyle &C: X [} MATERNITYAND PEDIATRIC 4 x 9 -E -© @ Notsecure | simserver.wkhpe.com/materity-tablet-combo/course/htmldeploy/ortolani.htm|?variant=MPC&lpatientid=CarlaHernandezCore-20131112&.. Q we §IAye es ee7:45amCarla Hernandez Gender Female Height 165 em Allergies No knownAdm DX Umbilical Cord Prolapse DOB 10/1/1985 (32y) Weight B1 kg Adm On 10/3/2018Clinical MedicationObservations ChartPatientInformation oiePatient Log JiagnosticsBlood analysis(146-429°107/L)(2.72-4.43°10°/L)(82.4-100.4 #1)MPV (8.2-10.4 fL)RDW (11.4-16.6%)weac (5.6-16.9°10°/L)MCH (29-32 pg/cell)MCHC (31.9:35.5 g/dL)Electrolytes Path ems Paula Zelinsky- VSIM- Carla Hernandez«* Topic: OB Week 2 General Quest x B ‘CoursePoint Plus: Ricci, Kyle & C> (i MATERNITY AND PEDIATRIC 41 x +COD Notsecure | simserver.wkhpe.com/matemity-tablet-combo/course/htmldeploy/ortolani.html?variant=MPC&patientld=CarlaHernandezCore-20131112&.. QVAS eo ese Oe a Le7:45amCarla Hernandez Gender Female 165 cm Allergies No knownAdm DX Umbilical Cord Prolapse 10/1/1985 (32y) Weigh Bike Adm On 10/3/2018Patient aceite “ a bila OrdersInformationType and ScreenBlood typeIndirect AntiglobutinSerology- ¥2 antibody screen NonreactiveGroup B Streptococcus NegativeGonorrhea/Chlamydia GC/CT NegativeSyphilis Treponemal IGA NonreactiveRubella immunecHepatitis A Ped 20) ead Paula Zelinsky- VSIM- Carla Hernandezx Topic: OB Week 2 General Quest X B CoursePoint Plus: Ricci, Kyle &C- X [). MATERNITY AND PEDIATRIC x + _CG @ Notsecure | simserver.wkhpe.com/maternity-tablet-combo/course/htmldeploy/ortolani.html?variant=MPC&patientid=CarlaHernandezCore-20131112&.. Qe &.Vay Beem Vere ea Pane Carla HernandezAdm on SURE)Deeg ETE C 0:15rd 9 o:3ad 9 o359 inYour main opportunities for improvement re9 1239oo You witnessed the patient's signature on aninformed consent. This was not indicated here, © 1:501:52& 209© 231Basic view Detailed view You introduced yourself.The electronic fetal monitor showed a nonreassuring drop in fetal heart rate.You assisted the patient into Trendelenburg position.You relieved pressure from the umbilical cord. This was indicated and the correct Jyresponse to the patient's condition.You palpated the uterus for contractions. This was reasonable. The uterus tonewas moderate between contractions. Regular contractions with moderateintensity had started. Contractions were approximately 4 minutes apart andlasted 50 seconds.The electronic fetal monitor showed a late deceleration.You checked the temperature at the mouth. The temperature was 99 F (37 C).You gave the patient 100% oxygen from a non-rebreathing mask.You turned the oxygen on.You assessed the patient's IV. The site had no redness, swelling, infiltration,bleeding, or drainage. The dressing was dry and intact. This is correct. Assessingany IVs the patient has is always important.You calmed and supported the patient and the family. This is reasonable. 100s m 99% Vv06000 SCORE ContinuePaula Zelinsky- VSIM- Carla Hernandezx Calendar X GB CoursePoint Plus: Ricci, Kyle& Co Xo€However, you cannot access the post-simulation quiz, documentation assignments, and guided reflectquestions until you have completed the vsim once. 1 Bi 4 5 6Suggested vSim_ Post Simulation Documentation Guided ReflectionReading Quiz Assignments QuestionsPre-Simulation QuizReset lof? i >‘A woman in active labor reports to the nurse that she thinks that her bag of waters has broken. What is thefirst assessment that the nurse performs at this time?a) Move the woman into semi-Fowler positionb) Check the color of amniotic fluidc) Insert a straight catheter to empty the bladder d) Monitor the fetal heart rate and patternThat's CorrectCorrect Response: _d) Monitor the fetal heart rate and patternExplanation: When the fetal membranes rupture, then the presenting part can put pressure on theumbilical cord. The first assessment to make is the fetal heart rate and pattern toensure that the fetus is getting enough oxygen through the umbilical cord. Puttingthis woman into semi-Fowler position would put more compression on the cord. Agreen-colored amniotic fluid indicates meconium, but the immediate assessment isto ensure there is adequate blood flow through the umbilical cord. If not, the nursewould promptly apply counter pressure on the presenting part. [irre © © Notsecure | thepointiww.com/Book/Show/677600?focus =vs#/CoursePointContent/Show/ 1¢5996e5-7279-419b-85 1d-39450068ad8e?forceView=False&.. & we f)] | @MiresaNSry Paula Zelinsky- VSIM- Carla Hernandez> Calendar x€BB CoursePoint Plus: Ricci, Kyle& Co Xo Suggested i Post-Simulation Documentation Guided ReflectionReading Quiz Assignments, QuestionsPre-Simulation QuizReset 2009 <>The labor and delivery nurse notices that a laboring woman’s external fetal monitor shows a variabledeceleration. What is the common etiology of this nonreassuring fetal periodic pattern?a) Anoxic continuous eventfb) Cord compression¢) Placental insufficiencyd) Fetal head compression That's Correct. aCorrect Response: _b) Cord compression 2Explanation: Fetal variable decelerations are commonly associated with umbilical cord Bacompression.Ei kicci, s., wyle, T,, and Carman, . Maternity and Pediatric Nursing, 3rd Edition,p. 494-498.Reset © © Notsecure | thepointiww.com/Book/Show/677600?focus =vs#/CoursePointContent/Show/ 1¢5996e5-7279-419b-85 1d-39450068ad8e?forceView=False&.. & we f)] | @Miresca10,0) Paula Zelinsky- VSIM- Carla Hernandezx Calendar X GB CoursePoint Plus: Ricci, Kyle& Co Xo < © © Notsecure | thepointiww.com/Book/Show/677600?focus =vs#/CoursePointContent/Show/ 1¢5996e5-7279-419b-85 1d-39450068ad8e?forceView=False&.. & we f)] | @Suggested i Post-Simulation Documentation Guided ReflectionReading Quiz Assignments, QuestionsPre-Simulation Quiz Reset 7 «>Which of the following statements is true concerning prolapsed umbilical cord?a) A prolapsed umbilical cord occurs rarely and can be resolved by pushing the cord back into thepatient,@ b) It is an emergency that requires immediate measures to minimize fetal mortality or morbidity from hypoxia.c) The blood flow to the fetus is minimally affected so there is time to prepare for a delivery by gcesarean section. 3d) A prolapsed umbilical cord could result from an occiput fetal position at +1 station with ruptured Bmembranes.That's CorrectCorrect Response: _b) It is an emergency that requires immediate measures to minimize fetal mortalityof morbidity from hypoxia.Explanation: The occurrence of prolapsed umbilical cord is approximately 1 in 300 to 600 births,or about 3% of cephalic presentations and 3.7% of breech presentations. A prolapsedumbilical cord is an obstetric emergency that requires immediate attention toprevent mortality and morbidity from fetal hypoxia. A cesarean birth irecommended to prevent acidosis from fetal hypoxia. The nurse monitors forprolapsed umbilical cord when the pregnant woman presents with a malpresentation,such as breech or shoulder, or when the presenting part is not engaged (i.e., stationwith a negative or zero value) (iter EE Bicci, S., kyle, T., and Carman, $. Maternity and Pediatric Nursing, 3rd Edition, Paula Zelinsky- VSIM- Carla Hernandezx Calendar X GB CoursePoint Plus: Ricci, Kyle& Co Xo€Suggested Sim Post-Simulation Documentation Guided ReflectionReading Quiz Assignments, QuestionsPre-Simulation QuizReset Cfo «>The nurse takes measures to preserve the integrity of the visible umbilical cord prolapse to maintain bloodflow to the fetus. Which of the following are appropriate measures? (Select all that apply)v 2) Use a gloved hand to lift the presenting part off the cordb) Monitor the color, amount, and smell of the amniotic fluidc) Push the exposed umbilical cord back into the open vagin*of 4) Assess the exposed umbilical cord for color and pulsatione) Check the maternal temperature, heart rate, and blood pressureThat's CorrectCorrect Response: a) Use a glovad hand to lift the presenting part off the cord, d) Assess the exposedumbilical cord for color and pulsationExplanation: The nurse would try to reestablish blood flow to the fetus by placing a gloved handinto the vagin* and lifting the presenting part off of the cord. The exposed umbilicalcord is not pushed back into the vagin*, because this action could cause theumbilical vessels to be kinked and cut off blood flow to the fetus. The risk for fetalhypoxia is determined by the color of the amniotic fluid, and the risk for infectionwould lead to monitoring the amniotic fluid for a foul smell. However, this questionis asking what actions would be directed at maintaining an intact umbilical cord.Maternal vital signs are not affected by a cord prolapse. Checking that there is bloodflow by palpating for a pulse and noting the color of the cord after pressure has beenrelieved are measures to assess that the umbilical vessels in the cord are functioningand intact.@ Feedback © © Notsecure | thepointiww.com/Book/Show/677600?focus =vs#/CoursePointContent/Show/ 1¢5996e5-7279-419b-85 1d-39450068ad8e?forceView=False&.. & we f)] | @Mires Paula Zelinsky- VSIM- Carla Hernandezx Calendar X GB CoursePoint Plus: Ricci, Kyle& Co Xo€ Suggested i Post-Simulation Documentation Guided ReflectionReading Quiz Assignments, QuestionsPre-Simulation QuizReset 7 fo «>What is the primary purpose for a provider order for terbutaline sulfate to be given to a laboring patientwho presents with a prolapsed umbilical cord?a) To accelerate the maternal and fetal heart rate and increase cardiac outputb) To bronchodilate the bronchial airway to allow more oxygen to reach the fetusc) To stimulate the beta-2 receptor sites that would increase fetal surfactant# 4) To relax the uterine smooth muscle to allow for improved fetal blood flowThat's CorrectCorrect Response: —d) To relax the uterine smooth muscle to allow for improved fetal blood flowOF FeedbackExplanation: This medication is being used as a tocolytic agent, which inhibits uterinecontractions. The primary reason for its administration is to prevent smooth musclecontractions of the uterus to allow for an immediate cesarean birth. EB tippincott Advisor, terbutaline sulfate © © Notsecure | thepointiww.com/Book/Show/677600?focus =vs#/CoursePointContent/Show/ 1¢5996e5-7279-419b-85 1d-39450068ad8e?forceView=False&.. & we f)] | @Mires Paula Zelinsky- VSIM- Carla Hernandez x Calendar X GB CoursePoint Plus: Ricci, Kyle& Co Xo - x€ © © Notsecure | thepointiww.com/Book/Show/677600?focus =vs#/CoursePointContent/Show/ 1¢5996e5-7279-419b-85 1d-39450068ad8e?forceView=False&.. & we f)] | @Reset oo </>A laboring woman called the nurse to report her bag of waters broke and she feels a pulsation in her vagin*.The nurse notes variable decelerations with fetal bradycardia on the fetal monitor and suspects prolapsedumbilical cord. Put into order the interventions the nurse should perform. 1. Call the Charge Nurse to notify the provider and prepare for immediate delivery v2. insert a gloved hand into the vagin* to retieve pressure on the umbilical cord v3. Assist the patient into a knee-chest position v4. Administer oxygen by nonrebreather mask at 10 L/min v5. Explain emergency measures and rationales to the patient and her support person v6. Ensure that there are no further abnormal fetal heart rate patterns v ra7. Document the actions and procedures taken to resolve this situation v 3B‘That's CorrectCorrect Response: 1. Call the Charge Nurse to notify the provider and prepare for immediatedelivery2. Insert a gloved hand into the vagin* to relieve pressure on the umbilical cord3. Assist the patient into a knee-chest position4, Administer oxygen by nonrebreather mask at 10 L/min5. Explain emergency measures and rationales to the patient and her supportperson6. Ensure that there are no further abnormal fetal heart rate patterns7. Document the actions and procedures taken to resolve this situationExplanation: The nurse would immediately call for assistance and delegate to get the providerinto the hospital and to prepare for an immediate cesarean delivery. The nextpriority is to reestablish blood flow through the umbilical cord by relieving thecompression on the cord by the presenting part. Any position that gets the woman’ships higher than her chest would redirect the fetus back inside the uterus. To = Paula Zelinsky- VSIM- Carla Hernandez > Calendar % BB CoursePoint Plus: Ricci, Kyle &C- x — G prolapsed cord -GoogleSearch x | ++ a x€ CG © Notsecure | thepoint.Iww.com/Book/Show/6776007focus =vs#/CoursePointContent/Show/Ge5ce37b-14f4-4002-b92d-39450068ad8e?forceView=Falseh.. & Fe §] | @ }QUESTION 3: What is the most important action the nurse would take when a prolaps.. moreYour Response: Correct!Correct Response: Apply gloved hand in the vagin* to alleviate cord compression.Explanation: It is most important that the nurse immediately retieves compression of... more Bi sicci, s., kyle, 7., and Carman, 5. Maternity and Pediatric Nursing, 3rd Edition,p. 824-825.EB ‘Lippincott Procedures, prolapsed Umbilical Cord Assessment and ManagementQUESTION 4: Carla Hemandez was in active labor when umbilical cord prolapse was i... moreYour Response: Correct!Correct Response: Subcutaneous, back of armExplanation: The best parenteral route for terbutaline sulfate is subcutaneous and th... moreMires B® Lippincott advisor, terbutaline sulfateQUESTION 5: ‘The nurse monitors for adverse effects from terbutaline sulfate, which moreYour Response: a) Maternal heart rate 154, regularCorrect Response: Maternal heart rate 154, regular‘Maternal blood pressure 152/94 mm Hg‘Auscultate crackles throughout lung fieldsExplanation: The adverse effects of terbutaline sulfate administration include the fol... more EB Lippincott advisor, terbutaline sulfate Paula Zelinsky- VSIM- Carla Hernandez > Calendar % BM CoursePoint Plus: Ricci, Kyle &C- x — G prolapsed cord-GoogleSearch x | + = x€ CG © Notsecure | thepoint.ww.com/Book/Show/6776007focus =vs#/CoursePointContent/Show/GeSce37b-14f4-4002-b92d-39450068ad8e?forceView=False&.. Q& yy §] | @QUESTION 5: ‘The nurse monitors for adverse effects from terbutaline sulfate, which moreYour Response: a) Maternal heart rate 154, regularCorrect Response: Maternal heart rate 154, regular‘Maternal blood pressure 152/94 mm Hg‘Auscultate crackles throughout lung fieldsExplanation: The adverse effects of terbutaline sulfate administration include the fol... more B® Lippincott advisor, terbutaline sulfateQUESTION 6: To prepare for an immediate cesarean delivery for Carla Hernandez, wh... moreYour Response: a) Ensure IV tine patencyCorrect Response: Obtain an informed consentExplanation: To prepare for a cesarean delivery, the nurse needs to obtain an inform... moreMires EB cippincott Procedures, Cesarean Birth (Scheduled) Preoperative CareQUESTION 7. After the umbilical cord prolapse has been identified, which of the follo... moreYour Response: Correct!Correct Response: ProviderNeonatal intensive care unit (N ICU)SurgeryExplanation: The first intervention for the nurse to take is to notify the primary care... more B® Lippincott Procedures, prolapsed Umbilical Cord Assessment and Management BD Lippincott procedures, Transfer within a FacilityPaula Zelinsky- VSIM- Carla Hernandez x6 Calendar X BB CoursePoint Plus: Ricci, Kyle & C= x | G prolapsed cord -Google Search x | a x€ CG © Notsecure | thepoint.Iww.com/Book/Show/6776007focus =vs#/CoursePointContent/Show/Ge5ce37b-14f4-4002-b92d-39450068ad8e?forceView=Falseh.. & Fe §] | @ }QUESTION 8: During the initial assessment for Carla Hernandez, there was fetal brad. moreYour Response: b) Fetal heart rate decelerated after the peak of a contraction.d) Long-term variability was 10 to 15 beats per minute (bpm).Correct Response: The umbilical cord had a pulse.Long-term variability was 10 to 15 beats per minute (bpm).The umbilical cord had a pH of 7.3 and maternal oxygen saturation was at 98%.Explanation: The nurse reevaluates if the measures to relieve compression of the Cor. more i Ricci, ., Kyle, 7., and Carman, 5. Maternity and Pediatric Nursing, 3rd Edition,p. 494-498,B® Lippincott Procedures, prolapsed Umbilical Cord Assessment and ManagementQUESTION 9: As Carla Hernandez is taken back to the operating room for an emergen.... moreMiresYour Response: Correct!Correct Response: Delivery is needed because the blood flow through the umbilical cord is not gettingenough oxygen to the baby. | understand that you are concerned about the well-beingof your wife and baby. What are you feeling? Explanation: Emotional support is best provided by using therapeutic communication... more Bi sicci, s., kyle, 7., and Carman, 5. Maternity and Pediatric Nursing, 3rd Edition,p. 830-832.QUESTION 10: Which of the following nursing diagnoses has the highest priority in the... moreYour Response: Correct!Correct Response: Impaired gas exchange in the fetus related to decreased blood perfusion. Fenlanatinn: Erne en aera eer rece el Serene ee =