SCENARIO in SIMULATION REFLECTION Name: Kimberly DunningAge: 20 years Weight 165 lbsHeight: 5 ft 9 in
Kimberly Dunning, a 20-year-old female with a 1-year history of adult-onset asthma, presented at 1000Friday with shortness of breath and wheezing despite the use of rescue bronchodilators. She reports she has not taken her maintenance asthma medication for the past several weeks due to the cost. The scenario takes place on Friday at 1515.
SBAR Hand -off Current day and time: Friday 1515 Admission Day & time: 1000 Friday
Name: Kimberly Dunning
Age: 20 Sex: Female Ethnicity: Caucasian Religion: Lutheran
Provider: Maude Riley, MD
Admission diagnosis: Acute asthma exacerbation
Pertinent Medical History: Diagnosed with adult-onset asthma 1 year ago after the birth of her son. The patient reports that she lost her job 2 months ago and that she hasn’t taken her maintenance asthma medications for several months due to the cost. She was diagnosed with anxiety in early adolescence at age 12.
Pertinent social history: The patient lives with her boyfriend, Steve. Steve is not the father of Kim’s son but is supportive and provides what he can.
Status: Full Code
Time: 0800 T: 38.3 BP: 148/88 P: 130 RR: 38 O2 Sat: 92%
Mode: Nasal Canula
LPM: 2L/min; has required progressive upward titration to maintain adequate saturation
Rating: 0 Most recent pain medication: None Time:
2 Practical Nurses (PN) came in, introduced themselves, identified the patient, and kept asking the patient questions about her condition: any pain or discomfort. The patient says she’s not in pain but her chest was tight.
PN asked, “what makes it feel worst?”
Patient: “just when I take a deep breath in, it’s really getting bad”
Pn 1: What makes it feel better?
Patient: Well I’m trying to take my mind off it but I can’t. I just keep worrying about how much my medications are gonna cost and everything
PN 2. Asked pt. if she was experiencing any cough
Patient: Yes a little bit but I just can’t breath
PN 2. Let me try to put you sitting positive, see if it might help
Again PN nurse 2 asked how her breathing makes it better or worst.
Patient: I can’t breathe, you gonna have to help me. Do you know when is steve (boyfriend) coming back?
PN 2. I think he’s coming back soon. Are you ok with I’m coming back?
Patient: Yeah but I just can’t breathe
PN 2 tried to divert her attention by asking about her relationship with her boyfriend. The patient said, “yeah but I really can’t take a breathe right now.”
PN nurse 2 decided to call and report SBAR to the Physician.
Physician: Repeat the salbutamol now and titrate the oxygen to maintain her O2 sat of 92. Get her chest x-ray done ASAP.
Patient: What did the doctor say? I really can’t breathe!
PN 2: Administered salbutamol and raised O2 to 3 L and order a chest x-ray
Patient: I don’t know if this is really helping me, I really can’t breathe
PN1: Check connections, volume to makes sure there is no air there. No air. O2 sat is not holding to 90% (O2 sat is at 88%)
Patient: this is not really helping, the one in my nose (nasal cannula) doesn’t help.
-Pt was sat up and back to lying down coz she complains of really having a hard time breathing.
PN1: Asked about her anxiety.
Patient: I don’t know. Trying not to think about it now coz I have a son and you know… but I really can’t breath
PN 1 & 2 kept asking her questions
The patient said I can’t breathe… I can’t breathe…I can’t breathe
-Boyfriend came in, what’s going on? My girlfriend is not looking good-
PN 2 explains: “She’s not feeling very well, she’s having difficult time breathing. so we are just getting her breathing pattern up. I notice that her O2 sats are falling 86% at3L so if we can go up a little bit more, let’s try that.
Boyfriend: Ok that’s a good idea. She sounds so bad. What do you make to what she sounds like?
Pn 1: I am going to call the x-ray to get her test done to make sure there is no fluid in her lungs and that is to confirm that it is just her asthma.
Write a simulation reflection relating to the scenario using the LEARN:
L-Looking back. What was one experience that is meaningful to you?
E-Elaborate. Who was involved? What did you see? What did you hear? How did you feel?
A-Analyze. What does the research say about what you experienced? Is there evidence to support your experience? Is the evidence opposite to what you experienced?
R-Revise. How you have responded differently based on the information you discovered in your analysis? Are there any strategies identified in the literature that you could have implemented?
N- New Learning. How will you apply your learning to future clinical settings/ situations?
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