vSim ISBAR ACTIVITY CONCEPT MAP WORKSHEET

CONCEPT MAP WORKSHEET

DESCRIBE DISEASE PROCESS AFFECTING PATIENT

(INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS)

DIAGNOSTIC TESTS

(REASON FOR TEST AND RESULTS)

PATIENT INFORMATION ANTICIPATED PHYSICAL FINDINGS

Marilyn Hughes is a 45-year- old female who suffered a left mid-shaft tibia-fibula fracture when she slipped on icy stairs this morning.She was taken to surgery for an Open Reduction with internal fixation. Returning from her surgery she had an ace/splint dressing below the

knee. Her vital signs were BP:

130/82, HR: 88, RR: 16.

The patient presents with pain, deformity, obvious hematoma, and considerable edema.Nurses must be vigilant in assessing for subtle neurovascular changes in these patients. The “6 Ps” indicative of symptoms of neurovascular compromise are pain, poikilothermia (temperature), pallor, pulselessness, paresthesia, and paralysis.

ANTICIPATED NURSING INTERVENTIONS

An X-ray because they are indicated to determine the location, type, and extent of the fracture.Fractures of the tibia and fibula often occur in association with each other and tend to result from a direct blow, falls with the foot in a flexed position, or a violent twisting motion. Most of these fractures tend to be more distal than proximal; distal fractures may extend into the ankle joint.

• The nurse gives the patient or family information about the underlying pathologic

condition and the purpose and expectations of the prescribed treatment regimen.

• Assessments are performed at least every hour for the first 24 hours and every 1 to 4

hours thereafter to prevent neurovascular compromise related to edema and/or the device.

• The nurse must carefully evaluate pain associated with the musculoskeletal condition.
• The nurse encourages the patient to move all fingers or toes hourly when awake to

stimulate circulation.

vSim ISBAR ACTIVITY STUDENT WORKSHEET

INTRODUCTION

Riad tabbouche Your name, position (RN), unit you are working on SITUATION Marilyn Hughes, 45-year-old female (9/22/1974)

C/O: suffered a left mid-shaft tibia-fibula fracture when she

slipped on icy stairs this morning.Patient’s name, age, specific reason for visit

BACKGROUND Primary: surgery for an open reduction with internal fixation (ORIF)

Date of Admission: 4/8/2020

Current Orders:

She returned from surgery at 1:45 p.m. with a below-the-knee

ace/splint dressing. She has an IV of Lactated Ringer’s infusing at 75 mL/hour and is tolerating liquids well without nausea.Patient’s primary diagnosis, date of admission, current orders for patient ASSESSMENT The patients last vital signs were BP: 130/82, HR: 88, RR: 16, when she returned from surgery, she was complaining of pain, so she was

given morphine 6mg IV at 2:15pm. The patient still c/o pain after the

medication is given. A neurovascular assessment confirms abnormal findings on the LLE. Pain of 8 on a scale 0-10, Decreased pedal pulse, prolonged capillary refill, the extremity appears cyanotic, the patient can’t feel or over toes.Current pertinent assessment data using head to toe approach, pertinent diagnostics, vital signs

RECOMMENDATION

The patient presents with signs of compartment syndrome, I will loosen her bandage and lower her extremity to see if her tissue perfusion improves. Quick treatment needs to be done because if not her LLE can become ischemic and she can lose her leg. In case these interventions don’t alleviate the patient, a Fasciotomy approach would be necessary to relive the constriction.Any orders or recommendations you mayhave for this patient

PHARM-4-FUN PATIENT EDUCATION WORKSHEET

NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE

MEDICATION: morphine

CLASSIFICATION: opioid analgesic

PROTOTYPE: Arymo ER , Duramorph PF, Infumorph, Kadian, , M-Ediat, M-Eslon , MorphaBond , Morphine LP Epidural , MS Contin, MS.IR , Statex, Statex DPS

SAFE DOSE OR DOSE RANGE, SAFE ROUTE

Adults: Initially, 10 mg (based on 70 kg individual) IM or 0.1 to 0.2 mg/kg IV every 4 hours p.r.n. Or, 15 to 30 mg (immediate-release tablets) PO, or 10 to 20 mg (oral solution) PO, or 10 to 20 mg PR every 4 hours p.r.n. IV route, given slowly IV push.

PURPOSE FOR TAKING THIS MEDICATION

Moderate to severe pain

PATIENT EDUCATION WHILE TAKING THIS MEDICATION

Caution patient or caregiver of patient taking an opioid with a benzodiazepine, CNS depressant, or alcohol to seek immediate medical attention for dizziness, light-headedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness.Explain assessment and monitoring process to patient and family. Instruct them to immediately report difficulty breathing or other signs or symptoms of a potential adverse opioid-related reaction.Encourage patient to report all medications being taken, including prescription and OTC medications and supplements.Warn patient that morphine can cause constipation.Caution patient to immediately report signs and symptoms of serotonin syndrome, adrenal insufficiency, and decreased sex hormone levels.When drug is used after surgery, encourage patient to turn, cough, deep-breathe, and use incentive spirometer to prevent lung problems.Caution ambulatory patient about getting out of bed or walking.Warn outpatient to avoid driving and other potentially hazardous activities that require mental alertness until drug’s adverse CNS effects are known.Drinking alcohol or taking drugs containing alcohol while taking extended-release capsules may cause additive CNS effects and potentially fatal overdose.Warn patient to read labels on OTC drugs carefully for alcohol content and not to use alcohol in any form.Tell patient to swallow morphine sulfate whole or to open capsule and sprinkle beads or pellets on a small amount of applesauce immediately before taking.Counsel patient not to discontinue opioids without first discussing with provider.

Clinical Worksheet

Date: 11/20/2020 Student Name: riad tabbouche Assigned vSim: Hughes, Marilyn Initial: Diagnosis: Left Tib-Fib Fracture

HCP: Chin A. Revis,

MD Isolation: Standard IV Type: 18 gauge

Location:

Right Hand

Fluid/Rate:

Lactated Ringers @ 75 ml/hr Critical Labs: Other Services: MH

Fall Risk:

Hemoglobin: 12.5

Hematocrit: 38

Age: 45 Consults Needed: Length of Stay: Consults:

M/F: F

Code Status: FULL

• day

Transfer: HCP

Physical Therapy Occupational Therapy

Allergies: NKA

Why is your patient in the hospital (Answer in your own words and include the History of present Illness)?: Patient suffered a left mid-shaft-tibia-fibula fracture when she slipped on icy stairs this morning

Health History/Comorbities (that relate to this hospitalization):

Patient fell on icy stairs this morning (acute care needed) She was taken to surgery for an Open Reduction with Internal Fixation and returned from surgery at 13:45

Shift Goals/ Patient Education Needs:

• Neurovascular assessment every hour to reassess status of the left lower leg
• Assist with mobility and passive ROM exercises
• Administer opioid analgesic at least every 4 hours or as needed based on pain scale assessment
• Teach the patient the signs and symptoms of altered neurovascular status and when to seek medical attention.

Path to Discharge:

• Identify any changes in anatomic structure or function as well as changes in ADLs, IADLs, roles, relationships, and spirituality.• Identify modification of home environment, interventions, and strategies used in safely promoting effective recovery and rehabilitation.• Control pain with pharmacologic and nonpharmacologic interventions.• Report pain uncontrolled by elevation and analgesics (may be an indicator of impaired tissue perfusion or compartment syndrome).