Questions on Pre-Briefing Paper

Questions on Pre-Briefing Paper

Questions on Pre-Briefing Paper

            This paper examines Annie Laduke’s case study. She is a 32-year-old Native American female who has come to her provider’s office with complaints of increased tenderness, pain, and warmth of the right lower leg in the calf area. Her provider directly admitted her to the inpatient medical unit. The paper focuses on applicable nursing diagnosis, treatments, and nursing considerations, non-pharmacological measures for pain relief and components of peripheral vascular assessment.

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Applicable Nursing Diagnosis, Treatments, and Nursing Considerations

            Laduke is likely to be suffering from thrombophlebitis. Thrombophlebitis arises from clot formation in the veins. It largely occurs in the legs but can affect any other body parts. Clot formation causes irritation, resulting in the symptoms of thrombophlebitis such as pain, warmth, inflammation, and tenderness (Di Nisio et al., 2018). One of the nursing diagnoses relevant to the patient is ineffective peripheral tissue perfusion related to venous status as evidenced by changes in small calf veins. The treatment of thrombophlebitis includes the use of anticoagulants, thrombolytics, compression stockings, venous stripping, and insertion of vena cava filter. Anticoagulants reduce risk of clot formation while thrombolytics dissolve the clots. Compression stockings reduce swelling risks while varicose stripping removes varicose veins to minimize the risk of recurrence. Vena cava filters prevent clots from causing complications such as pulmonary embolism by trapping them (Kurginyan & Raskin, 2019). Nursing considerations include elevating the affected limb, avoiding massage, applying warm compresses, and measuring leg circumference to determine response to treatment. It also includes patient education to minimize recurrence and prevent complications (Li & Xiao, 2022).

Non-Pharmacological Measures for Pain Relief

            Non-pharmacological interventions are effective for pain relief in thrombophlebitis management. One of them is using warm compresses. Warm compresses using warm washcloth on the affected leg promotes relaxation and increased blood flow, hence, minimizing pain due to edema. The other non-pharmacological treatment is elevating the affected limb while in sited position. Elevation increases venous return, which reduces leg swelling and associated pain. Mind based techniques may also be effective for the patient (Li & Xiao, 2022; Mollaelahi & Shahali, 2022). They include techniques such as breathing and relaxation techniques, guided imagery, and massage.

Components of a Peripheral Vascular Nursing Assessment

            Peripheral vascular assessment in nursing is a comprehensive process that provides insights into the severity of a health problem such as thrombophlebitis. The assessment relies on techniques of physical assessment such as inspection, palpation, percussion, and auscultation. The process starts with history taking where the nurse obtains relevant subjective data about the problem from the patient. The subjective data guides the nurse when performing objective assessment. The inspection component of the peripheral vascular assessment focuses on noting skin color, edema, presence of lesions or wounds, size of the extremity by comparing with the opposite and presence or absence of hair. The palpation aspect of the assessment focuses on temperature, turgor, rigidity, texture, and edema to determine if pitting or not. There is also the palpation of pulses to determine their strength and adequacy of capillary refill (Jensen & Smock, 2022). The data obtained from peripheral vascular assessment guides the development of nursing and medical care plans for the patient.

Conclusion

            In summary, Laduke is likely to be suffering from thrombophlebitis. Several treatment approaches such as the use of anticoagulants and thrombolytics can be adopted. Non-pharmacological approaches to pain management may also be used by the patient. A comprehensive peripheral vascular assessment would provide accurate data for developing Laduke’s treatment plan.

References

Di Nisio, M., Wichers, I., & Middeldorp, S. (2018). Treatment of lower extremity superficial thrombophlebitis. JAMA, 320(22), 2367–2368. https://doi.org/10.1001/jama.2018.16623

Jensen, S., & Smock, R. (2022). Nursing health assessment: a clinical judgment approach. Lippincott Williams & Wilkins.

Kurginyan, K. M., & Raskin, V. V. (2019). Endovascular treatment of acute thrombophlebitis of the lower extremities in patients with varicose veins]. Khirurgiia, 10, 50–54. https://doi.org/10.17116/hirurgia201910150

Li, Y., & Xiao, F. (2022). Preventive effect of intensive nursing intervention of deep vein thrombosis of lower extremities in elderly patients with gastrointestinal tumors after surgery. Journal of Oncology, 2022, e2967981. https://doi.org/10.1155/2022/2967981

Mollaelahi, F., & Shahali, S. (2022). Non-pharmacological interventions for the management of lower extremity edema during pregnancy: a narrative review study. Medical-Surgical Nursing Journal, 11(1), Article 1. https://doi.org/10.5812/msnj-123284

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Student Instructions for Standardized Simulation – Annie Laduke

PURPOSE: The following information is to be used in guiding your preparation and participation in the scenario for this course. This document will provide applicable course outcomes in preparation for your simulation.

SCENARIO OVERVIEW: Annie Laduke is a 32-year-old Native American female with no significant health history. This morning, she presented to her provider’s office with complaints of pain, increased redness, and warmth of the right lower leg in the calf area. She was directly admitted to the inpatient medical unit by her provider.

STUDENT ROLES DURING SIMULATION: During pre-briefing, you will be assigned one of these roles according to the description below to participate in the simulation as a nurse.

Charge Nurse (1): The charge nurse is responsible for the overall organization of safe, quality patient care. You are the team leader and serve as a resource to all interdisciplinary members and are responsible for appropriate delegation of duties. You will serve as the point person for communication and can anticipate speaking with the physician or other primary care provider, ancillary support services, and others directly involved with the care being provided. You must be knowledgeable about the patient’s condition and able to dictate orders obtained and assist with implementation if needed. Additionally, be prepared to prioritize care and anticipate future needs.

Documentation Nurse (1): The documentation nurse is responsible for recording of all patient event activities during the simulation apart from medication administration. You are responsible for documenting assessments, interventions, and outcomes on the designated tool (paper or electronic). Be prepared to read back and verify your documentation when requested and/or clarifying the details. Additionally, you will be part of the interdisciplinary team and will contribute observational assessment findings to include but not limited to changes in vital signs, alerts, psychosocial needs, and anticipated care.

Assessment Nurse (1): The assessment nurse is responsible for overseeing a comprehensive assessment of the patient. This includes but is not limited to obtaining vital signs, head-to-toe assessment of all systems, and psych/social assessment of the patient. You will be prioritizing care, executing independent interventions, collaborating with interdisciplinary team members, anticipating the needs of the patient/family, and re-assessing or continually monitoring the patient for any changes in condition. You are responsible for implementing all non-medication related interventions, verbalizing your findings to the team, and recommending any actions/interventions required. Additionally, you will be providing appropriate education to the patient and family/significant others.

Medication Nurse (1): The medication nurse is responsible for all actions and documentation related to safe administration of medications. You will identify and correct any medication errors related to prescribing or distribution. This may include speaking with the physician or primary care provider. Prior to administering medication, you will assure the “Rights of Medication Administration”. You must be knowledgeable regarding the action and expected effects of the medications being administered and are responsible for monitoring and reporting any adverse reactions or unforeseen consequences of administration. Part of your role includes verifying medication calculations with a colleague and identifying any incompatible drug combinations.

Observer Nurse: The observer is a non-participant role and will not communicate directly with the simulation team. The observer nurse will view the simulation in the briefing room through Learning Space as it is occurring. There may be multiple observer nurses in each scenario. The observer nurse will be given an observation guide to complete during the simulation. The data you collect will help the team during the debriefing process and facilitate an open and active discussion regarding the simulation experience. You will be an active participant in the debriefing and will be encouraged to share your observations and thoughts. Please keep in mind that your observations should be conveyed in a respectful, educational manner. The goal is to work together as colleagues in providing safe and effective care.

COURSE OUTCOMES:

The standardized simulation enables the student to meet the following priority course outcomes:

• Explain expected client behaviors while differentiating between normal findings, variations, and abnormalities
• Demonstrate beginning skill in performing a complete physical examination using the techniques of inspection, palpation, percussion, and auscultation
• Explore the professional responsibilities involved in conducting a comprehensive health assessment and providing appropriate documentation

**Although this scenario can address multiple course outcomes, faculty and students should focus on the course outcomes listed above**

REVIEW AND COMPLETE PRIOR TO THE START OF PRE-BRIEFING:

Please keep in mind you will also be required to recognize a variety of signs and symptoms linked to abnormalities in these skills.

Therefore, to prepare for the simulation, you are required to complete the pre-briefing questions below and submit to the faculty facilitating the simulation prior to the start of pre-briefing. If you do not complete the pre-briefing questions below and submit to faculty facilitating the simulation prior to the start of pre-briefing, you will not be permitted to participate in the simulation.

1. Based on what you’ve learned about the nursing process, describe one applicable nursing diagnosis, treatments, and nursing considerations for this diagnosis.
2. What are some non-pharmacological measures that can be used for pain relief in care for this patient?
3. Describe the components of a peripheral vascular nursing assessment.

• Use current APA format.
• Paper is 2 pages, excluding title and reference pages.

At least two (2) scholarly, primary sources from the last 5 years.