Surgical scenario 3 doris bowman

VSim #3- Doris Bowman 1. How did the scenario make you feel? I really enjoyed the scenario with patient Doris Bowman. Doris is a 39-year old female who underwent a total abdominal hysterectomy with bilateral salpingooopherectomy. This is the removal of the cervix, ovaries, uterus, and fallopian tubes. She tolerated the procedure well. Doris has an abdominal incision covered with a 4x4 gauze dressing and there is no drainage. I was in charge of caring for Mrs. Bowman in the PACU, which is where a patient remains until they recover from the effects of anesthesia, is oriented, and has stable vital signs with no evidence of complications. I started by checking Doris’s vital signs. When asked about pain she replied, “It’s pretty bad, I’d give it a 6.” I then gave her a 2mg dose of Morphine. She immediately started developing respiratory depression. Her breaths decreased from 21 to 8 breaths per minute. I screamed for help, ventilation was started at a rate of 2, and she was administered 0.2mg of naloxone IV. This is given to reverse the effect of the morphine. The ventilator was stopped when I saw Doris begin to breathe normally. This was the appropriate thing to do. 2. What further intervention would have been required if naloxone hydrochloride (Narcan) had not been effective in this case? If the first dose of naloxone hydrochloride was not effective within 2-5 minutes. Another dose should be given. Repeated doses may be necessary if a person is still showing signs of overdose even after the first dose. Narcan will not hurt you- it only affects people who are using opioids. Rescue breathing should also be done while waiting for the naloxone to take effect. If a victim is not responsive to stimulation, not breathing, and has no pulse after receiving naloxone and rescue breathing, then the victim needs cardiopulmonary resuscitation (CPR) via a trained bystander and the emergency medical system. 3. Discuss readiness for discharge from PACU criteria. A patient remains in PACU until fully recovered from anesthetic agent. Indicators of recovery include a stable BP, adequate oxygen saturation level and respiratory function. The Aldrete Score is used to determine a patient’s general condition and readiness for transfer from the PACU. During the recovery period, a patient’s physical signs are observed and evaluated by a scoring system. The patient is assessed at regular intervals and a total score is calculated on the assessment record. The Aldrete score is between 7 and 10 before discharge from the PACU. The patient is discharged from the phase I PACU by the anesthesiologist or CRNA to the critical care unit, med-surg unit, phase II PACU, or home with a responsible adult. Prior to discharge, the patient will require verbal and written instructions and information about follow-up care. The patient and caregiver are informed about expected outcomes and immediate postop changes anticipated. Prescriptions are given to the patient along with the nursing unit or surgeon’s telephone number. Instructions usually advise patient to limit activity for 24-48 hours. During this time, a patient should not drive a vehicle, drink alcoholic beverages, or perform tasks that require high levels of energy or skill. 4. What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format. Situation: My name is Molly Dombrowski, I am a student nurse at Bridgeport Hospital. I’m calling about my patient Doris Bowman whom was complaining of a pain level of 6/10. I administered 2mg of Morphine IV push and she almost immediately went into respiratory distress. Background: Doris Bowman is a 39-yr old female who underwent a total abdominal hysterectomy with bilateral salpingo-oopherectomy under general anesthesia. She tolerated the procedure well, without any complications. She has an abdominal incision covered with 4x4 gauze and no drainage. IV of potassium chloride in 5% dextrose and normal saline is infusing at 125 mL/hr. Estimated blood loss was 400 mL. She has Foley catheter placed with 200 mL urine output and compression stockings on. Assessment: Ms. Bowman’s vital signs are: BP: 142/80 mm Hg, RR: 21-chest is moving normally on both sides. SpO2: 93% room air, Pulse: 107, TEMP: 99F. PAIN: 5/10. She has a normal skin turgor. Her skin is cool and sweaty. She has about 200 mL of clear urine in bag. Her IV sites have no redness, swelling, infiltration, bleeding or drainage. Her abdominal dressing is dry and intact. Recommendation: Is to keep an eye on Ms. Bowman’s vital signs, breathing, and pain level closely.