Jennifer Goodlet

BSN266-01 VCBC Inflammation 10/12/2021 14:00-17:30

OMS-vr reflection
10-13-2021

What concepts do you think are important in this scenario and why?
1. Gas exchange is an important concept related to Sam, the five-year-old asthmatic patient
in OMS who is currently experiencing asthma exacerbation. Sam’s ventilation process is
impaired due to narrowed airways caused by bronchoconstriction related to his asthmatic
state.
2. Inflammation is another related concept to the OMS VR scenario in Sam, the five-year-
old male, because of the chronic inflammation of the airways caused by a
hypersensitivity reaction by the immune system that includes triggers such as secondhand
smoke, pollen, physical activity, or infection. Sam was at lunch at school when the
exacerbation started, probably due to his body's weakened state caused by a viral
infection he has had for two days per mother.
3. Infection is a related concept to the viral illness that Sam from OMS scenario has been
experiencing the last two days, along with the current dyspnea, inspiratory, and
expiratory wheezes with low oxygen saturations. A viral infection in the respiratory tract
by inflammation in the airways can cause bronchoconstriction with common cold
symptoms.
4. Immunity is a related concept to asthma and Same in OMS scenario through an
exaggerated immune response of Type 1 hypersensitivity, IgE mediated immune
response. In Sam’s scenario, the trigger could be the viral infection that has invaded his
body, causing the immune system to respond and, left untreated had exacerbated his
asthma.

2. What abnormal signs and symptoms did you recognize, and how did you prioritize your care
of this patient?
I first assess the situation by asking detailed questions to the mother and then Sam on the
presenting illness, the history of the presenting illness, past medical, medications, and allergies.
As I was talking to Sam, I noticed that he was very short of breath, tachypneic of 40 breaths per
minute with no accessory muscle use; while trying to speak and was unable to speak in complete
sentences. As an intervention to notice these signs and symptoms, I assessed his vitals signs
which included respirations (tachypneic), blood pressure, heart rate (tachycardia), oxygen
saturation (90%), and temperature checking mainly for increase respiration, blood pressure, and
heart rate. Depending on his vital signs, it could be an indication of hypercapnia due to his gas
exchange. Furthermore, I first want to assess his Airway since it is the first step in the A-E
assessment focusing on impaired gas exchange, ineffective breathing pattern airway. I performed
this intervention to check for airway clearance by palpating around his trachea to check for
patency or any obstructions to confirm his airway was clear and trachea is midline, only after
asking permission.
I assessed Sam for a pediatric emergency warning system (PEWS). I found that Sam has
respiration greater than thirty breaths per minute at forty breaths per min, which could indicate
increasing illness. Sam was tachypneic and in respiratory distress. I then assessed respiratory
distress looking at his skin for any accessory muscle use, nasal flares, grunting, audible wheezes,
intercostal or subcostal recessions; in Sam’s case, he had no accessory muscle use or retraction
did have inspiratory and expiratory wheezes and was unable to speak in a complete sentence
without gasping for breath. I further assessed his Conscious level; he was inactive but alert;
Jennifer Goodlet
BSN266-01 VCBC Inflammation 10/12/2021 14:00-17:30
OMS-vr reflection
10-13-2021
followed by his heart rate, which was tachycardic; I assessed Sam’s oxygen saturation rate on
room air and was 90%. Another parameter was involving the concern by the doctor/family/
nurse, which in Sam’s case was a concern due to his medical history and past hospitalizations for
similar exacerbations. An intervention I initiated was oxygen once I established a pediatric
emergency, and he was in respiratory distress with low oxygen saturation. Another intervention
done at this time was drawing labs for complete blood count, complete metabolic panel, and
venous blood gas to access his levels and electrolytes.
I then assess Sam for the pediatric asthma Severity score assessment to determine if
Sam’s case warrants a standing order of nebulizer and steroid therapy. Some of the parameters
include oxygen status on room air, auscultation of the lungs, retractions, and dyspnea. Based on
the PAS scoring system, Sam’s score was greater than eight. Intervention for this scenario was to
implement the standing orders for nebulizer and steroid treatment contacting the charge nurse
and the provider to inform and confirm.
After completing the nebulizing and steroid treatment, I need to reassess Sam’s vitals,
including his respiration, heart rate, blood pressure, temperature, oxygen saturation, and level of
consciousness. The vitals should not still be tachypneic, oxygen saturation should be increased,
signs of respiratory distress should be absent, and he should be able to speak in a complete
sentence. AN intervention I performed in conjunction with the reassessment was a peak flow to
measure the speed of air through the airways, and during asthma exacerbations, the airway
narrows. In Sam’s case, he was at 70%, which is in the yellow zone.

3. How would you change your actions or interventions if you had a second chance to care for
this patient? How would you apply what you have learned from this scenario to future patients?
To ensure the patient-centered care is first and foremost, getting the patient stable and
providing proper treatment is initiated in the correct prioritizing method. In the future, I will
assess the patient using the A-E assessment regarding an emergent respiratory health situation
such as ineffective airway exchange, impaired gas exchange, ineffective breathing pattern, and
critically ill patients. I will also be familiar with standing orders' guidelines or protocols
regarding patients presenting with specific signs and symptoms, using the proper assessments in
the correct order, and initiating the standing orders per the guidelines and protocols per the
facility.
In the scenario involving Sam, the five-year-old currently experiencing an exacerbation
and in respiratory distress, I should have obtained only the presenting illness, history of
presenting illness, medications, and allergies, and permission to treat according to agency
protocols with education to both patient and parent and followed by the implementation of the
PAS and PEWS before moving on to a detail social and immunization history. I also waited to
administer the oxygen when I should have not due to the assessment of vitals and auscultation of
lungs per standing orders. I have learned a lot through this scenario, especially the importance of
assessing and implementing interventions and screening tools. In real life, my patient would have
suffered longer than he should have, and his condition would have worsened quickly. I could
have aided him in his respiratory distress and his asthma exacerbation sooner than I did.