Learner Response Summary

Successful
Scenario: Assessment of the Post-Operative Patient (026)
Started On October 27, 2022

How do you respond to this report?

Your Choices:
- Clarify report

Patient arrived. What is the priority?

Your Choices:
- Assess patient first

Which option best describes what you heard during auscultation?

Your Choices:
- Diminished sounds in the bases

What was Lena’s calculated apical rate?

Your Choices:
- 90

What vitals would you act on?

Your Choices:
- SpO2 92

What intervention would be most appropriate?

Your Choices:
- Deep breathing / Incentive spirometry

Document your admission of Lena and the assessment findings using a narrative note style.

Your Response:
Lena Futris was transferred from the recovery room and received post R knee arthroplasty. Patient sleeping, arousable to
voice. A+Ox4 and follows commands. Patient reports pain is gone after receiving analgesic in the PACU. 18 gauge IV
insitu L forearm with RL infusing at 125/hr, no phlebitis or infiltration. RR 18 regular, no dyspnea. Breath sounds equal
bilaterally, sounds decreased to bases bilaterally. Apical rate 90 and regular. Skin warm, pink and dry. Pedal pulse
palpable to left foot, right foot pulse present by doppler. Colour, sensation and movement of feet bilaterally is WDL.
Right knee dressing dry and intact with small amount of serosanguinous drainage. No redness noted. Hemovac drain
insitu draining serosanguinous. Foley catheter insitu draining light urine. VSS, SpO2 92 on RA. Patient educated on
incentive spirometry and instructed to use it 3x per day when awake. Pt provided a return demonstration of the
spirometer. PCA pump handle and call bell within reach. Marina Di Pede RPN

How do you proceed with Lena's concern about pain medication?

Your Choices:
- Explore why Lena is concerns about addiction
- Assess pain using a numerical pain scale (0-10)

When considering a patient using a PCA pump, what health teaching would you provide related to pain, dosing and
potential side effects of the medication?

Your Response:
It is important to stay ahead of pain. It has been shown that when pain is managed people recover faster and it help with
mobility and prevent complications such as pneumonia. You cannot overdose because the pump is programmed to
deliver a maximum number of doses per hour. The pump won’t give you any more analgesic once the max dose is met.
Please notify us if you have any nausea, vomiting, itching so we can manage it right away.

What would you do next after explaining the PCA pump use?

Your Choices:
- Ask Lena to restate the information about PCA pump

When should you return to check on Lena?

Your Choices:
- 15-30 min

Document on your latest interaction with Lena.

Your Response:
Pt experiencing 7/10 pain, use of PCA pump reviewed and patient expresses comfort with using the pump. Pt verbalized
proper use of pump. Self administered a dose. Call bell within reach. Will monitor. Marina Di Pede RPN
List the cues Lena has presented in the previous interaction.

Your Response:
• Itching
• No difficulty breathing
• HR elevated
• Nausea
• Hives
• Talking
• Restless

What do the cues suggest/infer?

Your Choices:
- Allergic reaction

What is your next action in response to Lena's allergic reaction?

Your Choices:
- Remove the Morphine and call the MRP

Prepare SBAR

Your Response:
Hi, it’s Marina calling from the surgical unit. I’m calling regarding Lena Futris. I’m concerned she is having an allergic
reaction to her PCA medication morphine. She had a knee replacement this morning, she’s opioid naïve, and has a history
of asthma. On assessment, her airway is clear, she has no wheezing, she has hives on her chest and neck, her
respirations are 18, her SpO2 is 98%, HR 100, BP 130/84. She has an order for an antihistamine and the PCA protocol
that I can initiate. I’m concerned about keeping her on the PCA morphine. Can you come see her and consider prescribing
a different analgesic?

What might be contributing to Lena feeling so dizzy? Answer - all apply.

Your Choices:
- Fatigue
- Lying supine
- Hypovolemia
- Dehydration

Can you describe in one or two sentences how you felt after playing the virtual game?
Your Response:
I feel confident in my post-operative assessment skills and my documentation. I am proud that I answered majority of the
questions correctly

What were you proud of? What went well during the game and why do you think it went well?

Your Response:
I am proud of my documentation skills and eye for detail. I am proud that I was capable of choosing other interventions
other than the worst case. I think my assessment skills went well and my response to the acuity of the patient was fast
and effective. I am proud of my critical thinking skills

What challenged you during the game? What was the most difficult decision point and why was it difficult for you?

Your Response:
I think the acuity of the patient challenged me most throughout the game. This may be due to the commonality of the
patient's surgery, so I assumed it would be without complications.
The most difficult decision was when choosing what to ask when the patient believed she would become addicted to
opioids while using the PCA pump. It is often difficult to approach a situation like this with ease and carefully.

Were you satisfied with your ability to care for Lena Futris? If a similar situation arose in the future, what would you
take away from this simulation to incorporate into your clinical practice?

Your Response:
I was satisfied with my ability to care for this patient. If a similar situation occurred in my future, I would feel comfortable
and at ease with what to prepare my room with, how to assess and document my post operative patient, and how to
assess for complications.

What were your key learning points regarding post-opertaive assessment?

Your Response:
Key learning points regarding assessment include breath sounds, heart sounds, assessment of the surgical site's
integumentary, peripheral vascular, and intake/output values. Additionally, it is important to assess the patient's
perception of pain and when pain medication is effective.

What would you do differently next time?

Your Response:
Next time, I will think more critically when assessing how to approach a situation when an opioid naive patient is
assuming they will become addicted to narcotics using the PCA pump.
Is there anything else you would like to discuss?

Your Response:
I think everything was debriefed well!

Session ID: 362301