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Med Surg 2 Feedback Log & Score — Junetta Cooper Pharmacology
Medical-Surgical Nursing II (NSG 223)
Herzing University
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Date of Completion
May 28, 2022 09:16 AM
Junetta Cooper
Age: 75 years
Diagnosis: Primary hypertension, Angina due to coronary artery disease
Score
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1
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95%
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Feedback Log
0:00 You arrived at the patient's side.
0:00 You reviewed the patient information.
0:00 You reviewed the patient log.
0:00 You reviewed the diagnostics.
0:00 You reviewed the clinical observations.
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0:00 You reviewed the MAR.
0:00 You reviewed the 12-lead ECG.
0:00 You reviewed the orders.
0:00 You reviewed the intake and output.
0:00 You introduced yourself.
0:08 You washed your hands. To maintain patient safety, it is important to wash your hands as soon as you enter the room.
0:10 Patient status - ECG: Sinus rhythm. Heart rate: 92. Pulse: Present. Blood pressure: 151/ mm Hg. Respiration: 16. Conscious state: Appropriate. SpO2: 96%. Temp: 99 F (37 C)
1:10 Patient status - ECG: Sinus rhythm. Heart rate: 92. Pulse: Present. Blood pressure: 149/ mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 96%. Temp: 99 F (37 C)
1:19 You identified the patient. To maintain patient safety, it is important that you quickly identify the patient.
1:29 You asked if the patient was allergic to anything. She replied: 'No, I am not allergic to anything.'
1:35 You asked the patient if she had any pain. She replied: 'No, I don't have any pain.'
1:41 You asked the patient: What brings you here? She replied: 'I had some chest pain this morning. And the nitroglycerin didn't work.'
1:49 You asked the patient how she felt. She replied: 'Right now, I'm ok.'
1:54 You asked the patient when the symptoms started. She replied: 'This morning.'
2:01 You looked for normal breathing. She is breathing at 15 breaths per minute. The chest is moving equally.
2:10 Patient status - ECG: Sinus rhythm. Heart rate: 92. Pulse: Present. Blood pressure: 148/ mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 96%. Temp: 99 F (37 C)
2:34 You measured the blood pressure at 148/88 mm Hg. It is appropriate to monitor the patient by measuring the blood pressure.
2:45 You asked: What were you doing when the symptoms started? She replied: 'I was just making breakfast when it happened.'
2:50 You asked the patient if she had any difficulty in breathing. She replied: 'No, my breathing's fine.'
2:55 You asked the patient if she had experienced any visual changes. She replied: 'No, I don't think so.'
3:01 You asked the patient what other symptoms she had. She replied: 'I
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4:59 Patient status - ECG: Sinus rhythm. Heart rate: 99. Pulse: Present. Blood pressure: 146/ mm Hg. Respiration: 21. Conscious state: Appropriate. SpO2: 96%. Temp: 99 F (37 C)
5:12 You educated the patient about the drug nitroglycerin. This was reasonable.
5:44 You attached the automatic noninvasive blood pressure (NIBP) measurement cuff. It was correct to reassess blood pressure.
5:55 You checked the radial pulse. The pulse is strong, 100 per minute, and regular. It is correct to assess the patient's vital signs.
5:59 Patient status - ECG: Sinus rhythm. Heart rate: 99. Pulse: Present. Blood pressure: 142/ mm Hg. Respiration: 21. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
6:11 You looked for normal breathing. She is breathing at 21 breaths per minute. The chest is moving equally.
6:24 You asked: How would you rate your pain? She replied: 'It's pretty bad; I'd give it a 6. '
6:34 You asked the patient where the pain was located. She replied: 'I had pain in my chest this morning.'
6:44 You asked the patient if she could describe her pain. She replied: 'It feels heavy, like an elephant is sitting on my chest.'
6:55 You asked the patient if she had any pain. She replied: 'I have some chest tightness.'
6:59 Patient status - ECG: Sinus rhythm. Heart rate: 98. Pulse: Present. Blood pressure: 143/ mm Hg. Respiration: 21. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
7:07 You phoned the provider in order to discuss the patient.
7:59 Patient status - ECG: Sinus rhythm. Heart rate: 98. Pulse: Present. Blood pressure: 141/ mm Hg. Respiration: 21. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
8:20 You asked if the patient was allergic to anything. She replied: 'No, I am not allergic to anything.'
8:26 You compared the medication label with MAR. This was reasonable.
8:44 A 0-mg dose of nitroglycerin was given sublingually. This was indicated by order.
8:44 Patient status - ECG: Sinus rhythm. Heart rate: 97. Pulse: Present. Blood pressure: 142/ mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
9:00 You asked the patient if she had any difficulty in breathing. She replied: 'No, my breathing's fine.'
9:15 You measured the temperature in the ear. The temperature was 99 F (37 C).
9:33 You examined the patient's skin. There is normal elasticity of the skin. Her color is normal, and she is not sweating.
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9:44 Patient status - ECG: Sinus rhythm. Heart rate: 85. Pulse: Present. Blood pressure: 126/ mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
9:50 You assessed the patient's neurological status. This is reasonable.
10:44 Patient status - ECG: Sinus rhythm. Heart rate: 85. Pulse: Present. Blood pressure: 124/ mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 96%. Temp: 99 F (37 C)
11:09 You checked the eye movements. Extraocular movements within normal limits.
11:26 You checked the patient's pupils, and they were 4 mm and reactive.
11:36 You asked the patient if she had any pain. She replied: 'I have some chest tightness.'
11:40 You asked if the patient was allergic to anything. She replied: 'No, I am not allergic to anything.'
11:44 Patient status - ECG: Sinus rhythm. Heart rate: 86. Pulse: Present. Blood pressure: 126/ mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 96%. Temp: 99 F (37 C)
11:47 You compared the medication label with MAR. This was reasonable.
12:00 You administered 2 mg of morphine IV. It was reasonable to give an opioid here.
12:06 You flushed the cannula.
12:30 You listened to the lungs of the patient. The breath sounds are clear and equal bilaterally.
12:44 Patient status - ECG: Sinus rhythm. Heart rate: 87. Pulse: Present. Blood pressure: 124/ mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 96%. Temp: 99 F (37 C)
12:49 You listened to the heart of the patient. There were regular heart sounds without murmurs.
13:10 You listened to the abdomen of the patient. Normal bowel sounds were heard.
13:20 You examined the patient's head. There is no obvious airway obstruction. There is normal elasticity of the skin. Her color is normal, and she is not sweating.
13:40 You assessed the patient's mouth. This was reasonable.
13:44 Patient status - ECG: Sinus rhythm. Heart rate: 87. Pulse: Present. Blood pressure: 123/ mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 96%. Temp: 99 F (37 C)
13:58 You examined the patient's skin. There is normal elasticity of the skin. Her color is normal, and she is not sweating.
14:12 You examined the patient's chest. She is breathing at 12 breaths per minute. The chest is moving equally.
You should reassess the patient's pain level here.
14:21 You examined the patient's arms. There is nothing to find on examination of the arms.
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19:20 You educated the patient about frequent vital sign assessments.
19:37 You educated the patient about proper use of sublingual medication. This was reasonable.
19:44 Patient status - ECG: Sinus rhythm. Heart rate: 89. Pulse: Present. Blood pressure: 131/ mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 95%. Temp: 99 F (37 C)
20:01 You educated the patient about the drug nitroglycerin.
20:27 You asked the patient if she had any pain. She replied: 'No, I don't have any pain.'
20:35 A patient handoff was performed.
Junetta Cooper is a 75-year-old African American female with a 20-year history of primary hypertension, which is well controlled on medication. She has had stable (exertional) angina treated with a nitroglycerin patch and sublingual tablets. The patient came to the emergency room with angina unrelieved by nitroglycerin. Diagnostic tests indicate she was not experiencing a myocardial infarction (MI), but the angina pain persisted intermittently. A cardiac catheterization is scheduled. [newline]When heart muscle is damaged, as in MI, troponin I (TnI) and troponin T (TnT) leak out of cells and into the bloodstream; increased troponin levels indicate cardiomyocyte damage. Troponins are not normally present in serum, so any amount present in serum indicates structural damage to the heart, although not necessarily an MI. When the TnI is above 0 ng/mL or the TnT is 0 ng/mL or higher, MI is suspected.[newline] [newline]Hydrochlorothiazide is a thiazide diuretic. Hydrochlorothiazide is used to manage hypertension either as the sole therapeutic agent or in combination with other antihypertensives. Hydrochlorothiazide blocks the reabsorption of sodium and chloride ions, increasing the amount of water excreted. Thiazide diuretics are the most commonly used medication to treat hypertension in African Americans. [newline][newline]Nitroglycerin belongs to a class of drugs known as nitrates. Nitrates work by relaxing and widening blood vessels so blood can flow more easily to the heart, reducing angina.[newline][newline]Side effects of nitroglycerin include:[newline]- headache[newline]- hypotension[newline]- dizziness or weakness[newline]- heart palpitations [newline]- nausea and vomiting[newline]- sweating[newline]- flushing of the skin.[newline][newline] Students will be expected to perform an initial assessment and review the medications. The patient is initially pain free, but a few minutes into the simulation, the patient's chest pain will return. The student should complete a pain assessment, reassess vital signs, and administer the sublingual nitroglycerin. Patient education is needed regarding the difference between the sublingual and patch forms of nitroglycerin as well as storage of the medication.
You got 95%
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Med Surg 2 Feedback Log & Score — Junetta Cooper Pharmacology
Course: Medical-Surgical Nursing II (NSG 223)
University: Herzing University
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