Case 4: Scenario Briefing and Pre-Learning

Work through this chapter to prepare for the virtual case-based scenario. The estimated time for completing these activities is varied depending on the knowledge students have prior to engaging in the scenario. Completing all activities in their entirety may take up to 2 hours 45 minutes.

Scenario Briefing

Use the following client information to guide your preparation.

A woman in her fifties.

  • Name: Anna Lopez
  • Age: 52 Years Old
  • Sex: Female
  • Past Medical History: Pulmonary Embolism
  • Medications at Home: Warfarin
  • Social History: Mother of 3; twin boys aged 15, and a girl aged 20. She manages her own photography business out of her home.

Anna was involved in a motor vehicle collision two days ago and sustained a closed fracture to her right femur shaft. She is now post-op day 0 from an open reduction internal fixation. On admission, she tested positive for MRSA.

Anna was on warfarin pre-operatively for a history of pulmonary embolism. Pre-operatively her INR was 2.0. They gave her Vitamin K and her INR decreased to 1.1.

You have been assigned to care for Anna during a clinical night shift.

Post-Operative Orders:

  • Repeat blood work at 21h00 (INR, complete blood count)
  • IV normal saline @100ml/hr
  • Foley catheter in situ
  • Physio to assess, non-weight-bearing to the right leg.
  • Monitor peripheral vascular assessment, pain, and vital signs every 2 hours
  • Hydromorphone 1-2 mg SC q2h for pain
  • Hydromorphone 1-2 mg PO q2h for pain
  • Acetaminophen 500-1000mg PO q4-6h for pain to a max of 4gm in 24 hours
  • Start on Heparin 5,000 units SC at 22h00 then BID

Prerequisite Knowledge

For this case, it is anticipated that you would have basic competence in the following areas:

  • Psychomotor Skills
    • Basic vital signs assessment (adult)
    • Basic head-to-toe assessment (adult)
    • Dressing change
    • Personal Protective Equipment
  • Cognitive Skills
    • Fractures and orthopedic surgery
    • Post-operative complications
    • Medication administration and pharmacology (warfarin, heparin)
    • SBAR communication
    • Cultural safety
    • BCCNM Practice Standards
  • Affective Skills
    • Therapeutic communication

Self-Assessment

Complete this Case 4 Self-Assessment [Word] of your competence in the learning objectives for this case. At the end of the scenario, you can return to this rubric to identify any changes.

Pre-Learning Resources and Activities

Complete the following 5 activities (including associated readings, videos, and guiding questions) in order to fully engage in the scenario. You will be prompted to document your activities with an option to export your documentation to save for your own records.

1. Clinical Decision-Making

2. Diagnosis in Focus

Knowledge of the client’s current medical diagnoses and history is a key component of patient care. Use the following resources to prepare to provide care for the client. In the documentation activity, articulate your knowledge based on the client introduction provided.

Orthopedic fractures (10:30mins).[1]

Pulmonary embolism and DVT (5:45 mins)[2]

Post-operative complications.[3]

3. Assessments and Interventions

Read Vital Sign Measurement Across the Lifespan to review normal vital signs applicable to this case.[4]

Read about normal lab values for hemoglobin, INR, and PTT.[5]

Read the following resources to review assessments related to this case.[6]

Watch this video about how to set up a sterile dressing tray (6:10 mins).[7]

Review this checklist for a simple dressing change.[8]

Watch this video about nursing care for hypovolemia (27:42 mins).[9]

3. Medication in Focus

Prepare for the administration of medications included in the virtual case scenario by reviewing the following resources.

Read about safe medication administration: Basic Concepts of Administering Medications.[10]

Prepare for the administration of the following medications[11]:

5. Therapeutic Boundaries in Nursing Care

Practice Quiz

NCLEX Moment

Complete the following questions related to your pre-learning for the scenario. The questions are written in NCLEX formatting as an added form of review.

Media Attributions

  1. NURSINGcom (2020, April 6). Fractures Nursing Care [Video]. YouTube. https://www.youtube.com/watch?v=IsW2MR5d7p8 ↵
  2. DVT - Prevention and Treatment | NCLEX RN Review. (2017, March 27). [Video]. YouTube. https://www.youtube.com/watch?v=v5MgUuNw0Ro ↵
  3. NCLEX Study Guide (2018, February 5). Postoperative Nursing Care/NCLEX RN Review [Video]. YouTube. https://www.youtube.com/watch?v=iNTDoz70RKI ↵
  4. Lapum, J., Verkuyl, M., Garcia, W., Oona St-Amant, Tan A. (n.d.). Vital Sign Measurement Across the Lifespan – 2nd Canadian Edition. https://opentextbc.ca/vitalsignmeasurement/ ↵
  5. Medical Council of Canada: Clinical Laboratory Tests - Adult normal values https://mcc.ca/objectives/normal-values/ ↵
  6. Ernstmeyer, K., & Christman, E. (Eds.). (2021). Open RN Nursing Skills by Chippewa Valley Technical College is licensed under CC BY 4.0. ↵
  7. Setting Up A Sterile Dressing Tray and Principles of Sterility (Nursing Skills). (2018, April 17). [Video]. YouTube. https://www.youtube.com/watch?v=OIPjtclwP6k ↵
  8. Ernstmeyer, K., & Christman, E. (Eds.). (2021). Open RN Nursing Skills by Chippewa Valley Technical College is licensed under CC BY 4.0. ↵
  9. Hypovolemic Shock Nursing, Treatment, Management, Interventions NCLEX. (2019, January 8). [Video]. YouTube. https://www.youtube.com/watch?v=yZ7AXi_pkOg ↵
  10. Ernstmeyer, K., & Christman, E. (Eds.). (2021). Open RN Nursing Skills by Chippewa Valley Technical College is licensed under CC BY 4.0. ↵
  11. OpenMD.com (2021). Nitrofurantoin. https://reference.medscape.com ↵

License

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Nursing Virtual Case Studies Copyright © 2023 by Adrianna D'Ilio and Amanda Egert is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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