Brograph nigrus
Adult & Elder III
Pre-Simulation Assignment
Module I
Learning Outcomes:
1. Demonstrate therapeutic communication with a patient with dementia.
2. Initiate a plan of care for the patient with dementia.
3. Identify the signs and symptoms of hypoxia.
4. Evaluate the effectiveness of nursing interventions.
While making rounds on the unit, you notice your 85-year-old patient with a history of dementia,
Edythe Mellen, attempting to pull out her NG tube. She is receiving Jevity tube feedings at 40
mL/hr. You rush into her room and tell her why she needs the NG tube and to leave it alone.
She nods her head in agreement and you walk out. While making rounds again, you notice the
tape of the NG tube is no longer secured to her nose and more of the tube is hanging out of her
nose.
1. What is your priority nursing diagnose(s)?
Priority nursing diagnosis in this situation is risk for aspiration related to history of
dementia evidenced by patient’s removal of NG tube.
Another priority would be risk for imbalanced nutrition related to continued removal of
NG tube as evidenced by NG tube no longer secured to patient’s nose.
2. What do you do about the NG tube?
Contact the provider to discuss possible use of soft wrist restraints to ensure patient can’t
interfere with the NG tube.
The next time you pass by, you notice Edythe has a leg hanging over the siderail and she’s
yelling and screaming. You try to calm her and reorient her but she continues to scream in
agitation.
3. What is your priority nursing diagnose (s)?
The priority nursing diagnosis for this scenario is risk for injury related to patient
presenting as highly agitated evidenced by patient yelling and screaming in addition to
patient yelling and screaming.
4.
The MD orders Haloperidol 1mg IV push to be administered stat. What concerns you
about this order?
“In September 2007, the Food and Drug Administration (FDA) strengthened label
warnings for intravenous (IV) haloperidol regarding QT prolongation (QTP) and torsades
de pointes (TdP)” (C et al., 2010) Continued monitoring of the patient is needed due to
high risk of prolonged QT interval which can potentially lead to the fatal arrhythmia
torsades de pointes.
5.
You have an order for Quetiapine (Seroquel) 50 mg via NGT prn agitation. You have
the following on hand:
A
B
Would you administer A or B? What is your reasoning?
A would be administered since B clearly states it can not be crushed and must be
swallowed whole.
6. Before administering the Quetiapine, you check the residual from the NG tube and it is
50 mL. You administer the Quetiapine 50 mg with 30 mL water and flush it beforehand
with 30 mL and afterwards with 30 mL. How would you chart this on the I&O sheet
(what is your balance)?
50mg Quetiapine, and 90mL total of water so Intake would be 140 mL. residual volume
is 50 mL.
7. Your co-worker hands you a pair of mittens and suggests you put them on the patient
and tie them to the bedrails. What do you do?
“All restraints require an order from an HCP. Carefully document restraint use and the
reason for use.” (Harding et al. 2019) Due to the need for both thorough documentation
and a need for an order from an HCP I would refrain from placing the patient in the
restraints myself. Instead, I would inform my colleague that we need to call the provider
to discuss such measures.
Edythe’s daughter comes to visit her in the hospital and sees she is wearing a purple bracelet that
reads “DNR.” She asks what that means and how it affects her care while she is in the hospital.
8. How would you reply to Edythe’s daughter?
“A DNR order is a written medical order that documents a patient’s wishes about
resuscitation and, more important, the patient’s desire to avoid CPR” (Harding et al.
2019) I would reply as empathetically as possible that DNR stands for do not resuscitate.
This means that your mother wishes to avoid CPR should the worst happen and be
allowed to pass peacefully and without intervention. The DNR order does not affect her
care or how we care for your mother and will do our best for her throughout the length of
her stay.
References
C, M.-M., Cm, C., Ba, S., Cr, M., & Bj, G. (2010). The FDA extended warning for intravenous
haloperidol and torsades de pointes: How should institutions respond? Journal of
Hospital Medicine, 5(4). https://doi.org/10.1002/jhm.691
Harding, M. M. (n.d.). Lewis's medical-surgical nursing. Lewis's Medical-Surgical Nursing 11th Edition. Retrieved September 15, 2022, from https://www.elsevier.com/books/lewissmedical-surgical-nursing/harding/978-0-323-55149-6