Simulation Debriefing Form NUR221
1/21/22 – Amelia Sung/UTI
1: List three concepts that were the highest priority issues for this patient. Explain your rationale for
choosing the concepts
1A) Infection. I chose infection as the most important concept because this patient has a UTI.
The patient presented to the hospital symptomatic of a UTI, with c/o bladder spasms, pain with
urination, burning with urination, and flank pain. The patient had a UA/CS done STAT at the lab which
confirmed the diagnosis of UTI via elevated WBC count in her CBC, and a urinalysis positive for >100k
CFU of an unknown bacteria. This is likely happening to the patient because she is in her third trimester
of pregnancy, so pressure is exerted on the bladder in such a way that the bladder may not fully empty
when she voids. Her immune system may also be more vulnerable to infection due to pregnancy. If we
don not correct this problem, her UTI will likely advance to pyelonephritis, requiring more serious
inpatient treatment and putting her at risk of preterm labor.
1B) Pain. This patient was experiencing intense pain she rated as a 6/10 on a 0-10 scale. She
described the pain to her back as being flank pain, and sharp. She was also experiencing intense burning
pain with urination which had led her to try not to drink fluids to avoid urinating. This concept applies to
the patient’s situation because it is secondary to her primary diagnosis of UTI, as the UTI was the cause
of her flank pain, bladder spasms and burning upon urination. If we do not correct this problem, this
patient may go into pre-term labor as a result of the distress of the pain, or she may become dehydrated
trying to avoid urination due to burning pain with urination.
1C) Elimination. This patient is experiencing altered elimination secondary to a UTI. Her labs
showed infection (elevated WBC count and >100k CFU bacteria on urinalysis). This patient cannot
urinate normally due to the infection because the infection caused so much pain, she was avoiding fluid
and was not urinating often per her own report. The infection can also cause difficulty with urinating at
all. If we do not correct her altered elimination, kidney function could be altered which puts the patient
and her fetus at risk for additional problems like dehydration, pre-term labor, kidney failure and sepsis.
2: Identify at least two of Tanner’s critical thinking skills or strategies used to plan care.
2A) Interpreting: checking accuracy and reliability. Accuracy and reliability were checked in this
simulation by verifying lab results (this actually did not happen, but it should have and was addressed
post-sim). Abnormal vital signs were also double checked.
2B) Setting priorities. This patient had anxiety which was not addressed until her priority
concern of pain and painful urination were addressed. Lab results were obtained, a diagnosis was made,
and a treatment plan put into place before the patient was educated and soothed related to her anxiety
about her diagnosis.
3: For each of the chosen concepts, explain how the interventions provided addressed the needs of the
patient. If they didn’t, explain why.
3A) Concept: Infection. The intervention for this patient’s infection was to treat the infection.
This was accomplished by verifying the diagnosis with lab results, discussing with the physician,
obtaining orders to treat the infection, administering medication, and educating the patient. Ongoing
monitoring would be helpful to make sure the patient has sufficient urinary output. Effectiveness would
be monitored by ensuring the infection cleared appropriately. We could not evaluate the effectiveness
of the treatment during the sim, but this would be evaluated by a repeat UA/CS after treatment
concluded to ensure that the infection has cleared, and the urinalysis is normal.
3B) Concept: Pain. The intervention for this patient’s pain was to provide analgesics for pain
relief. After discussing the patient’s care with the physician, Tylenol 650mg was ordered to treat pain
and fever. The medication was administered for a pain rating of 6/10 on 0-10 scale, and the patient
reported an improvement of her symptoms with a pain level of 3-4/10 after receiving the Tylenol. We
know the medication was effective because the patient reported a reduction in pain and was
comfortable at the 3-4/10 level of pain.
3C) Concept: Elimination. The intervention for altered elimination was first to find the source of
the problem or the diagnosis, which was confirmed by lab results to be a UTI. This patient also selfreported she had not been urinating much due to poor intake to avoid the burning pain associated with
her UTI. The physician was consulted, who ordered a fluid bolus to prevent/treat dehydration and
increase elimination. This did not happen in the sim, but the patient should have been educated about
the importance of pushing fluids to flush out the bladder and help the infection clear. The effectiveness
of the fluid bolus was not assessed in the sim, but it would have been assessed by monitoring and
measuring the patient’s urine output to ensure a normal specific gravity and color, indicating an
appropriate dilution.
4: How will you apply the information and thinking used in this simulation to the care of patients in the
clinical setting?
I will apply this information by remembering that third trimester patients presenting with pain
and contractions are not necessarily in labor, which would be my first conclusion. In the clinical setting, I
will assess for other possible causes of back pain and contraction-like pain to ensure that nothing is
missed so labor is not assumed by these symptoms. Additionally, I will remember to educate pregnant
patients on the importance of staying hydrated and on good hygiene like wiping front to back to help
prevent UTI’s.
5: Reflect on how the care provided addressed the patient/family cultural, religious, age-related, or
personal preference. Explain which NCLEX-RN test plan categories you did for this simulation.
I believe the care provided addressed the patient’s personal preferences as she was very
concerned about her unborn baby and wanted to make sure she was not in labor. As her nurses, we
reassured her that her symptoms were related to a UTI, and her baby was not in danger as long as the
UTI was treated. We also addressed her anxiety related to pre-term labor and explained that her back
pain is related to her UTI and she was not experiencing labor pain. She was Filipino, but no cultural or
ethnic specific care was provided during the sim. NCLEX-RN test plan categories used were: Physiological
Adaptation (through helping her maintain her temperature- with antipyretic medication and the use of a
cool cloth on her forehead), and Psychosocial Integrity (by educating this patient on her condition and
reassuring her she is not in labor).
6: Active participation in simulation as evaluated by instructors. Demonstration of collaboration,
teamwork and communication skills are expected.
My role in this simulation was the assessment nurse. We collaborated by working together to
perform the assessment (there were two assessment nurses) and discussing results as a team to come
up with a plan to collect lab samples and call the physician to get treatment started. I displayed
teamwork by co-assessing the patient with another assessment nurse, with both of us doing different
parts of the assessment. We communicated by discussing the results as a team and giving all
information to the charge nurse, who could then call the physician to obtain orders to treat the patient.