Multi-Client simulation
Multi-Client simulation: Maria Hernandez and Keola Akana. Maria Hernandez, 81, with urinary tract infection (UTI) and who visited
emergency room (ER) for acute confusion has these vital signs; temperature 101.6 oF,
heart rate 110, respiratory 20, and blood pressure 96/60. She is alert and oriented to
person and place only and has reported poor eating and drinking habits.
Keola Akana, 71, who was urgently brought in had an acute left sided heart
failure. He weighed 210 pounds from 217 pounds 2 days ago. Both scenarios happened
on Monday at 1400.
Priority assessments for left-sided heart failure patients and how to differentiate it
from the right-sided heart failure clients.
Left-side heart failure patients portrays increased heart rates, oxygen saturation
below normal, restlessness, confusion, fatigue, weakness, consciousness level change and
lung crackles may be heard. Dry coughs, breathing difficulties while lying down flat,
frothy sputum, pink-tinged sputum, urinating increased rates at night and alternating
weak and strong pulses may also be experienced (Thibodeau & Drazner, 2018).
Right-sided heart failure patients may exhibit ascites, murmurs and weight gain.
Liver enlargement, bilateral body edema, nausea, gastrointestinal area bloating and right
quadrant pain and jugular venous distention in the neck may also be noted neck (Gorter et
al., 2018).
Two common medication classes for left-sided heart failure patients and two nursing
considerations for each medication class.
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SIMULATION FOR MARIA AND KEOLA 3
Angiotension-Converting-Enzyme (ACE) inhibitors and Angiotension II Receptor
Blockers Enzyme (ARBs) medication classes can be used to treat left-sided heart failure
patients (Bateman et al.,2017). In ACE, stop medication after 3 to 4 days if patient is
using diuretic or monitor patient’s blood pressure 2 hours after starting the treatment
since ACE aids in widening blood vessels for ease of heart functioning. In ARBs, notify
the patient’s health care provider if swelling of the tongue is noted and also monitor
patient’s blood pressure (Bateman et al.,2017).
Cultural difference between the nurse and the patient may impact how nurses will
teach the patient on diet and nutrition. However, the nurse should teach with
consideration of the client’s cultural background, client choice of diet their availability to
the patient. Culture humility requires the nurse not to consider his or her culture values
and beliefs as superior to those of the patient (Obeng & Paul, 2019). The nurse should be
conscious of culture differences and be sensitive with patients on their cultures and
choices.
Two nursing considerations used when prioritizing and deciding placement location
for a peripheral intravenous in a heart failure client?
On placement and location for a peripheral intravenous in a heart failure client,
consider how the patient will tolerate injection in order to avoid blockage of his/her vital
senses since this can pose harm to the patient (Ziaeian & Fonarow, 2016). Also be
conscious of connection of the injection to the heart and how other organs can be
affected.
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SIMULATION FOR MARIA AND KEOLA 4
Common signs and symptoms of acute infection in older population and two priority
nursing interventions to use.
Older people with acute infections mostly shows signs and symptoms like fatigue,
confusion, fever, agitation and incontinences. Antibiotics use and frequent hydration is
recommended.
Four classes of antibiotics and nursing priority considerations to review when a
patient is using antibiotics.
Penicillin antibiotics taken at start of meals are aimed at weakening bacteria cell
walls. Patient should report any difficulty in eating due to mouth pain or allergies to stop
medication (Walsh & Wencewicz, 2016). Kidney functioning should be monitored also.
Tetracyclines antibiotics taken with non-dairy products are aimed at destroying
micro-organisms growth and curb protein synthesis. They work well when taken 2 hours
after meal or when patient has not eaten. Patients should be advised that these antibiotics
reacts with calcium and calcium containing foods.
Sulfonamides and trimethoprim antibiotics inhibit bacteria growth mostly in
urinary tract infections. Intake of 2500-3000 ml of water daily is recommended. They can
be taken with meals and potassium levels should be monitored. Acyclovir are antivirals
that prevents viral DNA from reproducing thus interruption replication of cells with HIV
& AIDS (Walsh & Wencewicz, 2016).
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SIMULATION FOR MARIA AND KEOLA 5
How does Advanced Directives impact the way nurses provides care to the patients?
Name some resources that can be used in completing and adhering to the client’s end of life
wishes?
Advanced Directives requires the nurses to handle the patients according to their
(patients) wishes. This hinders service delivery by nurses to their patients since a nurse
may wish to give more care, but he/she face limitation due to the advanced directives
from patients (Miller, 2017). This may make nurses become stressed since they are
basically following their patient’s wishes whereas their obligation may require extra
service delivery as per their assessment of the patient. Though nurses are obligated to
save lives, advanced directives may hinder their service delivery since ethical obligation
requires her to consider and act towards patient rights/wishes to self-determination
(Miller, 2017).
Nurses, health workers, social workers and health care providers are themselves
resources and should help the patients in completing and adhering to their patient’s end of
life wishes. Patient Self Determination Act (PSDA) is a legal act enacted to ensure
patients are provided with adequate information on advanced directives (Edozien, 2016).
PSDA also requires that patients are fully made aware that the decision to either accept or
reject treatment is solely theirs to make.
The Joint Commission is where the patient is expected to call and seek more
information about advanced directives (Edozien, 2016). American Bar Association is yet
another alternative resource that requires the patient to engage a legal consultant in
seeking information regarding his/her advanced directives. The patient can also visit The
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SIMULATION FOR MARIA AND KEOLA 6
Health in Aging offices at 40 Fulton St., 18th Floor New York, NY 10038 or call
212.308.1414 of Fax: 212.832.8646 for them to access advanced directives information.
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SIMULATION FOR MARIA AND KEOLA 7
References
Bateman, B. T., Patorno, E., Desai, R. J., Seely, E. W., Mogun, H., Dejene, S. Z., … & Huybrechts, K. F.
(2017). Angiotensin-converting enzyme inhibitors and the risk of congenital malformations.
Obstetrics and gynecology, 129(1), 174.
Edozien, L. C. (2016). Self-determination in Health Care: A Property Approach to the Protection of
Patients’ Rights. Routledge.
fromhttp://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN
/TableofContents/Vol-22-2017/No3-Sep-2017/Articles-Previous-Topics/History-and-
Future-of-Advance-Directives.html
Gorter, T. M., van Veldhuisen, D. J., Bauersachs, J., Borlaug, B. A., Celutkiene, J., Coats, A. J., … &
Hill, L. (2018). Right heart dysfunction and failure in heart failure with preserved ejection
fraction: mechanisms and management. Position statement on behalf of the Heart Failure
Association of the European Society of Cardiology. European journal of heart failure, 20(1), 16-
37.
Miller, B. (2017). Nurses in the know: the history and future of advance directives. Retrieved
Obeng, O., & Paul, S. (2019). Understanding HIPAA Compliance Practice in Healthcare Organizations
in a Cultural Context.
Thibodeau, J. T., & Drazner, M. H. (2018). The role of the clinical examination in patients with heart
failure. JACC: Heart Failure, 6(7), 543-551.
Walsh, C., & Wencewicz, T. (2016). Antibiotics: challenges, mechanisms, opportunities. American
Society for Microbiology (ASM).
Ziaeian, B., & Fonarow, G. C. (2016). Epidemiology and aetiology of heart failure. Nature Reviews
Cardiology, 13(6), 368.
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