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- Concluding Questions How did the simulated experience of Mona Hernandez’s case make you feel? …
- Scenario Analysis Questions PCC What priority problem(s) did you identify for Mona Hernandez? …
- PCC What potential problems could arise due to pneumonia?
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Designed to simulate real nursing scenarios, vSim® for Nursing, co-developed by Laerdal Medical http://www.laerdal.com/us/ and Wolters Kluwer http://www.nursingeducationsuccess.com/nursing-education-solutions/ allows students to interact with patients in a safe, realistic online environment. Online interactive virtual simulations with integrated curriculum resources provide a full simulation learning experience for every student. vSim® for Nursing Fundamentals includes 10 fundamentals patient scenarios, authored by the National League for Nursing.
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Patient Introduction Mona Hernandez Assessment Answers
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- Date Published: 2015. 6. 8.
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Mona Hernandez Guided Reflection Questions Concluding Questions
Mona Hernandez
Guided Reflection Questions
Concluding Questions How did the simulated experience of Mona Hernandez’s case make you feel?
During the first attempt I felt nervous. I had to make sure that I hit all the points, especially when educating the patient throughout my care plan. However, after that attempt I became more comfortable navigating through the program and was able to give Mona a higher quality of care.
Talk about what went well in the scenario.
I was able to Identify her chief complain easily and plan accordingly. I identified that she needed a better positioning in bed as well as oxygen therapy. Med administration went well, except for giving the piggy back medication early. Lastly, introducing myself and making sure to assess her vitals went smoothly as well.
Reflecting on Mona Hernandez’s case, were there any actions you would do differently if you were to repeat this scenario? If so, how would your patient care change?
I needed to be better at educating the patient about her illness and the procedures before care implementation. It is important to educate the patient because it allows the patient to feel included during the care and creates an environment that encourages open communication.
Scenario Analysis Questions PCC What priority problem(s) did you identify for Mona Hernandez?
Mona’s priority problems were her shortness of breath, and a painful cough that produced rust colored sputum that arose from her pneumonia.
PCC What potential problems could arise due to pneumonia?
Some complications that can arise from pneumonia are heart failure, pleural effusion, septicemia, or/and hypoxia.
PCC/T&C Discuss the importance of support from her health care team in Mona Hernandez’s care.
The Scenario Analysis Questions are correlated to the Quality and Safety Education for Nurses (QSEN)
competencies: Patient-Centered Care (PCC), Teamwork and Collaboration (T&C), Evidence-Based Practice (EBP), Quality Improvement (QI), Safety (S), and Informatics (I). Find more information at: qsen/
The feeling of shortness of breath that arises from pneumonia can induce feelings of anxiety. It is important that there is support from the health care team to alleviate Mona’s shortness of breath, alongside soothing Mona’s anxieties.
S Identify potential patient safety issues related to oxygenation and specific to Mona Hernandez’s pneumonia.
Low oxygenation can cause Mona to have feelings of fatigue. Due to her fatigue, there is an increased risk for falls when ambulating. She also expressed being too tired to eat or drink, so malnutrition or dehydration could come to fruition.
T&C What other interprofessional team members should be involved in Mona Hernandez’s care?
In case her blood pressure dropped too low or got to high, the provider should be called and involved. The provider should also be contacted in the presence of a temperature greater that 101 F or lower than 97 F.
T&C/I Provide Mona Hernandez with education on the importance of smoking cessation and the role that smoking has on respiratory health. As part of this education, provide her with a list of smoking cessation support groups.
1. Nicotine Anonymous (NA)
2. UB EvarQuit Program
3. Erie-Niagara Tobacco-Free Coalition
Concluding Questions
Describe how you would apply the knowledge and skills that you acquired in Mona Hernandez’s case to an actual patient care situation.
I will make sure that I will adequately education the patient of their present illness and the plan
of care that follows. Education is important because it not only to encourages clear
communication between nurse and patient, but because it can be utilized across all patients to
improve their quality of care.
Guided reflection Q
Elliana Ramirez 11/01/
Mona Hernandez
Guided Reflection Questions
Concluding Questions 1. How did the simulated experience of Mona Hernandez’s case make you feel? The simulated experience of the Mona Hernandez’s case made me feel kind of nervous at first because it was my first-time taking care of a patient. I did not think that the order of tasks affected my score that I got for taking care of my patient Mona Hernandez in the Vsim, but it did. I liked how it made me feel like I was a nurse practicing on an actual patient but without making mistakes on a real patient. I would have liked if at the end of completing the Vsim that they would have shown us the correct way of completing the tasks for taking care of Mona Hernandez. Showing me the correct way would have made me feel like I learned from my mistakes.
Talk about what went well in the scenario. What went well in the scenario was that I knew that I needed to complete a focused assessment on my patients respiratory system due to her being diagnosed with Pneumonia, I knew that the patient needed the head of the bed elevated to a High Fowlers due to her difficulty breathing, and I knew that Mona Hernandez needed to receive oxygen to increase her SpO2 to 95% as the doctor prescribed. Reflecting on Mona Hernandez’s case, were there any actions you would do differently if you were to repeat this scenario? If so, how would your patient care change? Reflecting on Mona Hernandez’s case, there were some actions that I would have done differently if I repeated this scenario. I would have raised the head of the bed of the patient sooner than I did, I would have administered the oxygen before making my patient cough or before using the incentive spirometer, and I would have asked my patient more questions to figure out what was going on with her and how she was feeling after her interventions.
Scenario Analysis Questions PCC What priority problem(s) did you identify for Mona Hernandez?
The Scenario Analysis Questions are correlated to the Quality and Safety Education for Nurses (QSEN)
competencies: Patient-Centered Care (PCC), Teamwork and Collaboration (T&C), Evidence-Based Practice (EBP), Quality Improvement (QI), Safety (S), and Informatics (I). Find more information at: qsen/
From vSim for Nursing | Fundamentals. © Wolters Kluwer.
The priority problems that I identified for Mona Hernandez was that she had Pneumonia, she was having difficulty breathing, a persistent cough and that she had a temperature of 101 F.
PCC What potential problems could arise due to pneumonia?
Some problems that could arise due to pneumonia is that you can get bacteria in your blood stream, you can get a lung abscess, you can have fluid surrounding your lungs, and difficulty breathing.
PCC/T&C Discuss the importance of support from her health care team in Mona Hernandez’s care.
The support from her health care team in Mona Hernandez’s care is important because it helps us be safe and organized with providing optimal care for our patient. We will all know what our job for providing care would consist of for our patient to get better sooner and be able to monitor her progress.
S Identify potential patient safety issues related to oxygenation and specific to Mona Hernandez’s pneumonia.
Potential patient safety issues related to oxygenation and specific to Mona Hernandez’s pneumonia is that her mucous membranes could be compromised if she has the nasal cannula on for too long, using oxygen therapy could compromise the normal function of her lungs, she could possibly trip on the tubing if she ambulates to the bathroom, and her skin integrity will be affected due to her age/lying in bed more than usual.
T&C What other interprofessional team members should be involved in Mona Hernandez’s care?
Other interprofessional team members that should be involved in Mona Hernandez’s care are a Respiratory therapist, Radiologist, physician, Lab technician, and counselor.
T&C/I Provide Mona Hernandez with education on the importance of smoking cessation and the role that smoking has on respiratory health. As part of this education, provide her with a list of smoking cessation support groups.
Smoking cessation is important because it helps prevent smoking-related diseases, it can improve your circulation, increase your lung function, coughing/shortness of breath decreases, risk for heart disease/stroke decreases. The role that smoking has on your respiratory health is that it increases your risk for lung/oral cancer, damages your airways, can cause COPD, and increases respiratory/reproductive/GI system cancers. Some smoking cessation support groups are the American Cancer Society Quitline (800)227-2345, The American Lung Association
From vSim for Nursing | Fundamentals. © Wolters Kluwer.
Mona Hernandez Guided Reflection Questions Study guides, Class notes & Summaries
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Patient Introduction Mona Hernandez Assessment Answers
Patient Introduction Mona Hernandez (Pneumonia)
Location: Medical Unit 1600
Report from day shift nurse:
Situation: Mrs. Hernandez is a 72-year-old Hispanic female who was admitted to the medical unit yesterday afternoon with a diagnosis of pneumonia in her right lobe. Chest X-ray shows infiltrates in right lower lobe, indicative of pneumonia. She was started on antibiotics after a sputum specimen for Gram stain culture was obtained. We are monitoring her respiratory status closely.
Background: Mrs. Hernandez was experiencing symptoms of dry cough, fever, and malaise, and was diagnosed with influenza 10 days prior to admission. Her symptoms got progressively worse, and yesterday she had a temperature of 38.4 °C (101.2 °F), shaking, chills, and a productive cough of rust-colored sputum. Her primary care provider saw her yesterday and decided to admit her for treatment of pneumonia.
Assessment: Mrs. Hernandez is alert and oriented ×3, but appears tired. She reports sharp chest pain with coughing and shortness of breath with activity. She rated the pain as a 6 on a scale of 0–10 and was given acetaminophen 650 mg at 1400. Vitals signs were taken at 1200. Her temperature has been elevated since this morning and was 38.1 °C (100.6 °F). Pulse is 104/min, respirations 24/min, and blood pressure 112/72 mm Hg. Her saturation was 95% on nasal cannula with oxygen at 3 L/min. Her respirations were labored when she came back from the bathroom, but improved when she settled back in bed.
Recommendation: You should make sure to maintain saturation levels above 94%. Mrs. Hernandez needs encouragement to cough and deep breathe, and to use incentive spirometry. She only uses her incentive spirometer after much encouragement. You should also start patient education on disease process and management. Please also perform a head to toe assessment with a focused respiratory assessment.
Documentation Assignments
1. Document your focused assessment of Mona Hernandez.
My focus assessment was on the Lung due to her dx of Pneumonia.
-Auscultated lungs
-O2
-Respiratory Rate
-Encouraged to cough and observed emesis basin for Sputum
-Assessed for difficulty breathing
-Temperature
2. Document your assessment findings and any nursing interventions related to Mona Hernandez’s oxygenation.
Patient status – ECG: Sinus tachycardia. Heart rate: 119. Pulse: Present. Blood pressure: 142/86 mm Hg. Respiration: 22. Conscious state: Appropriate. SpO2: 87%. Temp: 101 F (38.2 C)
Due to her O2 saturation being so low and her verbalizing her she is having shortness of breath, Patient was assisted to a high sitting position and oxygen therapy was started via nasal cannula at 2L to begin, and ultimately ending in 4L.
3. Document your education to Mona Hernandez regarding the purpose of, and how to use, the incentive spirometer.
Patient used an incentive spirometer. This was indicated by order.
Incentive spirometer provides visual reinforcement for deep breathing. It encourages the patient to maximize lung inflation and prevent or reduce atelectasis. In addition, it helps to support optimal gas exchange, and clearing and expectoration of secretions. Before using incentive spirometry equipment, the patient needs instructions on using the equipment properly. Validate the correct use of this equipment and encourage use every 1-2 hour.
4. Referring to your feedback log, document the nursing care you provided to Mona Hernandez and her response.
Asked the patient if she had any difficulty in breathing. She replied: “Yes, for many days, but now it is worse.”
Assisted the patient into a high sitting position.
Asked the patient how she felt. Patient replied: “I am feeling short of breath.”
Attached the Pulse oximeter
Placed a nasal oxygen cannula, turned the oxygen on to 2 L. Started giving the patient warm, humidified oxygen.
Asked the patient if she felt better, patient stated “No, its the same”
Asked the patient: How would you describe your coughing? Is it dry, wet, or productive? She replied: “There has been quite a lot to cough up the last couple of days. It is worse in the morning.”
Encouraged coughing. This was indicated by order.
The patient used an incentive spirometer. This was indicated by order.
Gave patient sip of water
Listened to the lungs of the patient. There are reduced breath sounds at the right lung base.
Listened to the heart of the patient. There were regular heart sounds without murmurs.
Asked the patient if she had any difficulty in breathing. She replied, “It is better now. Thanks”
Educated the patient about coughing.
Educated the patient about pneumonia
Educated the patient about positioning
Educated the patient about use of incentive spirometer
Checked patient temperature, Temperature 101.
Checked patients Orders and administered 650 mg dose of acetaminophen
Measured patients blood pressure, 132/80
Asked patient if she was experiencing any pain, patient stated, “No, I’m ok”.
Assessed for normal breathing. She is breathing at 18 breaths per minute. The chest is moving equally.
Examined the patient’s skin. There is normal elasticity of the skin. She appears flushed and her skin is warm and dry.
Reassessed patients status: Patient status – ECG: Sinus tachycardia. Heart rate: 109. Pulse: Present. Blood pressure: 134/79 mm Hg. Respiration: 18. Conscious state: Appropriate. SpO2: 94%. Temp: 101 F (38.1 C)
Phoned provider.
Guided Reflection Questions
Opening Questions
1. How did the simulated experience of Mona Hernandez’s case make you feel?
-The Mona Hernandez made me feel prepared and unprepared all at the same time. It was a little overwhelming to try and remember everything and try and keep a particular order. However, over all it was pretty exciting to learn from this simulated experience.
2. Talk about what went well in the scenario.
-Over all, I did enjoy being able to see a patient’s full history, medications, labs, and all that jazz. It was exciting to see the patients O2 saturations get better while administering O2. It was nice to see that the patient was improving, and great to see how many interventions we can make to help this patient.
3. Reflecting on Mona Hernandez’s case, were there any actions you would do differently if you were to repeat this scenario? If so, how would your patient care change?
– If I were to repeat this scenario again, I think I would try and keep a better order of what I am doing, as well as educating the patient right after so that I am not missing key steps in the treatment for this patient. I believe that if the patient is educated right after the treatment, such as a spirometer for example, the patient will remember more easily and therefore use these tools at home to help prevent further issues. If I am more organized in how I assesse the patient, the patient will sense that and possibly take my recommendations more seriously.
Scenario Analysis Questions
1. What priority problem(s) did you identify for Mona Hernandez?
Going into the simulation the first observed symptoms was the clear dyspnea at rest, so the first step was to sit the patient up. The next step was to take a full set of vitals: Tachycardia, Heart rate: 119.
Blood pressure: 142/86 mm Hg.
SpO2: 87%.
Temp: 101 F (38.2 C)
The next priority was to administer oxygen due to the low O2 saturation.
2. What potential problems could arise due to pneumonia?
Due to pneumonia, several problems can arise, like Mona, difficulty breathing and needing oxygen therapy, cough and even as serious has septic shock caused by the bacteria spreading to the bloodstream. Have to make sure to continue to use the incentive spirometer as well as making sure she ambulating regularly.
3. Discuss the importance of support from her health care team in Mona Hernandez’s care.
Without the support of her health care team, Mona will be left without treating her pneumonia, and this could drastically take a turn for the worst. Mona needs encouragement to continue to utilize her incentive spirometer, encouragement to cough and keep up these interventions to get better.
4. Identify potential patient safety issues related to oxygenation and specific to Mona Hernandez’s
Fall Risk
Increased HR
Confusion
Cyanosis
5. What other interprofessional team members should be involved in Mona Hernandez’s care?
Social Worker
R.T
O.T
Concluding Questions
1. Describe how you would apply the knowledge and skills that you acquired in Mona Hernandez’s case to an actual patient care situation.
I believe this simulation helped tremendously in that I’ve learned to organized my actions better and also have made sure to educate the patient accordingly. The feedback given helped give a better understanding why we should/shouldn’t do things. I was actually able to use my skills learned here with one resident in the long-term care facility I am currently in. We had a patient who was experiencing dyspnea at rest, and the first the CNA and I did was sit the patient up and take vitals as we notified the RN. It was a pleasant surprise to have gained so much from a virtual simulation.
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Mona Hernandez vSim Flashcards
Mona Hernandez asks the nurse why it is necessary to use the incentive spirometer when she is already having difficulty breathing. What is the best response by the nurse?
SOLUTION: Pneumonia Difficulty Breathing and Elevated Temperature Questions
From vSim for Nursin g | Fun damentals. © Wolters Kluwer.
Candice Cooper
12/16/2020
Mona Hernande z
Guided Reflection Q uestions
Concluding Ques tions
How did the simulated experience of Mona Hernandez ’s case make you feel ?
It made me feel good to work on areas I have problems with. The assessment on the
breathing and the right measures to take.
Talk about what w ent well in the sc enario.
What went well was assessing the oxygen and taking the proper measures to bring the level
up. Also aware to call provider because of the low levels and vital signs.
Re flecting on Mona Hernandez ’s case, were there any acti ons you would do diff erently if you were to
repeat this scenario ? If so, how would your patient ca re change?
If I has to repeat the scenario I would change the way I assessed then gave oxygen once I
knew the oxygen was low I should have stopped and gave the canula with oxygen, then
continued my assessmen t.
Scenario Analysis Q uestions
PCC What priority proble m(s) di d you identify f or Mona Hernan dez?
Pneumonia, diffi culty breathin g, and elevated te mperature.
PCC What potential proble ms could arise du e to pneumon ia?
Bacrteria in the bloodstream, restrictive lung function deficits, accumulation of fluid in the
lun gs , risk of sleep apnea.
PCC /T &C Discuss the imp ortance of supp ort from he r health care tea m in Mona Hernandez ’s care .
Support comes fro m the do ctor and new orders such as antibiotics. Nu rsing team taking care of Mona
the correct way giving me dications on time, en couraging cou ghing and use of the incentive
spirometer on oth er shifts.
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