Quality and Safety Education for Nurses



Prioritization/Delegation Scenarios Maternal-Newborn Care“What would you do Walk -Through”Process:Students will approach five patient beds within the simulation lab. Each patient’s name is clearly designated at the head of the bed. There are orders, armbands, Kardexes, hand-off report sheets, and an explanation of each scenario at each patient bedside. Students are to review each scenario as a clinical group, collaborate with clinical group, and after review of each patient, determine priorities and/or delegations of care, documenting their decisions on the form provided. Students will be informed of the correct priorities at debriefing.1. Patient: Susan RightAge: 23; DOB 11/4/1995Scenario:You are the nurse. The health care provider has completed an assessment of the patient. You cared for her yesterday after delivery. She appears more confused than when you cared for her previously. The newborn is in the crib in the corner, sucking on her fist.Vital Signs are: Temp 100.9, HR 116, RR 32, BP 80/60, SPO2 85% on Room AirOn your assessment, you note a boggy fundus, large clots, fundus remains boggy on massage. Saline lock is in Right hand.What will you do next?2. Patient: Emma RightAge: 1 day; DOB 11/13/XXScenario:You are the nurse. The newborn is in the crib in the corner of the mom’s room.Vital Signs are: Temp 37.2 C., HR 140, RR 34, BP 70/55, SPO2 95% Weight: 7lb 2oz. Admit Apgar 8 at 1 minute and 9 at 5 minutesOn assessment, you note the vital signs are the same as what was given to you in the hand-off report. The baby is sucking on her fist and moving around. You attempt to obtain a feeding schedule from the mom, but she is not responding appropriately to your questions.What will you do next?3. Patient: Elizabeth WillyouAge: 24; DOB 3/24/1994Scenario:You are the nurse. Vital signs are: Temp 98.6, HR 80, RR 16, BP 116/80. On assessment the fundus is boggy with clots; the fundus firms with massage.Hgb is 8 from 11 on yesterdayHct is 28 from 32 yesterdayYou received from hand-off report that there was an order for a blood transfusion.You see the blood is sitting on the counter and it has been there for 20 minutes.What will you do next?4. Patient: JoAnna TrainAge: 27; DOB 04/19/1991Scenario:You are the nurse for the patient who is 39 weeks gestation, Gravida 2 Para 2. Vital Signs are: Temp 99.1, HR 88, BP 122/60.Her underpad is wet. You place the external fetal monitor and interpret the reading as contractions 8 minutes apart, irregular, FHR is 120-130, moderate variability.What will you do next?5. Patient: Rebecca DoweeAge 24: DOB 4/23/1994Scenario:You are the nurse. Vital signs are: Temp 98.6, HR 110, RR 28, BP 98/60. On assessment the fundus is boggy; she is diaphoretic. The patient is Muslim. Her husband is not present at the time of your assessment.Hgb is 8 from 11 on yesterdayHct is 28 from 32 yesterdayWhat will you do next, while being culturally sensitive?Decision/Delegation/Prioritization Activity“What Would You Do Walk-Through”1. Which patient requires attention First and how might you accomplish this?Please explain the rationale for your decision:2. Which patient will you see next, and how might you accomplish this BEST?Please explain the rationale for your decision?3. Which patient will you see next?Please explain the rationale for your decision?4. Which patient will you see next?Please explain the rationale for your decision?5. Which patient will you see last?Please explain the rationale for your decision?6. Place yourself in this situation, with this patient assignment. Reflect on what your BEST course of action would be and how you might ensure patient-centered care.Please Explain:ReferencesLondon, M., Ladewig, P., Davidson, M., Ball, J., Bindler, R. & Cowen, K. (2017). Maternal & Child Nursing Care, (5th ed.). Boston: Pearson. ................
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