STUDENT ROLES DURING SIMULATION

Full Answer Section

      Background Mrs. Naganashe has a history of chronic renal failure and has been on dialysis for the past 3 years. She also has a 15-year history of type II diabetes mellitus, hypertension, and hyperlipidemia. She is a proud member of the Odawa tribe and lives on an American Indian reservation. Assessment Mrs. Naganashe is a well-developed, well-nourished female in no acute distress. She is alert and oriented to person, place, and time. Her vital signs are as follows:

• Temperature: 98.6 degrees Fahrenheit
• Pulse: 100 beats per minute
• Respiratory rate: 24 breaths per minute
• Blood pressure: 160/90 mmHg

Mrs. Naganashe's lungs are clear to auscultation bilaterally. Her heart rate is regular and her rhythm is normal. Her abdomen is soft and non-distended. She has lower extremity edema. Her skin is warm and dry. Recommendation Mrs. Naganashe needs to be started on dialysis as soon as possible. She also needs to be monitored for fluid overload and other complications of chronic renal failure. She will need to be educated on the importance of dialysis and other aspects of her care. Additional Information Mrs. Naganashe speaks Odawa and English. She is married and has two children. She is a homemaker. She has no known allergies. She takes the following medications:

• Metformin 500 mg twice daily
• Lisinopril 20 mg once daily
• Atorvastatin 40 mg once daily

Nursing Notes Subjective Mrs. Naganashe reports feeling short of breath, swollen, and fatigued. She also reports that she has been unable to go to her dialysis treatment this week. Objective Mrs. Naganashe is a well-developed, well-nourished female in no acute distress. She is alert and oriented to person, place, and time. Her vital signs are as follows:

• Temperature: 98.6 degrees Fahrenheit
• Pulse: 100 beats per minute
• Respiratory rate: 24 breaths per minute
• Blood pressure: 160/90 mmHg

Mrs. Naganashe's lungs are clear to auscultation bilaterally. Her heart rate is regular and her rhythm is normal. Her abdomen is soft and non-distended. She has lower extremity edema. Her skin is warm and dry. Assessment Mrs. Naganashe is in fluid overload due to her missed dialysis treatments. She is also at risk for other complications of chronic renal failure, such as electrolyte imbalances, acidosis, and heart failure. Plan

• Start Mrs. Naganashe on dialysis as soon as possible.
• Monitor Mrs. Naganashe for fluid overload and other complications of chronic renal failure.
• Educate Mrs. Naganashe on the importance of dialysis and other aspects of her care.

Cultural Considerations It is important to respect Mrs. Naganashe's cultural beliefs and practices. For example, it is customary for Odawa people to address elders by their title and surname. It is also important to be aware that Odawa people may have different views on death and dying. Communication It is important to communicate with Mrs. Naganashe in a clear and concise manner. It is also important to use an interpreter if Mrs. Naganashe is more comfortable speaking Odawa. Collaboration I will collaborate with the physician, dialysis nurse, and other members of the healthcare team to provide Mrs. Naganashe with the best possible care.  

Sample Solution

   

SBAR Nurse's Notes

Situation

This is a report on Maggie Naganashe, a 62-year-old American Indian female with chronic renal failure, type II diabetes mellitus, hypertension, and hyperlipidemia. Mrs. Naganashe was admitted to the hospital for shortness of breath, swelling, weight gain, and fatigue. She reports that she was unable to go to her dialysis treatment this week because her husband had to use their only car for a job interview.