Brian MacConaghy

Community Health Sim Questions

Scenario: 85-year-old female who was diagnosed with ovarian cancer five years ago. Treated with
surgery and chemotherapy. Surgical treatment was removal of both ovaries and fallopian tubes, with a
total hysterectomy.

Patient was found to be BRCA1 positive creating an increased risk for certain cancers. Patient denied
any prophylactic treatment. 18 months ago she was found to have breast cancer and underwent a
lumpectomy of the right breast, along with chemo and radiation. Two months ago diagnosed with Stage
IV metastatic disease of the bones, brain and liver.

1. Describe the ethical and legal issues of advanced directives including the role and
responsibilities of the healthcare surrogate decision-maker.

There is a struggle between the ethical choice or the legal choice, and ensuring the
advanced directive is followed in the event the patient cannot make their own decisions. The
caregiver or surrogate needs to ensure the patient’s wishes are followed despite their personal
feelings on the matter.

2. Discuss the nursing management of the client-family unit at end-of-life.

Nurses have to maintain a balance of patient and family care, to find out if patients have
had advance care planning conversations with those closest to them, and that their expressed
wishes are known and understood. While defining and letting that person know who their
substitute decision maker is. The nurse spends a lot of time at the bedside, with the patient
their family while acting as a mediator with other care team members. They provide care and
comfort for both the patient and family. While also advocating for the patient to the staff and
family.

3. Based on what you’ve learned about the nursing process, describe one applicable nursing
diagnosis, treatments and nursing considerations for this diagnosis.

Nursing diagnosis: Anxiety, and ineffective coping related to anticipated loss.

Treatment would be therapeutic communication with the patient, allowing them to express
their concerns, pharmacological anxiety management as well.
Brian MacConaghy
Community Health Sim Questions

Scenario: Patient 1 is a 70 yo male, married, retired and enjoys cooking. While cooking
breakfast, a grease fire in the kitchen occurred and the patient attempted to extinguish the fire with
water. He received a burn on the right forearm. He went to the ER yesterday and was treated with
wound care and pain medication and was instructed to follow-up at the clinic for assessment and
monitoring. He arrives at the clinic the next day for follow up. He is on Warfarin, but likes to go to the
salad bar every week.

Patient 2 is a 65yo Native American who sustained closed head trauma following a motor
vehicle accident approx. 6 weeks ago. Patient has no residual effects from the closed head injury, except
for headaches. He presents to the community health clinic for follow-up on headaches. Patient admits
to minimal healthcare over the years, due to lack of insurance. Client takes Motrin 200mg tabs and
White Willow Bark 400mg tablets for when he is in severe pain.

1. Review classifications of burn injury depth.

First degree burns: minor skin discomfort and some reddening of the skin. No blistering
and minimal tissue destruction
Second degree burns: Burn affecting deep epidermal layers and top of dermal layers.
There is no complete destruction of the dermis blisters, severe pain, swelling and fluid loss, also
called partial-thickness burns.
Third degree burns: called full-thickness burns complete dermis and epidermis
destruction. There is damage to subcutaneous layer treatment skin grafts and amputation.
These burns are insensitive to pain due to destruction of nerves complications include
circulatory shock, fluid imbalance respiratory injury, and infections.
Fourth degree burns: Burns that go beyond subcutaneous layer to muscle or bone

2. Identify the key components of caring for the client with burns in the rehabilitation phase of
recovery.
The rehab phase integrates the physical, psychological and social aspects of care. This
begins when client no longer needs intensive care. The treatment focuses on increasing ROM,
strength, activity tolerance, higher level ADLs. The intervention focuses on work, recreation, and
self-skills necessary to return to normal roles and routines. Patient focus would be in wound
care, pain control, fluid volume control, stable cardiac output and diet with high in protein and
promote healing.

3. Describe one nursing or client teaching consideration in regard to each of the following for the
client receiving Warfarin therapy for atrial fibrillation.
Brian MacConaghy
Community Health Sim Questions

The patient must be watched for bleeding issues. Slow onset of 3 to 5 days and an
ongoing monitoring is required (PT/INR). Warfarin is affected by Vitamin K, so diet education is
important. Maintain current level of leafy greens and fish oil.
Warfarin: For adults its 2-5 mg/day for 2-4 days: then adjust daily dose by results of INR.
Initiate therapy with lower doses in geriatric or debilitated patients. The patient should report
unusual bleeding or bruising including on the gums, nose and tarry stools or hematuria.

4. Describe the recommended schedule for adult vaccination administration and the nurses’ role in
educating the client and administration.
The nurse role is to educate the client of why the vaccine is given and what herd
immunization means. From age 19 years old and older an influenza annually can be give,
td/tdap(every 10 years) varicella (2doses), HPV ( 3 doses for female from ages 19-26 years old),
MMR (1 or 2 doses) etc. The nurse can administer adult vaccination as well.

5. List four nursing considerations around NSAIDS and homeopathic preparations.

NSAIDS: take with food or after meals, periodic ophthalmologic exam, monitor liver and
renal function, avoid OTC drugs; may contain similar meds, also have analgesic and antipyretic
actions, it is contraindicated with patient with hemophilia.
They should be used with a healthcare provider approval and monitoring when dealing
with homeopathic. Homeopathic may have different concentrations and patients’ needs to be
careful of dosing.

6. What are some non-pharmacologic methods that can be used to relieve pain?
Some ways to relieve pain are listening to certain music, meditation, breathing
techniques, acupuncture, and hot/cold therapy, visual imagery, touch, animals and counter
pressure.