Surgical Case 1: Marilyn Hughes Kourtney Chaney Guided Reflection Questions 1. How did the scenario make you feel? a. This scenario was one we’ve discussed a lot in adult health. Compartment syndrome could become a potential post-op complication and we s

Surgical Case 1: Marilyn Hughes Kourtney Chaney Guided Reflection Questions 1. How did the scenario make you feel? a. This scenario was one we’ve discussed a lot in adult health. Compartment syndrome could become a potential post-op complication and we should assess for and quickly recognize this as nurses. I was mostly prepared for this vSim due to learning about it prior to this activity. 2. How would you recognize that Marilyn Hughes’ condition was deteriorating? a. She would exhibit signs of increased pain such as an increase in blood pressure, heart rate, and respirations. She might also complain of persistent, unrelieved pain after adequate medication administration. Worst case scenario, her lower left leg might also become cyanotic with loss of feeling. 3. What interventions exist to alleviate compartment syndrome, and what assessments indicate improved perfusion to the extremity? a. Lower leg to heart level and loosen dressing to improve tissue perfusion. b. Return of color to the toes, decreased capillary refill, and present pedal pulses would indicate improved perfusion to the extremity. 4. Why is it important to maintain the limb at heart level versus elevating it above heart level? a. Lowering the limb to the same level as the heart improves arterial tissue perfusion and prevents further fluid accumulation in the affected extremity. 5. What could have happened in this scenario if Marilyn Hughes’ condition was not treated expediently? a. The patient could have lost more feeling in her lower left leg, which could lead to excessive ischemia. Marilyn could eventually lose her toes, foot or even her whole leg if the issue wasn’t resolved. 6. What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format. a. S: 45-year-old female who suffered a left mid-shaft tibia-fibula fracture from slipping on icy stairs. She was taken to surgery for an ORIF and has returned with a below-the-knee ace /splint dressing. b. B: Full code. Clear diet, advance as tolerated. Patient is bedrest until she works with physical therapy. No known allergies. c. A: Skin intact and free of lesions. Neurological assessment performed, person alert and oriented x4. Vitals to be taken every 30 minutes. Last VS were: temp: 99F, RR: 21, HR:105, BP:158/81, O2: 98% on room air. IV site intact and dry. She has lactated ringers at 75ml/hr. Patient states pain is 7/10. She was given morphine IV 6mg at 1415. She developed severe pain in her left lower extremity for the past hour after returning from surgery. She had absent pedal pulse in the left foot and numbness in that extremity. Her leg was lowered on the bed and the dressing was loosened. This improved her pain and resulted in increased perfusion to her left foot. Patient states pain is now 4/10 after morphine injection. © Wolters Kluwer Health | Lippincott Williams & Wilkin