SURGICAL CASE 4: VERNON WATKINS GUIDED REFLECTION QUESTIONS
ACCURATELY ANSWERED
1. How did the scenario make you feel?
I was more comfortable doing this vSim since I have done a few now and I am aware of
where everything is in the simulation. I was able to identify signs and symptoms of a DVT
and PE. Due to the patient’s refusal to ambulate and perform deep breathing exercises
with the incentive spirometer, he was at a greater risk to develop this complication. I
liked this scenario because we learn about DVT/PE as a post-surgical complication of
immobility and this illustrated that.
2. Discuss your use of adjunct oxygen therapy for this patient, including why you chose a
particular oxygen device, rate, and flow.
At first I applied a nasal cannula at 2L/min. I continued to titrate up to 4L/min and
6L/min, but the patient was not improving. When the patient’s O2 sat dropped below
92%, I provided 100% O2 using a non-rebreathing mask at 10 L/min.
3. Discuss Vernon Watkins’ arterial blood gas (ABG) analysis result and explain what caused
this result.
The patient’s ABG showed respiratory alkalosis with mild hypoxemia. His PaCo2 was 32
and PaO2 was 74. His alkalosis was likely due to his fast respiratory rate of 24 breaths
per minute, causing him to blow off more CO2. His body was trying to compensate for
the lack of oxygen caused by the pulmonary embolism.
4. Discuss the use of a heparin nomogram (guideline for heparin titration) and safety
related to this intervention.
The provider ordered heparin threrapy to treat the patient’s DVT/PE caused by
immobility. Nurses use a nomogram to know how many units to give the patient wihout
having to call the provider. Nurses obtain baseline labs before calculating and
administering the initial bolus dose of heparin. After administration, the nurse will
evaluate the anticoagulation labs again and titrate heparin to the therapeutic goal set by
the provider based on those labs and patient presentation. Due to heparin’s narrow
therapeutic index, a patient receiving this therapy requires close monitoring for signs
and symptoms of bleeding.
5. What key elements would you include in the handoff report for this patient? Consider
the SBAR (situation, background, assessment, recommendation) format.
ACCURATELY ANSWERED
1. How did the scenario make you feel?
I was more comfortable doing this vSim since I have done a few now and I am aware of
where everything is in the simulation. I was able to identify signs and symptoms of a DVT
and PE. Due to the patient’s refusal to ambulate and perform deep breathing exercises
with the incentive spirometer, he was at a greater risk to develop this complication. I
liked this scenario because we learn about DVT/PE as a post-surgical complication of
immobility and this illustrated that.
2. Discuss your use of adjunct oxygen therapy for this patient, including why you chose a
particular oxygen device, rate, and flow.
At first I applied a nasal cannula at 2L/min. I continued to titrate up to 4L/min and
6L/min, but the patient was not improving. When the patient’s O2 sat dropped below
92%, I provided 100% O2 using a non-rebreathing mask at 10 L/min.
3. Discuss Vernon Watkins’ arterial blood gas (ABG) analysis result and explain what caused
this result.
The patient’s ABG showed respiratory alkalosis with mild hypoxemia. His PaCo2 was 32
and PaO2 was 74. His alkalosis was likely due to his fast respiratory rate of 24 breaths
per minute, causing him to blow off more CO2. His body was trying to compensate for
the lack of oxygen caused by the pulmonary embolism.
4. Discuss the use of a heparin nomogram (guideline for heparin titration) and safety
related to this intervention.
The provider ordered heparin threrapy to treat the patient’s DVT/PE caused by
immobility. Nurses use a nomogram to know how many units to give the patient wihout
having to call the provider. Nurses obtain baseline labs before calculating and
administering the initial bolus dose of heparin. After administration, the nurse will
evaluate the anticoagulation labs again and titrate heparin to the therapeutic goal set by
the provider based on those labs and patient presentation. Due to heparin’s narrow
therapeutic index, a patient receiving this therapy requires close monitoring for signs
and symptoms of bleeding.
5. What key elements would you include in the handoff report for this patient? Consider
the SBAR (situation, background, assessment, recommendation) format.
