Feedback Log & Score - Junetta Cooper Jun 26, 2020 8 - 09 PM

6/26/2020 Feedback Log & Score — Junetta Cooper Jun 26, 2020 8:09 PM
Date of Completion
Jun 26, 2020 8:09 PM
Junetta Cooper
Age: 75 years
Diagnosis: Primary hypertension, Angina due to coronary artery disease
Score
0 
1  84%
1 
https://simserver.wkhpe.com/debriefing/debrief.aspx?dss=https%3A%2F%2Fsso.wkhpe.com%2FDebriefingLog%2FSingle%3Fid%3D2a17e397-bdaa-4b57-94f8-d428943c2196 1/8
Feedback Log
0:00 You arrived at the patient's side.
 0:00 You reviewed the patient information.
0:00 You reviewed the patient log.
0:00 You reviewed the diagnostics.
0:00 You reviewed the clinical observations.
0:00 You reviewed the MAR.
0:00 You reviewed the 12-lead ECG.
0:00 You reviewed the orders.
0:00 You reviewed the intake and output.
0:00 You introduced yourself.
0:10 Patient status - ECG: Sinus rhythm. Heart rate: 92. Pulse: Present. Blood
pressure: 147/89 mm Hg. Respiration: 16. Conscious state: Appropriate. SpO2:
96%. Temp: 99 F (37 C)
 0:15 You washed your hands. To maintain patient safety, it is important to wash your
hands as soon as you enter the room.
96%. Temp: 99 F (37 C)
 1:30 You identified the patient. To maintain patient safety, it is important that you
quickly identify the patient.
 1:46 You looked for normal breathing. She is breathing at 15 breaths per minute. The
chest is moving equally.
2:08 You measured the <Bloodpressure>blood pressure<> at 150/90 mm Hg.


It is appropriate to monitor the patient by measuring the blood pressure.
96%. Temp: 99 F (37 C)
 2:35 You attached the automatic noninvasive blood pressure (NIBP) measurement
cuff. This will allow you to reassess the patient continuously.
2:39 You asked the patient if she had any pain. She replied: 'No, I don't
have any pain.'
2:45 You asked the patient if she could describe her pain. She replied: 'It felt
heavy, like an elephant was sitting on my chest.'
 2:54 You asked: How would you rate your pain? She replied: 'There is no
pain.'
3:08 You asked the patient: What brings you here? She replied: 'I had some
chest pain this morning. And the nitroglycerin didn't work.'
96%. Temp: 99 F (37 C)
3:20 You asked the patient when the symptoms started. She replied: 'This
morning.'
3:24 You asked: What were you doing when the symptoms started? She replied:
'I was just making breakfast when it happened.'
3:31 You asked the patient if she had any difficulty in breathing. She replied:
'No, my breathing's fine.'
3:36 You asked the patient what other symptoms she had. She replied: 'I
don't think I have other symptoms actually.'
 3:40 The patient developed severe chest pain again.

96%. Temp: 99 F (37 C)
3:49 You asked the patient if she had any medical problems. She replied: 'I
suffer from hypertension and I have heart problems.'
3:58 You asked the patient: Do you take any prescription medication? She replied:
'I take nitroglycerin for chest pain and something for my blood
pressure.'
4:08 You asked the patient if she had taken her medication, if any. She replied:
'I took some nitroglycerin this morning.'
4:24 You asked the patient: Why did you take the medication? She replied:
'What do you mean? I took it to relieve the pain.'
4:40 Patient status - ECG: Sinus tachycardia. Heart rate: 100. Pulse: Present. Blood
96%. Temp: 99 F (37 C)
 5:04 You compared the medication label with MAR. This was reasonable.
 5:31 A 0.4-mg dose of nitroglycerin was given sublingually. It is important to use the
basic rights of medication administration to ensure proper drug therapy. This was
indicated by order.
 5:32 Remember to ask the patient about allergies before administering drugs.
97%. Temp: 99 F (37 C)
6:03 You educated the patient about the drug nitroglycerin.
97%. Temp: 99 F (37 C)
 6:45 You listened to the heart of the patient. This is reasonable. There were regular
heart sounds without murmurs.
7:01 You checked the radial pulse. The pulse is strong, 100 per minute, and regular. It
 is correct to assess the patient's vital signs.
7:31 You measured the <Temperature>temperature<> in the ear. The

temperature was 99 F (37 C).
97%. Temp: 99 F (37 C)
 You should reassess the patient's pain level here.
8:33 You checked the capillary refill time. The capillary refill time was less than 2
seconds.
97%. Temp: 99 F (37 C)
 8:57 A 0.4-mg dose of nitroglycerin was given sublingually. This was indicated by
order.
97%. Temp: 99 F (37 C)
 9:12 You asked the patient if she had any pain. She replied: 'I have some chest
tightness.'
 9:52 You asked the patient if she had any pain. She replied: 'I have some chest
tightness.'

97%. Temp: 99 F (37 C)
96%. Temp: 99 F (37 C)
11:11 You flushed the cannula.
 11:26 You administered 2 mg of morphine IV. It was reasonable to give an opioid here.
11:36 You flushed the cannula.
96%. Temp: 99 F (37 C)
 12:15 You educated the patient about proper use of sublingual medication.
96%. Temp: 99 F (37 C)
 13:22 You changed the lactated Ringer's and 5% Dextrose infusion rate to 100
mL/hr. This was indicated by order.
96%. Temp: 99 F (37 C)
 14:21 You educated the patient about correct storage of medication.
have any pain.'
14:49 You looked for normal breathing. She is breathing at 12 breaths per minute. The
95%. Temp: 99 F (37 C)
15:19 You examined the patient's skin. There is normal elasticity of the skin. Her
color is normal, and she is not sweating.
15:39 You checked the patient's pupils, and they were 4 mm and reactive.
95%. Temp: 99 F (37 C)
 16:00 You assessed the patient's IV. The site had no redness, swelling,
infiltration, bleeding, or drainage. The dressing was dry and intact. This is correct.
Assessing any IVs the patient has is always important.
 16:29 You checked the radial pulse. The pulse is strong, 90 per minute, and regular.
 16:50 You checked the carotid pulse. The pulse is strong, 90 per minute, and regular.
95%. Temp: 99 F (37 C)
 17:10 You phoned the provider in order to discuss the patient.
95%. Temp: 99 F (37 C)
have any pain.'
 18:31 A patient handoff was performed.
Junetta Cooper is a 75-year-old African American female with a 20-year history of

primary hypertension, which is well controlled on medication. She has had stable
(exertional) angina treated with a nitroglycerin patch and sublingual tablets. The
patient came to the emergency room with angina unrelieved by nitroglycerin.
Diagnostic tests indicate she was not experiencing a myocardial infarction (MI),
but the angina pain persisted intermittently. A cardiac catheterization is
scheduled. [newline]When heart muscle is damaged, as in MI, troponin I (TnI)
and troponin T (TnT) leak out of cells and into the bloodstream; increased
troponin levels indicate cardiomyocyte damage. Troponins are not normally
present in serum, so any amount present in serum indicates structural damage to
the heart, although not necessarily an MI. When the TnI is above 0.7 ng/mL or
the TnT is 0.07 ng/mL or higher, MI is suspected.[newline]
[newline]Hydrochlorothiazide is a thiazide diuretic. Hydrochlorothiazide is used to
manage hypertension either as the sole therapeutic agent or in combination with
other antihypertensives. Hydrochlorothiazide blocks the reabsorption of sodium
and chloride ions, increasing the amount of water excreted. Thiazide diuretics are
the most commonly used medication to treat hypertension in African Americans.
[newline][newline]Nitroglycerin belongs to a class of drugs known as nitrates.
Nitrates work by relaxing and widening blood vessels so blood can flow more
easily to the heart, reducing angina.[newline][newline]Side effects of nitroglycerin
include:[newline]- headache[newline]- hypotension[newline]- dizziness or
weakness[newline]- heart palpitations [newline]- nausea and vomiting[newline]-
sweating[newline]- flushing of the skin.[newline][newline] Students will be
expected to perform an initial assessment and review the medications. The
patient is initially pain free, but a few minutes into the simulation, the
patient's chest pain will return. The student should complete a pain
assessment, reassess vital signs, and administer the sublingual nitroglycerin.
Patient education is needed regarding the difference between the sublingual and
patch forms of nitroglycerin as well as storage of the medication.
You got 84%

Feedback Log & Score - Junetta Cooper Jun 26, 2020 8 - 09 PM

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6/26/2020 Feedback Log & Score — Junetta Cooper Jun 26, 2020 8:09 PM

Diagnosis: Primary hypertension, Angina due to coronary artery disease

 0:00 You reviewed the patient information.

0:00 You reviewed the patient log.

0:00 You reviewed the diagnostics.

0:00 You reviewed the clinical observations.

0:00 You reviewed the MAR.

0:00 You reviewed the 12-lead ECG.

0:00 You reviewed the orders.

0:00 You reviewed the intake and output.

0:00 You introduced yourself.

2:08 You measured the &lt;Bloodpressure&gt;blood pressure&lt;&gt; at 150/90 mm Hg.

 3:40 The patient developed severe chest pain again.

pressure: 143/86 mm Hg. Respiration: 21. Conscious state: Appropriate. SpO2:

6:03 You educated the patient about the drug nitroglycerin.

7:31 You measured the &lt;Temperature&gt;temperature&lt;&gt; in the ear. The

 You should reassess the patient's pain level here.

pressure: 125/75 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2:

11:11 You flushed the cannula.

11:36 You flushed the cannula.

 14:21 You educated the patient about correct storage of medication.

chest is moving equally.

 17:10 You phoned the provider in order to discuss the patient.

 18:31 A patient handoff was performed.

Junetta Cooper is a 75-year-old African American female with a 20-year history of

You got 84%

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2:08 You measured the <Bloodpressure>blood pressure<> at 150/90 mm Hg.

7:31 You measured the <Temperature>temperature<> in the ear. The