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Olivia Jones Guided Reflection
OB/Pediatric (NUR223)
Helene Fuld College of Nursing
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Maternity Case 2: Olivia Jones (Complex)
Guided Reflection Questions
Opening Questions How did the simulated experience of Olivia Jones’s case make you feel?
I was really feeling empathetic with O. She was having such a hard time with her pregnancy, I wanted to give her anything she needed. She had a terrible headache that could not be relieved, and since I have a long history of migraines, I can understand how terrible they are. She was also having a lot of other symptoms that must have made her just feel so terrible, and the simulation made me want to take the best care of her and get her some relief as soon as possible.
Describe the actions you felt went well in this scenario.
This patient, unfortunately, had a lot going on. I felt that I was thorough in assessing her symptoms and gathering information. I feel that I asked a lot more than the simulation required because I wanted to practice being as thorough as possible so I could analyze the information that was priority. I wanted to get her some relief so she could feel better as soon as possible. But the physical assessment portion of this simulation was thorough as well. I took a lot of vital signs, called the doctor with new information, followed orders effectively and efficiently, and comforted the patient.
Scenario Analysis Questions 1 EBP What are the indications that Olivia Jones’s preeclampsia has progressed?
Some indications that preeclampsia has progressed would be elevated BP and FHR, nausea, “severe pain under right breast” (RUQ pain), headache, visual changes, chest tightness.
PCC What should the priority teaching for Olivia Jones include?
I will educate O. about her increasing symptoms are evidence of preeclampsia and what that means. She needs to understand seizure precautions and how to prepare for that. She needs to also understand the importance of bed rest and reducing stress. I will educate her on any medications given and why.
PCC/I Olivia Jones was placed on magnesium sulfate for treatment of her preeclampsia. What are the indications for this drug, and what should be taught to the patient regarding side effects?
1 The Scenario Analysis Questions are correlated to the Quality and Safety Education for Nurses (QSEN) competencies: Patient-Centered Care (PCC), Teamwork and Collaboration (T&C), Evidence-Based Practice (EBP), Quality Improvement (QI), Safety (S), and Informatics (I). Find more information at: qsen/
From vSim for Nursing | Maternity. © Wolters Kluwer Health.
Magnesium sulfate is given to prevent seizures associated with preeclampsia. I will educate O. on possible side effects such as decreased respiration, decreased deep tendon reflexes, decreased urine output, and drowsiness. I will want her to know that we will be monitoring her closely and taking good care of her.
T&C What key elements would you include in the handoff report for this patient? Consider the situation-background-assessment-recommendation (SBAR) format.
Situation: blood pressure, pulse, FHR, respiration rate and depth.
Background: O. is at 36 weeks of gestation. She has been diagnosed with severe preeclampsia and is being monitored in the L&D unit. Her blood pressure has been elevated, proteinuria was present, she has gained 3 pounds in the last week, and she has a headache that cannot be relieved with acetaminophen. She has reported vision changes and is seeing spots.
Assessment: O. reported her headache was a 5 on a 0-10 scale and her RUQ pain was a 4. Edema was assessed and upgraded to +3. Respiration rate and temperature are normal. Her most recent vitals were Heart rate: 101. Pulse: Present. Blood pressure: 166/100 mmHg. Respiration: 22. Conscious state: Appropriate. SpO2: 98%. Temp: 37 C. Per order, the patient was put on 10L O2 via nonrebreather.
Recommendation: Magnesium sulfate administration is recommended, vital signs and FHR should be assessed continuously.
S What safety measures should be initiated while Olivia Jones is in the hospital?
O. needs to remain on fall and seizure precautions.
S/QI Based on your experience with Olivia Jones’s case, reflect on possible nursing actions for enhanced safety and quality improvement.
Because of O.’s seizure precautions and headache, it would be a good idea to decrease stimuli such as light and noise. I would continue bed rest for this patient, put fall and seizure precautions in place, put the patient’s bed lowest setting with the hand rails up, and limit the amount of visitors.
Concluding Questions Reflecting on Olivia Jones’s case, were there any actions you would do differently? Explain.
After administering magnesium sulfate, I did a few assessments. But I failed to reassess her mental status afterwards. I definitely should have also checked her pain levels again to see if there were any changes in her headache or RUQ pain later in the simulation.
From vSim for Nursing | Maternity. © Wolters Kluwer Health.
Olivia Jones Guided Reflection
Course: OB/Pediatric (NUR223)
University: Helene Fuld College of Nursing
