VSIM 칼라 에르난데스 Carla Hernandez 제대탈출 5단계 documentation assignments

소개

"VSIM 칼라 에르난데스 Carla Hernandez 제대탈출 5단계 documentation assignments"에 대한 내용입니다.

목차

1. Document your initial assessment data for Carla Hernandez, including fetal heart rate activity (baseline fetal heart rate, long-term variability, accelerations, and decelerations) and maternal vital signs.
2. Document the medication(s) that you administered.
3. Document your situation-background-assessment-recommendation (SBAR) communication to Carla Hernandez's provider and note any provider orders that were obtained during this simulation activity.
4. Document the time that the umbilical cord prolapsed during this simulation and the nursing interventions that were taken, including the timing. Note an evaluation of the effectiveness of these measures in resolving the problem identified, and the times that the provider was notified.
5. Document the fetal heart rate monitoring and any abnormalities.
6. Record the communication that was expressed to Carla Hernandez's husband, Earl.
7. Document how the health care team worked together during this simulation and state your recommendations for improvement.

본문내용

1. 초기 평가
폐음
숨소리가 맑고 양방향으로 균일하다.

V/S
초기137/80-90-16-37-97% EFM: 조기하강 FHR 89
약물 투여 직전134/80-87-15-37-99% EFM: 기준선 FHR 93
약물 투여 직후138/82-87-15-37-99% EFM: 기준선 FHR 104

통증
NRS 2점이고 수축할 때 허리와 흉부, 아랫배가 아파요.

가변성, 가속도

2. 투여 약물
황산 테르부탈린 피하의 0.25mg
Regular medicine: terbutaline 0.25mg SQ STAT
자궁 경부 근육 이완을 통해 제대압박 해결

성인
0.25mg의 하위절단. 필요하면 15분에서 30분 후에 반복한다. 최대, 4시간 동안 0.5mg.

환자 교육
불안, 두근거림, 또는 심장이 뛰는 것처럼 느낄 수 있습니다.
두드러기, 가슴 조임, 심한 기침, 피부색 파랗거나 호흡곤란 등을 즉시 보고해주세요.

참고자료

· 없음