VSim #3- Doris Bowman
1. How did the scenario make you feel?
I really enjoyed the scenario with patient Doris Bowman. Doris is a 39-year old
female who underwent a total abdominal hysterectomy with bilateral salpingooopherectomy. This is the removal of the cervix, ovaries, uterus, and fallopian ...
1. How did the scenario make you feel?
I really enjoyed the scenario with patient Doris Bowman. Doris is a 39-year old
female who underwent a total abdominal hysterectomy with bilateral salpingo-
oopherectomy. This is the removal of the cervix, ovaries, uterus, and fallopian tubes. She
tolerated the procedure well. Doris has an abdominal incision covered with a 4x4 gauze
dressing and there is no drainage. I was in charge of caring for Mrs. Bowman in the
PACU, which is where a patient remains until they recover from the effects of anesthesia,
is oriented, and has stable vital signs with no evidence of complications.
I started by checking Doris’s vital signs. When asked about pain she replied, “It’s
pretty bad, I’d give it a 6.” I then gave her a 2mg dose of Morphine. She immediately
started developing respiratory depression. Her breaths decreased from 21 to 8 breaths
per minute. I screamed for help, ventilation was started at a rate of 2, and she was
administered 0.2mg of naloxone IV. This is given to reverse the effect of the morphine.
The ventilator was stopped when I saw Doris begin to breathe normally. This was the
appropriate thing to do.
2. What further intervention would have been required if naloxone hydrochloride
(Narcan) had not been effective in this case?
If the first dose of naloxone hydrochloride was not effective within 2-5 minutes.
Another dose should be given. Repeated doses may be necessary if a person is still
showing signs of overdose even after the first dose. Narcan will not hurt you- it only
affects people who are using opioids. Rescue breathing should also be done while
waiting for the naloxone to take effect. If a victim is not responsive to stimulation, not
breathing, and has no pulse after receiving naloxone and rescue breathing, then the
victim needs cardiopulmonary resuscitation (CPR) via a trained bystander and the
emergency medical system.
3. Discuss readiness for discharge from PACU criteria.
A patient remains in PACU until fully recovered from anesthetic agent. Indicators
of recovery include a stable BP, adequate oxygen saturation level and respiratory
function. The Aldrete Score is used to determine a patient’s general condition and
readiness for transfer from the PACU. During the recovery period, a patient’s physical
signs are observed and evaluated by a scoring system. The patient is assessed at regular
intervals and a total score is calculated on the assessment record. The Aldrete score is
between 7 and 10 before discharge from the PACU. The patient is discharged from the
phase I PACU by the anesthesiologist or CRNA to the critical care unit, med-surg unit,
phase II PACU, or home with a responsible adult.
Prior to discharge, the patient will require verbal and written instructions and
information about follow-up care. The patient and caregiver are informed about
expected outcomes and immediate postop changes anticipated. Prescriptions are given
to the patient along with the nursing unit or surgeon’s telephone number.
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