Lecture notes
Edith Jacobson VSIM
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This document provides post scenario analysis of Edith Jacobson's case in VSIM Nursing with APA citation.
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Case: Edith JacobsonVSIM Post Scenario Analysis and Reflection Activity (Adapted from VSim For Nursing & Wolters-Kluwer)
Review the medication list from the Electronic Health Record (HER) and please complete the medication research table below based on the medication listed in the assigned VSIM.
Medications – Classification and action Indication Side Effects Nursing Implications
Generic and Trade (reasons why this (pre and post assessments a nurse should be aware of
Names medication is prescribed prior to and after giving this medication)
for?)
1. Enoxaparin Classifications: Anticoagulant; Low Uses: DIGESTIVE: Abnormal liver function Assessment
Molecular Weight Heparin; − Prevention of deep vein tests. HEMA: Hemorrhage, − Monitor the ff.: platelet count (closely), withhold
Antithrombotic thrombosis (DVT) after thrombocytopenia, ecchymoses, drug and notify prescriber if platelet count less than
anemia; RESP: Dyspnea. Skin: Rash,
hip, knee, or abdominal − 100,000/mm3; (closely) patients with renal
pruritus; SYS: Allergic reactions
Action: surgery, treatment of insufficiency and older adults who are at higher risk
(rash, urticaria), fever, angioedema,
− Low molecular weight heparin DVT and pulmonary arthralgia, pain and inflammation at for thrombocytopenia; any sign or symptom of
with antithrombotic properties. embolism, management injection site, peripheral edema, unexplained bleeding;
− Does affect thrombin time (TT) of acute ST elevation fever (Shields et al., 2019, p. 587- − Report immediately for the ff.: any sign or
and activated thromboplastin myocardial infarction 588). symptom of unexplained bleeding; S&S of
time (aPTT) up to 1.8 × the control (STEMI), unstable angina, neurological impairment.
value. non-Q wave MI (Shields − Monitor lab tests: Baseline coagulation studies;
− Antithrombotic properties are et al., 2019, p. 587-588). periodic CBC, platelet count, urine and stool for
due to its antifactor Xa and occult blood.
antithrombin (antifactor IIa) in the
coagulation activities. Patient & Family Education
− An effective anticoagulation − Report to prescriber promptly signs of unexplained
agent, it is used for prophylactic bleeding such as: Pink, red, or dark brown
treatment as an antithrombotic urine; red or dark brown vomitus; bleeding gums or
agent following certain types of bloody sputum; dark, tarry stools.
surgery. (Shields et al., 2019, p. − Do not take any OTC drugs without first consulting
587-588) prescriber (Shields et al., 2019, p. 587-588).
2. Raloxifene Classifications: Selective Estrogen Uses: CV: Hot flashes, chest pain, Black Box Warning: Raloxifene has been associated with
Hydrochlorid Receptor Antagonist/Agonist; peripheral edema, decreased serum increased risk of venous thromboembolism and
e Osteoporosis Prophylactic ● Prevention and treatment cholesterol; CNS: Migraine death from stroke.
of osteoporosis in headache, depression, insomnia. GI:
Action: postmenopausal women; Nausea, dyspepsia, vomiting, Assessment
breast cancer prophylaxis. flatulence, GI disorder, ● Monitor: carefully for and immediately report S&S
● Exhibits selective estrogen (Shields et al., 2019, p. gastroenteritis, weight gain. RESP: of thromboembolic events; Lab tests: Periodic LFTs;
receptor antagonist activity on 1402-1403). Sinusitis, pharyngitis, cough, with concurrent oral anticoagulants, periodic PT
uterus and breast tissue. pneumonia, laryngitis; INTEG: Rash, and INR.
● Prevents tissue proliferation in sweating; UROGEN: Vaginitis, UTI,
both sites. cystitis, leukorrhea, endometrial
1
, Case: Edith Jacobson
VSIM Post Scenario Analysis and Reflection Activity (Adapted from VSim For Nursing & Wolters-Kluwer)
● Decreases bone resorption and disorder, breast pain, vaginal ● DO NOT: give drug concurrently with
increases bone density. bleeding; SYS: Infection, flu-like cholestyramine; however, if unavoidable, space the
● Effectiveness indicated by syndrome, leg cramps, fever, two drugs as widely as possible.
increased bone mineral density. arthralgia, myalgia, arthritis (Shields
● Reduces the risk of invasive et al., 2019, p. 1402-1403). Patient & Family Education
breast cancer in high risk ● Contact prescriber immediately if unexplained
postmenopausal women (e.g., calf pain or tenderness occurs.
breast cancer in situ, or atypical ● Avoid prolonged restriction of movement during
hyperplasia) (Shields et al., 2019, travel.
p. 1402-1403). ● Drug do not prevent and may induce hot flashes.
● Do not take drug with other estrogen-containing
drugs.
● Raloxifene is normally discontinued 72 h prior to
prolonged immobilization (e.g., post-surgical
recovery, prolonged bed rest). Consult prescriber
(Shields et al., 2019, p. 1402-1403).
Scenario Specific Questions
1. What priority problem(s) did you identify for Edith Jacobson? Activity and exercise
2. Document your focused skin assessment of Edith Jacobson. 10/11/2020 at 1555h
Based on the scenario, the findings regarding Mrs. Jacobson’s skin status are the ff.:
Skin
● Has normal elasticity,
● normal color (appropriate to her background),
● no sweating
IV site
● has no redness, swelling, infiltration, bleeding/ drainage.
● the dressing was dry and intact
3. Identify the pertinent assessments to be carried out with Edith Jacobson Aside from Skin assessment, the following are the pertinent assessments to be carried out with
(HINT: you may use the head to toe assessment tool during the Simulation Activity) Edith Jacobson:
PAIN
✔ Location
✔ PQRST
MUSCULOSKELETAL (Kozier et al., 2018, p.605)
✔ Inspect Muscles
✔ for size 🡪 (identify the discrepancies by measuring muscles with a tape)
✔ (+tendons) for contractures/shortening
✔ for tremors 🡪 (have the client hold the arm out in front of the body)
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