NUR4111P

10/2/14

Tim Efremidis
Guide for Reflection
Guide for Reflection Using Tanners (2006) Clinical Judgment Model
Program Thread: Communication and Collaboration
Introduction
This simulation was with a pregnant woman who was having signs and symptoms of preeclampsia. We had to properly assess, anticipate progression, and communicate findings
with the inter-professional team. My partner and I were responsible for the total hands on
care of this patient throughout the simulation.
Background
Our relationship with this patient was solely based on meeting her upon getting report and
interviewing her in regards to her current and past medical history. We had some report of
what her aunt had stated in regards to her being about 8 months pregnant but never having
received any prenatal care.
My recent experiences of having a baby and experiencing the care provided to my wife, who
was borderline pre-eclamptic, have helped me immensely during this simulation. My
knowledge of this simulation is based on our teachings and book reading. My hands on skills
knowledge is based on previous coursework and my current job as an ED tech. My
communication skills have grown throughout nursing school and with my work experience.
I believe that the nurse being pro-active in this situation is vital to the patients outcome. I
also believe we must remember to be there for the patient emotionally as well as treating her
medical issue. It can be very stressful for a patient to watch all of the medical treatment take
place without anyone communicating with her and/or reassuring her she is being taken care
of properly.
My emotions during this simulation were based on the fact that if there were a real scenario,
as we were caring for not just the mother, but also the baby. Knowing that you are caring for
two lives can add more stress and work to the scenario, so being prepared and proactive is
very important.
Noticing
Initially I noticed the patient was in distress and complaining of multiple symptoms that are
consistent with pre-eclampsia. We also noticed her VS were abnormal and quickly realized
that a focused assessment and quick action were necessary. As we continued to assess we
realized that this patient was worsening to eclampsia and needed medical intervention
quickly, not only for her sake but also for the fetus to be ok. As we assessed we also realized
the patient did not have any previous care while being pregnant, which posed a higher risk
for symptoms and sequalae.
Interpreting

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10/2/14

I thought that because she was already having progressive symptoms, she could worsen
quickly due to the fact she had not had any formal prenatal care. I believe that although we
do not know her cause, we know that there a multitude of factors that can lead to preeclampsia (obesity, DM, HTN, family hx, first gravida, etc).
I have experienced fetal monitoring before, so I was aware of the need for it in this patient. I
have also witnessed mag sulfate being given, so there was a need for cardiac monitoring.
I believe that we did a great job in gathering all the necessary assessment data (VS, DTRs,
physical changes, etc.) but could have also checked her urine for amount and protein
(proteinuria and oliguria are a common sign of pre-eclampsia).
Our data and interpretations lead us to believe that this patient had progressed to eclampsia
and should prepare for imminent delivery due to her signs and symptoms as well as her
bleeding and worsening condition.
Responding
Our goal for this patient was to make her more comfortable and ensure her and her fetuss
safety. We would help achieve these goals by controlling the mothers seizures, lowering her
BP, and continuously monitoring and assessing her for changes.
We experience some stress as we were caring for the patient in making sure we were doing
everything properly. We also wanted to ensure that the patients condition did not worsen.
Reflection-in-Action
The biggest event of the simulation was that the patient started seizing. We immediately
ensuring she was safe and administered magnesium sulfate to help stop and further prevent
seizures. The patient responded well and her condition improved. Our next step would be to
have the physician asses her for placental abruption and further prepare her for the OR in
order to safely deliver the fetus. We would also notify the NICU and keep them on standby in
case of delivery.
Reflection-on-Action and Clinical Learning
My nursing care/skills expanded by becoming more proficient and familiar with caring for an
OB patient who experiencing pre-eclampsia/eclampsia. I feel that I should have assessed the
patients urine for protein, made sure that I had calcium gluconate on hand as I administered
Mag Sulfate, and attempted to communicate with the patient to see if she had a support
person she would like us to call. I feel that it would be helpful to become more familiar with
testing urine using the dipstick as well as interpretation of FHR monitoring and changed that
I should be looking for during seizure activity. I feel that my values have grown with this
experience as to become more educated in regards to OB and this particular scenario. Also I
have realized that I need to be more confident in my skills and nursing knowledge when I am
caring for patients, whether in the hospital or in a simulation.