NR 305 Discussion: Debriefing of Week 3 iHuman Cardiovascular Assessment

Sample Answer for NR 305 Discussion: Debriefing of Week 3 iHuman Cardiovascular Assessment Included After Question

Purpose

The purpose of this debriefing is to re-examine the experience completing the Week 3 iHuman Cardiovascular Assessment assignment while engaging in dialogue with faculty and peers. In the debriefings, students:

  • Reflect on the simulation activity
  • Share what went well and consider alternative actions
  • Engage in meaningful dialogue with classmates
  • Express opinions clearly and logically, in a professional manner

A Sample Answer For the Assignment: NR 305 Discussion: Debriefing of Week 3 iHuman Cardiovascular Assessment

Title: NR 305 Discussion: Debriefing of Week 3 iHuman Cardiovascular Assessment

What went well for me in the simulation is that I didn’t ask any inappropriate questions.  I also managed to go in depth concerning the diagnosis that admitted Mr. Granger into the hospital.  I felt knowledgeable and confident in my skills when my findings were as expected (edematous bilateral lower extremities, crackles in the lung bases, low oxygen saturation).  The scenario was realistic because many of the findings were consistent with a patient suffering from exacerbation of heart failure.

The thing that I would do differently is inquire more about lifestyle choices.  I was surprised to learn that Mr. Granger was a smoker (he smoked cigarettes).  You would think that with a diagnosis such as heart failure, that he would pursue smoking cessation. 

The simulation reinforced things I find valuable with treating heart failure exacerbations such as daily weights and dietary/fluid restrictions.  I have no questions related to the scenario.

I did not do as well with the cardiovascular Assessment.I was frustrated and disappointed, because I felt I was prepared. After review I realized I missed a section of questions. I did the simulation a second time and that was better. I was confident in knowing the appropriate questions for the admitting diagnosis which lead to a smoother physical assessment. Ex irregular heart and lung sounds.

If I were caring for a patient similar to Mr. Granger I would address the smoking and nutrition issues sooner. I would ask if he would be interested in a nicotine patch or gum while hospitalized . I would also share information about the smoking cessation options. This would give me more insight to where he’s at on this issue and allow me  time to continue building a trusting rapport and educate as the rapport builds.  The simulation is realistic . working with patients with heart failure they usually have edema, fluid overload,weight gain and you have to start patient education  and discharge planning early. 

This simulation reinforces the importance of a thorough assessment, patient education and building a trusting rapport. I have no questions at this time.

Last week with the Michael Granger assignment I felt a lot more comfortable going through the history questions. I knew what base questions to ask and then pinpointed the areas that I needed more information on to perform the rest of the assessment. For example, Mr. Granger said that he had an 8-lb weight gain, leg swelling, and shortness of breath during the history questioning, so I made sure to focus on those areas and ask more in-depth questions. I was trying to figure out when the symptoms started, if he had tried to treat any of them, and if they got worse at certain times. This then helped in the physical assessment because I knew the areas I wanted to really focus on for abnormalities. I feel like this is a very realistic scenario because I have had several patients with these exact symptoms and experiences when I worked in the ICU.

One thing I would like to have done differently is to get a second opinion on the sounds in the heart. I have a terrible time distinguishing between different heart sounds, no matter how many videos I watch or audios I listen to. So, I would have liked to grab another nurse or even my charge nurse to listen to the sounds to verify what I was hearing, because the first time around I diagnosed the sound as a heart murmur. Listening to heart sounds and being able to differentiate between them is something that I have and will continue to work on. It is a necessary skill for our job, it’s just a tough one for me. I did receive feedback from iHuman on this one, which did not surprise me, because I labeled the heart sound incorrectly.

The other piece of feedback that I received that did surprise me a little bit (but in retrospect shouldn’t have) was that I labeled the blood pressure as normotensive, and it was supposed to be high. I have been a nurse for a few years now and I know that the textbook blood pressure is 120/80, but I have had patients with blood pressures all over the place and we tend to not balk too much at a blood pressure that is like 138/88 or something along that line. Yes, that is high and coupled with Mr. Granger’s other symptoms is not ideal, so I understand why I got the feedback on that one.

From this simulation, I learned the importance of distinguishing between heart sounds and realizing that if I can’t figure it out, I need to ask for help in that area. I also learned that even though I have been doing this for a while now I still need to pay attention to all my patient’s symptoms collectively. I tend to focus on symptoms that are very severe and diminishing symptoms that I feel can be treated quickly. While this may work for a few patients it’s not good practice to maintain.

I need to evaluate everything that is going on with my patients to figure out why they are having certain symptoms, be able to communicate with the doctor about what the patient may need, and, most importantly, for patient safety. I tend to get into a daily routine when I have patients with a lot of similar symptoms, and I need to remember that it is important to differentiate between my patients and treat their symptoms individually.