Vsim Nursing Assignment #1: Toua Xiong 501 Pathophysiology and Pharmacology Gelsey Jian University of Maryland School of Nursing 9/14/18

VSim Nursing Assignment #1: Toua Xiong
Jian 1

501 Pathophysiology and Pharmacology
Gelsey Jian
University of Maryland School of Nursing
9/14/18
Jian 1
Toua Xiong is a 64 year old male admitted to the hospital for throat pain. He had been
diagnosed with COPD previously and stated he had taken all his prescribed medication before
arrival. These medications were as follows:
Name Mechanism Indication Side Nursing Education

of Action of use effects/drug consideration points
interactions s
Generic: Antifungal. Thrush/ Side effects: For local Tell patient
Nystatin Binds to oral nausea, infections to monitor
Brand: steroid candidiasis vomiting, only. Avoid skin for
Nystop, Nyader alcohols in treatment[1] diarrhea, rash, skin contact rashes,
m[1] the fungus’s allergic and monitor redness,
cell reactions for skin swelling, or
membrane to Drug rashes[1] any
increase interactions: irritation.
permeability Inhibits effect Do not use
and cause of too much
leakage of progesterone[1 mouthwash
]
intracellular . Continue
components. use after 2
Administered days of
orally or symptom
topically[1] relief.[1]
Generic: Anticholinerg Reduce Side effects: Do not use Tell patient
Ipratropium ic. Ach exacerbatio headache, intranasally how to
bromide antagonist at n of nausea, for more than properly
Brand: muscarinic asthma[2] dizziness, 4 days. Be use an
Atrovent[2] receptors. chest pain, wary of inhaler and
Dilates hypertension, leakage nebulizer.
smooth blurred during Remind
bronchial vision, muscle nebulizer them this
muscles. pain, treatment drug will
Inhaled or coughing, because of not treat
administered difficult eye irritation. bronchospa
intranasally[2] breathing, Monitor sms when
bronchospasm patients with it is an
s, allergic glaucoma.[2] emergency
reaction that
Drug requires a
interaction: rapid
potentiates response. A
effects of minimum
other of 2 minute
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anticholinergi should pass

c drugs[2] between
the 1st and
2nd
inhalation.
Avoid eye
contact[2]
Generic: Anti- Reduce Side effects: Monitor liver Tell patient
Fluticasone inflammatory exacerbatio headache, enzyme how to
propionate corticosteroid n of nausea, levels, RR, properly
Brand: Advair[3] . Beta-2 COPD[3] vomiting, and skin. Do use an
agonist that diarrhea, URI, not use in inhaler.
dilates lower patients that They
smooth respiratory have should not
bronchial infection, controlled exhale into
muscles and coughing, asthma with the inhaler.
inhibits bronchitis, inhaled Store in a
mediator muscle pain, corticosteroid dry, cool
release. appendicitis, s. It is not an place and
Inhaled[3] skin infection, emergency do not
pneumonia, inhaler that wash any
allergic can be used to part of the
reaction stop an inhaler.
Drug asthma attack, Throw
interactions: and once away once
Can cause asthma is used up or
severe maintained, after one
bronchospasm medication month.
s if used with should be Rinse after
beta blockers. discontinued. use to
Potentiates prevent
adverse fungal
affects of infections.
[3
ketoconazole Tell patient
]
that effect
may not be
seen for up
to a week
or longer.
Do not
exceed
prescribed
dose. If
exposed to
chickenpox
or measles,
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seek
medical
help
immediatel
y.
Reflection of the virtual scenario reveals many points to address. Even though everything
in the provider’s orders was done correctly, some things were done unnecessarily and others
were done in a peculiar order. First of all, BP was measured twice, once manually and once with
a NIBP. The NIBP would have been attached first, eliminating the need to measure BP manually.
The NIBP also helps monitor BP continuously, which is not possible with the manual cuff.
Medication reconciliation should have been performed earlier in the scenario, particularly in the
beginning when Mr. Xiong was asked about his allergies. This would give the nurse a better
picture of what they would need to inform the provider and it would make more sense to the
patient, rather than being asked their medication regime randomly after all assessments have
already been completed.
In caring for Mr. Xiong, several things must be taken into consideration. He is 64, which
is not yet old enough for most risk factors associated with old age, but the nurse might want to
monitor him closely anyways. He is also on oxygen, which means his O2 levels and saturation
must be monitored frequently to prevent hypoxemia[4]. In addition, one of his chief complaints is
throat pain and difficulty swallowing. This can make providing him with adequate nutrition
difficult. If it hurts to swallow hard food, a nurse might want to provide him with liquids and soft
foods, like pudding-consistency foods or soups[6]. This would likely help reduce the pain in his
throat. All patients should be closely and carefully monitored as often as possible, and their vital
signs frequently checked. In this case, vital signs related to the heart and lungs are a strong
priority due to Mr. Xiong’s previous COPD diagnosis and current observational wheezing.
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In a hospital setting, all patients present with one or more priority problems. In Mr.
Xiong’s case, the most pertinent issues are associated with his lungs and throat. One problem
was diagnosed as an ineffective breathing pattern related to O2 therapy in COPD, as evidenced
by wheezing sounds in lungs heard during auscultation[5]. His respiration rate was 19, within
normal range, and relatively regular. However, audible wheezing is still an indication that
something is abnormal in the lungs. Therefore, the nurse should make it a priority to monitor his
respiration rate and check his O2 saturation in case his breathing becomes more labored or his
O2 saturation drops too low. A second problem that needed to be addressed was diagnosed as
impaired swallowing related to upper airway anomaly, as evidenced by difficulty swallowing
and esophageal pain. This is an issue for his nutritional status and means he may not be able to
eat the foods he needs to be nutritionally adequate. While he is in the hospital, care must be taken
to offer him food that he can eat with the least amount of difficulty while still providing him with
the nutrition he needs. Should his nutritional status fall, he could be at risk for malnourishment or
deficient for important bodily proteins.
Before release, it is imperative Mr. Xiong is well educated and confident about his future
course of treatment. It is the job of the nurse to provide him with this education. They should
teach him the proper use of all his medical equipment, including his portable oxygen tank and
inhalers. The nurse should tell him to store the inhalers in dry, cool places and not to wash them
if at all possible, to reduce risk of exposure to moisture[3]. Mr. Xiong should also be taught to
rinse and clean his mouth after use to reduce the risk of another fungal infection[3]. In terms of
treated the Thrush he already has, the nurse should tell Mr. Xiong to take all of his prescribed
medication at the proper time intervals through the course of the infection, and two days after
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visible signs are relieved[1]. In addition, nurses should always tell patients to watch for signs of an
allergic reaction. Mr. Xiong should be able to repeat back key points of education to ensure that
he fully understands how he is to progress after his discharge to prevent another hospital visit in
the near future.
Although the scenario presented was simply a computer simulation, it has many real
world applications. It provides an opportunity to see how patients and nurses operate in a
hospital setting and emphasizes key points such as hand hygiene, vital sign assessments, and
medication reconciliation that help to provide patients with the safest and highest quality of care.
Nursing should always be patient-focused, as acknowledged by the case of Mr. Xiong. In a real
hospital setting, medication reconciliation should always be performed and should always
include OTC and herbal drugs or supplements to prevent unknowing drug interactions. These can
be dangerous or even fatal. The introduction of the NIBP was also a helpful technique that can be
used in a real hospital setting as it eliminates the need to monitor BP manually and allows
continuous monitoring. This is more helpful for patients with an immediate concern for BP
changes rather than Mr. Xiong, but in general all patients should have their vital signs checked
frequently. At the end of the simulation, the provider was called. In a real hospital setting, this is
highly important in order to proceed with the treatment care. Nurses cannot operate without
orders, so it is imperative the provider come in to assess the patient as well, as soon as possible,
to generate new orders. At the end of the hospital stay, the patient should be discharged with
confidence and an increased health literacy in regards to their own treatment, knowing that they
received the highest quality of care from their nurses.

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References
[1] Nystatin. (n.d.). Retrieved September 14, 2018, from
http://lnareference.wkhpe.com/ref/view.do?
key=61410f7bc42ac377d2bb0c55e25129aacba94af1&nmn=openMonographFromGlobalId&mo
nographId=mono_nystatin&cssUrl=http://download.lww.com/simulation/lns_branding/vsimforn
ursing.css
[2] Ipratropium bromide. (n.d.). Retrieved September 14, 2018, from
http://lnareference.wkhpe.com/ref/view.do?
nographId=mono_ipratropium_bromide&cssUrl=http://download.lww.com/simulation/lns_brand
ing/vsimfornursing.css
[3] Fluticasone propionate–salmeterol inhalation powder. (n.d.). Retrieved September 14, 2018,
from http://lnareference.wkhpe.com/ref/view.do?
nographId=mono_fluticasone_propionate_and_salmeterol_inhalation_powder&cssUrl=http://do
wnload.lww.com/simulation/lns_branding/vsimfornursing.css
[4] Stoller, J. K., Panos, R. J., Krachman, S., Doherty, D. E., Make, B., & the Long-term Oxygen
Treatment Trial Research Group. (2010). Oxygen Therapy for Patients With COPD: Current
Evidence and the Long-Term Oxygen Treatment Trial. Chest, 138(1), 179–187.
http://doi.org/10.1378/chest.09-2555
[5] Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2016). Nurses pocket guide: Diagnoses,
prioritized interventions, and rationales. Philadelphia: F.A. Davis Company.
[6] Sura, L., Madhavan, A., Carnaby, G., & Crary, M. A. (2012). Dysphagia in the elderly:
management and nutritional considerations. Clinical Interventions in Aging, 7, 287–298.
http://doi.org/10.2147/CIA.S23404

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VSim Nursing Assignment #1: Toua Xiong

VSim Nursing Assignment #1: Toua Xiong

arrival. These medications were as follows:

Name Mechanism Indication Side Nursing Education

anticholinergi should pass

already been completed.

was diagnosed as an ineffective breathing pattern related to O2 therapy in COPD, as evidenced

impaired swallowing related to upper airway anomaly, as evidenced by difficulty swallowing

deficient for important bodily proteins.

the near future.

received the highest quality of care from their nurses.

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