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VSim Guided Reflection Questions Trisha Jenks

Amelia Sung

Opening Questions
How did the simulated experience of Amelia Sung's case make you feel?
I found myself feeling excited when I realized that this scenario included the patient delivering a baby! I felt
that this was a great scenario, and wanted to get it right, so I re-did it until I was satisfied with my results.
Describe the actions you felt went well in this scenario.
I felt like after the first run-through, I had a fairly good idea of what needed to be done, I just had to figure out
how to get it all done before the patient had the baby.

Scenario Analysis Questions


EBP/I Discuss why shoulder dystocia is an obstetrical emergency.
Shoulder dystocia is an emergency, because it halts the delivery progress. The baby needs to be manipulated to
fit and pass under the pubic symphysis. There are both maternal and fetal complications if the shoulder dystocia
is not resolved quickly.
EBP Name one of the two distinct signs that indicate shoulder dystocia is present.
If there is shoulder dystocia, you may see the baby present with a turtle sign. This means that after the head is
delivered, it get pulled tight against mom. Another sign is the baby’s cheeks may puff out due to the additional
pressure.
EBP List potential problems for Amelia Sung and her baby related to the shoulder dystocia.
Baby complications: asphyxiation, pinched nerves, paralysis of arm, nerve damage, broken clavicle, fractured
arm, contusions.
Mom complications: post-partum hemorrhage, cervical and/or vaginal lacerations, lacerations of the rectum
and/or bladder, femoral neuropathy.
PCC/T&C What preventive measures were put in place related to Amelia Sung's history of a previous
shoulder dystocia?
The patient was placed into a lateral tilt position to help the baby align properly, also a step stool was brought in
close in case the provider needed to provide suprapubic pressure to help release the baby’s shoulder.
S/QI/I Consider what points might be included in a safety checklist for shoulder dystocia.
Education seems to be the first thing that comes to mind. Mom needs to have a thorough interview and the
nurse needs to get a comprehensive history about any problems mom encountered with previous deliveries.
Mom needs to be educated about different positions she can get into that might help encourage baby to get into
the right alignment. The nurse needs to make sure there is a step stool close by in case the provider needs to use
suprapubic pressure.

Concluding Questions
Reflecting on Amelia Sung's case, were there any actions you would do differently? Explain.
I enjoy going through the vSim scenarios, because for me this question resolves itself. I typically redo the
simulation until I can get a perfect, or near perfect score. I find the repetition really helps to reinforce not only
the steps for me, but also the flow of the simulation improves each time.
Describe how you would apply the knowledge and skills that you obtained in Amelia Sung's case to an actual
patient care situation.
I have a deeper appreciation and respect for how urgent shoulder dystocia is, and what needs to be done to get it
resolved as soon as possible. I will watch to see if I get any experience witnessing this in real life practice. I will
be able to ask more focused and direct questions to make sure my patient’s delivery go smooth.

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