Michelle Pinkhasova

NUR 377 Advanced Medical Surgical Nursing

vSim Course Point Pharmacology: Junetta Cooper

Please complete the below activities to receive credit for the virtual simulation assignment.
A rubric is available under the “assignments” tab in BlackBoard, so you can review the
entire point breakdown.
 Pre-simulation Quiz, vSim and post-simulation quiz for Junetta Cooper in the
Pharmacology vSims.
o You do not need to complete the Documentation Assignment within vSim
o The Guided Reflection Questions within vSim are included within this Simulation
Worksheet
o Must achieve an 80% on the vSim with a maximum of 3 attempts
 The simulation worksheet (below)
 Submit the following to Blackboard by Wednesday May 20, 2020 at 9:00am EST
o Simulation Worksheet; information must be typed and submitted as a word doc
o Screenshot of pre-quiz score, post-quiz score, and vSim feedback
Simulation Worksheet
Describe the disease process affecting patient (include Pathophysiology of Disease
Process)
Angina due to Coronary Artery Disease:
Angina occurs when the load on the heart and the resulting myocardial oxygen demand exceed
the ability of the coronary arteries to supply an adequate amount of oxygenated blood.
Narrowing of the lumen is usually the result of atherosclerosis of the coronary artery, although
it may also be due to a spasm of the coronary artery or a stroke in the coronary artery. Angina
from coronary heart disease can be Stable and Unstable, in patients with stable angina, the
relationship between workload or myocardial demand and ischemia is usually quite
predictable, whereas in unstable angina it worsens clinically, for example, the angina at rest or
increased frequency and intensity of episodes, in patients whose cardiac biomarkers do not
meet the criteria for myocardial infarction.

Explain the following diagnostic tests (Include reason for test and result if applicable):
Cardiac Catheterization:
Cardiac catheterization is a procedure used to diagnose and treat certain cardiovascular
conditions. During cardiac catheterization, a catheter is inserted in an artery or vein and
threaded through your blood vessels to your heart. This can not only detect different heart
conditions but can check how your heart muscle is working.

Electrocardiography (ECG):
An electrocardiogram (ECG) is a test which measures the electrical activity of your heart. It is
used to show if the heart muscle is working normally. This test can often detect heart
disease, heart attack, an enlarged heart, or abnormal heart rhythms that may cause heart
failure. This patients ECG showed sinus rhythm with heart rate of 93 beats per minute.

Explain the following lab values and what the listed result means for the patient (normal
values are noted in the parentheses):
CK-MB (Creatine Kinase MB) (0.0-4.9ng/ml) 1.7: This test measures the amount of an
isoenzyme of creatine kinase (CK) in your blood. The patient has normal blood CK-MB
level. The value of the patient creatine kinase MB is within the reference range. This thus
demonstrates that the patient does not have any significant myocardial cell injury due to
hypoxia or other injuries. Thus the patient does not have myocardial infarction.
If the patient had value more than the upper reference value, it could have indicated major
myocardial cell injury which occur in conditions such as myocardial infarction.

Troponin T (0.0-0.1ng/ml) 0.05: The patient troponin T is within the normal reference range.
This indicate the patient does have any condition characterized by injury to heart cells that
may be caused by hypoxia such as myocardial infarction.

Medications: List classification, why is it prescribed for the patient and nursing
considerations.
Nitroglycerin 0.4 mg sublingual PRN:
 Classification: antianginals
 Use: acute and long-term prophylactic management of angina pectoris
 Nursing Considerations:
- Monitor BP and pulse before and after administration.
- May repeat q 5 min for 2 additional doses for acute attack
- Inform patient that headache is a normal side effect of this medication
- Exposure to air, heat, and moisture causes loss of potency

Morphine 2 mg IV push PRN:

 Classification: opioid analgesic
 Use: severe pain
 Nursing Considerations:
- Assess level of consciousness, BP, pulse, and respirations before and periodically
during administration

Aspirin 162 mg PO 1x daily:

 Classification: antipyretic
 Use: prevention of transient ischemic attack
 Nursing Considerations:
- Do not crush or chew enteric-coated tablets
- Monitor for the onset of tinnitus, headache, hyperventilation, agitation, mental
confusion, lethargy, diarrhea, and sweating

Clopidogrel 300 mg PO 1x daily:

 Classification: antiplatelet agents
 Use: reduction of atherosclerotic events (MI, stoke, vascular death) to those at risk
 Nursing Considerations:
- Monitor patient for signs of thrombotic thrombocytic purpura
 - Assess patient for symptoms of stroke, peripheral vascular disease, or MI periodically
during therapy.
- Monitor bleeding time during therapy

Fondaparinux 7.5 mg SC 1x daily:

 Classification: anticoagulant
 Use: Prevention and treatment of DVT and PE
 Nursing Considerations:
- Assess signs of bleeding and thrombocytopenia, including bleeding gums, nosebleeds,
unusual bruising, black/tarry stools, hematuria, or a sudden fall in hematocrit or blood
pressure.
- Assess blood pressure periodically 
- Pt should use soft toothbrush and electric razor
- Avoid injury that can cause bleeding

Hydrochlorothiazide 25 mg PO 2x daily:
 Classification: Thiazide diuretics
 Use: management of hypertension
 Nursing Considerations
- Monitor fluid intake and output, weight, BP, and electrolyte levels; correct electrolyte
disturbances before start of therapy.
- Watch for signs and symptoms of hypokalemia, such as muscle weakness and cramps.
- Drug may be used with potassium-sparing diuretic to prevent potassium loss.

Simvastatin 40 mg PO 1x daily
 Classification: HMG-CoA reductase inhibitors
 Use: to manage cholesterol levels
 Nursing Considerations:
- Avoid grapefruit juice during therapy
- Monior liver function
- Instruct patient to notify health care professional if unexplained muscle pain,
tenderness, or weakness occurs, especially if accompanied by fever or malaise.

Scenario Analysis Questions:

1. What priority problem(s) did you identify for Junetta Cooper?
Priority problems for the patient were uncontrolled chest pain (angina), high blood
pressure (Stage 1 hypertension), coronary artery disease and a suspected myocardial
infarction.

2. Identify Junetta Cooper’s risk factors specific to cardiovascular disease?

Patient has a 20-year history of hypertension, is over the age of 65 and she is also African
American. These are risk factors for cardiovascular disease that apply to the patient.
 3. What potential problem could arise from sublingual nitroglycerin therapy, and
what teaching should be included specific to this potential problem?

Patients may experience an intense headache right after the administration of sublingual
nitroglycerin. It is important to inform the patient that this is a common side effect and to
not be alarmed or concerned. Patients can take acetaminophen for the pain from the
headache and it should subside within an hour.

4. Discuss the potential synergistic effect(s) of Junetta Cooper’s medication, and

identify the potential side effect this could cause.

It is important to monitor blood pressure and heart rate because the combination of
nitroglycerin and morphine can increase the risk of hypotension. Morphine can decrease
heart rate and blood pressure and nitroglycerin decreases preload and heart rate as well,
inadvertently decreasing blood pressure. It is very important to monitor blood pressure as
well as assess the patient for any dizziness, lightheadedness and orthostatic hypotension
upon sitting and standing.

5. Path to Death or Injury: (What is the worst thing that can happen to your patient
and how will you prevent it?)

Patient can experience an MI. This can be prevented by giving proper medication and
checking patient’s vitals consistently and making sure to manage the patients pain and
high blood pressure.

6. What other interprofessional team members should be involved in Junetta Cooper’s

care?

The patient’s primary health care provider, cardiologist and assistive personnel.

Reflection Questions:
1. How did the simulated experience of Junetta Cooper’s case make you feel?

It was a surprisingly nerve-racking experience. I felt a great amount of responsibility

caring for a patient where, if things got terribly serious, the decisions were up to me and
her overall well-being was in my hands. Even though this was a simulated and online
experience, it felt very real and elicited many of the feelings that I imagine would come
out in a real-life situation.

2. Discuss the actions you felt went well within this scenario?

I feel that I was able to incorporate patient safety measures well in this scenario. I washed
my hands frequently between various interaction with the patient, checked patient
identification, and went through the appropriate steps of medication administration such
 as double checking the medication with the MAR, double checking the identity of the
patient as well as checking for any allergies and assessing for side effects and therapeutic
effects of the medication.

3. Reflecting on Junetta Cooper’s case, were there any actions you would do
differently if you were to repeat this scenario?  If so, how would your patient care
change?

I would organize the sequence of my assessment in a more streamline fashion. In the first
round of the simulation I felt that my actions were disorganized, and I could have been
more efficient with the order that I took vital signs as well as my pain assessment when
she verbalized that she was having some discomfort. I would also time my patient
education at a more appropriate time rather than randomly, toward the end of my time
with her.