[0:01]This program was made possible by a grant from the Healthcare Initiative Foundation. The following is one in a series of nursing simulation scenarios created to educate nursing students and refresh new practicing nurses about situations they could encounter in practice in a simulated context. Complete information about this scenario from setup to debriefing questions can be found at www.montgomerycollege.edu/nursingsimulations.
[0:40]Hello.
[0:43]Hi, my name is Terry, and I'm going to be the nurse working with you today in the emergency department. And I just wanted to check your ID band. Can you just tell me your name? Joyce W. All right, and your date of birth, Joyce? October 16, 1983. Okay. And are you allergic to anything? No. Okay. And I have your name, Terry. I am Austin and I'm Joyce's fiance. Okay, great. It's nice to meet you. Nice to meet you, Joyce. All right, now Joyce, I just need to ask you, is it okay if Austin stays in the room while I, you know, ask you some questions and do your assessment because of the confidentiality and privacy law of HIPAA? Yes, um, he's very comfortable to me, so I want him to stay, please. Okay. All right. So, um, I just want to check, uh, your it looks like your vital signs have already been done. Okay. And are you in any pain right now? No. Okay, great. So what I'm going to do, um, Joyce, is I'm going to do an assessment. I'm just going to, um, check your eyes, your pupils, look in your mouth. I'm going to listen to your heart and your lungs, listen to your abdomen, and I'm going to do some other narrow checks like check your strength in your hands, listen to your, um, feel your pulses and your, um, wrist and also, um, check your pulses on the top of your feet just to check your circulations and the strength in your feet, okay? All right. So, I just need you to just look at my finger.
[2:20]Right. Very good. Now I'm just going to ask you, and I just need you to open your mouth, stick your tongue out, all the way out, say ah. Ah. Okay, very good. All right. Now, I'm going to listen to your heart first. So I'll just need you to just breathe normally, okay?
[2:54]Okay.
[3:19]Okay, very good. Then the other thing I need you to do is sit up for me. And, um, and I need you to take a deep breath in and let it out. Let it out. There you go. Breathe in and let it out.
[3:39]Right. Breathe in and let it out. Right. Okay. And I just want to listen to your bowel sounds. We're just going to come up under your gown here. And you just, you can just breathe normally.
[3:57]Just want to hear some activity in your bowels. Yeah, here's some clicks and gurgles. That's normal. Very good. Okay. All right.
[4:16]And just check your pulses here. Very good. They're equal. All right. Now I need you to just grab my hands as strong as you can, as strong as you can. Great, great, great. Okay. Now let's just move down to your feet. And I know I can't feel your pulses through these thick socks. So I'm just going to bring them down a little bit. Okay. Great. You have good circulation. All right.
[4:58]You know, bring them back up. Now the last thing I'm going to do is I'm going to push your feet up and I want you to try to push them down as I push them up, okay? Very good. Yeah, you're very strong. All right.
[5:20]Okay, everything's looking good. Now, Joyce, the EMT reported that they found you unconscious as I was saying, um, in your bathroom and it looks like you have been vomiting quite a bit. Okay? Is that correct? Yes, it's correct. Okay, has anything like this ever happened before that caused you from, um, caused you to get sick from eating? I have a problem with food and eating. Okay. Okay. And so what else is going on? That it's never been it's it's never been this bad before. Um, I get anxious and then I tend to overeat and binge afterwards to cope with the stress that I'm going through. I I usually would stop when I'm full, but I've just been stressed out so much lately that I, you know, I went to the bathroom today and then I started vomiting and I saw blood. When I saw blood, I started getting really anxious and the next thing I know, I I remember falling down and Austin running towards me. Joyce, you've never told me that you have this problem with eating and vomiting. You should have told me. Oh, Austin, it's been going on for a while. Oh, come on. It's it's my dad. He's sick and he has cancer. And my mom, it's she they live so far away and I I just can't, it's just been so stressful because I'm not there to be there for him. And I can't see my mom and I sent her money to take care of him and I just been at work. I'm the head of this new project that's going on and I have to make sure that everyone's job is done the right way, and it's just so stressful for me. Everyone's counting on me. My dad's counting on me, my co-workers are counting on me, and I just eat and when I eat, I get full and then I just go to the bathroom and I just, that's just the way I've just coped with it. I just vomit and I don't want to lose. I don't want to gain any weight, so I just go to the bathroom and I just, I just, I just vomit everything out.
[7:53]Okay, Joyce. What I'm hearing now is that you've been binging on the food and vomiting to cope with your stress. Is that correct? Yes. I started this in college. Okay. But I was able to I was able to control it. I, it was under control. Um, but I just I I just, I just haven't been able to manage lately. Things are just getting worse. Now, when you were in college, you saw a therapist, and you were treated for this disorder back then? Yes. Okay. Okay. But that was nothing compared to the stress that I have now. My dad, what if, what if my dad dies? What if he dies? I have to be there for him and I don't want him to die and I'm in charge of this company and it's so stressful. I'm, but I I just I just can't stop. I just can't stop. It I do it for I used to do it for a few times during the week, but now it's every single day and every single time and I just can't stop. Okay.
[9:12]Did you know anything about this? I had no idea, Joyce, and no, Terry, I didn't know about this. I wish I knew, because if I did, I would have been there for you to help you with anything I could. I'm sorry, Austin, I didn't want to tell you. It's just I am so embarrassed. It's it's just this nasty of it. I'm so sorry. Okay. Well, Joyce, this is what we're going to do. Okay? We're going to stabilize you since you're here and it's good that you're here. Okay. We're going to stabilize you and we're going to discuss some points to help you with your follow-up treatment, all right?
[10:02]Okay. Thank you. So I'll be right back. Thank you very much.
[10:13]All right, I'm back. Just want to, um, just double check so your name and your date of birth once again. Joyce W., October 16, 1983. All right. Okay, just want to scan this. Okay. Now what we're going to do is we're going to hang some potassium. And basically, like when you were vomiting, not only did you vomit out, you know, all of your stomach contents, but also you vomit out like water and in that water you have like elements such as electrolytes.
[11:24]I didn't know that vomiting can do that. Yes, and so what we're going to do is replace those elements that would help your heart to keep pumping, okay? Okay. What is that bad? Yeah, it was, it can be it can be pretty serious, so that's why we're glad you're here. Let me just check your IV site here. Make sure everything's okay. And that looks good. Okay. And it's running really well. So, what we're going to do is, um, once this is in and it's usually takes about an hour to run in and just let me know if you feel any burning or any problems in that IV site area, okay?
[12:35]Okay. All right. And it's starting to run. Okay, so we're going to talk about some of your discharge planning. And I'm going to provide you with some names of your therapist who you said was helpful to you when you were in college. Okay. And also they use the cognitive therapy, um, approach. Okay. Here's that list.
[13:10]Now, when you leave here, the stress that contributed to bringing you here and, you know, with the, um, purging and the binging, it may not go away right away, okay? But we're going to talk about some ways to manage your, um, stress that are that may be more effective. And I just need to know what kind of things do you do or what have you done to help manage your stress up to this point? I enjoy running and working out. Right now, I'm on a, um, I'm on a, uh, marathon. I I have a group of people that I work out with at certain times. Um, but we only meet, um, it's infrequent. Um, and I also just enrolled in the gym. They have yoga and Pilates there, so I've been doing that as well. Okay, great. Those are all good measures. Um, I think maybe you need to do something or have something that's more accessible to like when you're at home or at work that when you feel overwhelmed, it will, um, you know, help you during those times when you have the urges of binging or purging. So, um, you see what I'm saying? Um, I I understand what you're saying. Um, I used to write have a journal where I write down my feelings, um, when I was stressed out and, uh, that used to at times help me see the solutions to the problems. Um, and that worked out a lot for me. All right. Okay. We're going to add that to the plan and, um, you have a journal to write in and the thing is, when you feel stressed at work, anytime at home, you can spend a few minutes writing in your journal and writing your thoughts down, you know, and your feelings down on paper. Okay. And also I suggest that you may call one or two people or text them, you know, just when you have those feelings of anxiety. And you can call me, baby, I'll be always there for you. Don't hesitate, you know? I've been such a bother, I don't. Oh, don't, don't say that, baby. No, I will be there for you and help you with anything I can. Okay. And then you have your, um, a friend or a relative. Do you have anybody like that, a friend or a relative? Um, I have this college roommate and she's been a great friend to me. Um, she's been there for me too when I've been stressed out, so I I trust her. She's someone that I can call. Okay. Okay, that's good. So, when you feel stressed or, you know, either you, um, want to write down something in your journal, your feelings, you can call Austin because he, you know, he's right there at your side. You can call your roommate. Also, um, I have here a list of therapists. Okay. You can call for an appointment, schedule an appointment. And also I have my card here from the emergency department. This is just a resource information from the emergency department. Oh, you could give us a call if, for instance, if none of these, uh, resource, uh, therapist, uh, the list I gave you, just by chance that they're not coming through, then we can provide you with some other resources, uh, and then just, you know, let us know how you're coming along. And I'll be more than happy to participate with whatever it takes to make sure that this plan is successful, Terry. Okay, great. Right, right, right, right. And, um, I'll follow up so I can get other things under control. Okay, that sounds good. So, sounds like a plan that we're on our way to recovery. And you seem like you're willing to work with us and this will run for about another 45 minutes. It takes a total amount of an hour to run in and, um, the doctor should be in between now and, um, by the time this finishes and you should be on your way. All right. Okay, thank you. Thank you. Thank you. Okay, thanks. Okay, thanks.
[17:37]This program was made possible by a grant from the Healthcare Initiative Foundation. The Healthcare Initiative Foundation is a non-profit grant-making trust governed by an independent volunteer Board of Trustees. The foundation supports organizations that offer solutions to improve the quality and delivery of healthcare for residents of Montgomery County, Maryland. For more information about the Healthcare Initiative Foundation, visit www.hifmc.org.
