SURGICAL CASE 04 VERNON WATKINS REFLECTION QUESTIONS 2025/2026

Surgical Case 4: Vernon Watkins
Guided Reflection Questions
1. How did the scenario make you feel?
At the beginning I felt very anxious because the patient was reporting a respiratory distress so it
was very challenging. I had to do it several times.
2. Discuss your use of adjunct oxygen therapy for this patient, including why you chose a particular
oxygen device, rate, and flow.
Oxygen administration was a challenge as well because I was not so sure on which kind of
oxygen supply to choose, I chose a nasal cannula and deliver a 6ml oxygen in order to maintain
the patient oxygen saturation at 92% due to the patient complaint, condition, and clinical findings,
and the Dr standing orders.
3. Discuss Vernon Watkins’ arterial blood gas (ABG) analysis result and explain what caused this
result.
He had respiratory alkalosis
Mr. Watkin’s ABG’s showed respiratory alkalosis most likely due to a fast respiratory rate that
was being
caused by his body trying to compensate for the hypoxemia from the pulmonary embolism..
Mild hypoxemia .
He had trouble maintaining his oxygen saturations at 92% therefore his condition of
hypoxemia.
Respiratory alkalosis was the result of the respirations per minute which were 24. This
caused him to blow off too much carbon dioxide.
He was hyperventilating that’s why he complained that he could not breath. This caused
his carbondioxide to drop.
4. Discuss the use of a heparin nomogram (guideline for heparin titration) and safety related to this
intervention.
Providers order a heparin therapy anticoagulation target, and nurses use a clinical algorithm to
guide care. Nurses obtain baseline labs, calculate and administer initial bolus dose, order and
evaluate anticoagulation labs, and titrate heparin to therapeutic goal based on clinical algorithm
and patient presentation. Heparin requires close monitoring because of its narrow therapeutic
index and increased risk for bleeding. Monitoring includes head-to-toe patient assessments for
potential side effects and laboratory monitoring.
5. What key elements would you include in the handoff report for this patient? Consider the SBAR
(situation, background, assessment, recommendation) format.
S: Mr. Watkins is a 69 year old patient who underwent a hemicolectomy.
B: He presented to the Emergency room 4 days ago with complaints of nausea, vomiting, and severe
abdominal pain admitted for emergent surgery for bowel perforation He has a midline abdominal
incision, tolerating a soft diet without nausea or vomiting. Abdominal pain has been controlled
with morphine. He has refused to ambulate this morning because of fatigue and a sore leg.
Patient complains about a pain in his right leg that goes worst every time he moves it,