University of Santo Tomas

College of Nursing
SIMULATION ACTIVITY
NCM10824 – Medical Surgical Nursing III

TOPIC: CARE OF PATIENT IN EMERGENCY SITUATION

FOCUS: Care of Patient with Anaphylaxis

LEARNING OUTCOMES:
CILO 1. Demonstrate appropriate holistic health care to adult-clients with alterations/problems in
life threatening conditions, acutely ill, multi-organ problems, high acuity and emergency
situations, in varied healthcare settings, guided by the Christian faith and the Catholic Church
teachings.
CILO 3. Utilize evidenced-based innovations, revisions and improvements in the therapeutic
management of clients experiencing alterations/problems in life threatening conditions, acutely ill,
multi-organ problems, high acuity and emergency situations.
CILO 4. Integrate legal, ethical and moral principles in the management of health and
alterations/problems in life threatening conditions, acutely ill, multi-organ problems, high acuity
and emergency situations.
CILO 5. Facilitate communication through therapeutic, efficient and effective use of Self in the
nurse’s relationship to clients, families and health care team in different health care settings.
CILO 6. Collaborate effectively and efficiently with clients, families and members of the health
care team and allied professionals with various cultural and ethnic backgrounds.
CILO7. Demonstrate competent, compassionate and committed leadership guided by ethico-
moral principles and legal standards while collaboratively working with health care team.

Simulation Learning Objectives

The student/s will be able to:
1. Classify the patient according to the level of care during triage;
2. Assess the patient using primary and secondary assessment approach;
3. Perform effective and efficient nursing care in Emergency and In-patient settings
appropriate to patient’s needs;
4. Document all significant information gathered and intervention performed using different
hospital forms.
5. Observe legal and ethical responsibility in the care of patient in emergency situation
6. Develop coordination, collaboration and communication skills during patient care.

Pre-Simulation Activity:
1. Review Concepts of Emergency Care and Triage.
2. Read on Assessment and Management of a Patient with Anaphylaxis
3. Nursing Skills such as History taking, Health Assessment, IV therapy, Airway
Management, and Medication Administration

Materials needed:
- Different hospital forms
- Standardized patient/student volunteers
- Online platform
- Review Concepts of Emergency
- Helpful links prior to the session:
Triage https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7127292/
Primary Survey, ABCDE Assessment https://www.youtube.com/watch?v=jcGlaj22HSE
ABC Assessment https://www.youtube.com/watch?v=Uo_Z-rH9qsg
The triage process https://www.youtube.com/watch?v=G8yGQ3Hgmns
Anaphylaxis https://www.jacionline.org/article/S0091-6749(09)02854-1/fulltext
Anaphylaxis https://www.youtube.com/watch?v=5Sn4bi3t7YE
Management and Prevention of Anaphylaxis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754021/
 Briefing: conduct a briefing of the scenario and discuss skills and procedures that may be
performed during the simulation, clarify procedural concerns and assess skills
level in the performance of the simulation procedure
• Pre-brief: details, expectations, roles and time allotment and practice
• Discuss ground rules during the simulation that this is a “safe space” for the students to
learn and non-competitive thus “time out” may be called to ensure patient safety
• Mistakes can happen and will be processed and discussed during the de briefing
• Establish fiction contract (suspended reality and confidentiality of the scenario)
• Assignments: Group of 4/6 students
1. Triage nurse
2. Charge Nurse
3. ER Nurse
4. Relative
5. Physician
6. Active Observer

Tasks:
1. Classify the patient using Triage.
2. Assess the patient and provide effective medical and nursing management according to
patient’s needs.
3. Report to Attending Physician important assessment findings using SBAR (Situation
Background Assessment and Recommendation)
4. Document Significant findings using the different hospital forms provided.
5. Transfer and endorse the patient to the ward.

Setting/Environment

Emergency Room ICU

Medical-Surgical Unit OR / PACU
Pediatric Unit Rehabilitation Unit
Maternity Unit Home
Behavioral Health Unit Outpatient Clinic
Other:

Equipment/Supplies:

Equipment Attached to Manikin/Simulated Equipment Available in Room:

Patient: Bedpan/urinal
ID band 02 delivery device (type) face mask
IV tubing Foley kit
Secondary IV line running at ___mL/hr Straight catheter kit
IVPB with _______ running at mL/hr Incentive spirometer
IV pump Fluids (PNSS 1L)
PCA pump IV start kit
Foley catheter with ___mL output IV tubing
02 IVPB tubing
Monitor attached IV pump
Other: Feeding pump
Crash cart with airway devices and
Other Essential Equipment: emergency medications
Defibrillator/pacer
Suction
Other: Nebulizer
 Medications and Fluids:
Oral Meds:
IV Meds: Diphenhydramine 50 and 25 mg;
Hydrocortisone 100mg; Paracetamol 300mg;
Ceftriaxone 1g
IVPB:
IV Incorporation: Soluset
Others: Salbutamol nebule

Roles

Client Observer(s) (Any number of observers)

Triage Nurse Recorder(s)
Charge Nurse Family member #1
Provider (physician/advanced practice Family member #2
nurse) Clinical Instructor
ER Nurse Unlicensed assistive personnel
Other:

Brief Description of Client

Name: Hannah Perez

Date of Birth: April 6, 1999 Age: 22
Gender: Female Weight: 54 kg Height: 162cm
Nationality: Filipino Religion: Roman Catholic
Major Support: Bobbie Perez Support Phone: 0909 1234567
Allergies: NKDA
Attending Physician: Dr. Ryan Chua

Past Medical History: No significant past medical history.

Family History: Hypertension (maternal side)

History of present illness:

4 days prior to admission, the patient experiences increased urinary frequency (at least every hour),
painful urination, and a sensation of incomplete voiding, which was relieved by Mefenamic Acid.

2 days PTA, she experienced high-grade fever ranging from 38.5-38.8C along with the
aforementioned symptoms. Fever was relieved with Paracetamol.

1 day PTA, above symptoms still hasn’t subsided, hence sought medical consultation the following
day.

10 hours PTA, she went to a nearby clinic for a consultation and was advised for the ff diagnostic
procedures: CBC and urinalysis. Test results suggest Urinary Tract Infection and was prescribed
with oral antibiotic Sulfamethoxazole trimethoprim (Bactrim DS), Paracetamol for fever, and
Mefenamic Acid for pain.

1 hour PTA, the patient felt something uncomfortable in her throat and keeps clutching her neck.
She experienced slight difficulty in speaking and progressed to difficulty in breathing which
happened 3 hours after taking her first dose of Bactrim, which prompted them to go to the ER.

At the ER, patient’s hemodynamic status was as follows: BP150/100mmHg, HR98bpm,

RR33breaths/min, T38.3C, and Sp0289%.
Primary survey:
Airway - with nasal congestion and flaring; mouth-breathing
Breathing: with dyspnea, use of accessory muscles noted, expiratory wheezes heard upon
auscultation; SpO2 89%
Circulation – heart rate regular at 98bpm, BP150/100mmHg, peripheral cyanosis
Deficits – neurological exam grossly intact
Exposure – unremarkable
Secondary survey:
HEENT: minimal periorbital edema noted, flushing noted
Neck: midline trachea, no JVD
Chest: use of accessory muscles, expiratory wheezes heard upon auscultation,
Cardiac: regular rate and rhythm (RRR), normal S1 and S2
Abdomen: normal bowel sounds, soft, nontender
Extremities: urticarial rash noted upon inspection, warm to touch, present distal pulses
Neuro: conscious, coherent

She is referred to ER resident on duty for further management

Social History: The patient is a call-center agent, an occasional alcoholic beverage drinker and
4-pack per year smoker. Patient also revealed engaging in casual sexual relations.

Primary Diagnosis: Uncomplicated UTI, Anaphylaxis secondary to intake of antibiotic

Current Medications: Paracetamol 500mg/tab 1tab q4 PRN for fever;

Mefenamic Acid 500mg/tab 1tab q6 PRN for pain;
Sulfamethoxazole trimethoprim (Bactrim DS) 800/160mg 1tab q12 for 14 days

Surgeries/Procedures: No previous surgeries