You are on page 1of 18

NSG2 Summer 2007 NCCC Ottawa Kansas State Boardof Nursing Slmulation Scenario Library

:,1P1

?CI1/

1{/ Ii

Level of the Scenario:

Beginning -.l-

Intermediate

Complex

Specialty: I, and Clinical Rotation, BasiclYedical/Suroical LCVeI SecondNursing Nursing BriefOverviewof the Scenario: Fourscenarios were developed reviewskillsfrom the to studentsfirst rotation(1) and to relnforce the new skillsintroduced this rotation(2). A: Scenario Prepare patientfor a bedside the procedure out patientprocedure. or

S c e n a r iB : o patientwith continuous Assess unresponsive coughing Dobhofor NGtube feeding.pt found with bubbles coughinB and tube feedinB faceand gown.HOB< 15 ". on

Scenario C: OBSPatient involvcd anAryrollover. R/Oclosed in headinjuryand Neck/spinal injuries. Multiple brasions. A

S c e n a r iD : o Pt.with new g-tubeplaced startbolusfeedings to and medication. HX:CVAmonth prior w/right sidedweakness, dysphasia, aphasia, confusion. and

Contributed by:

DebraK. BrownRN, BSNand TeresaFaustRN, t4SN(Facutty) Mary GrimesSchoolof Nursing Neosho CountyCommunity College Ottawa(School)

Date of Submission:

NSG2 Summer 2007 NCCC Ottawa Simulation Design Template Discipline: PN Course:NSG2,Scenario A Expected Simulation RunTinre: t hour Reviewed by: Debrief/GuidedReflection Time: 30 Prep/report minutes,10 minutes 10 charting,and 10 minute break

All four scenarios were designed run in one day, allowingeachgroup of studentsto to parlicipateI eachof rhe scelar o. Scenario A will be presented in full
Brief Descript on of Patientl Frede ck Clork Name: Mote Genderj Age: Race: 54 Notthern EurcpeonBlend Caucosion

Weight: Heig t: h christion Reliqion: Major Support: Phone: AllergiesI

lkg Jcm

1a5 /lh s:llAJft ir.

Psychomotor lls Required prior to Sk S mulation: Phone orders Pt positioning Sterile field Neuro/ circ checks Cognitive prior to SkillsRequired Simulation: Informed consent Focused Assessments Foley Placement Establishing priorities Concepts neededfor Review: Information on Spinal Steroid Epidural Iniections

Wile ond 2 childrcn

785-555-1222 horseserum
Cuffent

Immunizations:
Pl.4H: GERDI CA Prostrate History ol present Illness:

Attending Physician:Justin Simulation MD

SocialHistory:

Moftied, Cottlemen

In rctroctoble Primary Diagnosis: Poin Surgeries/Procedures: TURP 2 vrs prior, Vasectomv aqe 28

SimulationLearningObjectives: 1. 2. 3. 4. 5. 6. 7. Perform focused system assessments Interpreting initiating and writtenDR orders patient Prioritizing carefromwrittenorders Differentiate changes Ptconditions expected adverse in as vs Contact to report MD changes Take and Phone Orders Summarizes aspects Informed of Consent Accept to facilitate work roles Team

NSG2 Summer 2007NCCC Ottawa Fidelity


S e t tn q l E n vr o n m e n t l ER Med Surg l'ledications d Fuds an

tcu

O r a lM e d s : F e x e n 1 0 m g , P r l o s e c 2 0 m g , l SLrrrak 2.10mg, Percocet10/ 325 mq , Alivan 1 m 9P O Topical: Dlragesic Patclr75 mcq tM or SC: Morphrne mg tM lo

s mu ator mannequn /s Neeated: static nannequin D a q n o s t i cA v a ia b l e : s E q r p m c f t a t t - c h e dt o m a nk i n l IV tdrng w lh pr m.ry ne .t


fluldcrlr L q nr nU I

L a b s :C B C , l 4 P U A ,& P S A B ,

12 le-d EKG

S e . o n d a r yV I n c I r u n nn ! a t F o r e y- a l h e l e r . and.oor P C AP u r r p. u r i nn ! n'L/rrr. mLoulplt Do.!nreftalron orms F X Phys an Orders o

o2
)( 14()nrior.tt-.lre.l I D B a n d / A lj a y B n r d X MAR

Eq!ipmenavdil.D In rooli: t e 8-PdP-n/Ur l nX Foeykt Stra qht c.rLfeterk t ln.entrve pirometer S

5 t rf t A 5 s i g n d r e r i t

anesthesa Record Standn9 Orners O l h e r :C o n s e n tS p i n a l p r d u r a ln t e c t o nw t h : E I L S R e g i o n a l A n e s t h eAc o c k t l Chart and Lab reports p I t 4 s i t eo r I n j e c t i o n a d Ster le G oves size 7 1/2 ScrubSponge/brushes

Iv 'taft Kit M!brnq IV Pump Feednq Bag Pressu.eBa9 0 2 d e l v e r yd e v i c e t y p e , C r a s h a r tw / a i M a y sa n d M e d r c a t i o n s C Delbri atotPacer

X x X X x

Recommended l'4ode s mulation: for

2007 NCCC NSG2 Summer Ottawa Recommended Student Group Sizer


a s s g n m e n t s f R oe s o

4-5 studentsper qrouo, oer session


s t ! d e n t l n f o r m a b o n e e d e d ro r t o S c e n a r i o : N P Has been orientatedto simu ator gu Understands de lines/expectations

S s

Primary Nurse secondary Nurse 1 or 2 C l i n i c aIln s t r u c t o r l F a ml y M e m b e rl F a ml y M e m b e r 2 f

for the scenario H a sa c c o m ps h e da l l p r e - s i m u L a t i o n l requrremen$ A I particpants understandtheir a s sq n e or o e s Has been given a time frame expe.talon

Physiclan/Advanced Practi.e Nurse Respratory Thcrapy on Pr s.en-ro queshons/inform-tith.t.tudents l s e f o r d i s c u s s , o(n. e . w h e n w l i l d b v a l l e s l physrcanor.iers be presentedto rhe stlde.ts p r i . t rl a b , d l r n q r c p o d ,o t d u r n q t h e s i m un t o n ) Soc.lserv.cs C.rqy

unlicensed assistive Personal

prior io start n9 Repo.t studentswrll re.erv-a O t h e s m ! a h o n( r e p o r tf i o m I C U n u r s e , R , Nqht furse,ER)

verbal responses for the patient Night nurse: aasics on con*nt was not .tone. PLUS - Dr. Consult jtst phonecl an.t he wi be here in t5 - 20

I d e n t r t y a c u y R oe s N e e d e d : F t D.. Consult Important nformationrelated to roles Knowleclge of the bedside proce.lure

NSG2 Summer 2007 NCCC Ottawa References,Evidence-BasedPractice Guidelines, Protocols, or Algorithms used in this Scenariol (site source,author,year, and page)

Adams,Michael; Jesephson, DianneL.; and Holiand, Jr., Leland. Pharmacoloov Nursesfor (first printing),Pearson/Prentice UpperSaddleRiver,NJ, A Pathophysiolooic Approach, Hall, 2 0 05 . B e r k o w i t z , . M . ( 1 9 9 7 ) . E p i d L J rP a i nC o n t r o l I t ' s Y o u rl o b . R N ,V o l . 6 0 , s s . 8 , 2 2 2 7 . C al I Burke,Karen; Lel'lone, Priscilla; and lvlohn-Brown, Elaine. MedicalSuroicalNLlrsing.2nd e d . , P r e n t i c H a 1 1 ,0 0 3 . e 2 C u r r e n , A n n a 1 4D i r n e n o ' t a lA n a l v s i fso r M e d s , 3 ' d d . , D e l m a r 2 0 0 6 . . s e , Elkin,MarthaKeene;Perry,Annecriffin; & Potter,Patricia Nlfs1lS Intet{eltlals & A. Clinical Skills,3 " cd., l.losby, lnc., St. Louis,14O, 2004. Dr!g Reference, or !!qsbv's NLlrsing 2005;14osby, lnc., 5t. Louis,MO, 2002. Pagana, Kath een and Pagana, Timothy. Diagnostc and l.abqetArylest Relerence, ed., 7fh Mosby,Inc., Sl. Louis,l'lO, 2005. qf Potter,Patrica Ann and Perry,Anne Griff n. Fundamentals Nursing,6rhed., [4osby-year B o o k ,I n c . ,S t . L o u i s , 2 0 0 5 . B P s S i m i n i , . ( 2 0 0 0 ) . a t i e n t 'p e r c e p t i o n s p a i nw i t h s p i n a li,n t r d m u s c u l aa n d v e n o u s of r, injections.The Lancct,Vol. 355. 1076 Staehler,R. (2001). Lumbarepiduralsteroidinjections low back pain and sciata. for www.spine-health.com/topics/conserv/epidural/feature/epr0 1.html Weber,Janet. Nurses'Handbook Healt-bjsscsslrcft,5ti ed., J. B. Lippincott, ef Philadelphia,2005.

NCCC NSG2 Summer 2007 ottawa

ScenarioProgression Outline
T ming
P r o g r a m m i nD a t a g A {Manikln ctiont Initialstage: B a s e l i nV i t a lS g n s : T Pain8 of 10 BP NSR Rolesof Pt advocat CTA 51&52 Pre-medsas ordered Corelation of med, lab

Debrlfne

"What's the Dr. going to do andhow willit h e l pw i t h r h b a c k

Reviewconsenrform w and p.ocedure ith

W o r s i n go t C o i d i t i o n

T r a n 5 i e nd i m i n i s h e d t BLE numbnssafter spinal.

Expect Side effect vs c h a n g ea nP t o n d i t i o n .

y on the complexilof

conclugion the of

Procedureomplete. Pt stable,

Position comfort. for

Neuro/ckc BLE snsation returning, < Pain 5. Disposition supplies of

NSG2 2007NCCC Summer Oftawa

GuidedReflection Questionfor Simulation Homework

Type your responses. 1. Descrbe the new and reinforced skillsyou had with eachof today'sscenanos. InclLrde time, setting,and activities highlightthe events. to 2. For eachscenario describe what information will needto passon to the on-comrng describe 3. Please additional information that you might have received reportthat in may have madethe sessions more sussessful,

Debriefing Activity for Simulation Large 9roup Arranqesludentsln the s mulationgroups(4 5 STUDENTS) will be one team. this Assigneachteam a dry erasemaTker. Usea differentcolor for eachgroup. Haveeachrnemberof the team write their response the board,passing on the markeras a relay baton,until all have responded.All team start after the queslion/orrequestis made.

Lrstone thing you had to visit with the doctorabout Discuss srm laritiesof listedthings. The majoritywill be to report a changein pt. condition. List an ilem of information the Dr. requested you. of D scusssimilarities listedthings. Physical of assessment data, lab data or radiology reports. List something that made performingin s scena.io situationhard for you. Discuss similarityand the varietyof responses. the Conclusion: studentsnominated anotherstudentfor the outstanding student in a simulation given. ballet. Win was announced role by closed and speechwas

NSG2 2007 NCCC Summer Ottawa Complexity - Simple to Complex

Suggestions changing for the complexity this scenario adapt to differentlevelsof of to learners: 1. 2. 3. 4. 5. Adversereactionto medication Pt was not able to give consentfor self. PCAanalgesrc with IV pre-meds Pt in reverseisolation from recentchemo Complication form LP( headache, nausea,vomiting)

Suggestions chan9ethe presentation the scenario to of from one group to anotherto allow for "on the fly": T h i sc o m p o n e ni t i n c l u d e dn t h e d e s i q n . s i

NSG2 Summer 2007NCCC Ottawa

NCLEX PN Test PlanCategories


Health Promotion Maintenance of Safefl & lnfection Aging Process Managemenl Care AdvanceDirectives Cantrol DataCollection AccidentPrevention Techniques ErrorPrevention DiseasePreventron HomeSafety FamilyPlanning ClientC6re FamilyInteraction Patlerns Assignments & lredical& Surgical Grou/th Development ClientRights AsepsisSafeuseof Healih& Wellness Equipment Health Managemenl Security Plans Promotion/Screening & Supe'ision with Use of restrainis/ Safety Prograrns Consullat|on Devices HighRisk Behaviors ItlultrTeam Reporting of HumanSexuality disciplinary IncidenVEvenU lmmunizations confidentiality of lfregular Occurfence/ Lifestyle Choices Conlinuity Care Self Care EthicalPracuce Handling Consenl Hazardous and Techniques Physical of Informed lMaterials LegalResponsibrllties lniecuous Developmental stagesand QualityAssurance Transitions ExpectedBodylmage Changes Ante/lntra/Poslparlum & Management

SafeEffective CareEnvironment

Psychosocial Integrity
Abuseor Neglect U Behavior Inleruentions Behavior Management CopingMechanisms C sis lntervention CulturalAwareness End of LifeConcepts Griefand Loss MentalHealthConcepis I/lentallllnessConcepts Sensory/Perceptual Situational Changes Role Stress[,,lanagement Substance Related Disorders Suicide^/iolence SupportSyslems Therapeutic Environment Therapeutic Communication Religious and Spiritual Influences Heallh on

Basb Careand Comfoi Devices Assistive Elimination Mobility/lrnmobllity Non Pharmacologlca Comfortlnteruentions Nutrition Oral & Hydration Care Palliative/Comfort PersonalHygiene Rest& Sleep

Ph Pharmacological anrl Adver6eEf{ects

Diagnostic Tesis
Medication Administration SideEtrecls Phalmacological

Potential Alterations for in BodySystems Potential for MedicalEmergencies Complications Radiation Therapy Pharnacolog Agents ical of Diagnosiic Tests/ Response Unexpecled TreatmenUProcedures to Potential Complications Therapies of Procedures for Surgical andHealth Alterations Therapeutic Procedures

Physiological Adaplation Alteralions Body in Systems BasicPathophysiology Fluid& Electrolyie

Items addressed Scenario are highlighted A above.

RM NAIVIE DR

Frederick Clark MD JustinSimulation.

ALLERGIES

Horse serum

PATIEJ,iIT]WPEI ROOM ,iP{r,lEM #. IP 144A Hosp#274615 PAfIENT INFORMATION CIork,Frederick

:.

.:111t@rAticoRDNlrMB:i: rNrTtAis'
DKB NSG222

.. DATEOFSRV'CE ltMiaalii:ii..jjoB
0445 P H o N E : ' : : 'ttus 785-555-1222 M . RILATIONSHIP,:. spouse Daughter
Son

:-

' 'J:x ":i


M

54

07/05/1953

.r

S.S. NUMSER' 333-224444

RAe. Eiti c
AJ.,!1i.,t,,

EMERG ENCE CONTACT Clark, Emma


Cla.k-Brown, Beth C l a r k ,K e n n y

WORKPHONE HOMI PHONE 785-555-3434 785-555-1222 cell620-555-1212 Cell 620-555-2222

INsURANCE 1 Farmers Deluxe Topeka, Kansas 66001

INSURANCE 2

INSURANCE 3

SUaSCRIAER CONTRACT# # GROUP

FrcdcrickK.cla.k T1.T7.T77TT 0 1 1 17

ACCIDENT DAT
tVENTS HAPPTNINGS: OI

ACCIDENT PIACI NA

ACCIDNTTIME NA

ves!r.roE
ZIP 66069

GUARANTOR Frederick K.Clark


INFORMATION EMPLOYER self

RELATIO HIP NS self

ADDRESS CITY STATT Rd Rauntol, 1402 Gravel KS


PHONE na OCCUPATION Catlle Rancher

CHIEF COMPLIANT BackPain ADM|TT|NG PHyStCtAN , MD JustinSimulation,

rLY.. ..1 , FAM P..{Ys_lclAN DONALD SMITH MD

consult, MD lmma

9]sr!.t:: ':r ,t:.. . ::,:.ilitflj

coDEs olacN-osrs

E C Y N E O S H O O U N T Y O M M U N I TC OL L E G C O N 4 A RG R I M E S C H O O L F N U R S I N G Y S

P h v s i c i a nOs d e r s n dS i o n a t u r e 'r a Date I Time r-2 10:00 Admit to: Med/surg


DX:ln retroctoblePoin age 2 yrs Hx:CA-Prostate, GERD,TURP prior,Vasectorny 28 Allergies: Horse serum V i t a l S i g n s : Qh r 4 Activity:upwith assist 2 x Diet:General Lab: C8c,cMP, UA,& PSA Medication: Flexeri10 mg POQ8 Hr Prilosec rng PO Daily 20 Duragesic Patch mcg Q 3 days 75 po daily Surfak 240 mg Percocet 325 mg one Q4 PRNModerate 10/ Breakthrough Pain Morphine SLrlfate mg lM Q 6 PRN 10 Pain Severe Routine&O PTto evalLate NcuroConsult PainManagement Consult

S.--L.r,;" ///2
T-1 Prilosec Zantac to 150 mg Q am o900 Ok to change

T 1

raunds: 1730 lHovereddy marning for ot de rile spinotEpid ol Tr & 2 potrs7 1/2 ste gloves bedsi ur oy 11. Epidurollniection with Spinol 12.Consent: Block ts neqiono!Anesthetic I I TomqlM on my coll ttedicotew/ Ativon1mqPo and Morphine 13. prior to procedure 14. Ploce foley

I I

.9,:,,",1"2'a" /112

v/2
Rm 144C Pt:Clark, Frederick DoB 07105/1953 54Y/oMale Hospf274615

pa8e of 2 1

N E O S H C O U N TC O M N 4 U N C O L L E G E O Y ITY [ 4 A R Y R I M E S C H O OO FN U R S I N G G L P h y s i c i a nOs d e r s n dS i g a t u e 'r a n r


T postsprnal q BLE Neuroond CircCheck 30 minutes 8 X VSq 30 minutes I X 3 MointoinFoley DDfor 4 hour ta >45"fot 4 houts,thenOAB i ossist StrictBedrest HOB 5 CSF tubeto my lob

l"**t

4..",.21/D

Rm.144C Pt:Clark, Frederick DOB07/05/1953 54y/o Male Hosp t274615

Page ot 2 2

Administration Record 24 HourMedication


DX:ln retroctable Poin 2 Vasectomy 28 age Hx:CA-Prostate, TURP yrsprior, GERD, Dates effective: todav
vcd.r,o1 Do\Dpo-." r'"quq ., r-d "di! io \ o' Do\l .

Allergies: Horse serurn Administration Times 0701,1900 1901,0700

Flexeril mg POQg Hr 10

o9
17

o1

Prilosec mg PO Daily 20

o1

240 mg po dary Surfak docusatecalcium244 mg cap 75 Durageslc Patch mcgQ 3 days

o9

replace T+2 rm fentonyl tronsde ol 75 mcg/ hr Ativan1mg PO,l time only givewith Morphine1Omg lM
ca!l

Morphine10mg M givewith AtivanI mg PO

call

Moderate 10/ Percocet 325mg oneq4 PRN Breakthrough Pain 10mg/325 oxycodone/ocet
10 Pain MorphineSulfate mB lM Q 6 PRNSevere morphinesulfute injection10 mg / 1mL

lnitials/ Signatures Rm, Pt: clark,Frederick OOB07/0511953 54 y/o Male Hospf274515

.Hema
date / time WBC NEUTROPHIL % LYMPHOCYTES % MOMOCYTES % EOSINOPHILS % BASOPH % LS RBC HGB HCT MCV MCH MCHC RDW PLATELETS SFDRATF

TODAY 500 7.2 52 38 0 2


I 486 1 35 38 al l2 33 12.7 117 8

Reference Range Units 4.0- 10.0x 10 3U 30.o- 75.O% 18.O 40.O % 1.O 8.0 % .o 3.0 0/a .o-2.0% 4.20 5.00 MtL/UL 12.0 1s.0MG/DL f7.o 47.O % 80 100 FL . 2 6 . 0 3 50 P G 2 A . O3 l . 0 % 10.5 14.5 CV % 150 400 x 103U 0 19MM/HR

i . t . t i

_ : :

'ii

x: .-r1,,r;-,1.fff
DOB 07l05/19s3
54 y/o Male Hosp #274615

Frederick Pt:Clark,

date

TODAY 500 GLUCOSE BUN CREAT]NINE RATIO BUN/CRE SODIUM POTASSIUM CHLORIDE

Reference Range Units

co2
SGOT ALKALINE PHOS PROTIIN TOTAL SGPT ALBU IN M CALCIUM TOTAL BILI

11 1.4 2Z 139 4 8 88L 23 38 104 5.4 L l8 l 3 6.11 0.5

65, 100 MG/DL 7 . O 2 1 MG/DI 0 . 7- 1 . 5MG/DI 7.O 25.O 137 - 145 M M O L / L 3 . 6 5 . 0M M O L / L 98 - 107 MMOL/L 22 30 MMOL/L 8 . 0 3 9 U/L 2 0- 1 s 5U/L 6 . 3 8 . 2G/DL 9 . 0 s 2 u/t 3 . 3 5 0 G/DL 8.4 10.9MG/DL 0.2 1.3 MG/DL

SPECIAL CHEMISTRY
date tirne PSA

TODAY 500 28

Range units

ng/mL

*3 or less considered bein the normal to range a manunder years for 60 old is is for 60-69 4 or less normal a managed if is over70. 5 or less normal youareaged

)".1:.,1::.
Frederick Pt:Clark,

',

:rtx:

':"

';

l:,

DOB07l05/19s3 54ylo

4274675

UrinalysiS
date time
METHOD: URINE COLOR TURB DITY SPEC GRAVITY
pF1

t '

.:;.?xi,:''
a, TODAY Reference Range Units YELIOW CLEAR 1 . 0 0 5 ,1 . 0 1 5 5.0 8.0 NEGATIVE NEGATIVE NEGAT]VE NEGATTVE NEGATIVE 0.2 10 EU'S NFGAT]VE NEGATlVI

URGLUCOSF B I L I RB I N U PROTE N KETONES BLOOD UROBILINOGEN NITRITT LEUK ESTERACE

Straw clear 1.014 74 NEGATIVE NEGATIVE NEGATIVE NTGATIVE NEGATIVT NE6ATIVE NTGATIVE NEGATIVE

MtcRoscoPIc
EACTERIA RBC/H Pr WBC/II PF MU C U S EPPICITLS/tPF RTFLEX CULTURE

0 0 0 0 0 NO 0

NEGATVE NEGATIVE NEGATIVE NEGATIVE NEGATIVE

..: ,l:
Pti Clark,Frederick

.::,.
D O B07 /os/L9s3 s4y/o Male Hosp #274615

TODAY 500 PTT PROTIME NR 21g7 27

Reference Range Units 26.0 40 SECS 9.0- 13.0SECS 2.0- 3.0

NR Therapeutc rafqe 2 0 - 3 0 P2he.ts wilh Droslhelrc head valvesand/or cefebE embo[ 3 3 4 5

'i,.:11r

, ....,., Pt:Clark, Frederick

DOB