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Team Texas-Central Region
Simulation Scenario
Level of Scenario:
Beginning ______ Intermediate ___X___ Complex ______
Specialty: ______Medical COPD Exacerbation _________________________________
Brief Overview of Scenario:
A 62 year old female presented to the emergency department with shortness of breath and
a very productive cough. Patient states she has smoked for 40 years 1 pack a day but
recently quit 2 weeks ago. Patient states “I thought I was coughing a lot because my
lungs are breathing again”.
Patient admitted to the medical floor for COPD exacerbation, rule out pneumonia.
It is 0900 and you are entering the room to give morning medications. The patient is
lying in the bed:
Productive cough dark greenish sputum
Pale, in color
Wheezes to all other lung fields
SpO2 82% on room air
Developed by: _Central Texas Region Faculty______________________________
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Simulation Design Template
Discipline: Nursing/Medicine/Respiratory Therapy
Debrief/Guided Reflection Time: 45 minutes
Expected Simulation Run Time: 20 minutes
Brief Description of Patient: Psychomotor Skills Required prior to
simulation:
A 62 year old female presented to the
emergency department with shortness of -Physical Assessment
breath and a very productive cough. -Focused respiratory assessment
Patient states she has smoked for 40 -Intravenous Catheter
years 1 pack a day but recently quit 2 Maintenance.
weeks ago. Patient states she thought she -Communication techniques using a
was coughing a lot because her lungs are standardized report mechanism. I-SBAR
breathing again. -Oxygen therapy
Patient admitted to the medical floor for
COPD exacerbation, rule out
pneumonia.
It is 0900 and you are entering the room
to give morning medications. The Cognitive Skills Required prior to
patient is lying in the bed: simulation: (i.e. independent reading,
Productive cough dark greenish video review, computer simulations,
sputum lecture)
Pale, in color
Wheezes to all other lung fields (L)-Chronic Respiratory Disease
SpO2 82% on room air Diabetes
Name:
Gender: Female (IR)-Alcohol abuse, CAGE assessment
Age: 62 years old Musculoskeletal and orthopedic
Race: Caucasian (V)-Respiratory assessment
Weight: _____/kg _200____lb Oxygen therapy/administration
Height: ______cm __5’3_____ft/in
Religion: Catholic
Major Support: Son
Phone: 512-XXX-XXXX
Allergies: Iodine and Penicillin
Immunizations: Flu Shot
Attending Physician/Team: Hospitalist
PMH: Type II Diabetes, COPD,
osteoporosis, and ETOH abuse.
History of Present illness: Shortness of
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Breath, very productive cough, quit
smoking two weeks ago.
Social History: Widow alienated from
only son, lives independently, smoked
cigarettes until recently and drinks
alcohol occasionally, patient is on
disability and unable to work because of
respiratory disease process.
Primary Diagnosis:
COPD exacerbation rule out pneumonia
Surgeries/Procedures: T&A as a child,
abdominal hysterectomy at age 45.
Simulation Learning Objectives:
1. Gathers objective and subjective assessment findings to prioritize patient care.
2. Identify changes in patient’s status and perform nursing interventions to promote
positive patient outcomes.
3. Communicate with other healthcare disciplines using I-SBAR to improve
communication techniques and promote a well-balanced healthcare team.
4. Identify baseline respiratory assessment findings for a patient with chronic obstructive
pulmonary disorder.
5. Safely administers oxygen therapy to a patient with chronic obstructive pulmonary
disorder.
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Fidelity
Setting/Environment Medications and Fluids
○ ER ○ IV Fluids:
○ Med-Surg
○ ICU ○ Oral Meds:
○ OR/PACU
○ Women’s Center ○ IVPB
○ Behavioral Health Ancef 1 gram IV every 12 hours
○ Home Health
○ Pre-Hospital ○ IV Push:
○ Other Solu-Medrol 125mg IV every 6 hours
Simulator Manikin/s Needed: ○ IM or SC:
Manikin/Hybrid
Props: Diagnostics Available:
Equipment attached to manikin: ○ Labs
○ IV tubing with primary line _D5 ½ NS ○ X-rays (Images)
with 20 mEq KCL at 100ml/hr on ○ 12 lead EKG
pump_______ ○ Other:
○ Secondary IV line _________ running at
______ cc/hr
○ Foley catheter ________cc output Documentation Forms
color ______________________ ○ Physician Orders
○ PCA pump running ○ Admit Orders
○ O2 ○ Flow sheet
○ Monitor attached ○ Medication Administration Record
○ ID band ○ Kardex
○ Other ○ Graphic Record
○ Shift Assessment
Equipment available in room: ○ Triage Forms
○ Bedpan/Urinal ○ Code Record
○ Foley kit ○ Anesthesia/PACU Record
○ Straight Catheter Kit ○ Standing (Protocol) Orders
○ Incentive Spirometer ○ Transfer Orders
○ Fluids
○ IV start kit
○ IV tubing Other Props
○ IVPB tubing
○ IV pump Recommended Mode for simulation:
○ Feeding bag Sim-Man AVS
○ Pressure bag
○ 02 delivery devices type Programmed
○ Crash cart with airway devices and
emergency medications
○ Defibrillator/Pacer
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○ Suction complete suction set-up
○ Other
Recommended Student Group Size: ___________________
Assignment of Roles: Student Information Needed Prior to
NS = Nursing Student Scenario:
F=Faculty • Has been oriented to simulator
MS= Medical Student • Understands guidelines/expectations for
_NS__ Primary Nurse scenario
_NS_ Secondary Nurse • Has accomplished all pre-simulation
___ Clinical Instructor requirement
___ Family Member #1 • All participants understand their
___ Family Member #2 assigned roles
___ Observer(s) • Has been given time frame
_MS_ Physician/ Advanced Practice Nurse expectations
_F__ Respiratory Therapy
__F_ Anesthesia Pre-scenario questions/information that
___ Pharmacy students use for discussion (i.e. when will
_F__ Lab lab values/physician orders be presented
_F__ Imaging to the students – prior to lab, during report,
___ Social Services or during the simulation)
___ Clergy
___ Unlicensed Assistive Personnel Review of COPD
__F_ Code Team Oxygen administration
___ Other: Communication
Identify Faculty Roles Needed:
Nursing faculty will facilitate nursing
students simulation experience also making Report students will receive prior to
sure to evaluate the students performance. starting the simulation (report from ICU
Medical Faculty will facilitate medical nurse, OR, night nurse, etc.)
students learning experience in simulation
and evaluate performance. -Verbal report (RN to RN)
Important information related to roles:
Critical Lab Values:
Physician Orders (Use separate page(s)
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References, Evidence-Based Practice Guidelines, Protocols,
or Algorithms used for this scenario:
Center for Disease Control and Prevention (2010). Recommended Adult Immunization
Schedule United States.
The Joint Commission (2007). Improving Handoff Communication.
Oakbrook Terrace, IL: Joint Commission Resources
L. and Rounds, LA Conjoint screening questionnaires for alcohol and drug abuse.
Wisconsin Medical Journal 94: 135-140, 1995.
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Scenario Progression Outline
Timing Programming Data Expected Teaching Points for
(Manikin Actions) Interventions Debriefing
Initial Stage: 0900 Auscultation Wash hands 1.Handwashing
Assessment Focus sounds: Breath Introduce self decreases the risk of
sounds wheezing Identify patient spread of infection
5-10 minutes bilaterally Position patient
Baseline Vital Signs upright for 2. Safety identify
-T- 100.2 Pt vocal sounds: comfort and client prevents medical
-P- 92 “could I get some ease of care/procedures from
-R- 28 more tissues I am breathing. being done on the
-BP- 142/84 coughing up a lot of Apply O2 2 wrong client.
-SPO2-80% mucus” liters via nasal
cannula 3. Immediately obtain
Coughing Encourage purse vital signs when a
lip breathing client is
admitted/transferred to
Obtain vital
your unit. Identify
signs with SPO2
neurological,
level.
respiratory, cardiac,
Provides
GI/GU and if the client
appropriate
has any IV access or if
disposal of
they need O2 therapy.
tissues wearing
gloves.
4. By not disposing of
used tissue will
promote bacterial
growth.
Review Physician If student fails to call
Intervention Phase Vocal Sounds: orders call (Medical for RT for breathing
Continues to cough Student will call for treatment patient will
B/P 145/90 patient status report prompt student by
SpO2>93% over 5 and give orders) saying “I’m having a
minutes really hard time
Call respiratory breathing, at home I
therapist for use the breathing
breathing treatment machine”
(order proventil
neb)
Administer Solu-
medrol IV and
Ancef IVPB
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Stage 2- Conclusion Lung sounds: Student will monitor
of remain course patient for any
Scenario bilaterally adverse reactions to
Evaluation medications.
SpO2 increase 94%
on 2 L/nc
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Debriefing/Guided Reflection Questions for this Simulation
1. What were your primary concerns in this scenario?
2. Did you miss anything in getting report on this patient?
3. Did you have sufficient knowledge/skills to manage this situation?
4. What were your primary nursing diagnoses in this scenario? What nursing
interventions did you use, what outcomes did you measure? Where is your patient in
terms of these outcomes now?
5. What did you do well in this scenario?
6. If you were able to do this again, what would you do differently?
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NCLEX – RN Test Plan Categories
Safe Effective Care Environment Health Promotion & Psychosocial Integrity
Maintenance
Management of Safety & Infection Control Aging Process Abuse/Neglect
Care Accident Prevention Disease Prevention Behavior Interventions
Advance Disaster Planning Family Planning Chemical Dependency
Directives Emergency Response Family Systems Coping Mechanisms
Advocacy Plan Growth & Development Crisis Intervention
Case Management Error Prevention Health & Wellness Cultural Diversity
Client Rights Home Safety Health Promotion End of Life
Collaboration with Injury Prevention Health Screening Family Dynamics
Multidisciplinary Medical & Surgical High Risk Behaviors Grief and Loss
Team Asepsis Safe use of Human Sexuality Mental Health
Management Equipment Immunizations Concepts
Confidentiality Security Plan Lifestyle Choices Psychopathology
Consultation Use of restraints/ Safety Teaching/Learning Situational Role
Continuity of Care Devices Self Care Changes
Delegation Reporting of Techniques of Physical Stress Management
Prioritization Incident/Event/ Irregular Assessment Support Systems
Ethical Practice Occurrence/Variance Developmental stages and Therapeutic
Informed Consent Handling Hazardous and Transitions Environment
Quality Assurance Infectious Materials Expected Body Image Sensory/Perceptual
Referrals Changes Alterations
Resource Ante/Intra/Postpartum & Religious and Spiritual
Management Newborn Care Influences on
Staff Education Health
Supervision
Legal Rights &
Responsibilities
Physiological Integrity
Basic Care and Pharmacological and Reduction of Risk Physiological
Comfort Parenteral Therapies Potential Adaptation
Alternative & Adverse Effects Diagnostic Tests Alterations in Body
Complementary Contraindications Laboratory Values Systems
Therapies Side Effects Monitoring Conscious Fluid & Electrolyte
Assistive Devices Blood and Blood Sedation Imbalances
Elimination Products Potential for Alterations Hemodynamics
Mobility/Immobility Central Venous in Illness Management
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Non-Pharmacological Access Body Systems Infectious Diseases
Comfort Interventions Devices Potential for Medical Emergencies
Nutrition & Oral Dosage Calculation Complications Pathophysiology
Hydration Expected of Diagnostic Tests/ Radiation Therapy
Palliative/Comfort Care Outcomes/Effects Treatment/Procedures Unexpected
Personal Hygiene Intravenous Therapy Potential of Response
Rest & Sleep Medication Complications To Therapies
Administration for Surgical Procedures
Parenteral Fluids and Health Alterations
Pharmacological System Specific
Agents/ Assessments
Actions Therapeutic Procedures
Pharmacological Vital Signs
Interactions
Pharmacological Pain
Management
Total Parenteral
Nutrition
Safe Effective Care Environment Health Promotion & Psychosocial Integrity
Maintenance
Management of Safety & Infection Aging Process Abuse or Neglect
Care Control Data Collection Behavior Interventions
Advance Directives Accident Prevention Techniques Behavior Management
Advocacy Error Prevention Disease Prevention Coping Mechanisms
Client Care Home Safety Family Planning Crisis Intervention
Assignments Injury Prevention Family Interaction Patterns Cultural Awareness
Client Rights Medical & Surgical Growth & Development End of Life Concepts
Concepts of Asepsis Safe use of Health & Wellness Grief and Loss
Management Equipment Health Mental Health Concepts
& Supervision Security Plans Promotion/Screening Mental Illness Concepts
Consultation with Use of restraints/ Programs Sensory/Perceptual
Multidisciplinary Safety High Risk Behaviors Alterations
Team Devices Human Sexuality Situational Role Changes
Confidentiality Reporting of Immunizations Stress Management
Continuity of Care Incident/Event/ Lifestyle Choices Substance-Related
Ethical Practice Irregular Occurrence/ Self Care Disorders
Informed Consent Variance Techniques of Physical Suicide/Violence
Legal Handling Hazardous Assessment Precautions
Responsibilities and Developmental stages and Support Systems
Quality Assurance Infectious Materials Transitions Therapeutic Environment
Referral process Expected Body Image Therapeutic
Resource Changes Communication
Management Ante/Intra/Postpartum& Religious and Spiritual
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Physiological Integrity
Basic Care and Pharmacological and Reduction of Risk Physiological
Comfort Adverse Effects Potential Adaptation
Assistive Devices Expected Effects Diagnostic Tests Alterations in Body
Elimination Medication Laboratory Values Systems
Mobility/Immobility Administration Potential for Basic Pathophysiology
Non-Pharmacological Side Effects Alterations in Fluid & Electrolyte
Comfort Interventions Pharmacological Body Systems Imbalances
Nutrition & Oral Actions Potential for Medical Emergencies
Hydration Pharmacological Complications Radiation Therapy
Palliative/Comfort Care Agents of Diagnostic Tests/ Unexpected Response
Personal Hygiene Treatment/Procedures to
Rest & Sleep Potential of Therapies
Complications
for Surgical Procedures
and Health Alterations
Therapeutic Procedures
Vital Signs
Newborn Care Influences on Health