Simulation Design Template

Report as inappropriate Your report has been received

Shared by: HC111213154721

Tags

Stats

views:: 21
posted:: 12/13/2011
language:: Latin
pages:: 10

Public Domain

Document Sample

Date: File Name: Millie Larsen
Discipline: Nursing Student Level: Varied
Expected Simulation Run Time: Guided Reflection Time:
20 minutes 20 minutes
Location: Simulation lab Location for Reflection:
Classroom or debriefing area

Admission Date: Psychomotor Skills Required Prior to
Simulation
Today’s Date:
General head-to-toe assessment and the
Brief Description of Client following assessment tools: SPICES, Confusion
Assessment Method (CAM),
Katz Index of Independence, and Hendrich II
Name: Millie Larsen
Fall Risk Model.
Gender: F Age: 84 Race: Caucasian
Cognitive Activities Required prior to
Weight: 48 kg Height: 61 in Simulation [i.e. independent reading (R),
video review (V), computer simulations
(CS), lecture (L)]
Religion: Lutheran

Major Support: Dina (daughter) Basic knowledge of geriatric syndromes and the
Phone: 555-1210 atypical presentation of older adults. (L, R)

Tools in the Try This: ® and How to Try This
Allergies: no known allergies
Series, available on the ConsultGeriRN.org
(www.ConsultGeriRN.org). Specific tools
Immunizations: Influenza & pneumonia recommended for this scenario are the
(2 years ago) SPICES, Confusion Assessment Method
(CAM), Katz Index of Independence and
Attending Physician/Team: Hendrich II Fall Risk Model.(R)
Dr. Eric Lund
Read chapter in fundamentals text related to
Past Medical History: Glaucoma, HTN, care of the older adult; stress incontinence and
osteoarthritis, stress incontinence, confusion. (R)
hypercholesterolemia
History of Present illness: Millie Larsen is
an 84-year-old female admitted from home
with confusion about 36 hours ago with a
diagnosis of dehydration and urinary tract
infection. She has been receiving IV fluids and
antibiotics. Prior to admission she was not
taking her medications properly and as a result
had an elevated blood pressure yesterday
evening. Her blood pressure has improved.

Social History: Widow for one year; involved
in church activities and gardening. Daughter
and grandchildren live nearby.

Primary Medical Diagnosis:
Dehydration; UTI

Surgeries/Procedures & Dates:
Cholecystectomy at age 30.

Nursing Diagnoses: Risk for falls, urinary
incontinence, risk for fluid volume imbalance
Simulation Learning Objectives – for faculty

1. Perform a head-to-toe physical assessment and use the following assessment tools:
SPICES, Confusion Assessment Method (CAM), Katz Index of Independence, and
Hendrich II Fall Risk Model.

2. Identify changes in cognition from simulation scenario #1.

3. Recognize conflict between daughter and client regarding discharge plan.

4. Communicate therapeutically with patient and daughter.

5. Discuss the risks and benefits of discharge to home.

6. Identify and discuss geriatric syndromes evident in the simulation: fall risk, confusion,
incontinence.

Simulation Learning Objectives – for learners

1. Complete appropriate assessments during the simulation.

2. Use therapeutic communication techniques with the patient and family members.

3. Identify issues related to the transition of care specific to the patient in this simulation.

4. Identify geriatric syndromes evident in the simulation.
Fidelity (choose all that apply to this simulation)
Setting/Environment Medications and Fluids
ER IV Fluids: D5. 45 with 20 mEq KCL
Med-Surg Oral Meds: captopril; metoprolol,
Peds furosemide, Lipitor, pilocarpine eye gtts,
ICU Fosamax, Celebrex, tramodol (PRN pain);
OR / PACU ciprofloxacin; acetaminophen (PRN
Women’s Center pain/fever)
Behavioral Health
Home Health IVPB: Ciprofloxacin 200 mg IV q12
Pre-Hospital hrs
Other: IV Push:
IM or SC:
Simulator Manikin/s Needed:
Human patient simulator (example: SimMan, Diagnostics Available
VitalSim); standardized patient Labs
X-rays (Images)
Props: IV pump, IV bag 12-Lead EKG
Other:
Equipment attached to manikin:
IV tubing with primary line D5.45 Documentation Forms
with 20 mEq KCL fluids running at Physician Orders
60 ml/hr Admit Orders
Secondary IV line running at Flow sheet
mL/hr Medication Administration Record
IV pump Kardex
Foley catheter mL output Graphic Record
PCA pump running Shift Assessment
IVPB with running at Triage Forms
mL/hr Code Record
02 Anesthesia / PACU Record
Monitor attached Standing (Protocol) Orders
ID band Transfer Orders
Other: Other:

Equipment available in room
Bedpan/Urinal
Foley kit Recommended Mode for
Straight Catheter Kit Simulation
Incentive Spirometer (i.e. manual, programmed, etc.) either
Fluids
IV start kit
IV tubing
IVPB Tubing
IV Pump
Feeding Pump
Pressure Bag
02 delivery device (type)
Crash cart with airway devices and
emergency medications
Defibrillator/Pacer
Suction
Other:

Roles/Guidelines for Roles Student Information Needed Prior
Primary Nurse to Scenario:
Secondary Nurse Has been oriented to simulator
Clinical Instructor Understands guidelines
Family Member #1 /expectations for scenario
Family Member #2 Has accomplished all pre-
Observer/s simulation requirements
Recorder All participants understand their
Physician/Advanced Practice Nurse assigned roles
Respiratory Therapy Has been given time frame
Anesthesia expectations
Pharmacy Other:
Lab
Imaging
Social Services
Clergy
Unlicensed Assistive Personnel
Code Team
Other:

Important Information Related to
Roles:
Secondary nurse is an orientee. Family member
is a 50-year-old daughter.
Significant Lab Values: Report Students Will Receive
Urine Analysis: Before Simulation
Urine color: dark amber, cloudy
Specific gravity: 1.050 (normal 1.005-1.035) Time: 6:45 AM Shift Report
ph 6.0 (normal 4.5-8.0) ML is an 84-year-old female admitted from
RBC - 9 (normal 0-2) home with confusion about 36 hours ago.
WBC - 150,000 (normal 0-5) She was diagnosed with acute confusion and
a UTI. She had a near fall about 6:00 this
Basic Metabolic Panel morning; she was trying to get to the
Na - 149 bathroom. She has no visible injuries and her
K - 3.5 primary care provider and her daughter has
Glucose - 105 been notified. Her daughter is on her way in.
I did not have time to do her fall risk
CBC assessment, would you please get that done
H/H - 9.9/32 this morning? She may be discharged later
WBC 12,000 today, but she does live alone. Her blood
pressure was very elevated yesterday, we were
able to restart her meds and her B/P this
Physician Orders: morning is down to 160/92. She has had 450
Bedrest cc of amber urine out and she had no pain
Bathroom privileges with assist during the night. Mrs. Larsen has a history of
Regular, low fat diet hypertension, glaucoma, osteoporosis,
I&0 arthritis, elevated cholesterol, and stress
Notify physician if systolic BP >150 or < 100; incontinence.
temp > 38 C, I/O < 60 mL. in 2 hrs.

Home Medications:
captopril 25 mg. po daily, metoprolol 100mg.
po. daily; furosemide 40 mg. po twice daily;
Lipitor 50 mg po daily; pilocarpine eye drops
two drops each eye four times a day; Fosamax
10 mg. po daily, Celebrex 200 mg. po daily,
tramodol 50 mg po every 4 - 6 hours for
arthritis pain prn

Continue home medications and add:
ciprofloxacin 200 mg q 12 hours IV
acetaminophen 650 mg. po q 4 - 6 hours prn
IV fluids D5 .45 NaCl 20 mEq KCL at 60ml/hr
References, Evidence-Based Practice Guidelines, Protocols, or Algorithms
Used For This Scenario (site source, author, year, and page):

You may wish to have your students review these resources in preparation for the first
simulation scenario.

1. SPICES - An Overall Assessment Tool
Tool: http://consultgerirn.org/uploads/File/trythis/try_this_1.pdf
Article: http://www.nursingcenter.com/prodev/ce_article.asp?tid=742423
Video: http://consultgerirn.org/resources/media/?vid_id=4200873#player_container

2. Confusion Assessment Method Tool:
http://consultgerirn.org/uploads/File/Confusion%20Assessment%20Method%20(CAM).pdf

3. Katz Index of Independence
Tool: http://consultgerirn.org/uploads/File/trythis/try_this_2.pdf
Article: http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=781870
Video: http://consultgerirn.org/resources/media/?vid_id=4610636#player_container

4. Hendrich II Fall Risk Model
Tool: http://consultgerirn.org/uploads/File/trythis/try_this_8.pdf
Article: http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=751426
Video: http://consultgerirn.org/resources/media/?vid_id=4200978#player_container

5. Other tools in the Try This: ® and How to Try This Series are available on the
ConsultGeriRN.org (www.ConsultGeriRN.org), the website of the Hartford Institute for
Geriatric Nursing, at New York University’s College of Nursing, The tool, an article about using
the tool, and a video illustrating the use of the tool, are all available for your use.

6. Review the Essential Nursing Actions in the ACES Framework.
Scenario Progression Outline

Timing Manikin Actions Expected May Use the
(approximate) Interventions Following Cues
0-5 minutes “I just needed to go to Wash hands. Role member
the bathroom. I didn’t Introduce self. providing cue:
want to bother anyone, Identify patient. Daughter arrives visibly
they are so busy. I upset.
forgot that I had this Take VS (or have nurse
thing in my arm (IV & tech take VS). Cue: Mom, I heard you
pump) and I almost almost fell last night.
tripped over it.” It Why did you try to get
seems like everyone Begin general, SPICES, out of bed by yourself?
treats me like I’m a and CAM assessments.
child, they keep calling
me sweetheart and
honey. My name is
Millie; I wish they
would call me Millie.”

Resting in bed. Is
oriented to person,
place, time

Vital Signs:
BP 156/88,
P - 80
R – 16
T - 98 F

Response to daughter:
“I don’t know, I had to
go to the bathroom
and I didn't want to
bother anybody.”
5-15 minutes “I can take care of Complete fall risk Role member
myself! Who will take assessment/Katz ADL providing cue:
care of Snuggles? Have assessment. Daughter
you checked on her
since I've been in Cue: If you are falling,
here?” you can’t go home
Learner responds to alone. We've talked
daughter asking about about this before. Why
client going home alone don’t you come home
- asking about safety, with me for a while
support systems to until you get your
check on Millie, or if strength back?
someone could stay with
her for a few days. Daughter asks learner:

Do you think she
should go home alone?

15-20 minutes “I need to go to the Calls for assistance to Role member
bathroom.” help Millie to bathroom providing cue:
Daughter

Cue:
(Use only if learner
does not ask for help.)
She still seems to be
weak, don't you need
some help getting her
out of bed?
Debriefing/Guided Reflection Questions for This Simulation
(Remember to identify important concepts or curricular threads that are specific to your
program.)

1. How did you feel throughout the simulation experience?

2. Describe the objectives you were able to achieve.

3. Which ones were you unable to achieve (if any)?

4. Did you have the knowledge and skills to meet objectives?

5. Were you satisfied with your ability to work through the simulation?

6. To Observer: Could the nurses have handled any aspects of the simulation differently?

7. If you were able to do this again, how could you have handled the situation differently?

8. What did the group do well?

9. What did the team feel was the primary nursing diagnosis?

10. What were the key assessments and interventions?

11. How were you able to use the ACES Framework with Millie’s situation? (Assess Function
and Expectations, Coordinate and Manage Care, Use Evolving Knowledge, Make
Situational Decisions)

12. How do you feel about Millie being discharged home? What are your concerns? Talk about
the risks and benefits from Millie’s point of view and from Dina’s point of view.

13. Is there anything else you would like to discuss?

Complexity – Simple to Complex
Suggestions for Changing the Complexity of This Scenario to Adapt to
Different Levels of Learners

1. Have student start IV, perform venipuncture to draw labs, administer medication - oral
or parenteral.

2. Include additional findings/information that will require more assessment, such as
pressure ulcer, potential elder neglect, and financial concerns.

3. Have students investigate and discuss resources in your community that Millie may need
over both the short- and long-term.