Simulation - Lower Extremity Fracture

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					                            Initial Simulation Activity Development Form
          Use additional sheets if you require more room to complete the requested information

Individuals planning to use the Simulation Center or Simulation Center Equipment must receive
the appropriate training on the use of the Center and its Equipment. You will be contacted by the
Simulation Center Staff to make arrangements for the appropriate “next step” in the activity
development process. The next steps may differ for different types of simulation learning

   1. Developer(s) Name(s) and Contact Information:

        Nancy Duffy, RN, MSN, CEN              MUSC College of Nursing

        Kathy A. Neeley, RN, MSN, CCRN         MUSC College of Nursing

   2. Today’s Date: 10/16/2008          2a. Anticipated Date(s) of Activity:

   3. Activity Title: Lower Extremity Fracture

   4. General Statement of Activity Educational Objective(s):

   Expose Nursing students to common clinical situations that may not be encountered during routine
   clinical rotations.

   5.   Anticipated number and type(s) of Participants: (eg 40 nursing students; 25 Anesthesia
        Residents; 120 hospital employees, including nurses and respiratory therapists.)

   Fifty undergraduate nursing students from MUSC College of Nursing in groups of five.

   6. Anticipated Type of Learning Activity: (Select all that apply)
          a. I do not know yet
          b. Complete Course                                                            
          c. Module in Existing Course                                                  
          d. Individual Competency Training                                             
          e. Problem-based Learning Activity                                            
          f. Team Training                                                              
          g. Skill Training (with assessment of learner’s level of achievement)         
          h. Skill Practice (without assessment of learner’s level of achievement)      
          i. Individual or Small Group Demonstration at the Simulation Center           
          j. Individual or Small Group Demonstration Offsite                            
          k. Classroom Demonstration at the Simulation Center                           
          l. Classroom Demonstration Offsite                                            
          m. Other: specify
7. Desired Educational Outcome Measurement :
      a. None                                                                
      b. I do not know yet                                                   
      c. Participants’ Subjective Evaluation                                 
      d. Cognitive Exam                                                      
      e. Skill-based Exam/Assessment                                         
      f. High fidelity Simulator-based Evaluation of Knowledge,
                Skills, & Judgment                                           
      g. Other Assessment of Learner’s Achievement                           
      h. Other: specify                                                      

8. Known Limitations on Activity Development:
      a. Time                                                                
      b. Financial Resources                                                 
      c. Number of Available Instructors                                     
      d. Other: specify                                                      

9. In your own words, describe your vision for using the simulation center, i.e. What do you think the
   activity will “look” like when it is finalized?

        To facilitate the ease of transferability between SC shared file users, this
document will be completed for all modules. Please use a “√” for each of the areas

Module Name: Lower Extremity Fracture Simulation

Authors: Nancy Duffy, Kathy Neeley

                                Nursing Process
                                                                  Check (√)
Assessment                                                   
Planning                                                     
Implementation                                               
Evaluation                                                   

                                Blooms Taxonomy
                                                                  Check (√)
Knowledge                                                    
Comprehension                                                
Application                                                  
Analysis                                                     
Synthesis                                                    
Evaluation                                                   

                             Curricular Placement
                                                                  Check (√)
Adult Health/Medical Surgical                                
Women’s Health
Mental Health

                                  Student Level
                                                                  Check (√)
Lower/Beginner                                               
Upper/Midpoint to Graduation                                 
                                                               Check (√)
Professional Conduct                                       
SBAR                                                       

                               Team Concepts
                                                               Check (√)
Positive Regard for Teamwork                               
Respect                                                    
Openness to Feedback                                       

                               Safety Concepts
                                                               Check (√)
Patient ID x 2                                             
Infection Control                                          
Environmental                                              

                        Safe, Effective Care Environment
Management of Care:                                            Check (√)
Advanced Directives
Advocacy                                                   
Case Management
Legal Rights and Responsibilities
Staff Education
Clients’ Rights
Establishing Priorities                                    
Performance Improvement
Resource Management
Collaboration                                              
Delegation                                                 
Informed Consent                                           

                     Safe, Effective Care Environment
Safety and Infection Control:                                  Check (√)
Accident Prevention
Emergency Response Plan
Injury Prevention
Reporting of Incident Event
Standard/Transmission Based Precautions
Disaster Planning
Handling Hazardous and Infectious Materials              
Medical and Surgical Asepsis                             
Safe Use of Equipment                                    
Error Prevention                                         
Security Plan

                      Health Promotion and Maintenance
                                                             Check (√)
Aging Process
Developmental Stages
Expected Body Image Changes
Health and Wellness
High Risk Behaviors
Lifestyle Choices
Ante/Intra/Postpartum and Newborn Care
Disease Prevention
Family Systems
Health Promotion                                         
Human Sexuality
Self Care
Family Planning
Growth and Develop
Health Screening
Physical Assessment                                      

                             Psychosocial Integrity
                                                             Check (√)
Chemical Dependency
End of Life
Mental Health Concepts
Religious and Spiritual Influences
Situational Role Changes
Therapeutic Environment                                  
Behavioral Interventions
Coping Mechanisms
Family Dynamics
Sensory/Perceptual Alterations
Therapeutic Communications                           
Unexpected Body Image Changes
Crisis Intervention
Cultural Diversity
Grief and Loss
Stress Management
Support Systems

                             Physiologic Integrity
Basic Care and Comfort:                                  Check (√)
Alternative and Complimentary Therapies              
Non-Pharmacologic Comfort                            
Nutrition and Oral Hydration
Palliative/Comfort Care
Assistive Devices
Rest and Sleep
Personal Hygiene

                             Physiologic Integrity
Pharmacological and Parenteral Therapies:                Check (√)
Adverse Effects/Contraindications and Side Effects   
Blood and Blood Products
Expected Outcomes/Effects                            
Pharmacologic Interactions                           
Central Venous Access Device
Medication Administration                            
Pharmacologic Pain Management                        
Dosage Calculation                                   
Intravenous Therapy
Parenteral Fluids

                           Physiologic Integrity
Reduction of Risk Potential:                             Check (√)
Diagnostic Tests
Monitoring Conscious Sedation
Potential for Complications from Surgical Procedures and   
Health Alterations
System Specific Assessment
Laboratory Values
Potential for Alteration in Body Systems
Therapeutic Procedures                                     
Vital Signs                                                

                            Physiologic Integrity
Physiologic Adaptation:                                        Check (√)
Alteration in Body Systems                                 
Illness Management                                         
Unexpected Response to Therapies
Fluid and Electrolyte Imbalances
Infectious Diseases
Radiation Therapy
Medical Emergencies
            Lower Extremity Fracture Simulation
Learning Objectives:

   o   Evaluates patient assessment data including vital signs
   o   Identifies primary nursing diagnosis
   o   Incorporates patient safety measures
   o   Prioritizes and implements physician orders appropriately and timely
   o   Demonstrates effective teamwork
   o   Implements effective communication with interdisciplinary team members
   o   Exhibits therapeutic communication skills

Scenario Specific Learning Objectives:

   o Performs a focused neuromuscular assessment
   o Performs a focused circulatory assessment
   o Recalls indications, preparation, contraindications, and potential adverse effects of
     prescribed medications
   o Implements the “5 Rights” of medication administration
   o Recalls policies and documentation related to informed consent
   o Recognizes and addresses spiritual and psychosocial needs

Student Report:

J.B. is a 28 year old female recently transported to the emergency department by EMS after
falling at home. She is alert and responsive, presents with complaint of right lower leg pain.

Patient History
DOB: 11/22/XX

Height: 65 inches

Weight: 79.5 kg

HPI: Fall at residence, pain and deformity right lower leg.

PMH: TAH 10 years ago

Allergies: Penicillin, causes hives and facial edema.
◊   Universal precautions equipment
◊   Stethoscope
◊   Blood pressure cuff
◊   Pulse oximetry
◊   Thermometer
◊   IV pump
◊   Medication and IV administration supplies
◊   IV Task Trainer
◊   Right Lower Extremity Task Trainer

Medications/IV Fluids

◊ Fentanyl

Documentation Forms

◊ Consent Form

Environmental Preparation

Emergency Room Setting


◊ 1 Primary Nurse

◊ 1 Secondary Nurse

◊ 1 Observer

◊ 1 Surgeon

Nursing Diagnoses:

Acute pain related to bone trauma, muscle spasm, and edema AEB verbal report of pain.

Risk for peripheral neurovascular dysfunction related to trauma and cast application.
Knowledge deficit related to unfamiliarity with present health situation and treatment modality.
Debriefing: Per Debriefing Tool


                                         (To be added)
                   Lower Extremity Fracture
    Event           RN Action                              HPS                     Ø
First Encounter    Wash hands**                   BP 124/78 P 88 R 20
                   Introduce self (name and       O2 sat 96%
2-5 MIN            role)**
                   Verbally verify pt. name       “I got dizzy and lost my
                   Medical hx/allergy             balance.”
Deformity of right Assess:
lower extrem.           Vital signs
                        Pain**
                                                  “I’d give my pain a 6.”
                        Mechanism**
                        6Ps MSK
                        Neurovascular
                           status of extremity
                        Alignment of
                        Rest Ice                                             Scream: “Don’t touch
                           Compression                                        my leg!”
                           Elevation (RICE

Physician          S – Severe pain right leg      “Xray of right leg.
Encounter          B – Syncopal episode with      Give her Fentanyl 50
                   fall 1 hour ago                micrograms IV before she
5-8 MIN            A – Relay vital signs,         goes to Xray.”
                   pain, edema, and
                   deformity of right lower
                   R – Pain medication, Xray
Resolution of pain Repeat VS**                    BP 140/82 P 98 R 24         No VS 
                   Access IV                      R 24 O2 sat 96%             BP 90/60 P 52
IV Task Trainer    Calculate Fentanyl dose                                    R 20 O2 sat 93%
8-15 MIN
SCREEN             Respond to screen              BP 122/74 P 88 R 20         BP 82/56 P 50
Pt to Xray                                        O2 sat 96%                  R 14 O2 sat 88%
                   Reassess VS/Pain                                           “I don’t feel
15-18 MIN                                         “It’s better, maybe a 2.”   right…I’m sweaty.”
                     Procedure consent
MD informs of
fractured right
                     Reassess VS                      BP 120/80 P 78 R 20
Short leg cast       D/C IV                           O2 sat 100%

                     Patient teaching                 “How will I take care of
Follow-up with              6Ps MSK                  myself at home?”
Orthopedics                 RICE
                                                      “How am I going to get
                     Addresses transportation         home? I have no
15-20 MIN            home                             money.”

SCREEN                Siderails up
                      Verify LMP for female pt
                      Inform radiology of
What are safety      narcotic administration
concerns with         Pt teaching: call for assist
transporting a pt
to Xray?

SCREEN                Pt transportation home
                      Pt lack of funds
                      Consult Social Worker
Psychsocial issues    Contact Family/Friend

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