SIMULATION DESIGN & PLANNING TEMPLATE
Scenario Name CHF Senior level
Program/Curriculum Specific Objectives:
1. Utilize the nursing process to provide nursing care to adult clients.
2. Perform physical assessment and begin to: determine relevancy, critique
information, identify relationships, draw conclusions, and evaluation findings.
3. Determine relevancy, critique information, identify relationships, draw
conclusions, and evaluation findings related to laboratory findings.
4. Demonstrate proficiency in application of knowledge and skills.
Measurable Objectives (minimum 2, maximum 10)
1. Perform head to toe physical assessment
2. Explain physical assessment findings related to patient condition
3. Discuss assessment and laboratory findings.
4. Administer IV Lasix and IV Digoxin and discuss monitoring for effectiveness
5. Convert IV to saline lock
6. Document I/O
Authors: Lisa Nelson, Renton Technical College
Carly Williams, Northwest Hospital and Medical Center
Date Submitted Spring 2013
Will There Be Any Pre-Simulation Lecture?
Expected Scenario Time 20 min
Expected Debrief Time
No
30 min
Report and Information Provided To Participants Prior To Simulation
S.L. is a 84 year old man who lives with his wife in their own home. His health history
includes MI, HTN and obesity. Medications prior to admission include Lasix, Vasotec,
and aspirin. He was doing well until 2 days ago when he reports he “ran out of Lasix
from the pharmacy”. Mr L. presents with shortness of breath and cough. Has pedal
edema. A&O x3. Bibasilar crackles. IV running,
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
1
SIMULATION DESIGN & PLANNING TEMPLATE
Patient Information
Patient Name:
Age:
Samuel Laing Gender: M
84
Birth date:, 10/15/ 30
Weight:
___Height:
210 lb
5’ 10”
ID band MR #00001234 Acct. # 1198765432
Hx. Present Illness: shortness of breath and cough. Has pedal edema. A&O x3.
Bibasilar crackles
Social History:
lives with wife
Religion:
Methodist
Support System: wife, adult son lives locally
Allergies:
sulfa
Immunizations: Current
Attending Physician:
Past medical history:
Dr Dansell
MI, HTN, obesity
Physical description of how you want the manikin to present at start of scenario?
Moulage:
Edema Legs
Assignment Of Roles (Please indicate below roles to be assigned):
Primary Nurse
Clinical Instructor
Physician/ Advanced Practice Nurse
Family Member #1
Important Information Related To Roles:
Script for family member
SIM Setup
Moulage
Nasal O2 at 2L/Min. Bandaid R antecubital (from blood draw)
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
2
SIMULATION DESIGN & PLANNING TEMPLATE
Fidelity (choose all that apply to this simulation)
Setting/Environment
ER
Props:
Equipment attached to manikin:
Primary IV Fluid running at 75 ml/hr
O2
Monitor attached/ Type
ID band
Equipment available in room:
Bedpan/ Urinal
Crash cart c airway devices and emergency meds
Foley kit
IV pump
O2 delivery device
Other Props:
Edema legs, chair for family member
Medications and Fluids:
IV Fluids
IV Push
Lasix 40mg IVP
Diagnostics Available:
Labs Values
Documentation Forms:
Physician Orders
MAR
Graphic Record
Recommended Mode for Simulation
Manual
Programmed
Manual/Programmed Hybrid
Other
Manikin to be used SimMan3G
Significant Lab Values see attached
Physician Orders see attached
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
3
SIMULATION DESIGN & PLANNING TEMPLATE
Scenario Progression Outline
State 1 Patient Family
Initial Amount
Verbalization
Time in Initial
(Pt/Manikin
Stage- 5 mins
Cues)
Baseline Vital Signs Shortness of
T PR 98.4/116/30
breath
BP 168/94
SPO2: 90%
“I’ve been
Cardiac Rhythm
having trouble
AFib
walking up
Breath Sounds
stairs lately.”
bibasilar crackles
Heart Sounds S3
“Could you
Abdominal Sounds get me
another
Other Symptoms:
pillow? Or let
Eyes open, half
me dangle my
closed, or closed
legs over the
Trending:
bed?”
VS ↑ or↓ over time
Expected
Interventions
Identify self
Check ID
band
Alternate or Incorrect
Treatment Choice
That Will Affect Outcome
Confederate
Actions/Additional
Role Player Cues
Family Member: “They
can’t even walk to the
bathroom without
getting tired.”
Introduce self
Head to toe
physical
assessment
and gather
basic vital
signs
“I think it is all of the
McDonald’s he eats”
Give Patient
extra pillow
and/or raise
HOB
Discover
edema legs
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
4
SIMULATION DESIGN & PLANNING TEMPLATE
Correct Treatment Choice
State 2
Timing Sequence
Expected
10 min
Interventions
Baseline Vital Signs
Head to toe
T 98.4
physical
P 117
assessment
R 31
BP 168/94
Discuss
SPO2-92
assessment
Cardiac Rhythm AFib
findings with
Breath Sounds crackles instructor
Heart Sounds S3
Discuss findings
Verbalization
with MD
“I feel a little better with
oxygen but I feel so
Draw up and give
tired and I am so
Lasix IV
puffy!!! please do
something to help me.” Convert running
IV to saline lock
Alternate or Incorrect Treatment choice
State 2A
Timing Sequence
Expected
If no Oxygen or call to
Interventions
MD
Baseline Vital Signs
T 98.4
P 118
R 33
BP 168/94
SPO2 89
Cardiac Rhythm AFib
Breath Sounds crackles
Heart Sounds S3
Cough increases
Correct Treatment Choice
State 2
Timing 20 minutes post Expected
IV Lasix
Interventions
Baseline Vital Signs
T 98.4
Recycle vital
P 105
signs
R 31-25 (trending
down over 2 minutes)
Talk to patient
BP 168/94 (trends down about how they
to 157-89 over 2
are feeling.
minutes)
SPO2 92-93
Report findings to
Cardiac Rhythm AFib
MD.
Breath Sounds crackles
Heart Sounds S3
Alternate or Incorrect Treatment choice
State 2A
Timing Sequence
Expected
No Lasix given
Interventions
Baseline Vital Signs
T 98.4
P 117 (trending up to
Administer Lasix
122)
R 31 trending up to 35
BP 172/98
SPO2 91
Cardiac Rhythm AFib
Breath Sounds crackles
Heart Sounds S3
Verbalization
“I feel like that is really
helping. What did you
give me?”
Verbalization
“It’s harder for me to
breath”
Increasing dyspnea
Verbalization
Please help me
already!!! Increased
SOB
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
5
SIMULATION DESIGN & PLANNING TEMPLATE
Instructor Check List
(return to CHESC assistant at the end of class)
Pre-Scenario Check List
1.
2.
3.
4.
5.
6.
7.
8.
Equipment is staged as requested.
The learner has been oriented to the simulator.
The learner understands the guidelines/expectations for the
scenario.
Participants understand their assigned roles.
The time frame Expectations for simulation met: Yes No.
The time frame Expectations for debrief met:
Yes
No.
Audio/Visual Consent signed and turned into CHESC sheet.
Attendance sheet completed and given to CHESC staff.
Post Scenario
If you could change anything next time, what would it be?
Comments:
________________________________________________________
________________________________________________________
________________________________________________________
CHESC Assistant Name:
Did the person provide excellent support for the scenario?
Yes
No Comment
Instructor signature ________________________________
Date
________________________
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
6
SIMULATION DESIGN & PLANNING TEMPLATE
Participant Check List
(return to Instructor at the end of class)
Pre-Scenario Check List
1.
2.
3.
4.
5.
I have been oriented to the simulator.
I understand the guidelines/expectations for the scenario.
I understand the assigned role.
My questions about the simulation have been answered.
I have all necessary equipment for the simulation.
Post Scenario
If you could change anything next time, what would it be?
Comments:
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
Participant Signature ____________________________________
Date
________________________
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
7
SIMULATION DESIGN & PLANNING TEMPLATE
Simulation Post-Assessment Methods
Checklist
Tests
Evaluations
Turning Point
Jeopardy
Other
Optional Literature References
Debriefing Guidelines
(Remember to identify important concepts or curricular threads that are specific to your
program)
1. Leave the simulation room and go to a conference room, if possible. It allows for deescalation of emotions.
2. Solicit and validate emotions briefly. Validate simisms (the simulation isn’t 100% accurate
due to different equipment, personnel etc)
3. What went WELL in this simulation?
4. What DID NOT go well in this simulation?
5. If you could do it again, what would you do differently?
6. Summarize:
“What I hear you saying is . . .”
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
8
SIMULATION DESIGN & PLANNING TEMPLATE
Resources:
www.micromedexsolutions.com
http://home.mdconsult.com/groups/northwest112.html
http://www.chfpatients.com/tests/routine_tests.htm
http://nursing.uchc.edu/nursing_standards/docs/IV%20Push%20Medications.pdf
Drug handbook
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
9