Simulation Pre-Case Review
Student Name: Kelsey Lockamy
Simulation Name: Song
Name
Dan Song
Date:
3/20/22
Simulation Date: 3/21/22
Age
DOB
69
08/05/XX
Weight
90 kg
Height
182.88 cm
72 in
MR#
42671099
Case Objectives
 Relates significance of symptoms and assessment findings (EVALUATING)
 Records assessment findings, procedures and patient outcomes accurately (REMEMBERING)
 Evaluates the patient’s response to interventions and modifies nursing care (EVALUATING)
 Utilizes history information and assessment data to plan and provide care for the patient in cardiac rehabilitation
(APPLYING)
 Correlates co-morbidities and therapies for the patient in cardiac rehabilitation (ANALYZING)
 Prioritizes nursing management of the patient in cardiac rehabilitation (ANALYZING)
 Recognizes contributions of other individuals and groups in helping patient/family achieve health goals (APPLYING)
 Explains the role of evidence in determining best clinical practice (UNDERSTANDING)
 Integrates best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal
health care (APPLYING)
 Analyze social and cultural dimensions simulated patient encounters to build understanding and capacity for the provision of
culturally congruent nursing care.
Synopsis
69 year old individual who is two days postop CABG. Has a known cardiac and respiratory history. Smokes 2ppd. Admitted to ED 48
hours ago with substernal chest pain. Cardiac catheterization demonstrated significant blockage. Taken to OR for CABG. No
complications with surgery
Past Medical History:
 HTN, history of MI, DM type 2, COPD, unhealthy weight
Allergies:
 No known allergies
Medications:
 Does not remember but gave ED nurse a list
Code Status:
 Full code
Social/Family History:
 Divorced lies with cousin. Smokes 2PPD x 45 years. Does not exercise and eats out at fast food restaurants frequently
Questions:
Discuss the pathophysiology of coronary artery disease (CAD).
CAD is caused by a build up of plaque in the coronary arteries.
What are the nurse’s role in caring for a patient who is beginning cardiac rehab?
The main role for nurses in cardiac rehab is to assist patients in managing and recovering from their cardiovascular disease.
Discuss the care of the postop cardiac surgery patient and possible complications after ICU or discharge.
The main aim after a CABG, is to reduce the risk factors for heart disease. Some post op surgical complications are bleeding, stroke,
heart attack, etc.
Discuss the pharmacology of analgesics, anti-anxiety, bronchodilators, and other prescribed medications for this patient.
Beta Blockers are primarily used to regulate abnormal heart rhythms.
Aspirin is primarily used to alleviate mild to moderate pain.
Ace inhibitors is used to treat for high blood pressure and heart failure.
McCuistion, L. E., Vuljoin-DiMaggio, K., Winton, M. B., & Yeager, J. J. (2023). Pharmacology: A patient-centered nursing
process approach. Elsevier.
Nursing Management of your client (What will you do?):
1
Assess the patient for any post op pain. Educate the patient on avoiding the risk factors. Educate the patient on exercising regularly
and reduces stress.
2
Concept Map
Pathophysiology of Main Problem
CAD is caused by a build up of plaque
in the coronary arteries
Abnormal Labs (Rationale)
N/A
Chief Complaint/Reason for seeking healthcare
two days postop CABG
Priority Problem:
Secondary Problem:
NANDA Nursing Diagnosis – Ineffective peripheral
tissue perfusion
related to – clot formation at the puncture site
as evidenced by (ID 3 signs/symptoms)
1. two days post CABG
2. Substernal chest pain
3. History of HTN, history of MI, DM type 2, COPD,
unhealthy weight
NANDA Nursing Diagnosis – Risk for injury
related to –
as evidenced by (ID 3 signs/symptoms)
1. two days post CABG
2. Substernal chest pain
3. History of HTN, history of MI, DM type 2,
COPD, unhealthy weight
Patient outcome (Ensure SMART)
Patient will not experience bleeding from surgical site.
Patient outcome (Ensure SMART)
The patient will respond to sensation in extremities equally.
Medications (Rationale)
N/A
Interventions (Rationale)
1.Assess extremities.
2. Encourage bed rest.
3.Provide warmth to extremities.
4. Inform patient’s family on the importance of
assessing vital signs frequently.
Was priority problem corrected? How? (Explain)
Interventions (Rationale)
1.Monitor vitals.
2. Get baseline measurements.
3.Assess dressings for bleeding or infection.
4. Maintain bed rest.
Was priority problem corrected? How? (Explain)
Yes, the problem was corrected
Yes, the problem was corrected.
References (Two):
Doenges, M., Moorhouse, M., & Murr, A. (2019). Nurse’s pocket guide: Diagnoses, prioritized interventions, and
rationales (15th ed.). F.A. Davis Company. NANDA International Nursing Diagnoses: Definitions and
Classification 2012-14. Chichester, U.K ; Ames, Iowa: WileyBlackwell, 2012. NANDA
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