RACHEL KELLER
EDD 581
FEBRUARY 17, 2014
SUSAN GERTEL
1
Action Research Proposal
EDD/581
ACTION RESEARCH
PROPOSAL
PROBLEM STATEMENT

Action Research Proposal
The problem is the sequence of education in
medical simulation. Upon narrowing of the
problem, an intervention will be implemented.
2
PROBLEM DESCRIPTION


The problem is inconsistent sequence of education.
Setting problems include
Action Research Proposal
 Acceptability to standardize
 Student’s knowledge
3
WRITER’S ROLE
Education Specialist
 Train multi-discipline medical personal
 With high fidelity simulation

Action Research Proposal
4
PURPOSE OF THE PROJECT

The purpose of this project is to standardize the
sequence of education in medical simulation.
Action Research Proposal
(Microsoft, 2010)
5
PROBLEM DOCUMENTATION

Problem is inconsistent sequence of education

Influence learners




Action Research Proposal

Pre Simulation versus Post Simulation
Perspective
Facilitator
Conformability
Experience
6
SURVEY
1.
Please rank your value of receiving simulation as part of you educational experience.
1
2
3
Least Valuable
4
5
6
Neutral
7
Most Valuable
2. As the participant, please rank your perception of your facilitator’s attitude with delivering education pre
simulation.
2
3
4
5
6
Neutral
Action Research Proposal
1
Negative
7
Positive
3. As the participant, please rank your perception of your facilitator’s attitude with delivering education post
simulation.
1
Negative
2
3
4
Neutral
5
6
7
Positive
4. Rank your conformability with receiving education pre simulation.
1
2
3
Least comfortable
4
5
6
Neutral
7
Completely comfortable
5. Rank your conformability with receiving education post simulation.
7
1
Least comfortable
2
3
4
Neutral
5
6
7
Completely comfortable
SURVEY
Rank how your knowledge increased with first receiving education, then followed by simulation.
1
2
3
4
5
6
7
Increase
Action Research Proposal
No Change
Rank how your knowledge increased with first receiving simulation, then followed by education.
1
2
3
4
No Change
5
6
7
Increase
Please explain why you would prefer education pre simulation:
Please explain why you would prefer education post simulation:
Have you had experience with medical simulation prior to this training?
 Yes
 No
8
LITERATURE REVIEW
Simulation in medical education
 More effective
 Structure is key component

Simulation before education
 Better performance
 Increase knowledge

Action Research Proposal
(Microsoft, 2010)
9
LITERATURE REVIEW

Education before simulation

Action Research Proposal

Improves learning
Simulation before education
 Negative attitude
(Microsoft, 2010)
10
LITERATURE REVIEW
Title of the
study
Purpose of the
study
Pertinent findings
that support your
project
Cendan, J. C.
and T. R.
Johnson
Enhancing Learning
through Optimal
Sequencing of WebBased and Manikin
Simulators to Teach
Shock Physiology in
the Medical
Curriculum.
Investigate proper
linkage of simulation
experiences with
medical curricula.
The data suggest improved
learning when education
precedes simulation.
Ciceroa, M.,
Auerbacha, M.,
Zigmonta, J.,
Rieraa, A.,
Chinga, K., and
Baum, C.
Simulation training
with structured
debriefing improves
residents' pediatric
performance.
Measure the efficacy
simulation in
learners' skills.
Hypothesis
simulations and a
structured debriefing
would improve
performance.
Structured education is a
key component of simulation
education to improve
learners’ performance.
Action Research Proposal
Authors of the
study
11
LITERATURE REVIEW
Authors of the
study
Issenber, B., &
McGaghie, E.
McGaghie, W.,
Issenber, B.,
Cohen, E.,
Barsuk, J.,
Wayne, D.
Purpose of the
study
Pertinent findings that
support your project
Effectiveness of
computer-based
instructional
simulation: A meta
analysis.
Analyze effectiveness
between two forms of
simulation and modes
of instruction.
Simulation before education may
indicate better performance, but
negative attitude towards
simulation education.
Features and uses of
high-fidelity medical
simulations that lead
to effective learning.
Exploring features and
uses of high-fidelity
medical simulations
that lead to most
effective learning
High-fidelity medical simulations
are effective in medical education.
Does Simulation-based
Medical Education
with Deliberate
Practice Yield Better
Results than
Traditional Clinical
Education? A MetaAnalytic Comparative
Review of the
Evidence
This article presents a
comparison of the
effectiveness of
traditional clinical
education toward skill
acquisition goals
versus simulationbased medical
education.
Simulation is superior to
traditional clinical medical
education in achieving specific
clinical skill acquisition goals.
Action Research Proposal
Lee, J.
Title of the
study
12
LITERATURE REVIEW
Title of the
study
Purpose of the Pertinent findings that
study
support your project
Stefaniak, J.,
& Turkelson,
C.
Does the sequence
of instruction
matter during
simulation.
Examine sequence
of instruction
during simulation.
Learners who participated in
simulation before education
demonstrated increased knowledge
compared with learners who
participated in simulation after a
education.
Zendejas, B.,
Cook, D., &
Farley, D.
Teaching first or
teaching last: Does
the timing matter
in simulationbased surgical
scenarios.
Examine sequence
of instruction
during simulation.
Participants who received
instruction after simulated
scenarios achieved higher mean
knowledge scores than those who
received instruction before
simulated scenarios.
Action Research Proposal
Authors of the
study
13
ACTION GOAL

Action Research Proposal
The goal of the intervention is to improve knowledge of
participants in implementing a standardization in the
sequence of education in medical simulation. A threeprong intervention will be implemented to meet the
goal, which includes standardizing the sequence of
education in medical simulation, instructor training,
and weekly collaboration time supported by the
administration.
(Microsoft, 2010)
14
SELECTED SOLUTIONS
Standardizing the sequence of education
 Instructor training
 Weekly collaboration

Action Research Proposal
15
CALENDAR PLAN


1
3/3 3/7
2
3/103/14
3
3/173/21
4
3/213/28
WEEK
5
6
4/73/314/11
4/4
7
4/144/18
8
4/214/25
9
4/285/2
Action Research Proposal

Study Duration
 March 3, 2014 – May 2, 2014
Instructors
 Educators at the simulation center
Participants
 Nurses <1 year
Instructor Training
Group A
Group B
Weekly Collaboration
Evaluate Results
16
WEEK 1: MARCH 3-7, 2014
Tuesday
Wednesday
Thursday
Friday
Instructor
training
8:00- 10:00
Instructor
training
8:00- 10:00
Instructor
training
8:00- 10:00
Instructor
training
8:00- 10:00
Instructor
training
8:00- 10:00
Weekly
Collaboration
1:00- 2:00
Action Research Proposal
Monday
17
INSTRUCTOR TRAINING
Participant
Time
Where
Jerome
March 3, 2014
8:00-10:00
Oak Classroom
Jamie
March 4, 2014
8:00-10:00
Oak Classroom
Suzanne
March 5, 2014
8:00-10:00
Oak Classroom
Rami
March 6, 2014
8:00-10:00
Oak Classroom
Cheryl
March 7, 2014
8:00-10:00
Oak Classroom
Action Research Proposal
Date
18
INSTRUCTOR TRAINING AGENDA
Welcome and explain purpose of study
8:30- 9:00
Explain the education process with groups A and B
9:00- 9:10
Break
9:10- 9:50
Equipment, technology, and scenarios
9:50- 10:00
Questions and wrap-up
Action Research Proposal
8:00- 8:30
19
STUDENT AGENDA
Group A
Welcome and explanation of
study
8:05- 8:25
Education
8:25- 8:45
Simulation
8:45- 8:50
Questions
8:50- 9:00
Student complete survey and
test
Action Research Proposal
8:00- 8:05
20
STUDENT AGENDA
Action Research Proposal
21
WEEK 2: MARCH 10-14, 2014
Tuesday
Group A
8:00- 9:00
Wednesday
Thursday
Friday
Weekly
Collaboration
1:00- 2:00
Action Research Proposal
Monday
22
WEEK 3: MARCH 17-21, 2014
Tuesday
Group B
8:00- 9:00
Wednesday
Thursday
Friday
Evaluate
Results
Weekly
Collaboration
1:00- 2:00
Action Research Proposal
Monday
23
WEEK 4: MARCH 24-28, 2014
 Study

Friday, March 28
Monday
Tuesday
Group A
8:00- 9:00
Wednesday
Thursday
Friday
Action Research Proposal
Group A
 Weekly collaboration
Weekly
Collaboration
1:00- 2:00
24
WEEK 5: MARCH 31-APRIL 4, 2014
 Study

Friday, April 4
 Evaluate
Monday
Results
Tuesday
Group B
8:00- 9:00
Wednesday
Thursday
Friday
Action Research Proposal
Group B
 Weekly collaboration
Evaluate
Results
Weekly
Collaboration
1:00- 2:00
25
WEEK 6: APRIL 7-11, 2014
 Study

Friday, April 11
Monday
Tuesday
Group A
8:00- 9:00
Wednesday
Thursday
Friday
Action Research Proposal
Group A
 Weekly collaboration
Weekly
Collaboration
1:00- 2:00
26
WEEK 7: APRIL 14-18, 2014
 Study

Friday, April 18
 Evaluate
Monday
Results
Tuesday
Group B
8:00- 9:00
Wednesday
Thursday
Friday
Action Research Proposal
Group B
 Weekly collaboration
Evaluate
Results
Weekly
Collaboration
1:00- 2:00
27
WEEK 8: APRIL 21-25, 2014
 Study

Friday, April 25
Monday
Tuesday
Group A
8:00- 9:00
Wednesday
Thursday
Friday
Action Research Proposal
Group A
 Weekly collaboration
Weekly
Collaboration
1:00- 2:00
28
WEEK 9: APRIL 28-MAY 2, 2014
 Study

Friday, May 2
 Evaluate
Monday
Results
Tuesday
Group B
8:00- 9:00
Wednesday
Thursday
Friday
Action Research Proposal
Group B
 Weekly collaboration
Evaluate
Results
Weekly
Collaboration
1:00- 2:00
29
EXPECTED OUTCOMES
Standardization of course sequence is
complete
1.
2.
3.
outcomes:
100% of courses are sequenced
90% of instructor’s trained in course
sequence
100% of staff have time established for
weekly collaboration
Action Research Proposal
 The
30
MEASUREMENT OF OUTCOMES
The outcomes:
Knowledge Acquisition
1.

Learners tests


Learners surveys
Educators journal entries
Action Research Proposal
Acceptability of Sequence
2.
31
(Microsoft, 2010)
ANALYSIS OF RESULTS
Implemented plan has impacted the problem
Quantitative
Qualitative
Learner’s Survey
Educator’s Journal Entries
Action Research Proposal
Learner’s Test
32
ANALYSIS OF RESULTS
Present findings to leadership
Action Research Proposal
Written report
Presentation
33
QUESTIONS
Action Research Proposal
(Microsoft, 2010)
34
REFERENCES




Ciceroa, M., Auerbacha, M., Zigmonta, J., Rieraa, A., Chinga, K.,
and Baum, C. (2012). Simulation training with structured
debriefing improves residents' pediatric disaster triage
performance. Prehospital Disaster Medicine, 27(3), 239-244.
Lawrence D. (2007). The ethics of educational research. Journal
Of Manipulative & Physiological Therapeutics, 30(4), 326-330.
Lee, J. (1999). Effectiveness of computer-based instructional
simulation: A meta analysis. International Journal of
Instructional Media, 26(1), 71-85.
Action Research Proposal

Cendan, J. and Johnson, T. (2011). Enhancing Learning through
Optimal Sequencing of Web-Based and Manikin Simulators to
Teach Shock Physiology in the Medical Curriculum. Advances in
Physiology Education, 35(4), 402-407.
Hendricks, C. (2009). Improving schools through action research:
A comprehensive guide for educators (2nd ed.). Upper Saddle
River, NJ: Pearson
35
REFERENCES CONTINUED




McGaghie, W., Issenber, B., Cohen, E., Barsuk, J., Wayne, D.
(2011). Does simulation-based medical education with deliberate
practice yield better results than traditional clinical education? A
Meta-analytic comparative review of the evidence. Academic
Medicine, 86(6), 706–711.
Microsoft, (2010). Image “All graphics”.
Stefaniak, J., & Turkelson, C. (2013). Does the sequence of
instruction matter during simulation. Society for Simulation in
Healthcare, 00(00), 1-6.
Action Research Proposal

Issenber, B., & McGaghie, E. (2005). Features and uses of highfidelity medical simulations that lead to effective learning.
Medical Teacher, 27(1), 10-28.
Zendejas, B., Cook, D., & Farley, D. (2010). Teaching first or
teaching last: Does the timing matter in simulation-based
surgical scenarios. Journal of Surgical Education, 67(6), 432-438.
36
APPENDIX A: EDUCATION SCENARIOS
STATUS ASTHMATICUS
Level II (In-Hospital)
Action Research Proposal
Your patient is a 6-year old male, who was playing outside and
developed difficulty breathing and shortness of breath. The patient
came into the Emergency Department by his parents, who are
currently out registering him into the ED. The patient is unable to
answer the ED staff in complete sentences. Patient has audible
wheezing upon presentation. The parents are unable for additional
until midway through the scenario.
37
STATUS ASTHMATICUS ALGORITHM
6yo male presents with:
1. Severe respiratory distress
2. Audible wheezing upon auscultation.
3. Cannot answer questions w/ complete sentences
4. Tachycardia
ALTERNATE PROCESS
Delay Action
Recognizes distress and
wheezing, but maintains large
differential diagnosis – foreign
body, chemical aspiration, viral
pneumonitis, cardiomyopathy
Sats improve
with O2, but RR
now 50, HR
160, more
distress
Expected evaluation:
Primary assessment = A, B, C’s
Identification of poor air movement upon
auscultation.
Determine severe respiratory distress and
pending failure likely due to asthma
Expected management:
1. Identify need for high flow oxygenation via a
NRB mask.
2. Gather further patient history.
3. Preparation of nebulized medication:
albuterol and atrovent
1. Patient’s sats improve with
O2 and medication.
2. HR 160, RR 40, BP
110/83
3. Bilateral wheeze, better air
movement
CXR with hyperinflation, no
infiltrate, normal heart size
Does not recognize
as asthma
Maintains sats
in 90s, but
decreased
mental status;
more distress
Recognize as asthma, initiates
albuterol, atrovent and steroids
as first line management
Bronchodilator & steroid tx:
 Albuterol # 2 & 3
 Atrovent #2
 IV access
 Solumedrol administration
INCORRECT PROCESS
Fail to Act
Fail to recognize severity of
respiratory distress
Focus on only diagnosis –
obtain CXR and blood gas
Sats drop to low
80s, poor air
movement and
loss of wheezing
due to decreased
effort
Apply oxygen as NRB
Prepare for intubation – spend
time drawing up medications
and obtaining IV access
No BVM applied
Action Research Proposal
Administers O2
Orders CXR
RR 48, sats 88%
HR 150, BP 108/82
Pt becomes
apneic, HR drops
to 100, pt
unresponsive
Continued slow improvement:
RR 38, HR 160, BP 112/81
Better aeration, able to speak
more freely
Still with significant wheezing
Attempt intubation without
medications – despite
placement of ETT with
lower airway disease pt
becomes asystolic and
arrests
1. Determination of destination (e.g. ICU)
2. Consideration of additional medications, specifically
magnesium sulfate
3. NS bolus since increased insensible losses
4. Reassessment of patient’s respiratory status.
Pt death
38
FBAO ARREST
Level II (In-Hospital)
Action Research Proposal
Your patient is a 7-year old male, who was playing in the lobby and
collapsed suddenly. Witness assesses the child and called for help.
He is unresponsive, blue, and apneic.
39
FBAO ALGORITHM
Baseline
HR-220; T-37; RR- 60; BP 65/40, 02 satslow 90’s ; Pupils and mental status normal,
lungs clear, intact pulses; cap refill 3 sec,
grunting and irritable
Assessment
And
Decision
SVT
 S&S’s: Inc SOB; fluttering in
chest
 Vagal maneuvers
 Prepare IV
 Prepare for Adenosine
Complete Initial exam not done.
Patient continues to deteriorate
sinus tachycardia
Assessment
and Decision
Assessment
Assessme
and
nt
and
Decision
Decision
Unstable SVT develops if SVT not
recognized.
Patient stops moaning and respiratory
effort diminishes
Stable SVT (cont.)
 1st dose Adenosine (HR slows to
190)
 2nd dose Adenosine
 Becomes hypotensive (55/30)
Assessment
and
Decision
Unstable SVT
 Decompensated – Unresponsive
 Cardioversion
0..5-1j/kg
 Cardioversion – double dose of energy





SVT Recovery - END
Reassess
Confused mental status
Awake
Maintain oxygenation
Sinus tachycardia
Assessment
and
Decision
Unstable SVT
Patient continues to deteriorate
Patient stops moaning and respiratory effort
diminishes
Prepare for BVM and possible intubations
Action Research Proposal
Initial exam performed
Differentiate between
SVT and sinus
tachycardia
Assessment
and
Decision
Unstable SVT
(Defibrillation Error)
 Decompensated – Unresponsive
 Cardioversion 0.5-1 j/kg…Goes into vfib if not
synchronized
 Vfib; defibrillate at 2-4 J/kg
 Can go to Desired process final outcome if correct
defibrillation and meds are given
If v-fib algorithm not followed,
patient death will occur
40
SUPRAVENTRICULAR TACHYCARDIA
Level II (In-Hospital)
Action Research Proposal
Your patient is an 8-month-old male, Mother reports several days of
increased fussiness, breathing hard and sweating when eating.
Today seems short of breath and pale, refusing to eat or drink. Seen
at PCP and referred to the ED. HR 220, CR- 3 seconds. Liver down.
Patient irritable with decreased responsiveness.
41
SUPRAVENTRICULAR TACHYCARDIA
ALGORITHM
Baseline
HR-220; T-37; RR- 60; BP 65/40, 02 satslow 90’s ; Pupils and mental status normal,
lungs clear, intact pulses; cap refill 3 sec,
grunting and irritable
Initial exam performed
Differentiate between
SVT and sinus
tachycardia
SVT
 S&S’s: Inc SOB; fluttering in
chest
 Vagal maneuvers
 Prepare IV
 Prepare for Adenosine
Complete Initial exam not done.
Patient continues to deteriorate
sinus tachycardia
Assessment
and Decision
Assessment
Assessme
and
nt
and
Decision
Decision
Unstable SVT develops if SVT not
recognized.
Patient stops moaning and respiratory
effort diminishes
Stable SVT (cont.)
 1st dose Adenosine (HR slows to
190)
nd
 2 dose Adenosine
 Becomes hypotensive (55/30)
Assessment
and
Decision
Unstable SVT
 Decompensated – Unresponsive
 Cardioversion
0..5-1j/kg
 Cardioversion – double dose of energy





SVT Recovery - END
Reassess
Confused mental status
Awake
Maintain oxygenation
Sinus tachycardia
Assessment
and
Decision
Unstable SVT
Patient continues to deteriorate
Patient stops moaning and respiratory effort
diminishes
Prepare for BVM and possible intubations
Action Research Proposal
Assessment
And
Decision
Assessment
and
Decision
Unstable SVT
(Defibrillation Error)
 Decompensated – Unresponsive
 Cardioversion 0.5-1 j/kg…Goes into vfib if not
synchronized
 Vfib; defibrillate at 2-4 J/kg
 Can go to Desired process final outcome if correct
defibrillation and meds are given
If v-fib algorithm not followed,
patient death will occur
42
HEAT ILLNESS
Level II (In-Hospital)
Action Research Proposal
Your patient is a 6-month old male, who was not “acting like
himself”, is poorly responsive and “sweaty”, and seems to becoming
progressively worse over past few minutes. Help was called. He still
has poor responses, labored breathing, pale, and clammy upon
assessment.
43
HEAT ILLNESS ALGORITHM
Your patient is a 6-month old male, who was left in a hot car for “just a
minute.” The child was not “acting like himself”, is poorly responsive and
“sweaty”, and seems to becoming progressively worse over past few minutes.
911 is called. He is pink in color upon presentation.
Alternate process:
Delay in care
Incorrect process
Expected interventions:
Assess ABCs
Recognize deteriorating condition
O2/airway support, anticipate need for control
IV access, initial labs – especially I-stat
NS bolus 20 ml/kg
Attempt cooling measures: ice to groin, axilla,
neck; fan
O2/Airway Support with BVM
IV Ativan
20ml/kg NS bolus
Reassessment
HR 160, RR 48, BP
90/55, Temp 38.1,
O2 sat 94%
Failure to assess ABCs
Failure to obtain access
Do not recognize hyperthermia
as heat illness
Develops
generalized
seizure; poor
respiratory
effort, BP
60/40
O2/Airway Support with BVM
Need to establish access – now
more difficult with seizure
Try IM Ativan – no success
Once recognize need
for cooling, move
back to here
Seizure stops;
HR 170, RR
12/poor effort,
BP 80/50, Temp
40.8, O2 sat 94%
Airway control with RSI and
intubation
20 ml/kg NS bolus
Consult ICU for disposition
Screening labs
HR 170, BP
90/55, Temp
40.6, O2 sat 99%
Reassessment
Labs more specific to heat illness:
risk of liver, renal, cardiac injury; risk
of rhabdomyolysis
Continue cooling patient
Consults: ICU for disposition
Vitals normalize
I-stat: pH 7.2, PCO2 25,
BD -12, HCO3 10, Gluc
46, NA 130, K 5.5, iCa 1.1
IV D10w or D25W
Continue volume resuscitation for
metabolic acidosis
Pt stable for admission
Action Research Proposal
HR 200, RR 60 labored,
BP 85/50, Temp 41.6C
Rectal; O2 Sat 90%,
Cap refill 4-5 sec, skin
flushed and sweating;
pupils dilated, responds to
pain
Assess ABCs
Apply O2
IV access and NS bolus
But, delay in aggressive cooling
Temp 42.8, now
Apnea (but easy
to bag) without
pulses; monitor:
V-Fib Arrest
CPR
Intubation (no need RSI)
Defibrillation
But, failure to treat
underlying hyperthermia
Poor Outcome/Pt
Death
44
APPENDIX B:
PARTICIPANT TESTS AND ANSWERS
Action Research Proposal Test Weeks 2 and 3
1. What is not a typical sign of respiratory distress?
tachypnea
b.
fever
c.
nasal flaring
d.
tachycardia
2. What is the most common form of infectious pneumonia, which often causes empyema?
a.
streptococcus pneumoniae
b.
mycoplasma pneumoniae
c.
chlamydia pneumoniae
d.
staphylococcus pneumoniae
3. Children with increased ICP typically will present with all the following except which?
a.
irregular breathing
b.
bradycardia
c.
tachycardia
d.
hypertension
Action Research Proposal
a.
4. Shock occurs with which level of blood pressure?
a.
decreased
b.
increased
c.
normal
d.
all the above
45
CONTINUED ACTION RESEARCH PROPOSAL TEST
WEEKS 2 & 3
5. The recommended priority of treatment of ischemic hypoxia is what?
a.
oxygen administration
b.
increase cardiac output
c.
restore hemoglobin concentration
d.
none of the above
6. Myocardial dysfunction impairs cardiac output and stroke volume, which can typically lead to
which shock?
cardiogenic shock
b.
septic shock
c.
anaphylactic shock
d.
neurogenic shock
7. What should be the first priority when assisting a critically ill or injured child in shock?
a.
oxygen administration
b.
monitoring
c.
positioning
d.
fluid resuscitation
8. Which is not a common assessment when determining the effectiveness of fluid resuscitation?
a.
temperature
b.
heart rate
c.
skin coloration
d.
urine output
Action Research Proposal
a.
9. Monitoring of continuous arterial blood pressure can be accomplished with placement of a
__________.
a.
central venous catheter
b.
arterial catheter
c.
pulmonary artery catheter
d.
none of the above
10. To treat cold shock, _____________ is preferred.
a.
dopamine
b.
norepinephrine
c.
epinephrine
d.
dobutamine
46
ACTION RESEARCH PROPOSAL ANSWERS
WEEKS 2 & 3
Action Research Proposal
ANSWERS
1.B
2.D
3.B
4.D
5.B
6.A
7.C
8.C
9.B
10.C
47
Action Research Proposal Test Weeks 4 and 5
1. For cardiogenic shock, you should deliver a fluid challenge (5 to 10 mL/kg bolus) over what
length of time?
a.
b.
c.
d.
1-5 minutes
5-10 minutes
10-20 minutes
under 3 minutes
2. ______________ is described as an accumulation of pressurized air in the pleural space.
tension pneumothorax
cardiac tamponade
massive pulmonary embolism
none of the above
3. In a case of sinus tachycardia, the heart rate is ___________.
a.
b.
c.
d.
increased
decreased
unsteady
faint
Action Research Proposal
a.
b.
c.
d.
4. Ventricular tachycardia is common in children.
a. true
b. false
5. What is the first sign of the body's defensive response when a child or infant is in shock?
a.
b.
c.
d.
body temperature drop
body temperature rise
heart rate increase
heart rate decrease
48
Continued Action Research Proposal Test
Weeks 4 & 5
6. Each attempt for catheter insertion and suctioning of an infant should not surpass:
3 seconds
5 seconds
7 seconds
10 seconds
7. The first warning sign of respiratory dysfunction is:
a.
b.
c.
d.
decrease of heart rate
increase in blood pressure
increase in respiratory rate
decrease in body temperature
8. During resuscitation of a newborn infant, the blow-by oxygen rate of flow should always be
more than:
a.
b.
c.
d.
2
5
6
8
L/min.
L/min.
L/min.
L/min.
Action Research Proposal
a.
b.
c.
d.
9. What age period is croup most common to occur?
a.
b.
c.
d.
3
6
4
1
- 5 years
months - 3 years
- 7 years
month - 12 months
10. What is the recommended first energy level used for defibrillation?
a.
b.
c.
d.
0.3
1.5
2.0
2.5
joules/kg.
joules/kg.
joules/kg.
joules/kg.
49
ACTION RESEARCH PROPOSAL ANSWERS
WEEKS 4 & 5
Action Research Proposal
ANSWERS
1. C
2.A
3.C
4.B
5.C
6.D
7.C
8.B
9.B
10.C
50
ACTION RESEARCH PROPOSAL TEST WEEKS 6 & 7
1.
Simple measures to restore upper airway patency in a child may include any of the
following EXCEPT:
a.
b.
c.
d.
2.
Using head tilt - chin lift to open the airway
Cricothyrotomy
Perform foreign body airway obstruction relief techniques
Use airway adjuncts (e.g., nasopharyngeal or oropharyngeal airway)
Stridor is a sign of what?
a.
c.
d.
3. The Glasgow Coma Scale (GCS) is scored based on response to all of the following
EXCEPT:
a.
b.
c.
d.
Eye opening
Verbal response
Motor response
Cardiac Output
Action Research Proposal
b.
Pneumonia
Aspiration
Upper airway obstruction
Bronchoconstriction
4. Medications used in the treatment of Croup may include:
a.
b.
c.
d.
Dexamethasone
Nebulized epinephrine
Heliox
All of the above
5. Common causes of upper airway obstruction include all of the following EXCEPT:
a.
b.
c.
d.
Aspirated foreign body
Asthma
Swelling of the airway
Retropharyngeal abscess
51
CONTINUED ACTION RESEARCH PROPOSAL TEST
WEEKS 6 & 7
6. The initial impression consists of assessing all of the following EXCEPT:
a.
b.
c.
d.
Consciousness
Deformity
Breathing
Color
7. Types of shock include all of the following EXCEPT:
b.
c.
d.
Hypovolemic shock
Hypoglycemic shock
Distributive shock
Cardiogenic shock
8. Common causes of acute community-acquired pneumonia include which of the
following?
a.
b.
c.
d.
Streptococcus pneumonia
Mycoplasma pneumonia
Chlamydia pneumonia
All of the above
Action Research Proposal
a.
9. A room air SpO2 reading less than _____ in a child indicates hypoxemia.
a.
b.
c.
d.
99%
97%
95%
94%
10. Signs of increased respiratory effort include all of the following EXCEPT:
a.
b.
c.
d.
Abdominal bloating
Nasal flaring
Chest retractions
Head bobbing or seesaw respirations
52
ACTION RESEARCH PROPOSAL ANSWERS
WEEKS 6 & 7
Action Research Proposal
ANSWERS
1. B
2. C
3. D
4. D
5. B
6. B
7. B
8. D
9. D
10. A
53
ACTION RESEARCH PROPOSAL TEST WEEKS 8 & 9
1. You are caring for a 5-year-old patient with supraventricular tachycardia (hear rate =
220/min). The child is lethargic. The skin is pale and cool with delayed capillary refill.
Distal pulses are not palpable. Which of the following would be the best treatment to
provide without delay?
a)
b)
c)
2. You are initiating treatment for a child with septic shock and hypotension. While
administering high-flow oxygen you determine that the child’s respirations are adequate
and SpO2 is 100%. You have just established vascular access and obtained blood
samples. Which of the following is the next most appropriate therapy to support
systemic perfusion?
a)
b)
c)
d)
Administer repeated fluid boluses of isotonic colloid
Administer repeated fluid boluses of isotonic crystalloid
Begin immediate dopamine infusion
Begin immediate dobutamine infusion
Action Research Proposal
d)
Place cold packs on the distal upper and lower extremities
Ask the child to blow through a small straw
Exert light pressure on the eyes bilaterally
Provide synchronized cardioversion at 0.5 to 1 joules/ kilogram
3. You arrive on the scene of a 12-year-old who suddenly collapsed on the playground.
The child is unresponsive, apneic, and pulseless and CPR is in progress. A lay rescuer
just brought the school AED, turned it on, and attached it. The AED recommends a
shock. Which of the following should be done next?
a)
b)
c)
d)
Obtain intravenous access
Attempt defibrillation
Change compressions: ventilations from 30:2 to 15:2
Attempt endotracheal intubation
54
CONTINUED ACTION RESEARCH PROPOSAL
TEST WEEKS 8 & 9
4. You attempted synchronized cardioversion for an infant with supraventricular
tachycardia (SVT) and poor perfusion. The SVT persists after the initial 1 J/kg shock.
Which of the following should you attempt now?
a)
b)
c)
5. You are treating a 5-month old with a 2-day history of vomiting and diarrhea. The
patient is listless. The respiratory rate is 52 breaths/ minute and unlabored. The heart
rate is 170/ minute and pulses are present but weak. Capillary refill is delayed. You are
administering high-flow oxygen, and intravenous access is in place. At this point, the
most important therapy is to:
a)
b)
c)
d)
Administer an epinephrine bolus
Begin bag-mask ventilation
Provide a rapid 20ml/kg isotonic crystalloid fluid bolus
Administer a bolus of 0.5 g/kg of dextrose
Action Research Proposal
d)
Synchronized cardioversion at a dose of 2 J/kg
Synchronized cardioversion at a dose of 4 J/kg
Unsynchronized cardioversion at a dose of 2 J/kg
Unsynchronized cardioversion at a dose of 4 J/kg
6. Which of the following groups of clinical findings would be most consistent with
categorizing a patient with compensated shock?
a)
b)
c)
d)
Normal systolic blood pressure, decreased level of consciousness, cool extremities with delayed
capillary refill, and faint or nonpalpable distal pulses
Decreased level of consciousness, extensor posturing in response to pain, hypertension, and apnea
Normal blood pressure, normal level of consciousness, bounding distal pulses, hypercarbia,
hypoxemia, and normal urine output
Unresponsiveness, normal breathing, and good distal pulses.
55
CONTINUED ACTION RESEARCH PROPOSAL
TEST WEEKS 8 & 9
7. You are caring for an 8-month-old with bradycardia and very poor perfusion that has
persisted despite effective ventilations with high-flow oxygen. You should begin chest
compressions if the heart rate is:
a)
b)
c)
8. You are called to treat a 5-year-old with a 3-day history of worsening respiratory
distress. The child responds only to pain. The heart rate is initially 45/ min and regular
with poor capillary refill. You provide bag-mask ventilations (BVM) with high-flow
oxygen that produces good chest rise with full and clear bilateral breath sounds. The
heart rate rises in response to ventilation, but after you suction the posterior pharynx,
bradycardia recurs (40/min). Which of the following interventions would be most
appropriate for you to do first?
a)
b)
c)
d)
Action Research Proposal
d)
More than 200/min
More than 150/min
Less than 100/min
Less than 60/min
Perform transcutaneous pacing
Administer epinephrine IV
Administer atropine IV
Resume bag-mask ventilations
56
CONTINUED ACTION RESEARCH PROPOSAL
TEST WEEKS 8 & 9
a)
b)
c)
d)
Epinephrine IV
Transcutaneous pacing
Atropine IV
Dobutamine IV infusions
10. When monitoring the quality of chest compressions during resuscitation, you should
ensure that providers are
a)
b)
c)
d)
Action Research Proposal
9. You are caring for a child who was resuscitated after a drowning event. The child is
intubated and ventilated with 100% oxygen with equal breath sounds and exhaled CO2
detected. The heart rate is slow and the monitor shows a sinus bradycardia. The skin is
cool, mottled, and moist; distal pulses are not palpable and central pulses are weak.
Intravenous access has been established. The core temperature is 37.3 Celsius. Based on
the PALS bradycardia algorithm, which of the following should be provided first?
Pushing hard – ensure that the chest is compressed ¾ of the anterior-posterior diameter
Pushing fast – compress at a rate of 150/ min
Allowing complete recoil – let the chest return to its original position between compressions
Minimizing interruptions – do not permit interruptions for more than 1 minute
57
ACTION RESEARCH PROPOSAL ANSWERS WEEKS
8&9
Action Research Proposal
ANSWERS
1. D
2. B
3. B
4. A
5. C
6. B
7. D
8. D
9. A
10. C
58