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