Simulation Design Template:
Randy Adams-Simulation #2
Date:
Discipline: Nursing
Expected Simulation Run Time: approx.
20 minutes
Location: Physician’s office
Admission Date:
File Name: Randy Adams
Student Level:
Guided Reflection Time: twice the amount
of simulation run time
Location for Reflection:
|
Today’s Date:
Brief Description of Client
Name: Randy Adams
Gender: M Age: 28
Race:
Weight: 80 kg Height: 70 in
Religion: No preference
Major Support: Wife Support Phone: 222-345-7799
Allergies: no known allergies
Immunizations: Current
Attending Physician/Team: Joe Reynolds, MD
Past Medical History: 28-year-old male treated for severe headaches for the past several months
History of Present Illness:
Transported to the emergency room by ambulance after a single vehicle roll over five days ago. He was
confused and disoriented and suffering from a concussion. He was released after 24 hours observation with
referrals for a neurology and behavioral health evaluation.
Social History: Randy is married and he and his wife, Joy, have twin sons, Jeff and Jarod (age 18 months).
Randy was deployed to Iraq for 12 months with the US Army National Guard. He never sustained a lifethreatening injury but was involved in four separate convoy incidents and was placed under observation after
two of the improvised explosive device - IED -incidents. He currently works at a computer repair shop.
Primary Medical Diagnosis: Post concussive injury from car accident four days ago.
Surgeries/Procedures & Dates: None
Nursing Diagnoses: Pain related to headache (chronic), coping, defensive related to symptoms of head
injury, sleep pattern disturbance
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Psychomotor Skills Required Prior to Simulation

Cognitive Activities Required Prior to Simulation
[i.e. independent reading (R), video review (V), computer simulations (CS), lecture (L)]
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Readings in textbook on care of the patient with a concussion (R)
Review content on these websites:
http://www.cdc.gov/concussion/signs_symptoms.html
http://www.ptsd.va.gov/professional/ptsd101/course-modules/traumatic-brain-injury.asp
The Mini-Cog™:
Tool: http://consultgerirn.org/uploads/File/trythis/try_this_3.pdf
Video: http://consultgerirn.org/resources/media/?vid_id=4361918#player_container
Example of administration: https://www.youtube.com/watch?v=ql0ZKu1PTpY
Other information about eligibility for services:
http://www.va.gov/healthbenefits/apply/returning_servicemembers.asp
Additional reading about characteristics of veterans of this era: (R)
Cook, J.M., Dinnen, S., O’Donnell, C., Bernardy, N., Rosenbeck, R., and Hoff, R. (2013). Iraq and
Afghanistan Veterans: National findings from VA residential treatment programs. Psychiatry 76(1).
18-31. doi: 10.1521/psyc.2013.76.1.18 - Free access at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3661276/
Simulation Learning Objectives
General Objectives
1. Practice standard precautions throughout the exam.
2. Employ effective strategies to reduce risk of harm to the client.
3. Assume the role of team leader or member.
4. Perform a focused physical assessment noting abnormal findings.
5. Recognize changes in patient symptoms and/or signs of patient compromise.
6. Perform priority nursing actions based on clinical data.
7. Reassess/monitor patient status following nursing interventions.
8. Perform within scope of practice.
9. Demonstrate knowledge of legal and ethical obligations.
10. Communicate with client in a manner that illustrates caring for his/her overall well-being.
11. Communicate appropriately with physician and/or other healthcare team members in a timely,
organized, patient-specific manner.
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Simulation Scenario Objectives
1. Employ therapeutic communication.
2. Use concussion and mental status assessment tools.
3. Apply knowledge of concussion and traumatic brain injury to nursing assessments and
interventions.
4. Describe characteristics of veterans of this era that you see in the patient.
References, Evidence-Based Practice Guidelines, Protocols, or
Algorithms Used for This Scenario:
Online resources for concussion, posttraumatic stress disorder and traumatic brain injury:
http://www.ptsd.va.gov/professional/ptsd101/course-modules/traumatic-brain-injury.asp
http://www.polytrauma.va.gov/understanding-tbi/
http://www.mirecc.va.gov/visn6/TBI_education.asp
http://www.cdc.gov/concussion/signs_symptoms.html
http://www.cdc.gov/headsup/providers/index.html
Cook, J.M., Dinnen, S., O’Donnell, C., Bernardy, N., Rosenbeck, R., and Hoff, R. (2013). Iraq and Afghanistan
Veterans: National findings from VA residential treatment programs. Psychiatry 76(1). 18-31. doi:
10.1521/psyc.2013.76.1.18 Free access at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3661276/
http://www.oefoif.va.gov/
The Mini-Cog™:
Tool: http://consultgerirn.org/uploads/File/trythis/try_this_3.pdf
Video: http://consultgerirn.org/resources/media/?vid_id=4361918#player_container
Example of administration: https://www.youtube.com/watch?v=ql0ZKu1PTpY
Fidelity (choose all that apply to this simulation)
Setting/Environment:
ER
Med-Surg
Peds
Medications and Fluids:
IV Fluids:
Oral Meds:
IVPB:
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ICU
OR / PACU
Women’s Center
Behavioral Health
Home Health
Pre-Hospital
Other: Physician office
IV Push:
IM or SC:
Diagnostics Available:
Labs
X-rays (Images)
12-Lead EKG
Other:
Simulator Manikin/s Needed:
Standardized/simulated patient or a moderate Documentation Forms:
or high fidelity manikin in street clothes.
Physician Orders
Admit Orders
Props: Bandage to head
Flow sheet
Medication Administration Record
Equipment Attached to Manikin:
Kardex
IV tubing with primary line
Graphic Record
fluids running at mL/hr
Shift Assessment
Secondary IV line running at mL/hr
Triage Forms
IV pump
Code Record
Foley catheter mL output
Anesthesia / PACU Record
PCA pump running
Standing (Protocol) Orders
IVPB with running at mL/hr
Transfer Orders
02
Other: see chart materials
Monitor attached
ID band
Recommended Mode for Simulation:
Other:
(i.e. manual, programmed, etc.)
Equipment Available in Room:
Bedpan/Urinal
Foley kit
Straight Catheter Kit
Incentive Spirometer
Fluids
IV start kit
IV tubing
IVPB Tubing
IV Pump
Feeding Pump
Pressure Bag
02 delivery device (type)
Crash cart with airway devices and
emergency medications
Mode will not change for this scenario. Simulator
may be set manually or programmed or this
simulation may be conducted with a
standardized/simulated patient.
Student Information Needed Prior to
Scenario:
Has been oriented to simulator
Understands guidelines /expectations for
scenario
Has accomplished all pre-simulation
requirements
All participants understand their assigned
roles
Has been given time frame expectations
Other: Students will need a copy of the
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Defibrillator/Pacer
Suction
Other:
MiniCog tool. You may provide it or assign them
to retrieve it from www.consultgerirn.org
Note: blank Acute Concussion Evaluation (ACE)
form to be filled out today is provided in chart
materials.
Answers that Randy will give to student using
ACE tool are attached.
Roles/Guidelines for Roles:
Primary Nurse
Secondary Nurse
Clinical Instructor
Family Member #1
Family Member #2
Observer/s
Recorder
Physician/Advanced Practice Nurse
Respiratory Therapy
Anesthesia
Pharmacy
Lab
Imaging
Social Services
Clergy
Unlicensed Assistive Personnel
Code Team
Other:
Important Information Related to Roles:
Would be best to have just one nurse, given the
nature of the assessments, but could ask Randy
if second nurse can sit in to learn about how to
use these assessment tools.
Report Students Will Receive Before Simulation
Time: 1500, five days after Randy’s accident
Situation: Randy Adams is a 28-year-old male patient of mine who had a concussion after a motor vehicle
accident four days ago. Randy lost consciousness during the accident and was very confused so we kept him
in the hospital for 24 hours for observation and I referred him to neurology and behavioral health. He was to
follow up here tomorrow.
Background: He is an Iraq war veteran and he thought after the accident that this all happened in Iraq. I’m a
little concerned that he has some residual problems that may be the result of a couple of explosive incidents
while he was in Iraq. He takes Imitrex for migraines, which started after he came home from deployment.
Assessment: His appointment with me was for tomorrow, but I have some time today and I’m concerned
about him, so tell him I will see him in about a half hour. He may be mixed up on the time or date. The
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receptionist said his wife, Joy, is not with him today and she usually attends his appointments so I’m not sure
what is going on with him.
Recommendation: I’d like you to reassess his symptoms and compare to the assessment I did at the
hospital. Also, see how his visits at neurology and psychology went. You may want to do a Mini-Cog, a Mini
Mental State Exam or both on him too.
Significant Lab Values:
refer to chart
Physician Orders:
refer to chart
Home Medications:
refer to chart
Scenario Progression Outline
Timing
(approx.)
0-5 min
Manikin Actions
Expected
Interventions
May Use the
Following Cues
Patient is waiting in exam room.
Wife is not present. Very
nervous and a little impatient.

Wash hands and
introduce self
Explain that Dr.
Reynolds will see
him in about 30
minutes.
Explain
assessments to
be conducted.
Role member
providing cue:
Cue:
Do ACE
assessment.
Role member
providing cue:
Cue:
“I can wait to see him. Joy and
the boys have been sick and
she couldn’t come with me
today.”
5-10 min
(can do
assessments
in any order)
See attached completed ACE
form to provide Randy’s
responses.
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Randy will also use these
responses.
“Yes, I have headaches. I
always have them. I’m always
tired and sometimes when I
have a migraine the light and
noise bother me.”
“Joy says I have trouble
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remembering. I can concentrate
if it’s quiet. I try not to be
irritable with Joy or the kids, but
sometimes other people really
bug me. I feel really nervous
and I don’t know why I just cry
all the time now.”
“I have trouble sleeping, but we
have two babies so I don’t know
if that’s why.”
If pushed further on the
sleeping issue: Randy will say
he usually wakes several times
a night and sometimes has bad
dreams that he can’t remember
and doesn’t want to talk about.
10-15 min
Randy is able to recall all three
words.

See attached clock drawing.
Randy: “Apple, penny, clock”
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15-20 min
“I forgot about going to those
appointments. Joy and the kids
were sick and she usually
reminds me. I just need to get
my headache medicine refilled.
I don’t need to see anyone else
about whether I’m crazy. Look, I
just had a car accident. There
isn’t anything wrong with me. I
just got my bell rung a little.”

Administer MiniCog.: Please
repeat these 3
words:
Apple, watch,
penny
Ask to draw clock
per MiniCog
instructions
Ask to repeat
original 3 words.
Ask about
appointments
with neurologist
and behavioral
health.
Role member
providing cue:
Cue:
Role member
providing cue:
Facilitator
Cue: Ask student to
come to debriefing
room to give handoff
to Dr. Reynolds.
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Debriefing/Guided Reflection Questions for This Simulation
(Remember to identify important concepts or curricular threads that are specific to your program)
1.
How did you feel throughout the simulation experience?
2.
Describe the objectives you were able to achieve.
3.
Which ones were you unable to achieve (if any)?
4.
Did you have the knowledge and skills to meet objectives?
5.
Were you satisfied with your ability to work through the simulation?
6.
To Observer: Could the nurses have handled any aspects of the simulation differently?
7.
Have you ever served in the military, or do you know someone who has? If so, how did your personal
experience with these individuals influence your participation in the scenario?
8.
If you were able to do this again, how could you have handled the situation differently?
9.
What did the group do well?
10. What did the team feel was the primary nursing diagnosis?
11. How were physical and mental health aspects interrelated in this case?
12. What were the key assessments and interventions?
13. Is there anything else you would like to discuss?
Specific Debriefing Questions for this Scenario:
1. What symptoms and behaviors did you see in Randy that may be related to his concussion?
2. What symptoms and behaviors did you see in Randy that may be related to previous head injuries?
3. What are your concerns about Randy?
4. What, if any, behavioral health concerns do you have for Randy?
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Randy Adams – Simulation # 2
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Randy Adams – Simulation # 2
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