Simulation Design Template:
Eugene Shaw-Simulation #3
Date:
Discipline: Nursing
Expected Simulation Run Time:
approx. 20 minutes
Location: Hospital
File Name: Eugene Shaw
Student Level:
Guided Reflection Time: twice the amount of
simulation run time
Location for Reflection:
Admission Date: Yesterday |
Today’s Date:
Brief Description of Client
Name: Eugene Shaw
Gender: M Age: 82
Race:
Weight: 116.5 kg Height: 67 in
Religion: Catholic
Major Support: Nancy (wife) Support Phone: 561-788-9080
Allergies: No known allergies
Immunizations: Current, annual influenza shot, pneumococcal vaccine 4
yrs ago
Attending Physician/Team: Ian Stein, MD
Surgeon: Robert Moses, MD
Past Medical History: 82-year-old Korean War Veteran with documented injuries during military service in
Korea. Records from previous VHA Hospital confirm removal of 3 toes on right foot due to trench foot 60 years
ago and the loss of 4th digit 1 year later and diagnosis of Type 2 Diabetes 20 years ago. He has been
hypertensive for 30 years and has osteoarthritis of the knee and foot, fallen arches, and chronic cold
sensitization. Patient reports he usually seeks treatment at his local Veterans Health Administration Hospital.
History of Present Illness: Patient presented at the Veterans Health Administration Emergency Department
at 2100 with complaints of chronic pain in his right calf for the past several days and right foot, in particular the
heel after hitting his foot on the car door. Leg is dusky in color. He describes pain as aching and burning. He
also has discomfort in the muscles of his feet, calves, and thighs. A few small ulcerations on right leg; larger on
one heel. He has some unilateral edema of the right leg with dryness and scaling of the skin. He has
diminished peripheral pulses on the right side and the nail on his right big toe is brittle.
Social History: Retired commercial illustrator. Lives with his wife, Nancy, of 59 years. Has one son, Robert
Shaw, who lives 500 miles away. Close friend Jim Reynolds.
Primary Medical Diagnosis: Peripheral vascular disease, Diabetes Mellitus, Type 2
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Surgeries/Procedures & Dates: Surgical removal of 3 toes on right foot 60 years ago, subsequent loss of 4th
digit on right foot 1 year later. Femoral-popliteal bypass 2 days ago.
Nursing Diagnoses: Acute pain related to tissue injury; risk for impaired skin integrity related to surgery;
activity intolerance related to pain; risk for injury related to poor control of diabetes
Psychomotor Skills Required Prior to Simulation



Assessment of post-operative patient
Dressing change
Blood glucose monitoring
Cognitive Activities Required Prior to Simulation
[i.e. independent reading (R), video review (V), computer simulations (CS), lecture (L)]

Readings in textbook on care of the patient with peripheral vascular disease. Type 2 Diabetes and care
of the post-operative patient (R)
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.
12. Apply the nursing process to initiate care of the post-operative patient.
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Simulation Scenario Objectives
1.
2.
3.
4.
5.
Conduct a focused assessment of a post-surgical patient
Change dressing using sterile technique.
Assess incision site.
Respond to patient-specific physical and emotional needs related to post-surgical care.
Discuss management at home after discharge.
References, Evidence-Based Practice Guidelines, Protocols, or
Algorithms Used for This Scenario:
American Diabetes Association. (2012). Standards of medical care in diabetes-2012. Diabetes Care 35(Supp
1), s11-s63. doi: 10.2337.dc12-s011
Cole, C. A. (2012). Implied consent and nursing practice: Ethical or convenient? Nursing Ethics, 19(4), 550557. doi: 10.1177/0969733011436028
Lee, C.-K., & Lee, I. F. K. (2012). Preoperative patient teaching: The practice and perceptions among surgical
ward nurses. Journal of Clinical Nursing, n/a-n/a. doi: 10.1111/j.1365-2702.2012.04345.x
Lovell, M., Myers, K., Forbes, T. L., Dresser, G., & Weiss, E. (2011). Peripheral arterial disease: Application of
the chronic care model. Journal of Vascular Nursing, 29(4), 147-152.
Websites:
The Korean War Veteran's Association Home Page: www.kwva.org
The Korean War Project website: www.koreanwar.org
Fidelity (choose all that apply to this simulation)
Setting/Environment:
ER
Med-Surg
Peds
ICU
OR / PACU
Women’s Center
Behavioral Health
Home Health
Pre-Hospital
Other:
Medications and Fluids:
IV Fluids:
Oral Meds: see chart
IVPB:
IV Push:
IM or SC:
Diagnostics Available:
Labs
X-rays (Images) chest
12-Lead EKG
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Simulator Manikin/s Needed:
Other:
Standardized patient, moderate or high fidelity
Documentation Forms:
manikin. Right leg has bluish skin tone and
ulceration on heel. Moulage to simulate missing
Physician Orders
toes on right foot. Can tape picture or drawing
Admit Orders
to foot. (Note: some manikins have pedal
Flow sheet
pulses in both feet that can be regulated to be
Medication Administration Record
diminished/absent in right leg, but since schools
Kardex
may not have a manikin with this capability, we
Graphic Record
are providing neurovascular assessment
Shift Assessment
information in the nurse’s report.)
Triage Forms
Code Record
Props:
Anesthesia / PACU Record
Standing (Protocol) Orders
Equipment Attached to Manikin:
Transfer Orders
IV tubing with primary line running at mL/hr
Other:
Secondary IV line
IV pump
Recommended Mode for Simulation:
Foley catheter mL output
(i.e. manual, programmed, etc.)
PCA pump running
Mode will not change for this scenario. Simulator
IVPB with running at mL/hr
may be set manually or programmed or this
02
simulation may be conducted with a standardized
Monitor attached
patient.
ID band
Other:
Student Information Needed Prior to
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
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:
 Lab results
 Medication Reconciliation form
 Paper assessment flow sheet for
neurovascular assessment
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Defibrillator/Pacer
Suction
Other: dressing change supplies
Roles/Guidelines for Roles:
Primary Nurse
Secondary Nurse
Clinical Instructor
Family Member #1 Wife, Nancy
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:
Report Students Will Receive Before Simulation
Time: 1530 on Wednesday afternoon
Situation: Mr. Eugene Shaw, age 82, is in his second postoperative day. He came to the ER on Saturday at
2100 with complaints of pain and a burning sensation in his right leg. He had some small ulcerations of the
skin, especially on the heel, with bluish discoloration of his right foot and some ankle edema. He was admitted
to our unit Sunday morning at 0600. The surgeon evaluated him and said his angiogram revealed a clot in the
artery just below the right knee. He had femoral-popliteal bypass surgery on Monday morning.
Background: Mr. Shaw has a 30-year history of hypertension, osteoarthritis of the knee and foot, fallen
arches and chronic cold sensitization. For the past 40 years he has had nocturnal pain in lower limbs and
hands. He was diagnosed with Type 2 Diabetes 20 years ago. He admits that he does not stick to his diet and
the doctor put him on Simvastatin to prevent his cholesterol from going up. Mr. Shaw insists that he takes his
medications regularly. He says he stopped smoking at home over 50 years ago when his son was born, but
still sneaks a few cigarettes when out with friends at the local bar.
Assessment: Gene is alert and orientated to person, place and time. His vital signs have been stable with
temperature of 98.6 F (37 C), BP 128/70, heart rate 88, respirations 16, SpO2 96% on room air. Mr. Shaw’s
blood glucose was 115 mg/dL at 0600. His neurovascular checks have greatly improved. There is some
Eugene Shaw – Simulation # 3
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swelling in his leg. He has been eating well and voiding. He had a bowel movement this morning. He continues
to complain of some pain, but says it is not as bad as before surgery and he no longer has the aching and
burning in his leg. His last dose of Vicodin was at 1300. The incision site is healing well. Gene has had some
difficulty ambulating and needs a lot of assistance.
Recommendation: He is due for vitals and a pain assessment, along with a dressing change. His wife is
visiting. Encourage him to ambulate. He may be discharged in 2 days so we need to assess how he will
manage at home.
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
Resting in bed with right foot
elevated on a pillow.

Wash hands and
introduce selves.
Check patient ID.
Perform initial
assessment
including vital
signs.
Assess pain.
Offer to contact
physician for new
pain medication.
Make call to
provider using
SBAR by end of
simulation
regarding change
in pain
medication.
Role member
providing cue:
Patient
Cue: If students do
not ask about pain,
Gene will say, “My
pain is much less
now.”
Change
dressing, assess
incision,
Role member
providing cue: Wife
Cue: If students do
“You know, I don’t think I need
that real strong pain medication
anymore. Can we change it to
something lighter? I can take a
lot of pain. The war really
changes what a man can see
and feel. I always tried to take
the pain and not complain too
much about it. They told us
back then to just take it. You
know guys lost toes every day.
Losing your toes to frostbite
wasn’t considered a good
enough reason to evacuate
soldiers.”
5-10 min
“Is it healing OK? I’m worried
that it won’t heal up and I’ll lose
my leg, just like I lost those






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toes. I don’t know how I could
manage if that happened.”
Wife, Nancy: “Oh Gene, we
would manage; we always
have.”
comment on
how it is healing
to Gene and
wife.
not describe how
incision is healing,
Nancy will ask, “How
does it look? Is it
OK?”
Ask how much
he has been
ambulating.
Teach about
need for activity.
Role member
providing cue:
Cue:
“I remember trips to the front
line. The Marines had old
Mickey Mouse thermal boots
which were an innovation in
those days while the Army was
still wearing the old WWII
leather boots. It was so cold the
Army guys would sneak across
division lines and try and swipe
the Marines’ boots. There was
a ¾-inch inner sole that we
were supposed to dry out at
night in our sleeping bags but
we couldn’t. If you slept in your
bag you could get bayoneted,
so we slept with our bags over
us with our shoes on. But the
inner sole would freeze, leaving
your feet encased in ice.”
“Oh please don’t look at my
foot; it’s real ugly.”
10-15 min
“I don’t want to move too much
and spoil all the doc’s repair
work.”
Nancy: “Should he be doing
more walking?”
15-20 min



Discuss home
environment and
how Gene and
Nancy will be
able to manage
when he is
discharged.
Role member
providing cue:
Cue:
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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 were Gene’s specific nursing care needs related to this postoperative period?
2. Think about Gene and his situation, what did you think about the fears he expressed?
3. What potential problems might Gene encounter in this immediate post-op period and when he returns
home? Consider his medical diagnoses, lifestyle, and any other factors, as well as the challenges
presented by his surgery.
4. What do you think Gene and his wife will need before he is ready for discharge?
Eugene Shaw – Simulation # 3
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