Scaffolding NUR 365 Med-Surg Clinical
Concepts
Experience #
1
Course week
2/3
2
4/5
3
6/7
4
8/9
5
10/11
6
12/13
Concepts
Functional ability, pain, family dynamics,
culture, patient education
Gas exchange
Perfusion
Mobility
Fluid & Electrolyte
Acid/Base
Immunity, inflammation
Infection
Glucose regulation
Intracranial regulation
Nutrition, Elimination
Tissue Integrity
QSEN
Concepts
Pt Centered
Care
Safety
Teamwork &
Collaboration
EBP
Informatics
Quality
Improvement
Progression
VS, glucose I&O – documented by students
Week
Structure
Activities
1
Functional
ability, pain,
family
dynamics,
culture, patient
education
Shadow RN ½
day
Role of Nurse
Review patient charting, access patient medical record (All students to
access individually patient chart (verify access ability)
SBAR & 5Ps
60 second situational assessment
Review pre-clinical paperwork of (non-pharm pain techniques & policy)
Review assigned med cards that impact pain: acetaminophen, morphine,
dilaudid (hydromorphone), codeine, fentanyl, Vicodin (acetaminophen &
hydrocodone), percocet (acetaminophen & oxycodone), Opana
(oxymorphone), tramadol (Ultram)
Head to Toe Assessment
Functional Assessment Screen
Pain Assessment (Sim Chart)
Patient Education
Discharge planning (Document either PT Ed or D/C planning in Sim Chart)
**specifics of what to turn in for grading
Worksheet on roles and responsibilities
**Admission chart: Collect data on one patient as if “new admission” and
complete patient admission data in SimChart include documentation of
Head to Toe Assessment
2
Gas exchange
Perfusion
No Nurse
Assigned
Student Buddies
Vital Signs on all patients
SBAR- review and 5Ps
60 second situational assessment
Bed Bath: skin assessment
Review preclinical paperwork for diagnoses of COPD, Heart Failure,
Hypertension, Hyperlipidemia including significant labs and diagnostic
testing.
Review assigned meds that impact gas exchange and perfusion: albuterol,
Alpha-1 proteinase inhibitor (Zemaira), amiodarone, aspirin, diltiazem
(Cardizem), carvedilol (Coreg), atorvastatin (Lipitor), lisinopril, metoprolol
(Lopressor), simvastatin, sotalol, fluticasone (inhaled), donase alpha
(Pulmozyme), ferrous sulfate
Review patient documentation in chart: labs & procedures impacted by
gas exchange and perfusion
3
Mobility
Fluid &
Electrolyte
Nurse Assigned
Student Buddies
4
Acid/Base
Immunity,
inflammation
Infection
Nurse Assigned
Student Buddies
5
Glucose
regulation
Intracranial
regulation
Student
individually
assigned to RN
patients
Document pulse ox and vital signs in patient chart.
**specifics Document respiratory and cardiovascular (including
peripheral vascular) assessment on SimChart
Mock Medication Administration for one med (above)
Diagnostic procedures as able
Patient Education & Discharge Planning (Sim Chart)
SBAR & 5Ps
60 second situational assessment
Vital Signs on assigned patients
Daily care for assigned patients (bed baths, assist ADL’s etc)
Review pre-clinical paperwork for diagnoses of Osteoarthritis, hip
fracture, amputation (BKA), Dehydration including significant labs and
diagnostic testing.
Review assigned meds cards on medications that impact mobility and
fluid & electrolytes: ibuprofen, Potassium Chloride, magnesium sulfate,
furosemide (Lasix), bumetanide (Bumex), prednisone,
methylprednisolone, entancept (Enbrel)
Review patient documentation in chart: labs & procedures impacted by
mobility & fluid and electrolytes
I&O : review how to collect and document in EMR
** specifics Document IV site assessment on SimChart
Mock Medication Administration for one med (above)
Document physical assessment of IV site assessment, muscle strength
and integument assessment in SimChart.
Patient Education and Discharge planning (document 1 in Sim Chart)
Students practice reporting off to each other on one of assigned patients
in presence of the clinical instructor– turn in SBAR form to instructor as
clinical paperwork
Review of Mid-term progress
SBAR& 5Ps
60 second situational assessment
Review pre-clinical paperwork of assigned diagnoses of hypokalemia,
hypernatremia, Acute Renal Failure, Cohn’s Disease, Pneumonia
Vital Signs on assigned patients including significant labs, diagnostic
testing.
Review assigned med cards on medications that impact acid/base,
immunity, inflammation and infection: sevelamer carbonate (Renvela),
Sodium Bicarbonate, levofloxacin (Levaquin), vancomycin, Zosyn
(pipercillin & tazeobactam), cefepime, Primaxin (imipenem-cilastatin),
rifaximin, dexamethasone, IVIG.
Documentation
Daily care for assigned patients (bed baths, assist ADL’s etc)
Med administration for 1 patient (oral med)
Report off to nurse using SBAR format
SBAR & 5Ps
60 second situational assessment
Vital Signs on assigned patients
Review pre-clinical paperwork of assigned diagnoses of Type 2 diabetes,
Parkinson’s Disease and CVA including lab work and diagnostic testing.
Review assigned medication cards on meds that impact glucose and
intracranial regulation: insulin aspart (novolog), insulin glargine (Lantus),
mannitol, phenobarbital, ziprasidone (Geodon), lorazepam (Ativan),
levetiracetam (Keppra), clopidogrel (Plavix), alteplase (Activase),
Daily care for assigned patients (bed baths, assist ADL’s etc)
Glucose monitoring for assigned patients
Be prepared to pass all patient meds (time management/organization)
and pass meds agreed upon with clinical instructor
*** specifics Perform complete patient assessment. (Document head to
toe in SimChart)
Shadow off-unit diagnostic testing if appropriate
Discharge Planning
Patient Education
Report off to nurse using SBAR format
6
Nutrition,
Elimination
Tissue Integrity
(clotting)
Student
Individually
assigned to RN
patients
SBAR & 5Ps
60 second situational assessment
Vital Signs on assigned patients
Review pre-clinical paperwork of assigned diagnoses of Pyelonephritis,
Pressure ulcer, DVT including lab work and diagnostic testing.
Review assigned medication cards on meds that impact nutrition,
elimination, tissue integrity and clotting: enoxaparin (Lovanox), heparin,
Coumadin, pantoprazole (Protonix), tamulosin (Flomax), MVI,
ondansetron (Zofran)
Daily care for assigned patients (bed baths, assist ADL’s etc)
**specify what documentation from Sim Chart Perform focused
assessments on all assigned patients: nutrition, elimination, perfusion,
tissue integrity (document one assessment of each in SimChart)
Braden Scale Assessment: will document one patient in SimChart
Be prepared to pass patient meds (time management/organization) and
pass meds agreed upon with clinical instructor
Report off to nurse using SBAR format
Patient Education
Discharge planning
RN Work around assignment (?post conference)