Simulation Design Template:
Eugene Shaw-Simulation #1
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
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
one on 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
Nursing Diagnoses: Acute pain related to tissue injury; risk for impaired skin integrity related to poor
circulation; activity intolerance related to pain; risk for injury related to poor control of diabetes
Psychomotor Skills Required Prior to Simulation



Basic assessment skills
IV maintenance
Administration of medication
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 pre-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 pre-operative patient.
Simulation Scenario Objectives
1. Conduct a focused assessment of a pre-operative patient
2. Respond to patient-specific physical and emotional needs related to surgical procedure.
3. Assess and maintain IV.
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4. Provide pain management.
5. Conduct pre-op teaching.
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
Other:
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Simulator Manikin/s Needed:
Documentation Forms:
Standardized patient, moderate or high fidelity
Physician Orders
manikin. Right leg has bluish skin tone and
Admit Orders
ulceration on heel. Moulage to simulate missing
Flow sheet
toes on right foot. Can tape picture or drawing
Medication Administration Record
to foot. (Note: some manikins have pedal
Kardex
pulses in both feet that can be regulated to be
Graphic Record
diminished/absent in right leg, but since schools
Shift Assessment
may not have a manikin with this capability, we
Triage Forms
are providing neurovascular assessment
Code Record
information in the nurse’s report.)
Anesthesia / PACU Record
Standing (Protocol) Orders
Props:
Transfer Orders
Other: see chart
Equipment Attached to Manikin:
IV tubing with primary line Lactated Ringers Recommended Mode for Simulation:
running at 125 mL/hr
(i.e. manual, programmed, etc.)
Secondary IV line
Mode will not change for this scenario. Simulator
IV pump
may be set manually or programmed or this
Foley catheter mL output
simulation may be conducted with a standardized
PCA pump running
patient.
IVPB with running at mL/hr
02
Student Information Needed Prior to
Monitor attached
Scenario:
ID band
Has been oriented to simulator
Other:
Understands guidelines /expectations for
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
scenario
Has accomplished all pre-simulation
requirements
All participants understand their assigned
roles
Has been given time frame expectations
Other:
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emergency medications
Defibrillator/Pacer
Suction
Other:
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: 1600 Sunday afternoon
Situation: Mr. Eugene Shaw, age 82, came to the ER on Saturday at 2100 with complaints of pain and a
burning sensation in his right leg. He has 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 is
scheduled for a femoral-popliteal bypass surgery tomorrow, Monday morning, at 0800. The plan is to discharge
him to a rehabilitation facility about 2-5 days post-op. Physical therapy will evaluate him to develop a post-op
plan of care.
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
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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: On admission to this medical-surgical unit at 0600 hours his vitals were stable with temperature
of 98.6 F (37 C), BP 128/70, heart rate 86, respirations 16, SpO2 96% on room air, and pain at 6 on a scale of
zero to ten. He has continued to complain of burning pain in his right leg and has been medicated with Vicodin
for pain about every 3 hours. His last dose was at 1300. Mr. Shaw’s blood glucose was 130 mg/dL at 0630
before breakfast. Our neurovascular checks reveal a popliteal pulse but no pedal pulse. Pulses in the other
limbs are normal. He has a left antecubital IV with Lactated Ringers running at 125 mL/hr. He has had 1,000
mL of IV fluids and has been voiding. He is alert and orientated to person, place and time. He got pretty
anxious after the surgeon talked to him about the femoral-popliteal bypass surgery so we gave him a stat dose
of Xanax. Right now he is in bed. He’s been dozing on and off since he was medicated and seems to be doing
OK for now. Gene has not been ambulating because of his inability to put pressure on his right foot. Physical
therapy has come to evaluate for post-operative plan of care.
Recommendation: He is due for vitals and a pain assessment. Make sure the consent is signed and start
some pre-op teaching.
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.
Role member
providing cue:
Patient
Cue: If asked to
describe and rate
pain, Gene will say
he feels burning and
aching and rates it
as 7 out of 10.
Give pain
medication.
Assess IV.
Role member
providing cue:
Cue:
“What do you want? I don’t
want to talk to anyone.”
“My leg is in such pain. I need
something for the pain.”
5-10 min
Answers questions
appropriately. If students ask
questions about how he lost his





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toes, he will reply:

“Don’t look at my foot, it’s real
ugly and I think that you might
be scared to see how deformed
it looks. You know it don’t
bother me so much to see it. I
saw a lot worse in the war. So
many guys lost limbs cause of
being in the cold and having
wet feet. We spent one really
bad week in the windblown
mountains above North Korea’s
Chosin Reservoir towards the
end of 1950. It was 30 below
zero the whole time. That’s
when I knew I had injured my
feet for good.”

Respond to
bypass question.
Begin pre-op
teaching.
“I didn’t want to come here,
darn Nancy she made me come
to the hospital and look what
you’re going to do! The doctor
says he has to do a by-pass or
maybe they’ll cut off my leg. I
thought they did bypass for the
heart. Is there something wrong
with my heart?”
10-15 min
“Some doc I never met before
tells me we have to do some
kind of surgical procedure. I
said sure, Doc, you’re the boss.
You know we don’t ever
question the sergeant’s orders
when you’re in the field. Now
I’m in his field I suppose
(jokingly).Why did this happen
to me?”
“What will happen if I don’t go
through with this? I know that
this is one order that I will have
to take even though I don’t like
it one bit. You take a lot of
orders in the military and you

Teach about
peripheral
vascular disease;
explain why
physician is
recommending
that he have the
femoral-popliteal
bypass surgery;
review consent
form with Gene.
Role member
providing cue:
Cue:
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just do as you’re told. No
questions asked.”
15-20 min
“What will happen tomorrow –
before and after the surgery?”

“I told Nancy not to come
tomorrow. I don’t want her to
see me like that.”

Explain what will
happen pre- and
post-operatively.
Instruct on use of
incentive
spirometer.
Role member
providing cue:
Cue:
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?
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Specific Debriefing Questions for this Scenario:
1. What were Gene’s specific nursing care needs related to preparation for his femoral-popliteal bypass
surgery?
2. Think about Gene and his situation; what behaviors did you notice that may be related to his concerns
about surgery?
3. What potential problems might Gene encounter after surgery? Consider his medical diagnoses, lifestyle
and any other factors, as well as the challenges presented by his surgery.
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