SIMULATION DESIGN & PLANNING TEMPLATE
Scenario Name Nitroglycerin Overdose Junior Level
Measurable Objectives (minimum 2, maximum 10)
1. Identify signs and symptoms of a hypertension crisis.
2. Correctly assess prior medication administration
3. Use SBAR to report Patient NTG OD to physician.
Authors:
Peter Ford Bates Technical College
Carly Williams Northwest Hospital & Medical Center
Date Submitted Spring 2013
Expected Scenario Time: 10 min
Expected Debrief Time:
20 min
Target Audience: LPN
Report and Information Provided To Participants Prior To Simulation
Jerry Williams is an aeronautical engineer transferred from Seattle to Chicago
one year ago when his company relocated. He has a history of Hypertension and
Coronary Artery Disease. He has been admitted to the unit with flu-like symptoms
and complaints of chest pain.
Patient Information
Patient Name:
Age:
Jerry Williams
Gender:
Male
49
Birth date:, June 17, 1964
Weight: 210
Height: 70 IN
ID band MR #00001234 Acct. # 1198765432
Hx. Present Illness: Coronary Artery Disease
Social History: Recently relocated for work, living apart from family. Recent
history of alcohol and smoking abuse since relocation. Recent weight gain.
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
Religion:
Agnostic
Support System: Family lives out of state.
Allergies:
Morphine
Attending Physician: Sylvia Oberholtzer
Past medical history: Hypertension (HTN). Coronary Artery Disease (CAD),
Complaints of chest pain. Developed edema approximately 2 weeks before
admission.
Physical description of how you want the manikin to present at start of scenario?
Moulage:
Add picture here:
Patient or Family member holding bottle of NTG from home.
Peripheral Edema - legs (third party leggings/label stating edema - pictures below)
Assignment Of Roles (Please indicate below roles to be assigned):
Primary Nurse
Secondary Nurse
Family Member #1
Observer(s)
Important Information Related To Roles:
Family Member - overly protective and worried for patient's safety. Increasingly if NTG
is given by Nurse.
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
Med-Surg
Medications and Fluids:
Oral Meds: Lisinopril, HCTZ, NTG
Props:
Equipment attached to manikin:
Monitor attached/ Type
ID band
Documentation Forms:
Admit Orders
Physician Orders
MAR
Equipment available in room:
Recommended Mode for Simulation
Manual/Programmed Hybrid
Crash cart c airway devices and emergency meds
Other: Saline Lock
O2 Nasal Cannula
Manikin to be used: SimMan3G
Physician Orders PRN - NTG 0.4 SL tablet x3
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
Stage 1
Initial Amount
Time in Initial
Stage- 5 mins
Baseline Vital Signs
T PR 99-90-22
BP 150/92
SPO296
Cardiac Rhythm
Sinus
Breath Sounds
Crackles
Heart Sounds
Normal
Abdominal Sounds
Active
Other Symptoms:
Eyes open, half
closed, or closed
Trending:
VS ↑ or↓ over time
BP Trending down
Verbalization
(Pt/Manikin
Cues)
Dont feel well
- slight
headache
-I feel like I
should have to
urinate but
haven’t since
the middle of
the night
-I’m SOB
-Complain of
chest pain,
radiating
pressure
Expected
Interventions
-Assess chest
pain
-Identify prior
medication
ingestion
-Elevate head
of bed
-Administer
O2 2L/hr via
nasal cannula
Correct Treatment Choice: Identifies that
patient has taken NTG Stage 2
Timing Sequence
Expected
4:00
Interventions
Baseline Vital Signs
Monitor patient
T 99
and identify
P 84
stabilization of
R 22
vital signs and
BP 134/82
level of pain.
SPO295
Cardiac Rhythm Sinus
Breath Sounds Crackles
Heart Sounds Normal
Abdominal Sounds
Active
Other Symptoms:
Alternate or Incorrect
Treatment Choice
That Will Affect Outcome
Admin of NTG tablets
causing patient vitals to
crash and possibly lose
consciousness
Confederate
Actions/Additional
Role Player Cues
As the nurse is making
an assessment the
family member states,
"I just gave 2-3 NTG
tablets right before the
nurse entered the
room."
Alternate or Incorrect Treatment choice:
Gives additional NTG Stage 2A
Timing Sequence
Expected
1:00
Interventions
Baseline Vital Signs
T 99
P 105
R 27
BP 105/54
SPO287(if no O2 given)
Cardiac Rhythm Sinus>Vent Tachy
Breath Sounds Crackles
Heart Sounds Normal Tachy
Call for Help
Abdominal Sounds Active
Other Symptoms:
Verbalization
Verbalization
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
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).
5
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).
6
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).
7
SIMULATION DESIGN & PLANNING TEMPLATE
Resources:
www.micromedexsolutions.com
http://www.ncbi.nlm.nih.gov/pubmed/23247304
Medication Administration Record
Scheduled Medications
Diagnosis
Drug, Dose, Route, Frequency
Room/Bed#
2400-0659
0700-1459
1500-2359
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
Printed name
Initials Printed Name
Initials Printed Name
Initials
Printed Name
Initials Printed Name
Initials Printed Name
Initials
Affix
Patient Label
Medication Administration Record
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