Scenario Name Asthma Management of the Adolescent- RN Resident
Program/Curriculum Specific Objectives:
Basic developmentally appropriate care of an adolescent Asthma patient
Measurable Objectives
1. Learner completes an adolescent appropriate intake assessment including
information about home life, immunizations, and drug/alcohol use
2. Performs head to toe assessments as indicated
3. Critically thinks potential differential diagnosis based on the information received
4. Asks relevant history and assessment questions pertaining to the patient’s condition
5. Evaluates the patient’s condition and response to interventions and modifies the
nursing care in timely manner
6. Utilizes proper infection control and pt safety protocols
7. Utilizes resources in emergent situations
Authors: Heather Bissmeyer, Swedish Medical Center;
Tiffany Jasperson, Seattle University College of Nursing
Date: Spring 2013
Will There Be Any Pre-Simulation Lecture?
Yes
Duration 15 min
A/V Needs
No
Expected Scenario Time 45 min
Expected Debrief Time
45-90 min
Target Audience: RN Residents
Report and Information Provided To Participants Prior To Simulation
Patient history
Situation
This is a 16 year old male presenting to the emergency department with wheezing,
coughing, dizziness for 2 weeks. Brought in by girlfriend.
Background
This 16 year old male has had multiple clinic and emergency department visits for
asthma exacerbation and upper respiratory infections. Asthma diagnosed at age 2yrs. No
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
history of intubations or ICU admissions. Asthma managed with albuterol MDI from
free clinic. He is currently homeless.
Assessment
Vital Signs: T 102.6F, HR 120, RR 34, BP 140/80 SPO2 93% on room air
General Appearance: Client appears of slightly small-stature for height, weight, and
possible poor nutrition for stated age. He appears to be in moderate to severe respiratory
distress.
Cardiovascular: Sinus rhythm, no murmurs
Respiratory: Uncontrolled cough, tachypnea, subcostal, intercostal, and suprasternal
retractions, wheezing in all lung fields, stridor
GI: Active bowel sounds in all 4 quadrants
GU: No reported problems with urination. No current concerns.
Extremities: Moving all extremities well and symmetrically, good strength in grips,
arms, feet, and legs
Skin: Warm, dry, and pale. Flushed cheeks. No clubbing. Good turgor.
Neurological: Alert and oriented to person, place, and time; Pupils equal, round, and
reactive to light and accommodation. No neurological deficits. Anxious.
Pain: Reports of pain of 7 in his throat, lungs, and chest when he coughs
Labs: Capillary Blood Gas: pH 7.34, pCO2 49 mm Hg, HCO3 22 mEq
Recommendation:
Complete a more detailed history and physical regarding presenting symptoms. Notify
provider of findings. Consider SW consult.
Reading assignments on:
Development of Adolescents
Whooping cough, Tuberculosis, Asthma
Patient Information
Patient Name: James Evans Gender: Male
Age: 16 yrs.
Birth date:, April 7
Weight:
55 kg
Height: 175 cm
ID band MR # Acct. #
Hx. Present Illness: Presents to the emergency department with wheezing,
coughing, dizziness for 2 weeks. Brought in by girlfriend.
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
Social History:
Religion:
Homeless, lives in a co-ed youth shelter with girl friend
None
Support System: Girlfriend
Allergies:
NKDA
Immunizations: Unknown if up to date
Attending Physician:
Dr. Heather Hill
Past medical history: Asthma diagnosed at age 2yrs. Multiple emergency
department visits for wheezing and upper respiratory symptoms. No history of
intubations or ICU admissions. Asthma managed with albuterol MDI from free
clinic.
Physical description of how you want the manikin to present at start of scenario?
Moulage:
Manikin with tattoos and piercings, dressed in baseball cap, jeans, hoody, flip
flops. Have backpack and cell phone at bedside or in bed
Assignment Of Roles (Color Key)
Primary Nurse
Secondary Nurse
Family Member #1(Girlfriend)
Other: Observer roles Developmental/Communication Focus, Positive Feedback
Focus, Constructive Criticism Focus, Safety Focus
Important Information Related To Roles:
Primary Nurse: Your role is as manager and coordinator of care. You may delegate
tasks to other appropriate personnel on the healthcare team.
Secondary Nurse: The person in this role may take delegation from the primary nurse
and may provide hands-on nursing care including assessment, interventions, teaching,
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
and assistance in care coordination. You may provide SBAR report to other healthcare
team members.
Girlfriend: is defensive and worried. They have been together 2 years and rely on each
other heavily.
Other: Observer roles: If you have learners observing the simulation it is helpful to give
them active observation foci. These are suggestions and you can always add more:
 Developmental/Communication Focus: During the
simulation, your role is to observe and take notes for
feedback on pediatric developmental issues that arise
Additionally you will take notes on your observations
regarding team communication and communication with
the family and child
 Positive Feedback Focus: During the simulation, your
role is to observe and take notes on things that went well
during the simulation (e.g. hand washing, working as a
team)
 Constructive Criticism Focus: During the simulation,
your role is to observe areas where the participating
learners may want to improve in the future (e.g. more
detailed SBAR report). For this role, it is helpful to use
statements like: “I noticed” and “When I saw you do X, I
didn’t understand why. Can you clarify what you were
thinking?”
 Safety Focus: During the simulation, your role is to
observe and take notes on safety issues that arise during
the scenario (e.g. during medication administration)
SIM Setup
Moulage
Manikin with tattoos and piercings, dressed in baseball cap,
jeans, hoody, flip flops. Have backpack and cell phone at
bedside or in bed. Sitting up right in bed
Wounds: None
Lac / Burn /
Abrasion / Bruise
Chest, Abdomen,
Back, Groin
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
Lac / Burn /
Abrasion / Bruise
Lac / Burn /
Abrasion / Bruise
R / L ____, Head
Chest, Abdomen,
Back, Groin
R / L ____, Head
Chest, Abdomen,
Back, Groin
R / L ____, Head
Mannequin
IV site : No IV
3G or Task trainer arm
Site ________ Gauge ____
Site _________ Gauge ____
Art Line
Yes / No
Fidelity (choose all that apply to this simulation)
Setting/Environment
ER
Props:
Equipment attached to manikin:
O2
ID band
Other: IV saline locked with extension tubing
Equipment available in room:
Crash cart c airway devices and emergency meds
Fluids
Documentation Forms:
Physician Orders
Flow Sheet
MAR
Triage Forms
Recommended Mode for Simulation
Manual/Programmed Hybrid
Manikin to be used: high fidelity simulator or
standardized patient Manikin
Significant Lab Values
Capillary Blood Gas
pH 7.34
pCO2 49 mm Hg
HCO3 22 mEq
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
Scenario Progression Outlined
The focus of this simulated clinical experience is assessment, developmentally appropriate
communication and patient teaching
Stage 1
Initial Amount
Verbalization Expected
Incorrect Treatment Choice Confederate
Time in Initial
(Pt/Manikin
Interventions
That Will Affect Outcome
Actions/Additional
Stage 0 - 5 mins
Cues)
Role Player Cues
Baseline Vital Signs Patient is
Wash hands
Failure to ask about present Girlfriend is very upset
TPR 102.6, 120, 34 coughing and
illness will result in patient
and defensive.
BP 140/80
feels a little
Check
beginning to cough up blood
SPO2 93%
dizzy
patient’s ID
Cardiac Rhythm
band for name
Sinus
He is quiet
and birthdate
Breath Sounds
but
wheeze, stridor,
cooperative,
Ask about
cough
not
history of
Heart Sounds
comfortable
present illness,
Normal, S1, S2
with
and
Abdominal Sounds authority.
immunizations
Normal
Other Symptoms:
If asked, he
Perform
will mention
focused
that one of the respiratory
other kids at
assessment
the shelter has
whooping
cough
Correct Treatment Choice Stage 2
Ask about history of present illness
Timing Sequence
Expected
Stage 1: 15 min
Interventions
Baseline Vital Signs
T PR 102.6, 120, 34
Intake assessment
BP 140/80
of including
SPO2 93%
questions about
Cardiac Rhythm Sinus
hx of present
Breath Sounds wheeze, illness and
stridor
drugs/alcohol use
Heart Sounds
Normal, S1, S2
Suggest SW
Abdominal Sounds
consult
Normal
Other Symptoms:
Incorrect Treatment choice Stage 2A
No inquiry as to present illness
Timing Sequence
Expected
Stage 1: 15 min
Interventions
Baseline Vital Signs
T PR 102.6, 120, 44
Pt begins to cough
BP 140/80
up blood and has
SPO2 90%
increased SOB
Cardiac Rhythm Sinus
Breath Sounds
wheeze, stridor, cough
Heart Sounds
Normal, S1, S2
Abdominal Sounds
Normal
Other Symptoms:
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
Correct Treatment Choice Stage 3
Alternate Treatment choice Stage 3A
Notify MD of potential illness and place pt in Recognize decrease in O2 sats and place pt on
isolation
O2
Timing Sequence
Expected
Timing Sequence
Expected
Stage 2: 5 min
Interventions
Stage 2: 5 min
Interventions
Baseline Vital Signs
Baseline Vital Signs
Call for assistance
T PR 102.6, 120, 34
SBAR to MD
T PR 102.6, 120, 44
and support pt
BP 140/80
BP 140/80
respiratory status
SPO2 93%
Place pt in
SPO2 90%
Cardiac Rhythm Sinus
isolation
Cardiac Rhythm Sinus
Call MD and
Breath Sounds wheeze, anticipate swab
Breath Sounds wheeze, recommend order
stridor, cough
for whooping
stridor, cough
for albuterol
Heart Sounds
cough
Heart Sounds
nebulizer
Normal, S1, S2
Normal, S1, S2
Abdominal Sounds
Abdominal Sounds
Normal
Normal
Other Symptoms:
Other Symptoms:
Verbalization
“I feel like I can’t
breathe!!”
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
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).
8
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).
9
Simulation Post-Assessment Methods
Checklist
Tests
Evaluations
Turning Point
Jeopardy
Other
Literature References
Cornia P., Hersh, A., Lipsky, B., Newman, T., & Gonzales, R. (2010). Does this
coughing adolescent or adult patient have pertussis. Journal of the American
Medical Association, 304(8), p. 890-896. doi: doi.org/10.1001/jama.2010.1181 .
Hockenberry, M. & Wilson, D. (Ed). (2011). Wong’s Nursing Care of Infants and
Children, (9th Edition). Mosby Elsevier: St Louis.
Hockenberry, M. (Ed.) (2011). Wong’s Clinical Manual of Pediatric Nursing, (9 th
edition). Mosby: St Louis.
INASCL Board of Directors. (2011). Standard III. Participant Objectives. Clinical
Simulation in Nursing. 7(4), p. S10-S11, doi: 10.1016/j.ecns.2011.05.007)
INASCL Board of Directors. (2011). Standard VI: The Debriefing Process. Clinical
Simulation in Nursing. 7(4), p. s16-s17. doi:10.1016/j.ecns.2011.05.010
Jeffries, P. (2012). Simulation in nursing education: From conceptualization to
evaluation. (2nd ed.). New York, NY: National League for Nursing.
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).
10
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).
11