COPD/Pneumonia Simulation
Date: 11/15/11
Student Level: ADN/Med Surg.
# of Students: 6 (2 groups of 3 for each part)
Expected Simulation Run Time: 45minutes Guided Reflection Time: 20 minutes
Admission Date: 8/11/11
Psychomotor Skills Required Prior to
Simulation
Today’s Date: 8/12/11
Knowledge of Respiratory Diseases, Oxygen
administration, Lung assessments/Respiratory
Medications
Brief Description of Client
Name: James Wilson
Gender: M Age: 71 Race: White
Weight: 200 lbs
Height: 6 ft
Cognitive Activities Required prior to
Simulation
Independent Reading, Video Review, and
Lecture, Skills Lab
Religion: Methodist Major Support: Wife
Allergies: Codeine
Attending Physician/Team: Dr. Jones
Past Medical History: COPD, ½ pk/day
smoker/asthma, HTN
History of Present illness: Increased dyspnea,
productive cough, fever of 101.8
Primary Medical Diagnosis: COPD
exacerbation secondary to Pneumonia
Surgeries/Procedures & Dates: Appendectomy
2000
Nursing Diagnoses: Ineffective Airway
Clearance, Altered Breathing Pattern
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document may be reproduced as long as it retains the following copyright statement:
© Copyright, 2010. Simulation in nursing education: From conceptualization to evaluation. New York: National League for
Nursing. Reprinted with permission.
Simulation Learning Objectives
1. Student will identify key respiratory assessment and take steps to remedy an acute episode of
dyspnea.
2. Student will incorporate safety measures into their care.
3. Student will identify errors in setting (IV rate, foley catheter on the floor, O2 out of nose, and
tangled.)
4. Student will identify IV fluids and rate appropriately. Will be able to demonstrate how to
change IV fluids and administer IVPB medications.
5. Student will establish a therapeutic relationship by communicating with the client.
6. Student will notify MD of significant findings.
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© Copyright, 2010. Simulation in nursing education: From conceptualization to evaluation. New York: National League for
Nursing. Reprinted with permission.
Fidelity (choose all that apply to this simulation)
Setting/Environment
Medications and Fluids
ER
Med-Surg
Peds
ICU
OR / PACU
Women’s Center
Behavioral Health
Home Health
Pre-Hospital
Other:
Simulator Manikin/s Needed: Static
IV Fluids: NS at 100 cc/hr
Oral Meds:
IVPB:
IV Push:
IM or SC:
Diagnostics Available
Labs
X-rays (Images)
12-Lead EKG
Other:
manikin
Props: Oxygen/O2 sat monitor/IV bag and IV
machine/Foley catheter, nebulizer machine and
medicine
Equipment attached to manikin:
IV tubing with primary line
fluids
running at 100 mL/hr
Secondary IV line
running
at
mL/hr
IV pump
Foley catheter 850 mL output
PCA pump running
IVPB with Zosyn 3.375 g running at 50
mL/hr
02 2 liters per NC
Monitor attached
ID band
Other:
Equipment available in room
Documentation Forms
Physician Orders
Admit Orders
Flow sheet
Medication Administration Record
Kardex
Graphic Record
Shift Assessment
Triage Forms
Code Record
Anesthesia / PACU Record
Standing (Protocol) Orders
Transfer Orders
Other:
Recommended Mode for Simulation (i.e.
manual, programmed, etc.)
Bedpan/Urinal
Foley kit/Straight Cath Kit
Incentive Spirometer
Fluids
IV start kit
IV tubing
IVPB Tubing
IV Pump
Feeding Pump
02 delivery device (type) Nasal Cannula
Crash cart/airway devices
Defibrillator
Suction
Other: O2 Sat monitor
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document may be reproduced as long as it retains the following copyright statement:
© Copyright, 2010. Simulation in nursing education: From conceptualization to evaluation. New York: National League for
Nursing. Reprinted with permission.
Roles/Guidelines for Roles
Primary Nurse
Secondary Nurse
Clinical Instructor
Family Member #1
Family Member #2
Observer/s
Recorder
Physician/Advanced Practice Nurse
Respiratory Therapy
Lab
Imaging
Code Team
Other:
Significant Lab Values:
Chest X-ray shows Left lower lobe infiltrates.
Physician Orders:
Admit pt. to 4 East.
O2 at 2 L per Nasal Canula.
Check 02 sats and call for < 90%.
Insert Foley Catheter
IV-NS at 100cc/hr
Administer Zosyn 3.375 g IV at 1700, then Q 6
hrs thereafter.
Perform Med Reconciliation
Chest X-ray in am.
Teach Incentive Spirometer
Regular Diet
Albuterol 0.5% Nebulizer Treatment Q 6 hrs as
needed for SOB.
Student Information Needed Prior to
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:
Report Students Will Receive Before
Simulation
Time: 0700 (Nurse will be coming onto shiftgetting shift report)
Pt. admitted yesterday with COPD
exacerbation secondary to pneumonia. Pt
dehydrated so has NS at 100 cchr going in R
arm
O2 at 2L per N/C. O2 sats running low 90’s.
Pt. receiving IV antibiotic.
No c/o pain.
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document may be reproduced as long as it retains the following copyright statement:
© Copyright, 2010. Simulation in nursing education: From conceptualization to evaluation. New York: National League for
Nursing. Reprinted with permission.
Scenario Progression Outline
Timing
(approx)
10 min
10 min.
Manikin Actions/State of
client
Expected
Interventions
May Use the
Following Cues
VS: T-99.8,P-96, R-25, BP
140/88
O2 at 2L out of nose, and tubing
kinked.
Pt c/o dyspnea increasing x 1hr.
Lying Supine in bed.
Rhonchi heard in lower lungs
Bed is in high position with only
1 side rail up.
Client states “I am so short of
breath.”
Pain Level 1. (Uncomfortable
feeling in chest)
O2 sat is 89%. Pt states “I feel a
little better but I am still short of
breath. What is wrong with me?”
Introduces self
Foam in
Checks ID
Check P, R, BP, and O2
sat
Fix O2 tubing-put in nose
and untangle cord
Raise HOB to high
Fowler’s
Listen to Lungs and Heart
sounds
Ask student what they
may need to further check
Oxygen status- O2 sat
monitor
If student leaves room to
get monitor before
lowering bed and putting
side rails up- Ask them if
they are going to leave the
room in that condition.
Checks MAR for PRN
medications that may
assist pt. with breathing.
(Albuterol)
Keeps O2 sat monitor on
for continued monitoring.
Administers Albuterol
nebulizer treatment.
Explains to client what is
wrong with them.
Student continues to
assess pt. including:
IVsite, IV fluids and rate
Foley Catheter and
attaches to under be
Assesses other body
systems.
States they would check
chart to confirm IV rate
and fill out incident report.
Ask student what they
have that might help the
client.
5 min.
O2 sat is up to 92%.
Pt states “I am breathing much
better.”
P-88, R-20, BP 140/82
IV rate is set wrong at 125cc/hr.
Foley catheter bag is attached to
side rails.
Change
Groups
Tell Students they are coming
onto 2nd shift- The time is 1700.
What else would you
check during your am
assessment?
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document may be reproduced as long as it retains the following copyright statement:
© Copyright, 2010. Simulation in nursing education: From conceptualization to evaluation. New York: National League for
Nursing. Reprinted with permission.
10 min.
Pt. states they are “cold.” Skin is
hot and flushed.
T-102.5
No prn meds on MAR for fever.
10 min.
Pt. states, “Why are you giving
me this and what is it?”
Student performs
assessment and asks for
Temp
Student checks O2, IV,
foley
Student checks MAR for
prn med for fever.
Calls MD for orders for
prn med for fever.
Student repeats MD orders
and writes order on order
sheet.
Student
gives client
Acetaminophen 325 mg 2
tabs.
Student explains what
med is for.
Student looks at MAR and
sees that IV antibiotic is
due at 1700. Gives IV
Zosyn per IVPB.
Ask: What do you think
might be wrong with the
client?
MD orders:
Acetaminophen 325 mg 2
tabs Q 6 hr. prn.
Recheck Temp in 1 hr
after Tylenol.
Call for T >102
Prompt student to look at
MAR if doesn’t notice IV
antibiotic is due.
Downloaded from http://sirc.nln.org with the permission of the National League for Nursing and Laerdal Medical. This
document may be reproduced as long as it retains the following copyright statement:
© Copyright, 2010. Simulation in nursing education: From conceptualization to evaluation. New York: National League for
Nursing. Reprinted with permission.
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.
If you were able to do this again, how could you have handled the situation differently?
8.
What did the group do well?
9.
What did the team feel was the primary nursing diagnosis?
10.
What were the key assessments and interventions?
11.
Is there anything else you would like to discuss?
Complexity – Simple to Complex
Suggestions for Changing the Complexity of This Scenario to Adapt to Different
Levels of Learners
Downloaded from http://sirc.nln.org with the permission of the National League for Nursing and Laerdal Medical. This
document may be reproduced as long as it retains the following copyright statement:
© Copyright, 2010. Simulation in nursing education: From conceptualization to evaluation. New York: National League for
Nursing. Reprinted with permission.