Equipment available in room

Minnesota Simulation in Healthcare Education Professionals (M-SHEP)

Food Impaction Simulation

40 year old male admitted to the Emergency Room diagnosis of food impaction after eating beef tenderloin at dinner.

Date:

Discipline:

File Name:

Student Level:

Expected Simulation Run Time: Debrief /Guided Reflection Time:

Location: Location for Reflection:

Admission Date: Today’s Date:

Brief Description of Patient:

Name: Robert James

Gender: M Age: 40 Race:

Weight: 86 kg Height: ____cm

Religion: Major Support: wife

Phone:

Allergies: PCN, seafood

Immunizations:

Attending Physician/Team:

PMH:

History of Present illness: food impaction

Psychomotor Skills Required prior to simulation:

Social History:

Primary Diagnosis:

Surgeries/Procedures:

Cognitive Skills Required prior to

Simulation: i.e. independent reading

(R), video review (V), computer simulations (CS), lecture(L)

Simulation Learning Objectives:

1.

Prioritize care for patient

2.

Accurately perform assessment of a patient, gather relevant data and interpret findings in order to plan, implement, and evaluate appropriate nursing care.

3.

Interact with patient, family, physician, other nursing staff, and nursing assistant.

4.

Safely performs nursing care while maintaining dignity of client.

5.

Use critical thinking and sound nursing judgment throughout experience.

Submitted 2007 – Updated 2015 Page 1


Fidelity

Setting/Environment o ER

Simulator Manikin/s Needed: o Vital Sim

Props:

Equipment attached to manikin: o IV tubing with primary line

___________ fluids running at

__________ cc/hr o Secondary IV line __ running at _ cc/hr o IV pump o Foley catheter ________cc output o PCA pump running o IVPB with ___ running at ___ cc/hr o 02 _______ o Monitor attached o ID band _______

Equipment available in room o Stethoscopes o Pen lights o Emesis basin o O2 Sat Monitor o Chart o Telephone o Drug book o Lab book o At Med Cart: o Syringes – various sizes o Needles – various gauges o Vial of Versed o Vial of Fentanyl o IV start kit o Vial of normal saline for flush

Roles / Guidelines for Roles o Primary Nurse o Charge or Resource Nurse o Triage Nurse o Family Member #1

Submitted 2007 – Updated 2015

Medications and Fluids o IV Fluids : o Oral Meds : o IVPB : o IV Push : Versed 5mg, Fentanyl

100mcg o IM or SC:

Diagnostics Available o Labs o X-rays (Images) o 12-Lead EKG o Other

Documentation Forms o Physician Orders o Admit Orders o Flow sheet o Medication Administration Record o Kardex o Graphic Record o Shift Assessment o Triage Forms o Code Record o Anesthesia / PACU Record o Standing (Protocol) Orders o Transfer Orders

Other Props

Recommended Mode for simulation:

Student Information Needed Prior to Scenario:



Has been oriented to simulator

Page 2

Minnesota Simulation in Healthcare Education Professionals (M-SHEP) o Physician / Advanced Practice Nurse o Patient o Nursing Assistant

Important information related to roles:



Family Member:

Sit at the patient’s bedside, up by the head of the bed.

Hold the hand of the manikin or have your hand on his arm, and occasionally stoke the head of the manikin. Keep repeating “He is really uncomfortable.

Can’t you give him something?” “I don’t know why it takes so long to get something done around here” Be very attentive to the manikin and act really worried.



Patient: Answer any questions about you the nurse asks: o Name: Robert James o Age: 40 o Diagnosis: Esophageal Food

Impaction o Marital status: Married to

“Anne” o Children: none o Activities you enjoy: Be creative!

Moan of pain and discomfort. Rate it at

6/10 if asked. Verbalize and/or demonstrate anxiety. If the nurse does not ask you about your pain be insistent that you have pain and keep asking them to do something; moan or verbalize the discomfort. IF they still are not focusing on the pain issue, and seeing that you can’t have another pain medication until they call the doctor, say something like: “This is awful.”

“Can you give me something?” “What is taking you so long to help me?”

“When is the GI doctor coming in?” If the nurse continues to do other assessments, talk to your wife who is at the bedside. Say things like “Anne, I really need something” or “I don’t



Understands guidelines /expectations for scenario



Has accomplished all pre-simulation requirements



All participants understand their assigned roles



Has been given time frame expectations

Report students will receive before simulation:

Mr. Robert James is a 40 year old male admitted to the Emergency Room with the diagnosis of food impaction after eating beef tenderloin at dinner. He is unable to pass the food, is unable to swallow and came to the

ER with a cup full of saliva. He is anxious and uncomfortable. He has allergies to PCN and seafood. Admission weight is 86kg. He is married without children. His wife, an RN, is at the bedside. Triage nurse should get initial report and take vital signs, room patient and then give report to assigned RN.

Robert James in room 1 is a 40-year-old male who has a piece of beef tenderloin lodged in his esophagus. He is unable to swallow and is spitting all his saliva into a cup. He has tried drinking water, but it comes back up as well.

He said the piece of meat became lodged about three hours ago, and he was sure it would eventually pass through. His wife talked him into coming in. Vitals upon admission were: BP 144/82, HR 96, RR 20,

O2 sats 98%. His wife, who is a nurse, is with him. He says this has happened before but not for a long time.

NAR comes into room stating “Mr. James’ wife says he has been waiting a long time and wants to know what is going on. She wants you to come into the room right now and give her some information. I emptied the emesis basin and gave him a cool cloth for his head.

I was going to do VS but Mrs. James wants a


Minnesota Simulation in Healthcare Education Professionals (M-SHEP) know what else to do.” “Why won’t they help me?” When nurse starts the

IV, begin to verbalize feelings of dizziness, nausea, lightheadedness, etc.

Critical Lab Values:

Physician Orders: nurse to do it. I think you should come right away.

References, Evidence-Based Practice Guidelines, Protocols, or Algorithms used for this scenario: http://www.asge.org/uploadedFiles/Publications_and_Products/Practice_Guidelines/Manag ement%20of%20ingested%20foreign%20bodies%20and%20food%20impactions.pdf



Scenario Progression Outline

Timing

(approximate)

Manikin Actions

After patient is roomed by triage nurse

Manikin is in bed, semi-fowler’s position.

RR 24 clear and regular

HR 110 normal sinus rhythm

BP 156/88

Pain 4/10

Expected Interventions o Complete physical assessment including orientation, VS, lung sounds, pain level, bowel sounds. o Students should ask in-depth questions to found out history, medications, etc. prior to calling in the nurse practitioner.

May use the following Cues:

Role member providing cue:

Wife

Cue: o If the nurses do not ask the patient about his history, how he describes his pain level using the pain scale etc., but focuses on VS, be insistent and keep asking them to do something to help him. o If they still are not focusing on the issue, talk about your experience as a nurse and how you would handle things. o Be a bit frustrated.

Role member providing cue: o Physician

Cue: o Student should report

Patient name, brief history (previous diagnosis, current




Timing

(approximate)

Manikin Actions Expected Interventions

**After initial assessment is complete and nurse returns from talking with doctor**

Wife: o Continue to sit at patient’s bedside, being

Wife: o Continue to sit at patient’s bedside, being attentive and worried. o Inquire of the nurse “What are you going to do to help?” “Are you calling in the gastroenterologist?” “When will o Nurse should ask some questions of the patient related to his discomfort, inability to swallow. o The nurse should begin an IV with patient becoming lightheaded and slightly hypotensive as a result.

Submitted 2007 – Updated 2015

May use the following Cues: issue, medications),

VS, lung sounds, orientation, O2 sat, o Pain – current assessment and history. o If student does not provide sufficient information – ask for it and tell them to call you back when they have it. o If information is provided give following orders:

-Monitor BP, O2 sats,

LOC

-Contact GI doc on call

-Start IV

-Let me know any orders from GI Dr. and VS in 15 min

Role member providing cue: o MD

Cue:

Give following orders: o -Continue to monitor patient’s VS

Page 6



Timing

(approximate)

Manikin Actions o o attentive and worried.

Inquire of the nurse

“What are you going to do to help?” “Are you calling in the gastroenterologist?”

“When will they get here?” “Please do something” they get here?” “Please do something” o Patient becomes lightheaded and hypotensive with IV start

Expected Interventions o Nurse should lower the head of the bed and take repeat vitals. o If they don’t, ask them to. o Call report to MD: o IV started o Patient lightheaded and o o slightly hypotensive from IV start

GI Dr. on way in

No change with swallowing

May use the following Cues: o o o

-IV Versed and

Fentanyl now

Versed 5mg IVP

Fentanyl 100mcg IVP



Debriefing / Guided Reflection Questions for this Simulation

Link to Participant Outcomes and Professional Standards

(i.e. QSEN, NLN {Nursing}, National EMS Standards {EMS}, etc.)

Primary RN/Triage Nurse/Charge Nurse

1.

How did you feel in your role?

2.

Was the situation believable?

3.

Was it what you expected?

4.

What were your initial thoughts about the patient based upon the report you received?

5.

What did you initially think was wrong with your patient?

6.

Why do you think you reacted the way you did?

7.

What were the most important assessments for this patient? Why were they important?

8.

What mistakes do you feel may have been made? What would you do differently next time?

9.

What is the correct way to take a telephone order from an MD?

10.

Who should call the MD? Is there another way this could have been handled?

11.

What do you think was the most critical and important intervention? Why?

12.

How would you chart what occurred with this patient?

Family Member

13.

How did you feel during the simulation scenario?

14.

How did you feel the nursing staff treated you? How did they make you feel?

15.

What do you think could have been done differently by the nursing staff?

16.

What do you think was done well?

Team Members

17.

How did you feel about your role in this scenario?

18.

How was everything delegated? Is there anything you would do differently with delegation next time?



19.

What do you think about teamwork? How was teamwork utilized in this situation? Was it successful?

Complexity – Simple to Complex

Suggestions for changing the complexity of this scenario to adapt to different levels of learners:



SIMULATION SCENARIO

Food Impaction

Student Copy

LEARNING OBJECTIVES

1.

Prioritize care for patient

2.

Accurately perform assessment of a patient, gather relevant data and interpret findings, in order to plan, implement and evaluate appropriate nursing care

3.

Interact with patient, family, physician, other nursing staff, and nursing assistant

4.

Safely performs nursing care while maintaining dignity of client

5.

Use critical thinking and sound nursing judgment throughout experience

SUPPLIES NEEDED

Stethoscope

Pen light

Drug book

Calculator

PATIENT DATA

Mr. Robert James is a 40 year old male admitted to the Emergency Room with the diagnosis of food impaction after eating beef tenderloin at dinner. He is unable to pass the food, is unable to swallow and came to the ER with a cup full of saliva. He is anxious and uncomfortable. He has allergies to PCN and seafood. Admission weight is 86 kg. He is married without children. His wife, an RN, is at the bedside. Triage nurse should get initial report and take vital signs, room patient and then give report to assigned RN.

REFERENCES http://www.asge.org/uploadedFiles/Publications_and_Products/Practice_Guidelines/Managemen t%20of%20ingested%20foreign%20bodies%20and%20food%20impactions.pdf


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