Download Senior Level: Diabetes Management

SIMULATION DESIGN & PLANNING TEMPLATE
Scenario Name:
Diabetes Management Senior Level
Program/Curriculum Specific Objectives:
To provide basic diabetes management for a patient with high blood sugar
Measurable Objectives (minimum 2, maximum 10)
1.
2.
3.
4.
5.
6.
7.
8.
9.
Performs head to toe assessments and focused assessments as indicated
Asks relevant history and assessment questions pertaining to the patient’s condition
Identifies co-morbidities and medication effects on patients condition
Identifies outcomes of interventions ordered and proceeds appropriately
Demonstrates safe and accurate use of glucometer
Demonstrates safe and comprehensive medication administration
Demonstrates awareness of aseptic technique
Maintains effective closed loop communication with all members of the health care team
Provides support and education to patient
Authors:
Heather Bissmeyer RN MN CCRN
Swedish Medical Center
Peter Ford BA
Bates Technical College
Expected Scenario Time : 30 min Expected Debrief Time : 45 min
Report and Information Provided To Participants Prior To Simulation
You will be caring for a 73 year old female patient admitted to an inpatient unit post
operatively for a left total hip replacement related to a fall. She has a history of mild
dementia, hypertension, TAH/BSO, and type II diabetes.
Medications to review:
Carvedilol (Coreg CR)
Lispro (Humalog)
Glargine (Lantus)
Morphine
Hydrocortisone (Solu-cort)
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).
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SIMULATION DESIGN & PLANNING TEMPLATE
Patient Information (also see attached handoff report)
Patient Name:
Age: 73
Dolores Greer
Gender: Female
Birth date: 1/30/1940
Weight: 89 lbs/40.5kg
Height: 5’4”
ID band MR #00001234 Acct. # 1198765432
Hx. Present Illness: Status post left hip replacement r/t fall
Social History:
Windowed lives full time in SNF
Religion:
Pentacostal
Support System: 2 daughters both live out of state, oldest is at bedside
Allergies: Sulfa
Immunizations: up to date
Attending Physician: PCP: Dr. Hector Ford
Surgeon: Dr. Lynn Jerald
Past medical history: Mild dementia, hypertension, Type II Diabetes, Rheumatoid
arthritis, and TAH/BSO
Physical description of how you want the manikin to present at start of scenario?
Moulage:
Add picture here:
Grey hair, patient gown, Id band, L hip dressing (primapore), hip abduction pillow,
foley, PIV x2, SCD’s
Assignment Of Roles (Please indicate below roles to be assigned):
Primary Nurse (Assessment)
Secondary Nurse (Meds)
Family Member #1(played by an educator)
Other: Safety Observer (see attached checklist)
Other: Data collector
Other: MD and charge nurse (Played by educator)
Important Information Related To Roles:
The family member should be anxious and asking questions about the health of the
patient and what is going on with the patient.
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
Props:
Equipment attached to manikin:
Primary IV Fluid running at 125 ml/hr
Foley catheter 100 ml output; Urine color cloudy
yellow
PCA and or IV pump running
ID band
Equipment available in room:
Incentive Spirometer
IV tubing
IV pump
Other: Glucometer
Other Props:
Medications and Fluids:
Oral Meds
IM/Subcut/Intradermal
Documentation Forms:
Admit Orders
MAR
Recommended Mode for Simulation
Manual/Programmed Hybrid
Manikin to be used: High fidelity recommended
Significant Lab Values
See glucose: in hand off report
Physician Orders:
Glargine 10 units subq once daily at 0900
Lispro insulin subq per sliding scale Q AC and HS
Blood Sugar (mg/dL) Moderate Dose Sliding Scale:
70-130 0 units
131-180 4 units
181-240 8 units
241-300 10 units
301-350 12 units
351-400 16 units
>400
20 units and call MD
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 99.1 F/37.4 C
PR 112
BP
143/84
SPO2 98%
Cardiac Rhythm
N/A
Breath Sounds
Clear/diminished in
the bases
Heart Sounds S1S2
Abdominal Sounds
hypoactive
Other Symptoms:
Urine output 100ml
BS 404
Trending:
VS Stable
Verbalization
(Pt/Manikin
Cues)
Expected
Interventions
Pt answering
questions
mostly
appropriately.
Oriented to
self, and
place, not to
time, slightly
confused
about details,
minimal pain.
Learners will:
1. Wash hands
upon
approaching
patient
2. Introduce
themselves by
name and role
to patient
3. Perform
assessment and
VS
4. Check blood
sugar using the
aseptic
technique
5. Critically think
rationale for
increasing
blood sugar
6. Discuss
increasing
glucose with
Charge nurse
7. SBAR to MD
concerns about
blood sugars
8. Provide patient
and family
education
about
increasing
blood sugars
Alternate or Incorrect
Treatment Choice
That Will Affect
Outcome
If MD is not made
aware of increasing
blood sugars:
 BS will continue to
climb
 Urine output will
increase
 Pt will become
increasingly tired
and more confused
Confederate
Actions/Additional
Role Player Cues
Daughter at bedside,
notifying RN that
“mom seems more
confused”
“I’m very worried
about my mom”
MD or Charge Nurse,
“What do you think is
going on with the
patient?”
“Let’s increase her
sliding scale insulin
orders. I will bring you
orders”
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
Correct Treatment Choice
Stage 2
Timing Sequence:
Expected
Transition after MD is
Interventions
called and new orders
are given
NEW MD ORDERS:
Lispro insulin subq per
sliding scale Q AC and
HS
Blood Sugar (mg/dL)
High Dose Sliding
Scale:
70-130 2 units
131-180 6 units
181-240 10 units
241-300 12 units
301-350 14 units
351-400 18 units
>400
22 units and
call MD
Baseline Vital Signs
No change
T
P
R
BP
SPO2
Cardiac Rhythm
Breath Sounds
Heart Sounds
Abdominal Sounds
Other Symptoms:
Verbalization
1. Choose
correct
medications
according to
orders and
blood glucose
result.
2. Perform
medication
double checks
3. Administer
medications
4. Provide pt
education
about
medications
Alternate or Incorrect Treatment choice
Stage 2A
Timing Sequence
Expected
Notify learners that
Interventions
scenario has progressed
to next BS check in 6
hours
Baseline Vital Signs
T
1. Perform
P 122
assessment and
R 22
VS
BP
2. Check blood
SPO2
sugar
Cardiac Rhythm
3. Critically think
Breath Sounds
rational for
Heart Sounds
increasing
Abdominal Sounds
blood sugars
4. SBAR to MD
Other Symptoms:
concerns about
blood sugars
BS 487
Increased urine output
(Foley bag is full)
Verbalization:
Increased confusion
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
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).
6
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).
7
SIMULATION DESIGN & PLANNING TEMPLATE
Simulation Post-Assessment Methods
Checklist
Tests
Evaluations
Turning Point
Jeopardy
Other:
Optional Literature References
Refer to institutions selected nursing text book chapters related to:
Hyperglycemia, DKA, diabetes, subcutaneous injections, medication double checks, insulin administration,
aseptic technique, gloves and hand hygiene, and patient education.
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).
8