Download Resident Level: CHF

SIMULATION DESIGN & PLANNING TEMPLATE
Scenario Name CHF-Resident RN
Program/Curriculum Specific Objectives:
To familiarize nurses with the treatment of heart failure and the management of
atrial fibrillation with a rapid ventricular response.
Measurable Objectives (minimum 2, maximum 10)
1. Perform cardio-respiratory assessment.
2. Discuss heart failure admission orders.
3. Demonstrate titration of a Diltiazem drip.
4. Perform neurologic and FAST assessment
5. Initiate a rapid response team 2 for a code stroke.
6. Prepare patient for transfer to CT scan.
Instructor’s Name: Lisa Nelson RN Renton Technical College
Carly Williams Northwest Hospital and Medical Center
Date Submitted Spring 2013
Will There Be Any Pre-Simulation Lecture?
Yes
Expected Scenario Time 20 min (with 3 phases of simulation)
Expected Debrief Time
30 min
Report and Information Provided To Participants Prior To Simulation
Carol Bleckman is a 67 year old female who is being admitted with shortness of breath,
loss of appetite, orthopnea and heart palpitations. Her weight is up 6 kg over the last two
months. She is being admitted to SCU with CHF exacerbation and atrial fibrillation with
a rapid ventricular response.
Background: History of HTN, CAD, EF 46%, smokes 1PPD x 35 years,
cardiomyopathy.
Medications: Lisinopril 20 mg po daily, Metoprolol 25 mg po BID, Lasix 20 mg po
daily, KDUR 10 meq po daily.
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
Patient is alert and oriented with BP 130/80, HR 145-165, RR 24, T 37.2
Patient Information
Patient Name:
Age: 67
Carol Bleckman: F
Birth date: 10/15/ 1946 Height:
Weight:
5’ 3”
155 lb
Hx. Present Illness: Increase shortness of breath over the last week with palpations
starting last night. Weight up 6 kg over the last two months. Continues to smoke 1 PPD.
Social History:
married
Religion:
Methodist
Support System: husband Allergies: none Immunizations: Current
Attending Physician: Dr Dansell
Past medical history: Broke leg as a child
Physical description of how you want the manikin to present at start of scenario?
Edema legs, Red Wig on Manikin
Assignment Of Roles (Please indicate below roles to be assigned):
Primary Nurse
Secondary Nurse
Clinical Instructor
Family Member #1
Unlicensed Assistive Personnel/CNA/MA
Important Information Related To Roles:
Script for family member
Fidelity (choose all that apply to this simulation)
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
Setting/Environment
Med-Surg
Props:
Equipment attached to manikin:
Primary IV Fluid D51/2 NS
running at 42 ml/hr
O2
Monitor attached/ Type cardiac
ID band
Equipment available in room:
Bedpan/ Urinal
Crash cart c airway devices and emergency meds
Foley kit
IV pump
O2 delivery device
Other Props:
Edema legs, chair for family member, red wig
Medications and Fluids:
Medications and Fluids:
(list medications)
Diltiazem Gtt 100mg/ 100ml D5W
Lasix 40mg IVP
Potassium 20 meq PO
Diagnostics Available:
Documentation Forms:
Physician Orders
MAR
Graphic Record
Recommended Mode for Simulation
Manual/Programmed Hybrid
Significant Lab Values see attached
Physician Orders see attached
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
Part 1
Initial Amount
Time in Initial
Stage- 5 mins
Baseline Vital Signs
Baseline Vital Signs
T 37.2 PR 145-165
BP 130/80
SPO2 88%
Cardiac Rhythm
Atrial Fibrillation
Breath Sounds
Coarse Breath
Sounds-wet
Heart Sounds
Gallop-irregular
Abdominal Sounds
Hypoactive
Verbalization
(Pt/Manikin
Cues)
Expected
Interventions
Raise HOB up
I am so short
of breath
I feel like my
heart is racing
I feel like I
am having
palpitations
I need to sit
up to breath
Cardio-Resp
assessment
Alternate or Incorrect
Treatment Choice
That Will Affect Outcome
If correct treatment response
is not performed the patient
will decline
Confederate
Actions/Additional
Role Player Cues
Family Member: "I'm
so worried! She has
never been like this
before!!!!"
Monitor HR &
Oxygen
Start heart
failure orders
and
arrhythmia
orders
Start Oxygen
at 2 liters
Medicate
patient with
Lasix,
potassium and
start IV
Diltiazem
(bolus 10mg
then gtt at
5mg/hr)
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
Part 2
Announce that the simulation has been paused and it has now been 10 minutes
later
Unpaused-10 mins
later
Baseline Vital Signs
P 130 trending
down to 120 over 2
minutes after
Diltiazem
R 22 trending
down to 16 over 2
minutes after
Diltiazem
BP 120/72 to 100/64
trending down over
2 minutes after
Diltiazem
Expected
Interventions
Prepare patient
for transfer to
ICU using
SBAR
Reassess vital
signs
Listen to heart
and lungs
Talk with
Family member
and patient
about what is
happening.
SPO2 95% on 2
liters nc
Cardiac Rhythm A.
Fib.
Breath Sounds fine
crackles
Heart Sounds
unchanged
Verbalization:
“I’m feeling slightly
better. I would like
to get some sleep
now”
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
Part 3
Announce that the simulation has been paused and it has
now been 10 minutes later
10 minutes later
Verbalization
(Pt/Manikin
Cues)
Baseline Vital
Signs
P 110
R 14
BP 88/50
SPO2 95% 2
liters
Cardiac Rhythm
Sinus rhythm
Breath Sounds
Crackles bases
Heart Sounds
normal
Other
Symptoms:
slurred speech
Expected
Interventions
Confederate Actions
Verbalization
Assess the situation
and recognize the
patient is having a
stroke.
Why is she having a
stroke? We were here
for chest pain. What
did you give her?
Neuro assessment,
FAST assessment
Call for Rapid
Response using
SBAR
“Why can’t I
move my right
arm?”
Comfort Family
Member
Transfer to CT
scan, then patient
to go to the ICU
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
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).
7
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).
8
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 . . .”
7. What would the nurse expect to find after Lasix IV given?
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 DESIGN & PLANNING TEMPLATE
Resources:
www.micromedexsolutions.com
http://home.mdconsult.com/groups/northwest112.html
http://www.chfpatients.com/tests/routine_tests.htm
http://nursing.uchc.edu/nursing_standards/docs/IV%20Push%20Medications.pdf
http://nursing.uchc.edu/unit_manuals/intensive_care/docs/Diltiazem%20(Cardizem)%2
0Infusion%20-%20for%20Treatment%20of%20Atrial%20Tachyarrhythmia.pdf
Drug Handbook
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