Download Simulation Assignment

Student _____________________________
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A Simulation Project
Student Worksheets
Simulation Objectives-Course Outcomes
Area
Scenario Objectives
Course Outcomes
Knowledge
Student will: recognize
pediatric patient symptoms of
DKA, do focused physical
assessment and recognize
significance of lab values. Use
SBAR for reports (lab analysis
and application-simulation
prep and bedside)
Student will: implement
appropriate nursing
interventions, displaying ability
to manage time and plan care
during hospitalization,
discharge, and follow up.
Student will perform basic
safety measures…ID, hand
hygiene, etc. Identify and
provide age appropriate
activities for the school aged
child. (Simulated role
performance, SBAR, care
planning)
Student will: be able to
effectively communicate using
SBAR, with other members of
the healthcare team and
provide culturally appropriate
education to patient and family.
Will collaborate with other HCP
to provide holistic care in a
timely manner. (SBAR, Family
interaction in simulated
setting)
Student will: Objectively
evaluate their performance and
others in the simulated health
care team, as to the
performance of nursing care,
interventions, teaching, and
professionalism. (Simulation
debriefing, evaluation check
off)
Human Flourishing:
Demonstrates knowledge of
growth and developmental
levels of the school aged child
with a chronic health problem.
Skills
Communication
Professionalism
Nursing Judgment:
Demonstrates the ability to
meet the physical,
developmental and social needs
of the school aged child and the
family in a variety of settings.
Home, school, community.
Spirit of Inquiry: Seek out and
implement evidence based
practice for the safe care of the
school aged child and care
givers experiencing a health
care alteration.
Nursing Judgment: Utilize
appropriate communication
methods specific to culture,
patient, and family needs that
enable all to understand
medical needs and overcome
barriers to self-management of
chronic condition.
Professional Identity:
determine the nursing roles
that establish continuity of care
in an inpatient,
outpatient/home, and
community setting.
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Student (4-5 hours) Preparation-complete this workbook before simulation
Pre-requisite knowledge/activities
 DKA management and pathophysiology
 Labs: A1c, blood lipids, blood glucose levels (what levels are concerning, emergent, desired),
Urinalysis, chemistries, electrolytes, ABGs,
 Assessment methods for 10 year old
 Insulin-how to draw, administer, teach, monitor
 Read text pages 992-1006 also 458-467
 Role expectations-scenario overview
Roles: You will draw for one of these roles within your assigned group. This is the general role
descriptions.
Diabetic Educator-teach insulin administration, use of insulin pen, signs and symptoms of Hypo/hyper
glycemia…what to do. #2 Educator-diet, exercise
Admission nurse: assessment, call to physician to report admission (SBAR) and take orders for
treatment. Handoff report to primary nurse). Order labs.
Primary-discuss plan of care, vitals, gather supplies, start IV, labs return, call MD (SBAR), report to med
nurse.
Discharge nurse: go over discharge plan with the patient, gather supplies, DC the IV, let them know that
the Diabetic Educator will come to the room for teaching.
Med nurse: gather supplies for IV fluids, insulin gtt, explain treatment to patient and her grandmother,
start fluids and do finger stick for blood glucose, if 250, start insulin gtt. Call MD with results. if DC orders
hand off to discharge nurse.
Remember safety, documentation, etc.
Scenario:
Jessalyn is a 10 year old 4th grade student who lives with her grandparents and younger
brother Jonathan (8 years old) in a middle class neighborhood. Mr. and Mrs. Mendoza work
in the community where they live. Jessalyn was diagnosed with Type I diabetes mellitus at
the age of 8. Her DM has been well controlled with morning and evening injections of NPH
Humulin insulin, diet, and exercise. Jessalyn has been staying up late studying and spending
extra time in the afternoons practicing for the semi-finals of her school softball team
(she is a pitcher). These changes in her daytime routine have contributed to her changes in
eating and sleeping habits. Jessalyn weighs 64 lbs. and is 4 ft. 6 in.
Case Study:
Jessalyn developed a cough, nasal congestion, and a low grade temperature 3 days ago, but
assured her grandparents that she felt well enough to go to school and did not want to
miss her classes or softball practice. Today Jessalyn felt worse, very thirsty and didn’t
want to eat so Mrs. Mendoza called her pediatrician. On arrival to the clinic, Jessalyn was
assessed with elevated pulse and respirations and slight fruity smell to her breath. Her
capillary blood sugar level was elevated. Her pediatrician ordered stat labs at the clinic
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with results to be forwarded to the hospital and admission to the 2 West pediatric floor.
Jessalyn’s initial labs are as follows;
Chemistries: glucose, 380 mg/dL; sodium 130mEq/L; chloride, 79 mEq/L; and potassium,
3.3 mEq/L
Arterial blood gases: pH, 7.13; PaCO2, 25 mm Hg; HCO3, 10 mEQ/L; PaO2, 93 mm Hg;
Oxygen saturation, 97%
Answer the following questions.
1. Explain all the abnormal lab values
2. What factors place Jessalyn at risk for DKA?
3. What other data would be helpful to determine whether she has developed other
complications of either worsening DKA, or her flu-like symptoms?
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4. Identify at least 4 nursing diagnoses that would apply to Jessalyn’s case?
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5. What nursing interventions should be utilized to facilitate Jessalyn’s recovery?
6. What are the teaching priorities for Jessalyn and her family prior to discharge?
7. Discuss potential complications for Jessalyn if she is not compliant with her
medical regimen when she goes home?
This is a copy of the admission orders.
General Pediatric Unit
Physician’s Orders
Date/Time
Order
9-8-2015
Admit to General Pediatric Unit
0830
2 West
Diagnosis: Mild Diabetic
Ketoacidosis
On arrival Cardiac monitor
PIV access x 1
No Known food/drug allergies
9-8-2015
Labs:
1430
ABGs
Urine
Lipid panel
CBC
Throat culture
Chemistries
Vital signs/neuro status, every 2
hours
Activity as tolerated
Diet: NPO
I&O
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Noted
Medications:
 0.9 NS bolus @
10mL/kg/hr for 60 min
 Check blood sugar. 250
start insulin gtt.
 Insulin R drip @ 0.1
unit/kg/hour-piggyback
A. Kidsdoc, MD
Mendoza, Jessalyn
MR # 1122345
DOB: 09/01/2005
Allergies: none known
*normally you would have 2 PIV lines. We are only going to start 1 and discontinue the saline
to run the insulin.
The clinic pediatrician, A. Kidsdoc, MD has sent Jessalyn Mendoza to the hospital for
admission for treatment of mild diabetic ketoacidosis. As the admitting nurse you are going
to do a focused admission assessment. How will you address her needs for growth and
development? What fears or concerns might you anticipate on the part of Jessalyn?
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Be able to do a focused assessment at bedside. (Admission nurse) 5-10 minutes. Make
notes as to how this should be conducted. Keep basic and simple. Also
Figure the rates of IV fluid bolus and insulin gtt.
Three days later Jessalyn is ready for discharge home. Based on your knowledge of her
history, diagnosis, and events leading to her hospitalization what points might you want to
include in her discharge planning? Be able to state the rates you will be running your fluids
and insulin-show your work on this page. Choose and organize 4-5 points to cover with
family.
What questions might you as (grandparent) ask? Meal planning? Sick day plans? Others?
Activity?
On Jessalyn’s return to school she joins a newly formed group at her school for children
and families dealing with diabetes. As the (Diabetic Educator) who conducts these
monthly meetings what 4 things might you want to cover in your first meeting?
Develop a concept map below, illustrating and teaching about Jessalyn’s illness. If
performing role of the school nurse you can teach with this.
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Develop a 3day meal plan for Jessalyn. Remember that she comes from a very happy,
extended Latino family, so use foods that might work well in her culture.
Day 1
Day 2
Day 3
Breakfast:
Breakfast:
Breakfast:
Lunch:
Lunch:
Lunch:
Dinner:
Dinner:
Dinner:
Snacks:
Snacks:
Snacks:
Lunch
Dinner
Now do a “sick day” plan:
Breakfast:
Snacks:
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For your information, review the importance of cardiac and electrolyte monitoring for
the diabetic patient.
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Electrocardiography (ECG) is a useful adjunct to monitor potassium status. Characteristic
changes appear with extremes of potassium status. Characteristic changes of hypokalemia as
represented on ECG (see the image below) are as follows:

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



Apparent prolongation of QT interval
ST segment depression
Flat or diphasic T waves
Prominent U waves
Prolongation of PR interval
Sinoatrial block
Hyperkalemia may develop due to overcorrection of potassium loss, with electrocardiographic
changes occurring as follows (see the image below):






Notes:
Broadening of the QRS
Peaked T waves
Prolonged PR interval
Disappearance of P wave
Diphasic QRS complex
Asystole
Resource Library
https://www.ucdmc.ucdavis.edu/children/patients_family_resources/Patient_and_Family_
Education_A_to_Z/PDFs/Ped_diabetes_booklet.pdf (Pediatric Diabetes-A Patient Guide)
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https://youtu.be/tpjVmLIUWCo (DKA)