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Simulation Design Template:
Sherman “Red” Yoder-Simulation #2
Date:
Discipline: Nursing
Expected Simulation Run Time: 20
minutes
Location: Simulated emergency room
Admission Date:
File Name: Sherman “Red” Yoder
Student Level:
Guided Reflection Time: 20 minutes
Location for Reflection: Classroom
|
Today’s Date:
Brief Description of Client
Name: Sherman “Red” Yoder
Gender: M Age: 80 Race: Caucasian Weight: 109 kg Height: 72 in
Religion: Protestant
Major Support: Jon (son) Support Phone: 869-555-3452
Allergies: no known allergies
Immunizations: Influenza last fall; tetanus – 4 years ago
Attending Physician/Team: Dr. Frank Baker
Past Medical History: Diabetes Type 2 diagnosed ______ (insert month that is six months prior)
History of Present Illness:
This patient developed an ulcer on his big toe 5 weeks ago. He is currently being treated with an oral antibiotic
and wet to moist saline soaked dressing daily. The home health nurse last assessed the foot 3 days ago.
Social History: Widower; his son Jon lives nearby
Primary Medical Diagnosis: R/O sepsis
Surgeries/Procedures & Dates: L4-5 laminectomy – 25 years ago; transurethral resection of the prostate – 6
years ago
Nursing Diagnoses: Ineffective Health Maintenance; Ineffective Self Health Management; Impaired Skin
Integrity; Risk for Shock
Red Yoder Simulation 2
© National League for Nursing, 2015
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Psychomotor Skills Required Prior to Simulation
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General head to toe assessment including vital signs
Focused assessment of circulatory and neurovascular status of foot and wound
Specimen collection: Blood cultures, labs, wound
Medication administration: IV, Subcutaneous
Oxygen administration
Cognitive Activities Required Prior to Simulation
[i.e. independent reading (R), video review (V), computer simulations (CS), lecture (L)]
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SBAR or other standardized communication tool. (R)
Review care of the client with an infection, specifically sepsis (R)
Read atypical presentation of infection by older adults (R)
Tools in the Try This ® and How to Try This Series, available at http://consultgerirn.org/resources
Specific tool recommended for this scenario is the Confusion Assessment Method (CAM) tool. (R)
Review the Essential Nursing Actions in the ACES Framework. (R)
Simulation Learning Objectives
General Objectives
1. Practice standard precautions throughout the exam.
2. Employ effective strategies to reduce risk of harm to the client.
3. Assume the role of team leader or member.
4. Perform a focused physical assessment noting abnormal findings.
5. Recognize changes in patient symptoms and/or signs of patient compromise.
6. Perform priority nursing actions based on clinical data.
7. Reassess/monitor patient status following nursing interventions.
8. Perform within scope of practice.
9. Demonstrate knowledge of legal and ethical obligations.
10. Communicate with client in a manner that illustrates caring for his/her overall well-being.
11. Communicate appropriately with physician and/or other healthcare team members in a timely,
organized, patient-specific manner.
Simulation Scenario Objectives
1. Demonstrate a general head-to-toe assessment and focused assessments as appropriate.
2. Assess the patient’s delirium (acute confusion) using standardized assessment tool.
Red Yoder Simulation 2
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3. Use communication techniques to recognize, respond to, and respect an older adult’s strengths,
wishes, and expectations.
4. Use the SBAR or another standardized tool to communicate with other health care providers
regarding Red’s transfer to the medical intensive care unit.
5. Discuss pertinent assessment findings and what was found that was specific to the older adult
patient.
6. Implement appropriate interventions based on the assessments and primary health care provider
orders.
References, Evidence-Based Practice Guidelines, Protocols, or
Algorithms Used for This Scenario:
These and other tools in the Try This: ® and How to Try This Series are available on the ConsultGeriRN.org
(http://consultgerirn.org/resources), the website of the Hartford Institute for Geriatric Nursing at New York
University’s College of Nursing. The tool, an article about using the tool, and a video illustrating the use of the
tool, are all available for your use.
Review medical-surgical nursing text related to care of the patient with sepsis.
Confusion Assessment Method Tool:
Tool: http://consultgerirn.org/uploads/File/trythis/try_this_13.pdf
Video: http://consultgerirn.org/resources/media/?vid_id=4361983#player_container
Insights into severe sepsis in older patients:
Girard T.D., Opal S.M., Ely, E.W., (2005) Insights into severe sepsis in older patients: from epidemiology to
evidence-based management. Clinical Infectious Diseases: An official publication of the Infectious
Diseases Society of America. 40:719-27.
Recognizing sepsis in the adult patient:
Nelson, D.P., LeMaster, T.H., Plost, G.N., Zahner, M.L., (2009) Recognizing sepsis in the adult patient.
American Journal of Nursing. 109(3):40-45.
Review the Essential Nursing Actions in the ACES Framework at: http://www.nln.org/professionaldevelopment-programs/teaching-resources/aging/ace-s/nln-aces-framework
Fidelity (choose all that apply to this simulation)
Setting/Environment:
ER
Med-Surg
Peds
ICU
Medications and Fluids:
IV Fluids: see chart
Oral Meds:
IVPB: see chart
IV Push:
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OR / PACU
Women’s Center
Behavioral Health
Home Health
Pre-Hospital
Other:
IM or SC:
Diagnostics Available:
Labs
X-rays (Images)
12-Lead EKG
Other:
Simulator Manikin/s Needed:
Minimally, manikin with vital sign assessment
capability, or standardized patient
Props: Wound moulage: right great toe should
have a wound that has some depth, has bright
red tissue with opaque drainage. If available,
may consider using the foot with the wound on
the toe (Laerdal product). Entire foot should be
red.
Equipment Attached to Manikin:
IV tubing with primary line IV 0.9% NS
fluids running at 500 cc’s bolus, repeat once
Secondary IV line running at mL/hr
IV pump
Foley catheter mL output
PCA pump running
IVPB with running at mL/hr
02
Monitor attached
ID band
Other:
Equipment Available in Room:
Bedpan/Urinal
Foley kit
Straight Catheter Kit
Incentive Spirometer
Fluids
IV start kit
IV tubing
IVPB Tubing
IV Pump
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.)
Manual or programmed; mechanism needed for
transmission of the voice of the patient via
manikin
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: Knowledge of previous “Red”
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© National League for Nursing, 2015
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Feeding Pump
Pressure Bag
02 delivery device (type)
Crash cart with airway devices and
emergency medications
Defibrillator/Pacer
Suction
Other:
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
Anesthesia
Pharmacy
Lab
Imaging
Social Services
Clergy
Unlicensed Assistive Personnel
Code Team
Other:
monologues and simulation
Important Information Related to Roles:
Family member may be present. (daughter-in-law
or son to give history)
Report Students Will Receive Before Simulation
Time:
Red Yoder is an 80-year-old with a pressure ulcer on his right great toe which developed about 5 weeks ago.
He has been treated at home with an oral antibiotic and wet to damp saline dressings daily.
He will arrive here in the ER momentarily.
Dr. Baker has written preliminary orders.
Significant Lab Values:
refer to chart
Physician Orders:
refer to chart
Red Yoder Simulation 2
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Home Medications:
refer to chart
Scenario Progression Outline
Timing
(approx.)
0-5 min
Manikin Actions
Expected
Interventions
May Use the
Following Cues
Patient drowsy but easily
aroused; has trouble keeping
track of what is said.
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Wash hands
Introduce self
Identify patient
Head to toe
assessment
Role member
providing cue:
Family member
Cue: “Red is usually
awake and alert.
This is really a
change for him.”
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Apply O2
Draw labs
Initiate IV fluid
Begin IV antibiotic
Insert Foley
catheter and
monitor urine
output
Assess wound
and take culture.
Assess
pain/sensation
Assess wound
size including:
color of wound
tissue, wound
margins, depth,
color and
temperature of
foot; edema, odor,
drainage, pulses
Use CAM
assessment tool
Role member
providing cue:
Family member
Cue: “How come
you said he has an
infection? He hasn’t
had a fever at home
and he doesn’t have
one now.”
Temperature: 38C/100F; pulse
86; respiratory rate 28; blood
pressure 116/64
5-15 min
Patient status remains the
same. Able to answer most
questions. Not able to focus
attention. Rambles at times.
Vital signs unchanged.
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 Request lab
results.
 Give report to the
nurse in medical
intensive care unit
using a
standardized hand
off tool.
15-20 min
Role member
providing cue:
Family member
Cue: “Is he going to
be o.k.? Can we go
to the ICU with
him?”
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. How were physical and mental health aspects interrelated in this case?
11. What were the key assessments and interventions?
12. How were you able to use the ACES Framework with Red’s situation? (Assess Function and
Expectations, Coordinate and Manage Care, Use Evolving Knowledge, Make Situational Decisions)
13. Is there anything else you would like to discuss?
Red Yoder Simulation 2
© National League for Nursing, 2015
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Complexity – Simple to Complex
Suggestions for Changing the Complexity of This Scenario to Adapt to Different Levels of Learners
1. For more advanced students, have them start IV, perform venipuncture to draw labs, administer IV
medication, insert catheter, apply ECG leads. Students at a more basic level can monitor IV, urinary
output, etc.
2. Include additional findings/information that will require more assessment, e.g., an additional pressure
ulcer, potential elder neglect, financial concerns.
3. Students could begin to manage his ketoacidosis.
4. Create another scenario that would take place in the ICU and provide an experience caring for a patient
with sepsis.The Institute for Healthcare Improvement website contains excellent information on sepsis
(http://www.ihi.org/IHI/Topics/CriticalCare/Sepsis/).
Red Yoder Simulation 2
© National League for Nursing, 2015
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