Download Hyperglycemia_2015

Minnesota Simulation in Healthcare Education Professionals (M-SHEP)
Hyperglycemia Simulation
Peggy is a 66 year old female admitted to the floor for treatment of a kidney infection. She has a
fever, and has a history of Type II diabetes. She has an IV that is to a saline lock for antibiotics
that she will receive three times a day. Her weight is down 2 pounds in just 24 hours. She has
been struggling to lose weight and her usual weight is 165 pounds and her stated height is 5’1”.
Her primary physician has ordered sliding scale insulin. She has used a long-acting insulin every
morning and evening for 15 years. There is a concerned family member present in the room and
continues to ask questions and interrupt you as the nurse.
Date:
Discipline:
Expected Simulation Run Time:
Location:
Admission Date: Today’s Date:
Brief Description of Patient:
File Name:
Student Level:
Debrief /Guided Reflection Time:
Location for Reflection:
Psychomotor Skills Required prior
to simulation:
Name: Peggy Gender: F Age: 66
Race:
Weight: 165 lbs
Height: 5’1”
Religion:
Major Support:
Phone:
Allergies:
Immunizations:
Attending Physician/Team:
PMH: Type II Diabetes, peripheral
neuropathy, recent trouble with vision
History of Present illness: Peggy is a 66 year
old female admitted to the floor for treatment
of a kidney infection. She has a fever, and has
a history of Type II diabetes. She has an IV
that is to a saline lock for antibiotics that she
will receive three times a day. Her weight is
down 2 lbs in just 24 hours. She has been
struggling to lose weight and her usual weight
is 165 lbs and her stated height is 5’1”. Her
primary physician has ordered sliding scale
insulin. She has used a long-acting insulin
every morning and evening for 15 years. There
is a concerned family member present in the
room and continues to ask questions and
interrupt you as the nurse.
Submitted 2007 – Updated 2015
Cognitive Skills Required prior to
Simulation: i.e. independent reading
(R), video review (V), computer
simulations (CS), lecture(L)
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Minnesota Simulation in Healthcare Education Professionals (M-SHEP)
Social History:
Primary Diagnosis:
Surgeries/Procedures:
Simulation Learning Objectives:
1.
2.
3.
4.
5.
6.
Recognize the signs and symptoms of hyperglycemia.
State when to check blood glucose levels in a health care facility.
Recognize normal blood glucose ranges.
Initiate appropriate intervention for hyperglycemia.
Demonstrate accurate subcutaneous insulin administration.
Demonstrate therapeutic communication with the client and family.
Fidelity
Setting/Environment
o Med-Surg
o
Simulator Manikin/s Needed:
Medications and Fluids
o IV Fluids:
o Oral Meds:
o IVPB:
Props:
Equipment attached to manikin:
o IV tubing with primary line saline
locked
Equipment available in room
o
o
o
o
o
o
o
o
o
o
o
o
o
Bedpan/Urinal
Foley kit
Straight Catheter Kit
Incentive Spirometer
Fluids
IV start kit
IV tubing
IVPB Tubing
IV Pump
Feeding Pump
Pressure Bag
02 delivery devices type
Crash cart with airway devices and
emergency medications
Submitted 2007 – Updated 2015
o IV Push:
o IM or SC:
NPH Insulin 24 units every AM 0730
NPH Insulin 12 units every PM 1730
Sliding Scale: Novolog or Humalog
Insulin
80-150 0 units
150-180 2 units
181-200 4 units
201-250 6 units
251-280 8 units
281-300 10 units
>300
Contact Physician
Diagnostics Available
o Labs
o Blood Glucose: 280
o Na: 128
o K: 4.2
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Minnesota Simulation in Healthcare Education Professionals (M-SHEP)
o Defibrillator/Pacer
o Suction
o Other_________
o BiCarb: 18
o Base Excess: -3
o X-rays (Images)
o 12-Lead EKG
o Other
o BP: 98/54
o HR: 122
o RR: 28
Documentation Forms
o
o
o
o
o
o
o
o
o
o
o
o
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 Props
Recommended Mode for simulation:
Roles / Guidelines for Roles
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Primary Nurse
Secondary Nurse
Clinical Instructor
Family Member #1
Family Member #2
Observer/s
Physician / Advanced Practice Nurse
Respiratory Therapy
Anesthesia
Pharmacy
Lab
Imaging
Social Services
Clergy
Unlicensed Assistive Personnel
Code Team
Submitted 2007 – Updated 2015
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
Report students will receive before
simulation:
Peggy is a 66 year old female admitted to the
floor for treatment of a kidney infection. She
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Minnesota Simulation in Healthcare Education Professionals (M-SHEP)
o Other
Important information related to
roles:
Critical Lab Values:
Physician Orders:
See sliding scale orders or follow protocol of
facility
NPH Insulin 24 units every AM 0730
NPH Insulin 12 units every PM 1730
Sliding Scale: Novolog or Humalog Insulin
80-150 0 units
150-180 2 units
181-200 4 units
201-250 6 units
251-280 8 units
281-300 10 units
>300
Contact Physician
has a fever, and has history of type II
diabetes. She has an IV that is saline locked
for antibiotics that she will receive three
times a day. Her weight is down 2 pounds.
She has not been hungry, and she has noticed
she has been urinating a lot in the last several
days. Her primary physician has ordered
sliding scale insulin. She has used a longacting insulin every morning and every
evening for 15 years. Her initial blood sugar
is 280.
References, Evidence-Based Practice Guidelines, Protocols, or Algorithms
used for this scenario: (site source, author, year, and page)
http://www.cdc.gov/diabetes
http://www.diabetes.org
http://www.webMD.com
Submitted 2007 – Updated 2015
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Minnesota Simulation in Healthcare Education Professionals (M-SHEP)
Scenario Progression Outline
Timing
Manikin Actions
(approximate)
0730
Blood glucose 280
Expected Interventions
May use the following
Cues:
Give 24 units NPH
Give 8 units regular insulin
Role member providing
cue:
Cue:
1100
Blood glucose 248
Give 6 units regular insulin
Role member providing
cue:
Cue:
1730
Blood glucose 210
Give 6 units regular insulin
Give 12 units NPH insulin
Role member providing
cue:
Cue
2100
Glucose 180
.
Give 2 units regular insulin
Role member providing
cue:
Cue:
Submitted 2007 – Updated 2015
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Minnesota Simulation in Healthcare Education Professionals (M-SHEP)
Scenario Progression Outline
Timing
Manikin Actions
Expected Interventions
(approximate)
Submitted 2007 – Updated 2015
May use the following
Cues:
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Minnesota Simulation in Healthcare Education Professionals (M-SHEP)
Debriefing / Guided Reflection Questions for this Simulation
Link to Participant Outcomes and Professional Standards
(i.e. QSEN, NLN {Nursing}, National EMS Standards {EMS}, etc.)
1. What were your primary concerns in this scenario?
2. Did you miss anything in getting report on this patient?
3. Did you have sufficient knowledge/skills to manage this situation?
4. What were your primary nursing diagnoses in this scenario? What nursing interventions
did you use, what outcomes (NOC) did you measure? Where is your patient in terms of
these outcomes now?
5. What did you do well in this scenario?
6. If you were able to do this again, what would you do differently?
7. How do you think this simulation went?
8. What went well?
9. What would you do differently?
10. I saw a few symptoms this client had that were of concern. What symptoms were
concerning to you?
11. What could you do to get more information about this client?
12. There was added family dynamics in this scenario, how did it go? How did it feel?
13. Teamwork is essential in nursing, how did the group dynamics work for you?
Complexity – Simple to Complex
Suggestions for changing the complexity of this scenario to adapt to different
levels of learners:
Submitted 2007 – Updated 2015
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Minnesota Simulation in Healthcare Education Professionals (M-SHEP)
SIMULATION SCENARIO
Hyperglycemia
Student Copy
LEARNING OBJECTIVES
1.
2.
3.
4.
5.
6.
Recognize signs and symptoms of hyperglycemia
State when to check blood glucose levels in a health care facility
Recognize normal blood glucose levels in a health care facility
Initiate appropriate intervention for hyperglycemia
Demonstrate accurate subcutaneous insulin administration
Demonstrate therapeutic communication with the client and family
SUPPLIES NEEDED
PATIENT DATA
Peggy is a 66 year old female admitted to the floor for treatment of a kidney infection. She has a
fever, and has a history of Type II diabetes. She has an IV that is to a saline lock for antibiotics
that she will receive three times a day. Her weight is down 2 pounds in just 24 hours. She has
been struggling to lose weight and her usual weight is 165 pounds and her stated height is 5’1”.
Her primary physician has ordered sliding scale insulin. She has used a long-acting insulin every
morning and evening for 15 years. There is a concerned family member present in the room and
continues to ask questions and interrupt you as the nurse.
To prepare for this simulation experience, complete the following information prior to class.
1.) What are the signs and symptoms of hyperglycemia?
2.) What are some risk factors that are associated with diabetes and hyperglycemia?
3.) List at least 3 diagnostic or laboratory tests you will need to be familiar with to care for the
diabetic client. Why are they important?
4.) Using the nursing process, list at least two priority nursing interventions for the
hyperglycemic client and explain why each action is essential for care of this client.
Submitted 2007 – Updated 2015
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Minnesota Simulation in Healthcare Education Professionals (M-SHEP)
5.) What are some areas for teaching opportunities for the client and/or family?
REFERENCES
http://www.cdc.gov/diabetes
http://www.diabetes.org
http://www.webMD.com
Submitted 2007 – Updated 2015
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