Download Junior Level: Chest Pain

SIMULATION DESIGN & PLANNING TEMPLATE
Scenario:Chest Pain : Junior level
Program/Curriculum Specific Objectives:
Recognize and manage a patient with chest pain in the acute care setting.
Measurable Objectives (minimum 2, maximum 10)
1. Learner delegates appropriately such as VS to NAC
2. Learner performs a basic patient assessment with a focus on cardiac
3. Learner applies information garnered through assessment to perform at least three
appropriate Nursing Interventions such as administering O2, NTG, calling for charge
RN
4. Learner integrates therapeutic communication and teaching into patient care
Instructor’s Name: Janine Buis, Northwest Hospital & Medical Center
Donna Wahbeh, Shoreline Community College
Date Submitted Spring 2013
Will There Be Any Pre-Simulation Lecture?
orientation to room Duration 10 minutes
Yes Introduction to Manikin and
Expected Scenario Time 15 Expected Debrief Time
25 minutes
Report and Information Provided To Participants Prior To Simulation
Sam is a 49 y/o male who came in with c/o abd pain and constipation. He has been
newly diagnosed with colon cancer. He is waiting for a second opinion. His
constipation has since been relieved. Past medical history includes 1 pack/day smoker
and HTN.
Patient Information
Patient Name:
Age:
Sam
49
Gender:
M
Birth date:, 8/19
Weight:
Height:
195
5’7”
ID band MR #00001234 Acct. # 1198765432
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
Hx. Present Illness: Came in with c/o abd pain and constipation. Newly diagnosed
colon cancer this admission. He is currently waiting for a second opinion. Constipation
has been resolved.
Social History: software engineer Support System: Wife and three kids
Allergies: None
Immunizations:
Current
Past medical history:
1 pack/day smoker and HTN
Physical description of how you want the manikin to present at start of scenario?
Moulage: Patient in hospital gown with slippers, HOB elevated with legs dangling over
the side, call bell in hand. Diaphoretic face and arms.
Assignment Of Roles (Please indicate below roles to be assigned):
Primary Nurse
Secondary Nurse
Charge Nurse (Instructor)
Family Member #1
Unlicensed Assistive Personnel/CNA/MA
Other: Student nurse x2 with one as primary
Observer(s) 2 or more
Protocol specialist (Student who has protocols available to review during scenario)
Important Information Related To Roles:
Wife is very anxious about husbands chest pain. The role of Charge Nurse is to be
played by the instructor. If the students are having difficulty, they may call the Charge
Nurse into the simulation for guideance.
SIM Setup
Mannequin
IV site :
Art Line
High or moderate fidelity manikin
Site L forearm Gauge 20G
Site _________ Gauge ____
Yes / No
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
Setting/Environment
Med-Surg
Props:
Equipment attached to manikin:
Primary IV Fluid running at 80 ml/hr
O2 2l nc
Monitor attached/ Type available if possible
ID band
Other
Equipment available in room:
Crash cart with airway devices and emergency meds
Incentive Spirometer
IV tubing
O2 delivery device non-rebreather, ambu, HHN, face
mask
Defibrillator/Pacer
Other:
Other Props:
box of tissues
Significant Lab Values normal CBC and electrolytes
Medications and Fluids:
Oral Meds nitro SL, baby ASA
IV Fluids
IV Push Morphine sulfate
Other Nitro paste
Diagnostics Available:
Labs Values CBC, lytes
12 lead EKG ischemia
Documentation Forms:
Flow Sheet or shift assessment
MAR
Standing (Protocol) Orders Chest Pain protocol and
Respiratory emergency protocol, Oxygenation protocol
Recommended Mode for Simulation
Manual
Programmed
Manual/Programmed Hybrid
1 Manikin to be used High or moderate fidelity with
heart and lung sounds
Key for Roles:
Wife in Yellow
Patient in Blue
CNA
Green
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
#1
Initial Amount
Time in Initial
Stage- 5 mins
Baseline Vital
Signs
T PR 37-110-14
BP 134/82
SPO2 93%
Cardiac Rhythm
sinus tachycardia
Breath Sounds
clear
Heart Sounds slight
murmur
Abdominal Sounds
hypoactive
Eyes open,
diaphoretic
Verbalization
(Pt/Manikin
Cues)
I just got back
from the
bathroom and
I don’t feel
good, I am
nauseous, my
chest hurts
Expected
Interventions
-Straighten
patient in bed
-Assess VS
-Assessment of
Chest pain,
respiratory,
cardiac and
relevant history
-Differentiates
between cardiac
and abdominal
pain
Alternate or Incorrect
Treatment Choice
That Will Affect Outcome
Freezes and gets help,
doesn't assess or calm
patient/wife
Confederate
Actions/Additional
Role Player Cues
Anxious wife:
"What are you going to
do to help my
husband?"
Role player cue if off
track:
Patient:
“This is not like my
abdominal pain. This is
new. Crushing like.”
Patient’s will state pain
better with each nitro
-Administers
until finally resolved
NTG, O2
after third Nitro SL
Stage 2 Correct Treatment Choice
Stage 2A Alternate or Incorrect Treatment
choice
Timing Sequence
Expected
1 minute after
Interventions
Timing Sequence
Expected
assessment complete
Interventions
Baseline Vital Signs
-Elevate HOB
Baseline Vital Signs
T same P 125
P 130
R 18 BP 140/86
-Apply Nasal
R 18
SPO293%
Cannula 2 L
BP 144/92
CNA can ask if the
Cardiac Rhythm same
SPO293%
instructor or
Breath Sounds same
-VS q 15 minutes
Cardiac Rhythm Same
primary nurse
Heart Sounds same
-Obtain EKG
Breath Sounds same
should be called if
Abdominal Sound same
Heart Sounds same
no progress is
Other Symptoms:
-Is Chest Pain
Abdominal Sounds
made and then end
Slight shortness of
protocol available
same
the scenario.
breath, anxiety
Yes: give 3 nitro
Other Symptoms:
Verbalization
OR
What is going on? My
Notify primary
Verbalization
chest really hurts.
RN or instructor
Wife: Aren't you going
to do something?
-Call MD
-Assure pt &
family
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
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).
5
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).
6
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 . . .”
Resources:
Harvey, S. (2004) The nursing assessment and management of patients with angina. British Journal of Nursing 13(10), 598601.
Smeltzer, S.C., Bare, B.G., Hinkle, J. L. & Cheever, K.H. (2010). Chapter 28 Management of Patients with Coronary
Vascular Disorders. In Brunner & Suddarth’s textbook of medical-surgical nursing 12th ed (pp 755-796).
Philadelphia: Lippincott Williams & Wilkins.
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
CHEST PAIN STANDING ORDERS
____ Call a Rapid Response and Notify Attending MD STAT
Monitoring:
____ Assess vital signs stat and every 15 minutes while chest pain persists.
____ Cardiac monitor, oximeter
____ Oxygen via NC at 2-4 L
Tests:
____ ECG
____ CBC, BMP, PT, PTT, CKMB and total CK, Trop I
Medications:
____ ASA Dose 81 mg PO, chew
____ Nitroglycerine SL x3 if Systolic >90 Dose 0.4 mg PO
____ Morphine Sulfate 1-8 mg IV x3 every 30 minutes prn chest pain
____ NTG by infusion: 50 mg/250 cc D5W at 3mcg/min, titrate to pain and SBP > ___ torr
____ Heparin _____u bolus then infuse at ____ u/hr OR Lovenox ___ mg IV and ___ mg SQ
____ Metoprolol 5mg IV over 5 min, repeat x 2 additional doses (total 15 mg over 15 min)
____ Metoprolol 25 mg PO 60 min after IV metoprolol
____ other: _______________________________
IV:
____ Start one peripheral saline lock
____ other: _______________________________
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