Download Resident Level: CVA

SIMULATION DESIGN & PLANNING TEMPLATE
CVA – ICU Progression (Target Audience: Resident RN)
Program/Curriculum Specific Objectives: - RN Resident – level 3 Neuro
Scenario Name
Measurable Objectives (minimum 2, maximum 10)
1. Identify risks and treatment for hypertension
2. Perform comprehensive neuro exam
3. Identify nursing interventions for Sub-Arachnoid Hemorrhage (SAH)
4. Demonstrate safe administration of vasoactive medications
5. Initiate/assist with rapid sequence intubation
Authors: Heather Stephen-Selby Renton Technical College
Jennifer More, Specialist Swedish Medical Center
Date Submitted Spring 2013
Will There Be Any Pre-Simulation Lecture?
2011390417.pdf
Yes
Duration 30
Journal articles:
2010885333.pdf
Expected Scenario Time 45 minutes
Expected Debrief Time
1 hour
Target Audience RN residents, staff RN
Report and Information Provided To Participants Prior To Simulation
Past History: Mr. Dumphey is a 74 year old widower who lives alone and relies on his
daughter to assist him with his medical needs. He worked for metro transit for 35 years
in the maintenance yard and uses the bus when he needs groceries. He has no friends
and tends to stay to himself. He has a history of uncontrolled hypertension and he
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
forgets to take his antihypertensive medications on a regular basis. He was recently
diagnosed with atrial fibrillation on his last visit to his doctor 3 months ago. He has
started medication. He still smokes 1/2 a pack a day as he has for 50 years even though
he has been told to quit by his PCP. His daughter is supportive but exhausted and
worried as this is the third time in the past year he has been admitted to the hospital for a
fall.
Present Illness: Mr. Dumphey is transferring to your ICU for BP management and
potential treatment for stroke. On the floor, he developed sudden on-set of word finding
difficulty, coughing/distress, and right-sided weakness. He’s been to CT, which shows a
sub-arachnoid hemorrhage around, in addition to a left MCA infarct. His daughter is
with him.
Patient Information
Patient Name:
Age: 74
Charles Dumphey
Birth date: 4/2/1940
Gender:
Male
Weight: 80 Kg
Height: 5’11
ID band MR #00001234 Acct. # 1198765432
Hx. Present Illness: Admitted from the ED with small sub-dural hematoma after
falling at home. Getting q4 hour neuro checks.
Social History: Widowed. 2 adult children. Smokes ½ pack a day. Does not
drive.
Religion: Baptist
Support System: 2 adult children, daughter involved in care & is local.
Allergies: PCN, Shellfish
Attending Physician:
Past medical history:
Immunizations: Flu shot in October
Greg Shaw
Atrial Fibrillation, Hypertension
Physical description of how you want the manikin to present at start of scenario?
Moulage:
Add picture here:
In bed with patient gown, clammy, coughing, anxious
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
Assignment Of Roles (Please indicate below roles to be assigned):
Primary Nurse
Physician/ Advanced Practice Nurse
Secondary Nurse
Respiratory Therapy
Clinical Instructor
Family Member #1
Social Services
Unlicensed Assistive Personnel/CNA/MA
Code Team List Members: Intensivist arrives to intubate
Other: Speech Therapist
Important Information Related To Roles:
The daughter is in the room. She is concerned about her dad, he seems more
uncomfortable and anxious. Questions his BP.
SIM Setup
Moulage
Wounds
Bruise
L hip
Mannequin
IV site :
Site __Right AC_______ Gauge _18 ___
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
Fidelity (choose all that apply to this simulation)
Setting/Environment
Med-Surg
ICU
Props:
Equipment attached to manikin:
Primary IV Fluid running at 100 ml/hr in RAC IV
IV pump running
O2
Monitor attached/ Type ECG leads
ID band
Equipment available in room:
Bedpan/ Urinal
Crash cart c airway devices and emergency meds
Foley kit
Fluids
IV tubing
IVPB tubing
IV pump
O2 delivery device & nasal cannula
Suction
Medications and Fluids:
Oral Meds
IV Fluids
IVPB
IV Push
Diagnostics Available:
Labs Values
Other: Head CT
Documentation Forms:
Physician Orders
Flow Sheet
MAR
Standing (Protocol) Orders: Sepsis Order Set
Recommended Mode for Simulation
Manual/Programmed Hybrid
Significant Lab Values Cr 1.3, Na 135, K 3.4
Physician Orders Bedrest, NPO until swallow screen,
Swallow Screen, ASpiration precautions, SAH
precautions, Seizure precautions, VS & Neuro Check
q1hr, NIHSS on admission then twice daily, DVT
Prophylaxis, Pepcid 20mg IV q12hr, Morphine 2mg IV
q2h PRN, Keppra 500mg IV Q12h, Nimodipine 60mg
PO Q4hr, Nicardipine 5-15mg/hr continuous to keep
SBP Less than 160.
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
Scenario Progression Outline
State 1
Initial Amount
Time in Initial
Stage- 5 mins
Baseline Vital Signs
T 37.4, 115, 26
BP 172/94
SPO2 92% RA
Cardiac Rhythm ST
Breath Sounds
Coarse Crackles
Heart Sounds WNL
Abdominal Sounds
WNL
Other Symptoms:
Anxious, coughing,
Verbalization
(Pt/Manikin
Cues)
“My head
hurts.”
(slurred)
Slow to
respond to
RN, restless
Expected
Interventions
Alternate or Incorrect
Treatment Choice
That Will Affect Outcome
Respiratory decompensation
if no O2 applied.
Identify self
Reassure pt
Assess pt, note
neuro exam
Next BP – 200/90
variations
Assess VS
Note low
SpO2 &
elevated BP
Call MD on
phone, using
SBAR
Confederate
Actions/Additional
Role Player Cues
“I’ve never seen his BP
THAT high!”
“What are you going to
give him for pain?”
“What did the results of
the scan show?”
VORB
Color Key: Patient speaking
Daughter speaking
Correct Treatment Choice
State 2
Timing Sequence
Expected
interventions
Receives orders from
Start drip and
MD on phone to start
titrate for BP in
Nicardipine drip and
goal.
keep SBP less than 150;
oxygen by nasal cannula Complete
to keep FiO2 > 95%;
swallow screen,
acetaminophen 650mg
chart & stop w/
po now and q 6 hours.
facial droopremains NPO.
Call Speech
therapy.
Correct Treatment choice
State 3
Timing Sequence
Expected
2 hours later
Interventions
Baseline Vital Signs
Call rapid response
T 38.6
team
P 110
Anticipate
R 22
intubation
BP 200/98
SPO2 89% on 2 L/NP
Cardiac Rhythm ST
Breath Sounds
unchanged
Heart Sounds WNL
Abdominal Sounds
WNL
Other Symptoms:
Unresponsive, L pupil
larger than R.
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
Correct Treatment ChoiceState 4
Timing Sequence
Expected
2 hours later
Interventions
Baseline Vital Signs
Assist with
T 38.2
intubation.
P 120
Give medications
R 28
as ordered.
BP 150/80
Communicate w/
SPO2 91% on 4 L/NP
RT & team.
Cardiac Rhythm ST
Breath Sounds labored
Heart Sounds WNL
Abdominal Sounds
WNL
Other Symptoms:
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
American Association of Neuroscience Nurses (AANN) (2009) Care of the
Patient with Aneurysmal Subarachnoid Hemorrhage. Practice Guideline
Series.
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 . . .”
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
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