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Minnesota Simulation in Healthcare Education Professionals (M-SHEP)
Diabetes Management Simulation
Patient 82 year old female. Newly admitted to Health Care Center.
Patient with history of Atrial fibrillation and 30 year history of type 2 Diabetes.
Recently started on 75/25 Novolog Insulin 15 units BID
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:
Gender: F Age: 82
Race:
Weight: ____kg
Height: ____cm
Religion:
Major Support:
Phone:
Allergies:
Immunizations:
Attending Physician/Team:
PMH: Atrial Fibrillation, Type 2 Diabetes
Cognitive Skills Required prior to
Simulation: i.e. independent reading
History of Present illness:
(R), video review (V), computer
simulations (CS), lecture(L)
Social History:
Primary Diagnosis:
Surgeries/Procedures:
Simulation Learning Objectives:
1.
2.
3.
4.
5.
6.
Identify different types of insulin and oral diabetic medications
State action times of the different insulins
Recognize signs and symptoms of hypoglycemia/hyperglycemia
Develop a plan for appropriate follow-up management
Know the protocol for initiation and termination of hypoglycemia management.
Review blood glucose testing technique
Submitted 2007- Updated 2010
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Minnesota Simulation in Healthcare Education Professionals (M-SHEP)
Fidelity
Setting/Environment
o Long Term Care
Simulator Manikin/s Needed:
o Sim Man
Props:
Equipment attached to manikin:
o IV tubing with primary line
___________ fluids running at
__________ cc/hr
o Secondary IV line __ running at _
cc/hr
o IV pump
o Foley catheter ________cc output
o PCA pump running
o IVPB with ___ running at ___ cc/hr
o 02 _______
o Monitor attached
o ID band _______
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
o Defibrillator/Pacer
o Suction
o Other_________
Submitted 2007- Updated 2010
Medications and Fluids
o IV Fluids:
o Oral Meds:
Diabeta 5 mg BID
Lasix 20 mg QD
Metformin 500 mg BID
Colace 100 mg QD PRN
ASA 81 mg QD
Lisinopril 20 mg QD
Lanoxin 0.25 mg QD
o IVPB:
o IV Push:
o IM or SC:
Diagnostics Available
o
o
o
o
Labs
X-rays (Images)
12-Lead EKG
Other
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
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Minnesota Simulation in Healthcare Education Professionals (M-SHEP)
Other Props
BGM monitor
Different insulins
Syringe pens
Pen needles
Glucagon
Glucose tabs
D50
Glucose gel
NBP monitor
BVM
RSI tray
PPE
Glascow Scale
Recommended Mode for simulation:
Roles / Guidelines for Roles
o
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
Other
Important information related to
roles:
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:
Time:
 Patient 82 year old female. Newly
admitted to Health Care Center.
 Patient with history of Atrial
fibrillation and 30 year history of type
2 Diabetes.
 Recently started on 75/25 Novolog
Insulin 15 units BID
Critical Lab Values:
Submitted 2007- Updated 2010
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Minnesota Simulation in Healthcare Education Professionals (M-SHEP)
Physician Orders:
Diabeta 5 mg BID
Lasix 20 mg QD
Metformin 500 mg BID
Colace 100 mg QD PRN
ASA 81 mg QD
Lisinopril 20 mg QD
Lanoxin 0.25 mg QD
References, Evidence-Based Practice Guidelines, Protocols, or Algorithms
used for this scenario:
American Diabetes Association: http://www.diabetes.org/
Center for Disease Control: http://www.cdc.gov/diabetes/home/index.html
Clinical Practice Recommendations (ADA):
http://professional.diabetes.org/ResourcesForProfessionals.aspx?cid=84160&loc=rp-slabnav
Submitted 2007- Updated 2010
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Minnesota Simulation in Healthcare Education Professionals (M-SHEP)
Scenario Progression Outline
Timing
Manikin Actions
Expected Interventions
(approximate)
 Patient found
unresponsive in her
room, diaphoretic,
cold, clammy, and
responding only to
painful stimuli
T 98.2
HR 122
R 12 shallow
O2 sats 88% on room air
BP 108/52






BGM 1st stick – 28 mg/dl
BGM –recheck – 22 mg/dl
Unable to start IV ok
Interventions addressed:
O2 sats – 96%
BGM 20 mg/dl per lab draw



May use the following
Cues:
Check airway status
(reposition head)
Apply 100% (15 L/m) O2 via
non-rebreather
Check pulses and attempt BP
Cap refill time < 3 seconds
Check blood glucose status
(use proper technique),
recheck – correctly identify
symptoms (decrease LOC,
diaphoresis, tachycardia) then
lab recheck of blood glucose
Should attempt IV start
Role member providing
cue:
Give glucagons (reconstitute
appropriately),
reattempt IV placement if
previously unsuccessful give
amp of D50,
followed by BGM recheck in
15 minutes
Role member providing
cue:
Cue:
Cue:
Interventions not addressed:
O2 sats – 80%
Seizure
Submitted 2007- Updated 2010
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Minnesota Simulation in Healthcare Education Professionals (M-SHEP)
Scenario Progression Outline
Timing
Manikin Actions
Expected Interventions
May use the following
Cues:
Assess based on Glascow Coma Scale
Role member providing
cue:
(approximate)
No response to glucagon
IV fluids NS
Interventions addressed:
BGM 120 mg/dl
Interventions not addressed:
Respiratory arrest
Interventions addressed:
Responding to voice
Cue
Interventions not addressed:
Respiratory arrest
Submitted 2007- Updated 2010
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Minnesota Simulation in Healthcare Education Professionals (M-SHEP)
Follow up management:
- Physical history and medication review
- RN assessment
- Activity pattern evaluation
- Review of blood glucose log
- Review of underlying health problems
- Notify MD of patient status – take orders as necessary
- Notify family
- Diet history
Patient regular at 1st meal times. At 0630 pt given 15 units of 75/25 insulin and found in room
unresponsive at 0700. Pt did not eat between time of insulin and time found.
Need for assessing if better to have patient eat prior to giving insulin dose, or give closer to meal
time.
Patient is now stable after D50
New orders received:
- Insulin dose – keep the same, but give only 5 minutes prior to meal. For PM insulin dose
recheck and review with rest of days results, may need to check with hospital nurse or ER
MD.
- Diet – same as previous, maintain good intake and output
- Monitor BGM – every hour until NPH wears off (1830)
o BGMs to QID for always, check prior to meals and at HS and 2 hours after meals
for 1 week, then change to QID before meals and at HS daily and every 2 hours
after meals 3 days a week.
Submitted 2007- Updated 2010
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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 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?
Complexity – Simple to Complex
Suggestions for changing the complexity of this scenario to adapt to different
levels of learners:
Submitted 2007- Updated 2010
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Minnesota Simulation in Healthcare Education Professionals (M-SHEP)
SIMULATION SCENARIO
Diabetes Management
Student Copy
LEARNING OBJECTIVES
1. Demonstrate skills in rapid assessment of an ill patient
2. Implement appropriate nursing interventions for an ill patient
3. Describe and prepare for possible interventions and diagnostics an ill patient may need
SUPPLIES NEEDED
Based on history gather supplies you may need to care for this patient
PATIENT DATA
Adult, elderly 82 year old female. Newly admitted to Health Care Center. Pt with history of
Atrial Fibrillation and 30 year history of type 2 Diabetes. Recently started on 75/25 Novolog
Insulin 15 units BID
REFERENCES
American Diabetes Association: http://www.diabetes.org/
Center for Disease Control: http://www.cdc.gov/diabetes/home/index.html
Clinical Practice Recommendations (ADA):
http://professional.diabetes.org/ResourcesForProfessionals.aspx?cid=84160&loc=rp-slabnav
Submitted 2007- Updated 2010
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