Assignment Paper

V SIM SCENARIO

Attend VSim Scenario meeting . During the Meeting the instructor will
1. VSim Scenario Pre Quiz Completion and Discussion
2. Pre-Conference discussion Patient
3. V-Sim Scenario Completion and Discussion
4. Post Conference Discussion
5. Post Quiz Completion and Discussion
6. Once Completed, Please complete the Post Scenario Documentation

SCENARIO 1

Henry Williams Part 1
Scenario Overview
Patient: Henry Williams
Diagnosis: COPD exacerbation
This scenario is part of the Henry Williams Unfolding Case. The scenario can be used as a standalone scenario or as part 1 of the case.
The Unfolding Case
Henry Williams is a 69-year-old African American, a retired rail system engineer who lives in a small apartment with his wife, Ertha. Henry and Ertha had one son who was killed in the war 10 years ago. They have a daughter-in-law, Betty, who is a nurse, and one grandson, Ty. Henry is concerned about Ertha because she is experiencing frequent memory lapses.
The scenarios focus on the physical and psychosocial changes that Henry encounters over the next few weeks. His failing health and his concern for his increasingly forgetful wife lead him through various transitions that affect his family and his living situation. The objectives focus on assessment and appropriate use of assessment tools such as SPICES: An Overall Assessment Tool for Older Adults, the Geriatric Depression Scale, the Pittsburgh Sleep Quality Index, the Katz Index of Independence in Activities of Daily Living (ADL), the Modified Caregiver Strain Index, and the Transitional Care Model : Hospital Discharge Screening Criteria for High Risk Older Adults. The objectives also focus on psychosocial issues with Henry’s wife, and their daughter-in-law’s concern for their living arrangements and making appropriate community referrals.
Brief Summary of Present Scenario
This scenario takes place a few hours after Henry was admitted through the emergency room with an acute exacerbation of COPD. His O2 saturation has been at 88 percent. He is alert, oriented, and appears depressed. The admission has not been completed due to his shortness of breath. His neighbor brought him and Ertha in. Their daughter-in-law, Betty, is taking care of Ertha while Henry is at the hospital because of her problems with confusion. The students will have cues to report labs and arterial blood gas results to the physician. They will also have cues to address Ertha’s confusion. The assessment tools recommended for this scenario include SPICES: An Overall Assessment Tool for Older Adults (required) and the Geriatric Depression Scale (optional).
Learning Objectives
Upon completion of the scenario, the student should be able to:
• Assess the patient’s individual aging pattern and functional status, using standardized assessment tools, to include:
– SPICES: An Overall Assessment Tool for Older Adults
– Geriatric Depression Scale (optional)
• Use communication techniques to recognize, respond to, and respect an older adult’s strengths, wishes, and expectations
• Implement appropriate interventions based on the assessment data collected (e.g., low SpO2 and critical lab values)
• Identify geriatric syndrome(s) evident in the simulation using the ACES framework
Patient Case Introduction to Students
Time: 0730, day 1 after admission
Change of shift report:
Henry Williams is a 69-year-old retired rail system engineer who lives in a small apartment with his wife. He was admitted during the night with progressive shortness of breath. His oxygen saturation on admission was 82% on room air. He has a history of COPD and coronary artery disease, and is hard of hearing. His oxygen saturation has improved and is now running 88% on oxygen 2 L/min by nasal cannula. His respiratory rate has been 24-30/min.
Henry is concerned about his wife, Ertha, because she is experiencing frequent memory lapses. Ertha went home with their daughter-in-law, Betty, and they have just returned.
Due to his shortness of breath the admission is not complete. A fall risk assessment has been done and indicates a moderate fall risk, but he still needs an overall assessment. Blood pressure has been 134/88 mmHg, pulse was 112/min, and respirations were 28/min. He is alert and oriented. The morning labs were just drawn, and the physician wants to know the arterial blood gases. Henry denies pain and says he is just tired.
Patient Details
Patient Data: Male- Age: 69 years. Weight: 88 kg (194 lbs). Height: 183 cm (72 in).
Allergies: Penicillin
Past Medical History: Chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), asthma, hearing loss (wears hearing aids).
History of Present Illness: Patient was admitted last night with an acute exacerbation of COPD. He was not able to catch his breath and his doctor told him to go to the emergency room. His neighbor brought him to the emergency room. He is concerned about his wife, Ertha, who has problems with memory and seems confused at times. His daughter-in-law Betty is a nurse. She mentioned that Henry appears depressed, and noted that his appetite has diminished over the past two months and he has lost some weight. He has also lost interest in his previous activities, such as following major league football and working on crossword puzzles. Betty will look after Ertha while Henry is here.
Social History: Retired.
Primary Medical Diagnosis: COPD, cardiovascular disease.
Surgeries/Procedures & Dates: Appendectomy at age 15.
Provider’s Orders
• Bed rest, bathroom privileges with assistance
• Regular, low fat diet
• I & O
Respiratory treatment:
• Albuterol nebulizer treatment 2.5 mg and ipratropium bromide 0.5 mg in 3 mL normal saline every 20 minutes x 3, followed by albuterol 2.5 mg and ipratropium bromide 0.5 mg in 3 mL normal saline every 2 hours (decrease frequency, as tolerated)
• Titrate oxygen to maintain SpO2 at or above 90%
• Lactated Ringer’s solution IV at 50 mL/h
• Complete Blood Count (CBC)
• Brain Natriuretic Peptide (BNP)
• Basic Metabolic Profile (BMP)
• Arterial Blood Gases (ABG’s)
• Chest X-Ray
Continue home medications and add:
• Prednisone 40 mg PO daily x 10 days
• Lisinopril 12.5 mg PO daily
• Metoprolol tartrate 50 mg PO daily
• Acetylsalicylic acid 81 mg PO daily
• Rosuvastatin calcium 20 mg PO every evening
• Montelukast 10 mg PO every evening
Home medications:
• Fluticasone propionate 250 mcg every 12 hours nebulized
• Albuterol 2 puffs as needed for acute onset of shortness of breath
Nursing Diagnoses
• Ineffective breathing pattern related to exacerbation of COPD
• Activity Intolerance related to situational life changes
• Anxiety related to worries about wife
• Risk for powerlessness related to lack of participation in previous life activities and weight loss

PRE-CONFERENCE DISCUSSION
1. Who is my client? (for example: age, marital status).
 Patient’s initials

 Patient’s sex and gender

 Patient’s age

 Admission date

2. State significant events of this hospitalization (admitting diagnosis, surgery, emotional crises, fracture).
 Admission reason

 Pertinent medical and surgical history
Medical Hx
Surgical Hx=

3. What are your major concerns for this patient today?

Reason for seeking care (history of present illness)
.
 Paint a picture of the patient’s problem(s), including:

➢ Discussion of the pathophysiology

4. Discussion of how the medical and surgical history impacts the current problem(s)

 Impact on normal body function

 Signs and symptoms (and rationale for those signs and symptoms)

 Important laboratory and diagnostic exam results and the significance

 Discuss Common complications experienced because of your patient’s problem(s)
5. Patient’s current treatment plan (Discuss diet, activity, medications, therapy, etc.)

Discuss the nursing plan of care for your patient –
• What will you focus on?
• What are your key safety considerations for the day?

CONCEPT MAP WORKSHEET

DESCRIBE DISEASE PROCESS AFFECTING PATIENT (INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS)

DIAGNOSTIC TESTS (REASON FOR TEST AND RESULTS)

PATIENT INFORMATION

ANTICIPATED PHYSICAL FINDINGS

ANTICIPATED NURSING INTERVENTIONS

vSim ISBAR ACTIVITY STUDENT WORKSHEET
INTRODUCTION
Your name, position (LPN), unit you are working on
SITUATION
Patient’s name, age, specific reason for visit
BACKGROUND
Patient’s primary diagnosis, date of
admission, current orders for patient
ASSESSMENT
Current pertinent assessment data using head to toe approach, pertinent diagnostics, vital signs
RECOMMENDATION
Any orders or recommendations you may have for this patient

PATIENT EDUCATION WORKSHEET
NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE

MEDICATION:

CLASSIFICATION:

PROTOTYPE:
SAFE DOSE OR DOSE RANGE, SAFE ROUTE

PURPOSE FOR TAKING THIS MEDICATION

PATIENT EDUCATION WHILE TAKING THIS MEDICATION

Date: Student Name: Assigned vSim:
Initials: Age: M/F:
Code Status: Diagnosis:

Length of Stay: Allergies: HCP:

Consults: Isolation:
Fall Risk: Transfer: IV Type: Location:

Fluid/Rate: Critical Labs: Other Services:

Consults Needed:

Why is your patient in the hospital (Answer in your own words and include the History of present Illness)?:
Health History/Comorbities (that relate to this hospitalization):
Shift Goals/ Patient Education Needs: 1.

2.

3.

4.
Path to Discharge:
Path to Death or Injury:

Alerts:
What are you on alert for with this patient? (Signs & Symptoms)

1.

2.

3.

What Assessments will focus on for this patient? (How will I identify the above signs &Symptoms?)

1.

2.

3.

List Complications may occur related to dx, procedure, comorbidities:

1.

2.

3.

What nursing or medical interventions may prevent the above Alert or complications?

1.

2.

3.

4.
Management of Care: What needs to be done for this Patient Today? 1.
2.

3.

4.

5.

6.

Priorities for Managing the Patient’s Care Today
1.

2.

3.

4.

What aspects of the patient care can be Delegated and who can do it?

Post Conference Questions
1. Document your assessment findings regarding the patient’s individual aging pattern and functional status.
2. Document identified nursing diagnoses that are associated with the current assessment findings.
3. Referring to your feedback log, document the nursing care you provided and the patient’s response.
Opening Questions
1. How did the simulated experience of Henry Williams’s case make you feel?
2. What nursing actions did you feel were appropriate within this scenario?
Scenario Analysis Questions*
1. What priority problem did you identify for Henry Williams?
2. What is the rationale for recognizing Henry Williams’s shortness of breath and for initiating actions in a timely manner?
3. What is the rationale for recognizing Henry Williams’s anxiety and concern for his wife and for initiating actions in a timely manner?
4. What teaching strategies and information should be included during Henry Williams’s visit to the clinic?
5. What appropriate assessments were made to help you decide what interventions Henry Williams needed?
6. What was the relevance of the nursing communication with Henry Williams’s daughter-in-law, Betty?
7. What health care team members and services may play a role in Henry Williams’s care and why?
8. What actions should take place to improve Henry Williams’s quality of care?
9. How do you think Henry and Ertha Williams will be coping 1 month after the scenario?
Concluding Questions
1. Reflecting on Henry Williams’s case, were there any actions you would do differently? If so, what were these actions, and why would you have done them differently?
2. How would you apply the knowledge and skills that you obtained in Henry Williams’s case to an actual patient care situation?

Reflections
In addition to reporting on your patients, please consider these questions each week at the end of your clinical day and be ready to discuss in post conference with your group.

1. What went well for you today?

2. What can I improve?

3. Describe the most important new learning that you experienced today.

4. If you were caring for this patient tomorrow, what additions or changes would you make to your plan of care?

5. Identify one area for further learning related to this patient assignment.

6. Identify any questions concerning the rational for the delivery of this patient’s multidisciplinary plan of care.