VSIM Hansen packet notes for vsim, Assignments of Nursing

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STUDENT

Medical Surgical

VIRTUAL

SIMULATED

CLINICAL

PACKET

Student Resources

CONCEPT MAP/ PLAN OF CARE EST. TIME: 30 MINUTES

This activity creates an opportunity for you to organize the nursing care required for the patient care presented in your assigned vSim.

STUDENT LEARNING OUTCOMES

At the end of this activity, student will be able to:

1. Describe pathological events associated with the patient’s disease process or condition.
2. Create a plan of care and prioritized nursing interventions based on patient care needs.
3. Identify anticipated diagnostics and physical assessment findings related to the identified condition or disease process.

ASSIGNMENT

1. Log into thePoint and launch the assigned vSim, after following all Pre-Sim reading instructions posted on Schoology.
2. Review the information contained in the patient introduction.
3. Review the smart sense links associated with Nursing Care, Diagnostics, and Pharmacology found in the suggested reading area (there may only be one or two of these topics present depending on the vSim).
4. Review the smart sense links associated with Nursing Care, Diagnostics, and Pharmacology found in the suggested reading area.
5. Create the following “concept map”. List the pathophysiology associated with the patient’s disease process or condition, the anticipated physical assessment findings, vital signs, diagnostics, specific nursing interventions, and other pertinent information associated with the patient situation.
6. Submit your concept map for review through Schoology.

IS AR EST TIME MIN

This ISBAR activity assists you in building the skill of communicating pertinent information when caring for a patient. Appropriate actions you should do to complete this activity include finding appropriate data to provide a thorough ISBAR report.

STUDENT LEARNING OUTCOMES

At the end of this activity, student will be able to:

1. Identify pertinent data from the patient information area of the vSim suggested reading section.
2. Communicate pertinent information for a patient using ISBAR.

ASSIGNMENT

1. Log into thePoint and launch the assigned vSim, following all Pre-Sim Reading instructions posted on Schoology.
2. Review the information contained in the patient introduction area of the suggested reading section.
3. Review the smart sense links found within the Nursing Care, Diagnostics and Pharmacology areas of the suggested reading (there may only be one or two of these topics present depending on the vSim).
4. Navigate and fill out the data in the following document using the patient information provided in the suggested reading area as instructed above. Utilize this information that you know so far, without meeting your virtual patient yet to complete your ISBAR Activity.
5. Submit for review on Schoology.

vSim ISBAR ACTIVITY STUDENT WORKSHEET

INTRODUCTION

Your name, position (RN), unit you are Marina Geiger Emergency Department 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 See a dietician or a diabetes coach on how to handle diabetes and how to live with it Skyler Hansen is an 18-year-old male diagnosed with type 1 diabetes 6 months ago. The friends report that he started acting “weird” while they were playing basketball. He has not eaten anything for 5 hours. Skyler told them that he felt lightheaded and was going to lie down on the cement. The patient is drowsy, wakes with stimulus, has slurred speech, is diaphoretic, and is acting irrationally. Hypoglycemic episode, Admitted 4/16/ Orders- Give carbohydrates and protein Access a IV site for venipuncture Saline lock, IV access Reinforce education for diabetes self-management Finger stick glucose test Activity as tolerated Vital signs with SPO2 every 4 hours Administer O2 as needed to maintain SPO2 greater than 92% Attach the patient to continuous 3 lead ECG and closely monitor the patient’s heart rhythm Closely monitor vital signs including BP, Respirations, pulse, oxygenation Administer O2 as needed Administer medications Dextrose or Glucagon. Lung sounds- Clear Heart sounds- Clear LOC- disoriented, irrational, unresponsive Diagnostics- Finger stick glucose test- 62 LOW Prothrombin Time- 9 LOW Vitals- 124/74 BP 96 O2 86 HR 97 Temp 20 RR 22

PATIENT EDUCATION WORKSHEET

NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PHARMACOLOGICAL ACTION:

MEDICATION: Dextrose 50% CLASSIFICATION: Carbohydrate caloric agents EXPECTED PHARMACOLOGICAL ACTION: A simple water-soluble sugar that minimizes gluconeogenesis and promotes anabolism in patients whose oral caloric intake is limited. SAFE DOSE OR DOSE RANGE, SAFE ROUTE Fluid replacement and caloric supplementation in patients who can’t maintain adequate oral intake or are restricted from doing so Adults and children: Dosage depends on fluid and caloric requirements. Use peripheral IV infusion of 2.5%, 5%, or 10% solution for minimal fluid needs. Insulin-induced hypoglycemia Adults: 10 to 25 g IV infusion of 50% solution. May need to repeat doses in severe cases. Determine blood glucose level before injecting; in an emergency situation, promptly administer without waiting for pretreatment test results. PURPOSE FOR TAKING THIS MEDICATION PATIENT EDUCATION WHILE TAKING THIS MEDICATION Prevention and treatment of hypoglycemia.  Explain the purpose of dextrose administration to patient.  Instruct diabetic patient on the correct method for self–blood glucose monitoring.  Advise patient on when and how to administer dextrose products for hypoglycemia.

PATIENT EDUCATION WORKSHEET

NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PHARMACOLOGICAL ACTION:

MEDICATION: Glucagon

CLASSIFICATION: pancreatics

EXPECTED PHARMACOLOGICAL ACTION:

 Stimulates hepatic production of glucose from glycogen stores (glycogenolysis).  Relaxes the musculature of the GI tract (stomach, duodenum, small bowel, and colon), temporarily inhibiting movement.  Has positive inotropic and chronotropic effects. SAFE DOSE OR DOSE RANGE, SAFE ROUTE PURPOSE FOR TAKING THIS MEDICATION PATIENT EDUCATION WHILE TAKING THIS MEDICATION IV IM SC (Adults and Children) >25 kg) 1 mg; may be repeated in 15 min if necessary. SC (Adults and Children) ≥12 yr) Gvoke– 1 mg; may be repeated in 15 min if necessary.  Increase in blood glucose.  Relaxation of GI musculature, facilitating radiographic examination.  Teach patient and family signs and symptoms of hypoglycemia. Instruct patient to take oral glucose as soon as symptoms of hypoglycemia occur; glucagon is reserved for episodes when patient is unable to swallow because of decreased level of consciousness.  Instruct family on correct technique to prepare, draw up, and administer injection. Health care professional must be contacted immediately after each dose for orders regarding further therapy or adjustment of insulin dose or diet.  Advise family that patient should receive oral glucose when alertness returns.  Instruct family to position patient on side until fully alert. Explain that glucagon may cause nausea and vomiting. Aspiration may occur if patient vomits while lying on back.  Instruct patient to check expiration date monthly and to replace outdated medication immediately.  Review hypoglycemic medication regimen, diet, and exercise programs.  Patients with diabetes mellitus should carry a source of sugar (such as a packet of sugar or candy) and identification describing disease process and treatment regimen at all times.  Advise patient to notify health care professional if pregnancy is suspected or if breast feeding.

vSim Worksheets Grading Rubric Criteria 5 Points 4 Points 3 Points 2 Points 1 point Total Points Content (^) -Follows all requirements for -Follows all requirements -Knowledge of topic is - Knowledge of topic is -Knowledge of topic is Knowledg e (^) the assignment. for the assignment. partially covered. (^) general in more than general throughout -Conveys well-rounded -Major points of topic are -Key information is missing three areas of the entire worksheet, knowledge of the topic. mostly covered in the from 2 or more assignment worksheet. and/or does not cover -Content well organized, required assignment areas. areas. - 1 or more areas of all the required logical. -Content organized, logical -Worksheet difficult to follow^ worksheet left blank.^ assignment areas. -Easy to read and understand flow.^ in two or more areas. -Content unorganized -Two or more areas left throughout all of worksheet. -Easy to read and -Information is incomplete in^ throughout worksheet. blank on worksheet. understand through most two or more areas. -Difficult to understand^ -Unable to follow flow of of worksheet. content of paper. worksheet. Critical (^) -Concisely explains each -Explains each content -Few aspects of the -Information is basic. Thinking (^) content area. area. content areas presented. -No aspects of the -Analyzes information, -Presents information Few insights presented, content present in the connects data points to about the topic. lacking analysis. worksheet. provide accurate, concise -Some analysis, insight -Data points not -Lacks insight, analysis, information. (^) present, some data points connected to information (^) and conclusions. -Scholarly work. threaded together. provided. -No understanding from -Scholarly work. -Little understanding^ the content presented. gained from information presented. Writing, -An occasional spelling error -Some minor errors (1-3 -Frequent errors (4-5 errors) -Numerous errors (5-6 -Excessive errors (> Compositi on (^) present. errors) with spelling, with spelling, grammar errors) with spelling, errors) occur with (Spelling, (^) -Grammar, readability, and grammar and/or sentence and/or sentence structure. grammar and/or spelling, grammar Grammar, sentence structure is error structure, not consistent -Errors effect ability to sentence structure and/or sentence free. throughout worksheet. comprehend information^ throughout worksheet. structure, throughout Sentence -Errors do not interfere present on worksheet and -Difficult to understand^ worksheet. Structure) with the readability or readability. information presented^ -Unable to understand comprehension of due to numerous errors. information presented in information. (^) the worksheet. Total Points: _________

Clinical Worksheet Date: 4/16/20 Student Name: Marina Geiger Assigned vSim:Skyler Hansen Initials:SH Diagnosis: HCP: Isolation: IV Type: Critical Labs: Other Services: Hypoglycemia N/A standard Location: Finger stick glucose test 62 low N/A Age: Peripheral IV 18 gauage right forearm Prothrombin time-9 low Fall Risk:yes M/F:M Length of Stay: 1 day 4/16/20 Consults: Fluid/Rate: Consults Needed:

Code Status:Full N/A Transfer:home to ER N/A Dietician/Nutritionist

**Allergies: NKDA 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:

Path to Discharge: Path to Death or Injury:** Patient is a recently diagnosed Type 1 Diabetic. The patient was playing basketball with friends then a hypoglycemic episode occurred. The patient is drowsy, wakes with stimulus, has slurred speech, is diaphoretic, and is acting irrationally. The patient is also pretty disoriented above arrival to the ED. Diabetes Mellitus Type 1

1. Elevate blood glucose level
2. Closely monitor patients LOC
3. Educate patient on what cause hypoglycemic episodes and how to prevent.
4. Closely monitor Vital Signs Patient will have stable blood glucose levels as well as vital signs. Patient will also have improved LOC and necessary medications will be administered to improve hypoglycemia. Hypoglycemia can cause major decrease LOC which may cause injury in addition to Hypoglycemic shock.

Rubric for Grading vSim Clinical Worksheet

Patient Information: All documented areas 100% complete and Three listed areas completed OR Less than three listed areas completed Patient information area blank. provide thorough information. documented areas 75% complete. OR documented areas less than 50% Demographics, Diagnosis, completed. Allergies, Provider, Consults, Isolation, Fall Risk, Intravenous Therapy, Critical Labs, Services and Needed Consults Medical History: 100% of HPI, Past Medical/Surgical 75% of HPI, Past Medical/Surgical History 50% of HPI, Past Medical/Surgical 25% of HPI, Past Medical/Surgical History and Comorbidity Factors and Comorbidity Factors completed. History and Comorbidity Factors History and Comorbidity Factors Why patient is in the hospital, completed with thorough, relevant Information relevant to scenario. completed. Information basic and lacks completed. Information not History of present Illness, Past information. relevancy. relevant, or content areas left blank, Medical/Surgical History, Comorbidity Factors Patient Education/Goals: Thorough and detailed patient education. Provides patient education but lacks Patient education lacks thoroughness Missing patient education and/or Patient shift. goals are SMART, relevant, thoroughness or details. Patient shift and details. Patient shift goals missing 3 patient shift goals. Patient shift Shift Goals, Patient Education and detailed goals. 100% of worksheet goals missing 1-2 components of SMART – 4 components of SMART goals. 50% goals lack all components of Needs area is complete. goals. 75% of information needed for of the information needed for worksheet SMART goals. 25% of the worksheet area present. area present. information needed for worksheet area present. Disease Progression: Pathway to death and health is identified Pathway to death and health is identified. Missing over 50% of needed information Pathway to death and health with detail. Information is concise, relevant, Information is relevant and accurate. for worksheet area present. Pathway to contains information not relevant or Pathway to Death or Injury accurate and portraits appropriate Missing timeframe for occurrence. 75% of death and health identified but content accurate to the scenario or section Pathway to Health timeframe for occurrence. 100% of the information needed for worksheet area either not relevant or accurate for left blank. information needed for worksheet present. present. situation present in scenario. AACIP: Alerts, Assessments, Complications and Alerts, Assessments, Complications and Missing 2 – 3 areas on worksheet. Missing 4 or more areas on Interventions/Preventions identified Interventions/Preventions identified. Most Answers not relevant to scenario. 50% worksheet. Answers not relevant to Alerts, Assessments, thoroughly. Answers relevant to scenario. answers relevant to scenario. 75% of the of the information needed is present. scenario. 25% of the information Complications, Interventions 100% of the information needed is present. information needed for worksheet area needed for worksheet area is and Prevention present. present. Nursing Care Plan: Management of Care relevant to case Management of Care, Priorities or Missing relevant data in one or more Information provided not relevant to scenario and detailed. Priorities for delegation sections relevant to scenario. categories (management of care, scenario. Answers are basic Management of Care, Priorities scenario identified. Identifies all aspects of Answers generic to situation. Some prioritization, delegation). Answers basic without detail. No evidence of for Patient Care, Delegation care that can be delegated and identifies evidence of critical thinking present. without detail. Little to no evidence of critical thinking. Missing answers in appropriate personnel to delegate activities critical thinking present. one or more area. to. Answers detailed, Critical thinking evident.

TOTAL POINTS