Carla SIM - yes ths is it PDF

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yes ths is it...

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STUDENT

CLINICAL REPLACEMENT PACKET- Level 3 & 4

Student Resources

vSim CLINICAL REPLACEMENT PACKET for STUDENTS

EST. TIME: 6 HOURS

STUDENT INSTRUCTIONS FOR VIRTUAL CLINICAL REPLACEMENT This activity packet is intended to be used with your assigned virtual patient found in vSim. The Six Step learn flow in vSim is to be followed as instructed below. Once you have completed the Six Steps, in additon to this Clinical Replacement Activity Packet, submit for grading as instructed in your syllabus.

LEARN FLOW - STEP ONE

1

 Finish the Suggested Readings, then complete the following four activities: o Clinical Worksheet o Plan of Care Concept Map o Pharm4Fun Worksheet (one per medication) o ISBAR Worksheet LEARN FLOW - STEP TWO

2

 Take the Pre-Simulation Quiz o Student may take several times using the answer key to provide immediate remediation prior to the virtual simulation. Quiz is recorded as complete. LEARN FLOW - STEP THREE

3

 Launch the virtual simulation o Suggest student complete the vSim Tutorial prior to launching Step Three. o Each clinical experience in the simulation lasts a maximum of 30 minutes. o Student is to complete the simulation as many times as it takes to meet an 80% benchmark. LEARN FLOW - STEP FOUR

4

 Complete the Post-Quiz o The answer key is not visible to the student until after they have submitted the quiz. o The quiz grade is recorded as a percentage LEARN FLOW - STEP FIVE

5

 Document o The student documents the clinical events that occurred during the simulation using the information contained in step five. o If using DocuCare, the instructor assigns the same vSim patient which can be found in DocuCare cases. LEARN FLOW - STEP SIX

6

 Reflection Questions o Students are to complete the reflection questions and submit to instructor post clinical replacement (see syllabus for details). o The quiz grade is recorded as a percentage

2

CONCEPT MAP/ PLAN OF CAREEST. TIME: 30 MINUTES This activity creates an opportunity for you to organize the nursing care required for the patient 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 diagnostic and physical assessment findings related to the identified condition or disease process.

ASSIGNMENT 1. Log into thePoint and launch the assigned vSim, following all instructions posted on your learning management system (LMS). 2. Review the information contained in the patient information. 3. Review the smart sense links associated with Nursing Care, Diagnostics, and Pharmacology found in the suggested reading area. 4. 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 patient information associated with the patient situation. 5. Utilize the smart sense links throughout the vSim to complete the worksheet. 6. Submit your concept map for review.

CONCEPT MAP WORKSHEET DESCRIBE DISEASE PROCESS AFFECTING PATIENT (INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS)

Umbilical cord prolapse is a complication that occurs prior to or during delivery of the baby. In a prolapse, the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby. The cord can then become trapped against the baby's body during delivery.

DIAGNOSTIC TESTS (REASON FOR TEST and results) Fetal heart monitor (possible fetal bradycardia) Pelvic exam ( to see a prolapsed cord, or feel the cord with fingers) Blood type screening- if possible transfusion is needed for emergency c-section.

PATIENT INFORMATION

Carla Hernand ez 32 y/o, Hispanic

ANTICIPATED PHYSICAL FINDINGS -Premature delivery of the baby - Delivering more than one baby per pregnancy (twins, triplets, etc.) - Excessive amniotic fluid -Breech delivery (the baby comes through the birth canal feet first) -An umbilical cord that is longer than usual

ANTICIPATED NURSING INTERVENTIONS Possible c-section, moving the fetus away from um. Cord, contact NICU, contact HCP, contact pacu – for surgery, consent provided by patient and checking orders.

IS AREST TIMEMIN

This SBAR actvity 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 SBAR 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. 2. 3. 4. 5.

Log into the Point and launch the assigned vSim, following all instructions posted on your learning management system (LMS). Review the information contained in the patient information area of the suggested reading section. Review the smart sense links found within the Nursing Care, Diagnostics and Pharmacology areas of the ssuggested reading. Navigate and fill out the data in the following document using the patient information provided in the suggested reading area. Submit for review.

vSim ISBAR ACTIVITY INTRODUCTION

STUDENT WORKSHEET Hi, this is Samm from maternity unit, I am calling about….

Your name, position (RN), 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

Carla Hernandez 32 y/o, Hispanic, The patient has a fetal heart rate decrease and umbilical prolapse . (prolapsed umbilical cord,) orders: Nalbuphine 10 mg IVPB Q 1-2 hrs. for pain- Lactated Ringer’s 500 mL IV bolus (for non-reassuring fetal heart patterns)- Lactated Ringer’s solution at 125 mL/hr. when in active labor Terbutaline 0.25mg sub. Lt. arm 100% O2 NRM @ 10 L --Notified: HCP, Surgery, Anesthesia, NICU, and Blood bank STAT

HR was 85, B/P 136/82, RR 16, O2 sat 99%, on 10ml on nonbreathable mask, temp ,fetal heart rate: 89. IV site is present and intact on LAC. Chest is equal bilaterally, umbilical prolapse was identified, relieved pressure on the cord was attempted, ready for emergency c-section- consent was provided to continue..

Possible c-section, moving the fetus away from um. Cord, nonpharmaceutical measures such as music, meditation, emotional support. Continuous FHR and monitoring until surgery/delivery

PHARM-4-FUN

EST. TIME: 30 MIN (PER MEDICATION)

This activity provides you with the opportunity to create pertinent patient education on the pharmacological agents associated with the vSim activity. You will utilize this worksheet for each drug listed under the pharmacology are of the suggested reading section. STUDENT LEARNING OUTCOMES At the end of this activity, student will be able to: 1. 2.

Explain purpose for taking the identified pharmacological agents. Discuss pertinent patient education related to all the listed pharmacological agent.

ASSIGNMENT 1. 2. 3. 4. 5.

Log into thePoint and launch the assigned vSim, following all instructions posted on your learning management system (LMS). Review the information contained in the patient information. Review the smart sense links associated with the Pharmacological agents found in the suggested reading area. Use the smart sense link to complete the following “patient education” worksheet for each pharmacological agent listed in the Pharmacology are of the suggested reading section. Submit for review.

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

Terbutaline Sulfate MEDICATION: Brand name: Brethaire, Brethine, Bricanyl

CLASSIFICATION: Bronchodilators (tocolytic) Prototype drug: terbutaline

SAFE DOSE OR DOSE RANGE, SAFE ROUTE -- injection: 1 mg/mL Tablets: 2.5 mg; 5 mg

PURPOSE FOR TAKING THIS MEDICATION Prevention and reversal of bronchospasm in patients with asthma and reversible bronchospasm associated with bronchitis and emphysema Action: Relaxes bronchial smooth muscle by stimulating beta2 receptors

PATIENT EDUCATION WHILE TAKING THIS MEDICATION – Monitor glucose and potassium levels, pulmonary function, and CV effects (HR, BP, ECG, QTc-interval prolongation) in pregnant patients. - Ensure patient and caregivers understand drug’s use. (timing, dose, what to look out for warnings) -Instruct patient to immediately report changes in heart rate or rhythm, which patient may experience as feeling anxious, palpitations, or a racing heart. -Advise patient to immediately report wheezing, chest tightness, bad cough, blue skin color, or difficulty breathing. Educate on adverse reactions of all systems such as ..: CNS: Nervousness, tremor, headache, light-headedness, drowsiness, fatigue, seizures. --CV: Tachycardia, hypotension or hypertension, palpitation, maternal and fetal tachycardia. --GI: Nausea, vomiting. ALSO- Sweating, muscle cramps.

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

MEDICATION: Lactated ringers solution

CLASSIFICATION: Electrolyte

PROTOTYPE:

Lactated ringers SAFE DOSE OR DOSE RANGE, SAFE ROUTE Physician direction for the the dose – depending on age and weight against lab value- route is for intraveneous use only. In Carla case: 125ml/hr

PURPOSE FOR TAKING THIS MEDICATION

This solution is indicated for use in adults and pediatric patients as a source of electrolytes, calories and water for hydration.

PATIENT EDUCATION WHILE TAKING THIS MEDICATION

-

Monitor patient input and output, watch for edema because: It can cause overhydration, serum electrolyte concentrations or pulmonary edema, hypovolemia, or urinary tract obstruction. Frequent monitoring of electrolyte levels is very important. Hypernatremis may occur with edema and exacerbation of CHF due to the water retention, so this would add to expanding extracellular fluid volume

NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE MEDICATION: Nalbuphine CLASSIFICATION: Opiod analgesics PROTOTYPE: Butrorphanol SAFE DOSE OR DOSE RANGE, SAFE ROUTE Nalbuphine 10 mg IVPB Q 1-2 hrs. IM, IV and subcutaneous.

PURPOSE FOR TAKING THIS MEDICATION

To help reduce / relieve labor pains during labor.

PATIENT EDUCATION WHILE TAKING THIS MEDICATION Use caution in clients who have MI, kidney or liver disease, respiratory depression and patients receiving MAOI’s -can cause the mother cardiac issues, dizziness, sedation, confusion. Dysphoria, euphoria, hallucinations, respiratory depression (all in the mother)

Clinical Worksheet CLINICAL WORKSHEET This activity creates an opportunity for you to prepare for a virtual clinical experience. This activity provides you with the opportunity to manage patient care, prioritize interventions, and identify aspects of care that could be delegated.

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 that is prioritized and is based on the patient’s care needs. 3. Identifies path to healing or health and path to death or injury. 4. Describes aspects of care that can be delegated and appropriate personnel to complete delegated tasks.

Clinical Worksheet

ASSIGNMENT 1. Log into thePoint and launch the assigned vSim, following all instructions posted on your learning management system (LMS). 2. Review the information contained in the patient information. 3. Review the smart sense links associated with the Nursing Care, Diagnostics, and Pharmacology, found in the suggested reading area. 4. Complete all areas of the attached clinical worksheet. 5. Submit the completed worksheet.

Clinical Worksheet vSim Worksheets Grading Rubric Criteria

5 Points

4 Points

3 Points

Content Knowledge

-Follows all requirements for the assignment. -Conveys well-rounded knowledge of the topic. -Content well organized, logical. -Easy to read and understand throughout all of worksheet.

-Follows all requirements -Knowledge of topic is for the assignment. partially covered. -Major points of topic are -Key information is missing mostly covered in the from 2 or more assignment required assignment areas. areas. -Content organized, logical -Worksheet difficult to follow flow. in two or more areas. -Easy to read and -Information is incomplete in understand through most two or more areas. of worksheet.

Critical Thinking

-Concisely explains each content area. -Analyzes information, connects data points to provide accurate, concise information. -Scholarly work.

-Explains each content area. -Presents information about the topic. -Some analysis, insight present, some data points threaded together. -Scholarly work.

Writing Composition (Spelling, Grammar, Sentence Structure)

-An occasional spelling error present. -Grammar, readability, and sentence structure is error free.

-Some minor errors (1-3 errors) with spelling, grammar and/or sentence structure, not consistent throughout worksheet. -Errors do not interfere with the readability or comprehension of information.

-Frequent errors (4-5 errors) with spelling, grammar and/or sentence structure. -Errors effect ability to comprehend information present on worksheet and readability.

2 Points

1 point

- Knowledge of topic is general in more than three areas of the worksheet. - 1 or more areas of worksheet left blank. -Content unorganized throughout worksheet. -Difficult to understand content of paper.

-Knowledge of topic general throughout entire worksheet, and/or does not all the required assignment areas. -Two or more areas blank on worksheet. -Unable to follow worksheet.

-Few aspects of the content areas presented. Few insights presented, lacking analysis. -Data points not connected to information provided. -Little understanding gained from information presented.

-Information is basic. -No aspects of the content present in worksheet. -Lacks insight, and conclusions. -No understanding the content

-Numerous errors (5-6 errors) with spelling, grammar and/or sentence structure throughout worksheet. -Difficult to understand information presented due to numerous errors.

-Excessive errors (>6 errors) occur with spelling, grammar and/or sentence structure, throughout information the worksheet.

Total Points

Clinical Worksheet Date: due 2-27-2021 Initial: c.h

Student Name:samm clark

Diagnosis: Umbilical cord prolapse

HCP:dr.sittner

Assigned vSim: Carla hernandez Isolation:

standard

Age: 32 LengthofStay:12hr

Consults:N/A

IV Type: Location: Peripheral; left forearm

Critical Labs: n/a

Fluid/Rate: Lactated ringers 1000 ml at 125ml/hr

FallRisk:n/a

M/F: f Code Status: full

Transfer:n/a

Allergies:nka

Why is your patient in the hospital (Answer in your own words and include the History of present Illness): the patient came into the hospital for a delivery with active labor. She is admitted at 39 5/7 weeks gestation. Patient does not have any significant health history prior. No history related to the cord prolapse, this is her second pregnancy. She has a child at home and is primary care giver. Health History/Comorbities (that relate to this hospitalization): - nothing significant is noted for the umbilical cord prolapse.

Shift Goals/ Patient Education Needs: 1. Monitor spO2 > 98 % 2.Monitor FHR, since there was a sudden fetal decrease, 3.Position patient in Trendelenburg position 4.Relieve pressure off the umbilical cord til the baby is delivered. 5. educate patient on medications being administered. 6.educate the patient about umbilical cord prolapse, emergency c section and what care will be provided. (expectations) Path to Discharge: - first priority is to stabilize fetal HR in the normal range. -pressure relieved from cord until delievery – no sign of respiratory distress in mother and baby – apply oxygen mask provide 10L/m. – spo2 in parameters of >98% - emergency c section and normal/appropriate blood pressure for mother -healthy baby without and distressing complications Path to Death or Injury: - patient does not comply with medical advice – sp02 destat – pressure is not relieved

Other Services: NICU for baby, surgical, anesthesia

Consults Needed: unknown at this time.

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

Management of Care: What needs to be done for this Patient Today?

1.

Circulation and perfusion of the fetus (baby)

1. Educate patient about devices (oxygen)

2.

Approp. Position for mother and changes in vital signs/exam

2Relieve the pressure of the cord continuously

3. Fetal heart rate (should be rate-110-160) 4. Non-rebreather oxygen mask (spo2>98%) What Assessments will focus on for this patient? (How will I identify the above signs &Symptoms?) 1.

Monitor FHR and EHR

2.

Assess positioning of a patient (physically observed)

3.

Continuous EFM to monitor FHR /patient position.

List Complications may occur related to dx, procedure, comorbidities: 1.

Cord is not relieved from the pressure of the fetus and it is compressed, the fetus will suffer from hypoxia.

2.

Discomfort, increment of the pain level and anxiety

3.

It can be life-threatening for mother and baby. It can cause hypoxia in baby and can cause serious complications What nursing or medical interventions may prevent the above Alert or complications? 1.

Use appropriate technique to relieve the pressure off the cord and apply an oxygen mask

2.

Assist patient in trendelburg position

3.

Admin. Oxygen with a non-rebreather oxygen mask as the providers orders

3.

Start terbutaline as providers order

4.

Educating the patient and support person about prolapse cord,

5.

Apply monitoring devices for the safety of the mother and baby

Priorities for Managing the Patient’s Care Today (TASKS) 1. To minimize the anxiety when interventions are in process 2.

To prevent and slow the contractions, to prevent the complication of hypoxia on the fetus.

3.

Relieve the pressure off the cord will help the fetus gain enough circulations and perfusion

4.

To prevent further complications and continuously monito the mothers situation and baby’s status.

What aspects of the patient care can be Delegated and who can do it? RN is the o...