Clinical Replacement Student Packet-3 PDF

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Download Clinical Replacement Student Packet-3 PDF

Description

Virtual Clinical Replacement Student Requirements 1. 2. 3. 4.

Students must wear uniform. Students must have camera on during the entire session. Student must be on camera during the session free of noise and distractions. Clinical Replacement Packets must be submitted in its entirety by 11:59PM within 24 hours of the clinical via Blackboard. If packet is not turned in, student will not get credit for clinical.

CONCEPT MAP/ PLAN OF CARE This activity creates an opportunity for you to organize the nursing care required for the patient care presented in your assigned vSim. Student Learning Outcome 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 priori zed 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 the instructions posted on your learning management system (LMS) or given by your clinical instructor. 2. Review the information contained in the patient information. 3. Review the smart sense links associated with the Nursing Care, Diagnostics, Pharmacology found in the suggested reading area. 4. Create the follow concept map. List 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 on 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.

2 Adapted from vSim for Nursing Wolters Klewur

Concept Map Worksheet Describe Disease Process Affecting Patient (include pathophysiology of disease process) Acute myocardial infarction is a life -threatening condition that occurs when blood flow to the heart muscle is abruptly cut off, causing tissue damage. This is usually the result of a blockage in one or more of the coronary arteries. The coronary arteries supply the myocardial muscle with oxygen and the nutrients necessary for optimal function, in CAD the arteries are narrowed or obstructed , potentially resulting in cardiac muscle death

Diagnostic Tests (Reason for test and results)

Patient Information Carl Shapiro, 54 years-old, male, the patient denied allergies, The patient came to the E.D complaining of chest pain, diaphoresis and shortness of breath . He was treated with aspirin and two doses of sublingual nitroglycerin, an IV infusión of normal saline at 25 ml/h, patient receiving O2 at 4 L/min with SpO2 at 97%

Hb 14 g/dl HCT 44 % WBC 8.2 HCO3 18 mEq/L Na 140 mEq/L Creatinine 0.7 mg/dl CK-MB 20 ng/ml

Anticipated Physical Findings The pacient present with diaphoresis chest pain shortness of breath cool, pale, and moist skin

HR, RR faster than normal.

The patient is Hypertensive and smokes less than half packet a day

Troponin T 2.2 ng/ml

Anticipated Nursing Interventions

-Assess vital signs frequently and report to the M.D - Assess the lungs and chest and report any change - Teaching the patient about the importance of the medications, the dosage and what to do is the pain is not relief with the 3 doses of Nitroglycerin - Monitor the Lab values daily - Teaching the patient about safety when change positions from sitting or lying - Assess the patient about chest pain and the importance to report to the physician

3 Adapted from vSim for Nursing Wolters Klewur

ISBAR ACTIVITY

This SBAR 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 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. 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 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. 4. Navigate and fill out the data in the following document using the patient information provided in the suggested reading area. 5. Submit for review.

4 Adapted from vSim for Nursing Wolters Klewur

vSim ISBAR Activity Introduction

STUDENT WORKSHEET Hello, I’m Victoria, I’m calling you from the E.D

Your name, position (RN), unit you are working on

Situation Patient’s name, age, specific reason for visit

The patient Carl Shapiro, 54 years old, who came to the E.D complaining with chest pain, diaphoresis, shortness of breath, the patient was treated with aspirin and two doses of subligual Nitroglycerin, Oxygen 4L/min

Background

Dx: Acute Myocardial Infarction, date of adm: 09/26/2020

Patient’s primary diagnosis, date of admission, current orders for patient

Orders: Aspirin, sublingual Nitrogycerin, two doses, O2 4L/min, IV infusión of NS at 25 ml/h, Morphine 2 mg IV push PRN Chest x-ray and continuos ECG and SpO2 monitoring

Assessment

Pt is AAOX3, cranial nerves intact, PERRLA, Resp : lungs are CTA B/L, Cardio: normal heart sounds no S3 or S4, RR 12 per min, Current pertinent assessment data using head to toe the chest is moving normally , no extrasounds, IV placed in R. approach, pertinent diagnostics, vital signs forearm, IV site had no redness, swelling, infiltration, bleeding or drainage, GI and GU WNL, Skin: good turgor

Recommendation Any orders or recommendations you may have for this patient

5 Adapted from vSim for Nursing Wolters Klewur

-Pt should be remain in continuos 3 lead monitoring and continuos pulse oximeter. -The patient should be transffered to the ICU for further monitoring

PHARM-4-FUN

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. Explain purpose for taking the identified pharmacological agents. 2. Discuss pertinent patient education related to all the listed pharmacological agent. 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 Pharmacological agents found in the suggested 4. reading area. 5. Use the smart sense link to complete the following “patient education” worksheet for each 6. pharmacological agent listed in the Pharmacology are of the suggested reading section. 7. Submit for review.

6 Adapted from vSim for Nursing Wolters Klewur

PATIENT EDUCATION WORKSHEET Name of Medication, Classification, and Include in Prototype MEDICATION:

Morphine

CLASSIFICATION:

Therapeutic: opioid analgesics Pharmacologic : opiod agonists PROTOTYPE:

Schedule II

Safe Dose or Dose Range, Safe Route IM, IV, SQ – For MI 8-15 mg for very severe pain, smaller doses may be given every 3-4 hrs PO 30 mg q 3-4 hrs initially Purpose for Taking this Medication Severe pain ( the 20 mg/ml oral solution concentration should be used in opioid tolerant patients) Moderate to severe chronic pain in opioid-tolerant patients requiring use of daily, around the clock long term opioid treatment and for wich alternative treatment options are inadequate ( extended reléase ). Pulmonary edema. Pain associated with MI

Patient Education While Taking this Medication . May cause drowsiness or dizziness, avoid driving and call for assistance for ambulation . Caution patient to avoid concurrent use of alcohol or other CNS depressants with this medication. . Explain to patient and family how and when to administer Morphine and how to care for infusión equipment properly. . Advise the patient to change positions slowly to minimize orthostatic hypotension

7 Adapted from vSim for Nursing Wolters Klewur

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. 2. 3. 4.

Describe pathological events associated with the patient’s disease process or condition. Create a plan of care that is prioritized and is based on the patient’s care needs. Identifies path to healing or health and path to death or injury. Describes aspects of care that can be delegated and appropriate personnel to complete delegated tasks.

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.

8 Adapted from vSim for Nursing Wolters Klewur

Clinical Worksheet Date: Initials: C.S

Student Name: Diagnosis:Acute Myocardial Infarction

HCP: Dr: F.G

Assigned vSim: Isolation: No

Age:54 M/F:M

Fall Risk:

Length of Stay:Unknow

Yes

Consults:Respiratory Code Status:FULL CODE

Allergies:n/a

IV Type: Picc line Location: Right arm Fluid/Rate:NS

Transfer:No

Critical Labs:

Other Services:

Hb 14 g/dl Trop T 2.2 ng/ml CK-MB 20ng/ml

Consults Needed:

Nutrition

Creat 0.7 mg/dl

respiration

Why is your patient in the hospital? (Answer in your own words and include History of present illness) The patient came to the unit complaining with chest pain, diaphoresis and shortness of breath, and during the admission the patient develop a ventricular fibrillation

Health History/ Comorbidities (that relate to this hospitalization): Hypertension

Shift Goals/ Patient Education Needs: 1. The patient will remain without chest pain, chest discomfort and symptoms 2. The patient will understand and verbalized signs and symptoms of the MI 3. The patient will remain stable with an adequate cardiac output as evidenced by: Stable/improving electrocardiogram (ECG) HR, BP, urine output serum, BUN and creatinine 4. The patient will understand and verbalized indications and dosages of Nitroglycerin Path to Discharge: The patient understand and verbalized the signs and symptoms of a Ventricular Fib , the use of the Nitroglycerin, the correct dosage , the patient may repeat dose every 5 min for a maximum of three doses, if the drug doesn’t provide relief, patient should obtain medical help promptly Path to Death or Injury: The patient suffers from ventricular fibrillation (VF), which is a rapid, disorganized ventricular rhythm that causes ineffective tremor of the ventricles. A common cause of VF is acute myocardial infarction (MI). Patients with VF should receive CPR if a defibrillator is not immediately available, prolonged VF can cause hypotension, unconsciousness or death.

Clinical Worksheet Alerts:

Management of Care: What needs to be done for this patient today?

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

1. Assess the vital signs

1. Chest pain / heart sounds

2. Chest X-ray

2. Respiration rate/ Lung sounds

3. Check the IV line

3. Lab values ( Troponin and cardiac enz )

4. Activated the code team 5. Started CPR at a ratio of 30:2

What assessments will focus on for this patient? (How will I identify the above signs and symptoms?) 1. Cardiovascular 2. Respiratory 3. Assess pain

6. Attach defibrillator pads and deliver a shock with the AED Defibrillation

Priorities for managing the patient’s care today 1. Assess vital signs 2. Auscultate lungs and heart 3. Chest X-ray and IV line

List complications that may occur related to dx, procedure, comorbidities:

4. Administered medications

1. Cardiac arrest 2. cardiogenic shock 3. Death

What aspects of the patient care can be delegated and who can do it? . Assess vital signs . Reposition the patient

What nursing or medical interventions may prevent the above Alert or complications? 1. Monitoring vital signs frequently 2. Auscultate the heart and lungs 3. Monitoring Lab values of Troponin and Creatinine 4. Administer medications

10 Adapted from vSim for Nursing Wolters Klewur

vSim Worksheets Grading Rubric (Not used for Clinical Worksheet) Criteria Content Knowledge

5 Points

4 Points

Follows all requirements for the assignment.

Follows all requirements for the assignment.

Conveys well-rounded knowledge of the topic. Content well organized, logical.

Major points of topic are mostly covered in the required assignment areas.

Easy to read and understand throughout all of worksheet.

Critical Thinking

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

Writing Composition (Spelling, Grammar, Sentence Structure)

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

Content organized, logical flow. Easy to read and understand through most of worksheet.

3 Points Knowledge of topic is partially covered. Key information is missing from 2 or more assignment areas. Worksheet difficult to follow in two or more areas. Information is incomplete in two or more areas.

2 Points 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.

Few aspects of the content areas presented.

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

Few insights presented, lacking analysis. Data points not connected to information provided.

Scholarly work.

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.

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

1 Point

Total Points

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

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

Excessive errors (>6 errors) occur with spelling, grammar and/or sentence structure, throughout worksheet. Unable to understand information presented in the worksheet.

Total Points: __________________

11 Adapted from vSim for Nursing Wolters Klewur

Rubric for Grading vSim Clinical Worksheet 5

3

1

0

Patient Information: Demographics, Diagnosis, Allergies, Provider, Consults, Isolation, Fall Risk, Intravenous Therapy, Critical Labs, Services and Needed Consults Medical History: Why patient is in the hospital, History of present Illness, Past Medical/Surgical History, Comorbidity Factors Patient Education/Goals: Shift Goals, Patient Education Needs

Disease Progression: Pathway to Death or Injury Pathway to Health

AACIP: Alerts, Assessments, Complications, Interventions and Prevention

Nursing Care Plan: Management of Care, Priorities for Patient Care, Delegation

All documented areas 100% complete and provide thorough information.

Three listed areas completed OR documented areas 75% complete.

Less than three listed areas completed OR documented areas less than 50% completed.

Patient information area blank.

100% of HPI, Past Medical/Surgical History and Comorbidity Factors completed with thorough, relevant information.

75% of HPI, Past Medical/Surgical History and Comorbidity Factors completed. Information relevant to scenario.

50% of HPI, Past Medical/Surgical History and Comorbidity Factors completed. Information basic and lacks relevancy.

25% of HPI, Past Medical/Surgical History and Comorbidity Factors completed. Information not relevant, or content areas left blank,

Thorough and detailed patient education. Patient shift. goals are SMART, relevant, and detailed goals. 100% of worksheet area is complete.

Provides patient education but lacks thoroughness or details. Patient shift goals missing 1-2 components of SMART goals. 75% of information needed for worksheet area present.

Patient education lacks thoroughness and details. Patient shift goals missing 3 – 4 components of SMART goals. 50% of the information needed for worksheet area present.

Missing patient education and/or patient shift goals. Patient shift goals lack all components of SMART goals. 25% of the information needed for worksheet area present.

Pathway to death and health is identified with detail. Information is concise, relevant, accurate and portraits appropriate timeframe for occurrence. 100% of the information needed for worksheet present.

Pathway to death and health is identified. Information is relevant and accurate. Missing timeframe for occurrence. 75% of information needed for worksheet area present.

Missing over 50% of needed information for worksheet area present. Pathway to death and health identified but content either not relevant or accurate for situation present in scenario.

Pathway to death and health contains information not relevant or accurate to the scenario or section left blank.

Alerts, Assessments, Complications and Interventions/Preventions identified thoroughly. Answers relevant to scenario. 100% of the information needed is present.

Alerts, Assessments, Complications and Interventions/Preventions identified. Most answers relevant to scenario. 75% of the information needed for worksheet area present.

Missing 2 – 3 areas on worksheet. Answers not relevant to scenario. 50% of the information needed is pr...