Level 3 4 v Sim2 Olivia Jones.docx PDF

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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)

Preeclampsia  Preeclampsia refers to a blood pressure higher than 140/90 mm Hg after 20 weeks of gestation.  Preeclampsia is a multisystem, vasopressive disorder that affects the cardiovascular, hepatic, renal, and central nervous systems  It can be classified as mild or severe  Pathologic changes include pulmonary edema, oliguria, seizures, thrombocytopenia, and abnormal liver enzymes  Several research studies have concluded that calcium, magnesium, and zinc supplements, salt restrictions, diuretic therapy, or fish oil have not proved to prevent this condition DIAGNOSTIC TESTS (REASON FOR TEST AND RESULTS)

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CBC – to get an accurate answer in regards to the number of RBCs, WBCs and platelets that the patient has. BUN and creatinine – to check for kidney damage Hepatic enzyme levels – to check for elevated ALT and AST Urine protein - to check for elevated protein in the urine

PATIENT INFORMATION   

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Olivia Jones, 23 y.o. African American female G1P0 at 36 weeks of gestation Diagnosed with preeclampsia at her 30 weeks visit when her BP was 140/92 mm Hg Patient has been at bedrest since her last prenatal visit, but symptoms have worsened Currently she is experiencing a headache, nausea, fatigue, epigastric pain, visual changes, and chest tightness

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ANTICIPATED PHYSICAL FINDINGS Weight gain Swelling of face (edema) Headache Visual disturbances Oliguria SOB Epigastric pain Nausea and vomiting

ANTICIPATED NURSING INTERVENTIONS Weight patient regularly Check for edema Monitor for signs of excessive/ intensified edema, headache, epigastric pain, nausea and vomiting Assess and monitor VS Head-to-toe assessment Obtain ultrasound Administer medications as ordered Implement fall and seizure precautions Educate and comfort the patient

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 

Good morning. My name is Dora, and I am an RN on the labor and delivery unit.



I have a patient, Ms. Olivia Jones 23-year old patient who was admitted at 36 weeks of gestation for assessment and surveillance of preeclampsia.

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Sheha da nune v e n t f ulp r e gna nc yunt i lhe roffic evi s i ta t30 we e k sofge s t a t i onwhe nhe rBPme a s u r e d14 6/ 92mmHg ,s he ha dpr ot e i nur i a ,a ndmi l dpr e e c l a mps i as ympt oms . Al t h ough t hepa t i e ntha sb e e na tb e dr e s te v e rs i n c e ,h e rs y mp t omsha v e wo r s e ne d ,t h uss h ec a met ot heED. Sh eha sg a i ne d3l b ss i nc e he rl a s tOBvi s i t1we e ka g o . Cur r e nto r d e r si n c l ud e :be dr e s t ,c he c kVSf ol l o wi n gpr o v i de r ’ s i ns t r u c t i ons , O2pe rNRB10L, La c t a t e dRi n g e r ’ s10 0mLI V 12 5mL/ hri nf u s i on ,Ma g ne s i um Su l f a t e20gi n5 00mL s t e r i l ewa t e ra t5 0ml /hr .

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

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ASSESSMENT

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Current pertinent assessment data using head to toe approach, pertinent diagnostics, vital signs

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RECOMMENDATION Any orders or recommendations you may have for this patient

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Ol i vi a ’ sl a t e s tVSa r ea sf ol l o w:HR: 112 ,BP:176 / 1 0 5mm Hg , Re s p :22,O2 :8 9%,Te mp :37 C,FHR:1 67 . Th e r ei samo de r a t et os e v e r ep i t t i n ge de magr a d e dt o+3 . Th e r ei snoob v i ou sa i r wa yob s t r uc t i on.Th e r ei sno r ma l e l a s t i c i t yoft hes ki n.He rs ki ni sc oola nds hei sv e r ys we a t y . Th ed e e pt e ndonr e fle x e swe r ev e r yb r i s k ,h yp e rr e fle xi v e ,a nd wi t hc l onus . Gr a de dt o+4 . Pa t i e ntr e po r t e de pi g a s t r i cpa i n4 / 10a ndah e a da c he5/ 10 . Th e r ea r ec r a c kl e sa tt h eb a s e sofbo t hl un g s . My recommendations would be: - Monitoring the vital signs as ordered - Continue with the head-to-toe assessments as ordered - Provide patient education and comfort measures

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

MEDICATION: Magnesium sulfate

CLASSIFICATION: Therapeutic class: Electrolyte replacements Pharmacologic class: Minerals PROTOTYPE: Magnesium Sulfate

SAFE DOSE OR DOSE RANGE, SAFE ROUTE Depending on the reason of treatment (please see below).

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PURPOSE FOR TAKING THIS MEDICATION Mild hypomagnesemia: 1 g IM every 6 hours for four doses, depending on magnesium level Symptomatic severe hypomagnesemia, with magnesium level of 0.8 mEq/L or less: 5 g IV in 1 L of D5W or NSS over 3 hours Magnesium supplementation in total parenteral nutrition (TPN): 8 to 24 mEq IV daily added to TPN solution. Seizures in preeclampsia and eclampsia: Initial dose: 10 to 14 g IV. Give 4 to 5 g IV in 250 mL of solution and simultaneously give up to 10 g IM (5 g or 10 mL of the undiluted 50% solution in each buttock.

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PATIENT EDUCATION WHILE TAKING THIS MEDICATION   

Explain the use and administration of the medication to the patient. Stress the importance of keeping lab appointments Advise patient to report all adverse effects which include: diarrhea, diaphoresis, hypotension, flushing, drowsiness, stupor, paralysis.

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: 11/22/2020 Initials OJ

Student Name: Diagnosis: Preeclampsia

Assigned vSim: Olivia Jones HCP: Dr. Sarah Anderson

Isolation: Standard

Age: 23 M/F: F

Length of Stay: 1 day Allergies: No known

Code Status: Full

Fall Risk: 25 (low

risk)

IV Type Peripheral Location: Left wrist

Fluid/Rate: LR 1000 mL IV 125mL/hr

Critical Labs: Platelets: 98, RBC:5, MCH: 28, MCHC:12, Creatinine: 2.6, BUN: 32, ALT: 40, AST: 42, LDH: 220, Triglycerides: 180, Creatinine clearance: 154

Other Services: N/A

Consults Needed: Yes

Why is your patient in the hospital (Answer in your own words and include the History of present Illness):  Ms. Jones’s preeclampsia symptoms have gotten worse. She is currently experiencing headache, nausea, fatigue, epigastric pain, visual changes and chest tightness. Health History/Comorbities (that relate to this hospitalization):  None Shift Goals/ Patient Education Needs: 1. Administer O2 as ordered to keep O2 levels over 92%. 2. Maintain vital signs within normal limits throughout the shift.

3.

Determine optimal timing of delivery.

4.

Maintain proper perfusion to fetus.

Path to Discharge: Although she has preeclampsia, the patient’s BP will decrease to manageable levels and the patient will be able to carry out the pregnancy to 40 weeks of gestation.

Path to Death or Injury: The patient’s preeclampsia will not be able to be managed, and the patient will suffer either a brain, liver, or kidney injury which could cause clotting problems, pulmonary edema, seizures, and even death of both the patient and her baby.

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.

High BP.

1. Attempt to manage BP, otherwise prepare for preterm delivery.

2.

Seizure precaution

2.Initiate fall and seizure precautions.

3.

Headache, nausea, fatigue, epigastric pain, visual changes, and chest tightness.

3.Administer medications as ordered to manage symptoms.

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

Priorities for Managing the Patient’s Care Today 1. Attempt to manage BP, otherwise prepare for preterm delivery.

4. 5. 6.

Ask the provider for an order for NIBP to continuously monitor her BP. Pad the side rails of the bed, remove all hazardous items from her surroundings. Head-to-toe assessment and patient interview.

2.Initiate fall and seizure precautions. 3.Administer medications as ordered to manage symptoms.

List Complications may occur related to dx, procedure, comorbidities: 7. 8. 9.

Inability to manage the BP and need for preterm delivery. Patient will have a seizure before the appropriate Inability to manage symptoms and need for preterm delivery.

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

10. Nothing can prevent early delivery. 11. Pad the side rails of the bed, remove all hazardous items from her surroundings. 12. Administer medications as ordered by the provider.

What aspects of the patient care can be Delegated and who can do it? 1.

Obtaining vital signs. – CNA

Grading Rubric for DocuCare Entry: vSim Purpose: This rubric analyzes the components of the electronic health record that students would utilize when documenting the care of a patient during a simulated event.

Components: Each criterion contains performance criteria to demonstrate the critical thinking and clinical reasoning utilized during a simulated patient care encounter. The performance criteria describe the traits that are linked to a level of performance. There are four levels of performance as well as a “not applicable” column. The levels of performance indicate the degree to which the student documented the events of the simulated patient care situation.

Using the Rubric: 

Students: Prior to the simulation experience, the students can use the rubric to prepare for the documentation requirements associated with a simulated experience. The emphasis on thorough, systematic documentation of the nursing care provided during the simulation will facilitate clinical reasoning and critical thinking development. The student can utilize the rubric to perform a self-assessment of their documentation of the simulated events prior to...