Sentinel U prioritization NURS 233 PDF

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Summary

Sentinel university virtual simulation assignment and logs...

Description

Lou Hecker [email protected] Shoreline Community College Wednesday, April 14, 2021

Prioritization of Care 2 Report Category

Success Percentage

Cardiac

100%

Endocrine

100%

Neurology

100%

Dermatology/Burn

100%

Reproductive

91%

Mental Health

89%

Drugs/Alcohol

82%

Respiratory

75%

GI/GU

67%

Badge Earned

Percentages are calculated using categorized patients across all levels; even if the learner has yet to come across all patients in a category. We recommend using the percentages in this table to simply analyze categorical strengths and weaknesses of the learner. We do not recommend using these percentages as part of the grading criteria.

Lou Hecker [email protected] Shoreline Community College Wednesday, April 14, 2021

Prioritization of Care 2 Report Time Progress Spent

Department Level Prioritization Prioritization Level Selection Attempts Dept. A Dept. B Score Score

Level 1: Behavioral 100% Health

66 mins

0

10/10

5/5

5/5

20/20

100%

65 mins

0

10/10

5/5

5/5

20/20

Level 3: Jail 100% Level 4: Pregnancy 100% (Obstetrics) Level 5: Pediatrics 100%

22 mins

0

7/10

0/5

2/5

9/20

47 mins

0

9/10

5/5

5/5

19/20

38 mins

0

8/10

3/5

3/5

14/20

44/50

18/25

20/25

82/100

Level 2: Geriatric

Totals

3 hrs 58 mins

Lou Hecker [email protected] Shoreline Community College Wednesday, April 14, 2021

Prioritization of Care 2 Report Level 1: Behavioral Health Level 1: Department Selections Patients/ Category

Irma Garcia: Mental Health

Notes

Selection

S: Comes in because quote "someone is telling me to kill my baby and myself". Partner tells me pt has been confused, unable to speak, and doesnt answer to her name occationally. Partner tells me patient had 1st baby 5 days ago and hasnt slept since getting home from the hospital. She has not paid any Hospital attention to the baby. B: Mother has bipolar disorder. NKDA. Prenatal vitamins. A: Does not make eye contact, not aware of others, will not answer questions, and is pacing back and forth. R: Send to ER for psych eval d/t auditory SI + HI (child) hallucinations

Rationale

Status

Auditory suicidal and homicidal delusions

Correct

Lou Hecker [email protected] Shoreline Community College Wednesday, April 14, 2021

Prioritization of Care 2 Report

Eduardo Herrera: GI/GU, Mental Health

Tayo Satoh: Mental Health

S: Spouse says she can not take care of him anymore d/t increased care load over last 2 weeks. Spouse reports confusion, speech hard to understand, not recognizing children, and he wont interact with friends. Irritable and confused to time of day. Suspicious of everything and thinks spouse will hurt him. Grabbed spouse by neck earlier today. Urinary freq and Hospital hematuria. B: Alzheimer dsease mild,. NKDA. Wife has been taking care for 3 years. Donepezil prescription but hasnt taken for 3 days. A: Pt in w/c and does not make eye contact. He appears withdrawn. R: Send pt to ER for UA, culture, sepsis montioring, and finding why hes confused more than baseline. S: Just needs someone to talk to. PT exhibits some gender confusion. physically ok but confused about who I am. B: Fully immunized, reports never going to Dr. A: The pt is AxOx4 and Clinic dressed masculinely. R: Send to clinic to discuss options about gender confusion and other helpful resources.

Monitor sepsis. UA, culture.

Correct

Not life threatening, no labs/test, stable.

Correct

Lou Hecker [email protected] Shoreline Community College Wednesday, April 14, 2021

Prioritization of Care 2 Report

Bradley Robinson: Mental Health

S: The police brought pt in today. Police brought pt in for violating restraining order with wife and bringing gun to home. B: Doctor reports mood swings and a great deal of aggresion. Started pt on fluoxetine after assault charge. Hospital Also taking valporic acid. A: AxOx4, pacing, hands cleched, angry expression. R: Pt is a threat to self and others, needs psych and mental health work up. Check compliance with meds and why BP is so high other than frustration.

S: Reports just having a panic attack today. Reports having possible panic attacks for the last 3 months. Doyle McGee: B: Really healthy and active. Clinic Drugs/Alcohol, A: AxOx4, calm and w/o Mental Health distress. R: Send to outpt clinic to discuss anxiety management options. S: Pt feels anxious and reports crying all the time. B: High cholesterol. Pt reports depression 6 mos ago after mom passed. Doctor prescribed new antidepressant and pt started feeling better in Carmello Uba: 3 weeks. Gained 25 lbs in past Drugs/Alcohol, few months so stopped taking Clinic Mental Health antidepression med last week. Takes atorvastatin and paroxetine. A: AxOx4 w/ husband, in w/c. R: Out-pt visit with PCP to discuss medication options.

Threat to self and others - psych + mental health eval. Possible noncompliance with meds and high BP.

Correct

Stable, no labs/tests - outpt to discuss anxiety management

Correct

Out-pt visit with PCP to discuss medication options.

Correct

Lou Hecker [email protected] Shoreline Community College Wednesday, April 14, 2021

Prioritization of Care 2 Report

Zaan Pech: Mental Health

Antony Okilo: GI/GU, Mental Health

S: Mother and father brought d/t suspension of school and anger issues. B: Hx ADHD managed with lisdexamfetamine. Mother reports uncontrolled anger for the past year or two. Clinic A: AxOx4, facial expression indicates annoyance. answers all questions. R: stable. out pt workup for medications and coping management skills. S: Pt reports that someone is trying to poison him. Father reports not eating/drinking or taking medications. B: hx of schizophrenia - living in group home for 2 years. Unable to manage medications on his own. Takes clozapine - father reports he hasnt been eating ro drinking and most likely not taking medication. Hospital A: Pacing back and forth with poor personal hygiene. Speech is incoherent and rambling. Pale skin color and stiff posture. R: Pt needs labs to ensure he does not have infection. Investigate close pulse pressure and tachycardia. Follow up with PCP for medication recommendations.

stable. out pt workup for medications Correct and coping management skills.

Pt needs labs to ensure he does not have infection. Investigate close Correct pulse pressure and tachycardia. Follow up with PCP for medication recommendations.

Lou Hecker [email protected] Shoreline Community College Wednesday, April 14, 2021

Prioritization of Care 2 Report

Young-Soon Lee: Mental Health

S: Pt reports not wanting to live anymore and stopping his lithium medication two weeks ago. Reports feeling manic with racing thoughts and inability to sleep. Lost over $1000 at casino during manic state and now feels guilty and unable to get out of bed, go to work, or do much of anything. Wife brought in because really worried about him. B: hx of bipolar disorder Hospital reports usually under control when he takes lithium. Reports he does not like the waylithium makes him feel s he stopped taking 2 weeks ago. A: AxOx4, thin, pale, and a sad expression. R: In pt mental health work up d/t saying he does not want to live anymore. Work with patient with medication adhereance.

S: Reports husband hit her again and that she is scared. Knows she needs help with situation and anxiety. B: Reports insomnia, panic attacks, anxiety, and HA over the last year. Takes ibuprofen Valeria Flores: for pain. Drugs/Alcohol, A: Bruises on L side of face Mental Health and lips. Answers questions appropraitely and does not make eye contact. R: Need social work consult and mental health eval. Provide resoruces for DV victums.

Clinic

In pt mental health work up d/t saying he does not want to live anymore. Work with patient with medication adhereance.

Correct

Need social work consult and mental health eval. Provide resoruces for Correct DV victums.

Level 1: Patient Prioritization by Department Rationale

Status

Score

Lou Hecker [email protected] Shoreline Community College Wednesday, April 14, 2021

Prioritization of Care 2 Report Clinic

Hospital

physical trauma is apparent, worst injuries.Risk for violence to self and others.Unstable mood d/t medication stoppage.Panic attacks can cause serious physical symptoms.Anxiety from gender dysphoria is difficult. immiediete danger to self and others.Danger to her self and her child.Unstable VS, needs nutrional support, medication to assist with AHunstable VS, potential infection, unstable mental status.Manic behavior causing irrational decisions and inability to sleep. Axniety.

Correct

5

Correct

5

Lou Hecker [email protected] Shoreline Community College Wednesday, April 14, 2021

Prioritization of Care 2 Report Level 2: Geriatric Level 2: Department Selections Patients/ Category

Notes

Selection

S: cant move L arn and leg, voice sounds funny, SOB. B: COPD, smoker, 02 all the time, aneurysm, depression. HCTZ, salmeterol and Hazel Cantrell: beclomethasone, fluoxetine A: does not respond to name Hospital Cardiac, or answer questions. in w/c Neurology with spouse. hemiparesis of L side. R: Hoispital check up for CT and stroke treatment.

Rationale

Hoispital check up for CT and stroke Correct treatment.

S: open wound on eye. B: overwight, DM, peripheral vascular disease, high cholesterol, HTN. Reports not being very active. Glucophage, Ricardo A: obese, partial thickness Pacheco: Home health for wound care, DM Home Health burn 3x3 inches R thigh. Endocrine, education, and infection screen. Dermatology/B Wound has red edematous borders, white drainage, and urn foul odor. R: Home health for wound care, DM education, and infection screen.

Virgil Brodie: Cardiac, Respiratory

S: Bilateral LE swelling and SOB just from going to bathroom. B: DM II, HTN, hx MI 5 years ago. Naoroxen for arthritis, metofrmin for DM, captopril for HTN. A: AxOx4 with pale skin. lower Hospital extremity edema, w/o SOB. in w/c R: Send to hospital for cardiac work up, respiratory assessment,a dn DVT prevention.

Status

Correct

Send to hospital for cardiac work up, Correct respiratory assessment,a dn DVT prevention.

Lou Hecker [email protected] Shoreline Community College Wednesday, April 14, 2021

Prioritization of Care 2 Report

Teresa Vicenta:

Samuel Wilson: Cardiac, Respiratory

Keiko Eng: GI/GU

S: Pt reports having trouble walking after L total knee replacement 2 weeks ago. Reports trouble getting around messy house and that pain medication doesnt work. B: Knee injuries in high school. Was taking ibuprofen but gave pt stomach problems. Oxycodone for Home health consult for pain knee pain, but doctor wont Home Health assessment and management prescribe anymore. L total options. knee replacement 2 weeks ago. A: AxOx4. 2 inch incision lateral aspect L knee that is clean, dry, and intact. R: Home health consult for pain assessment and management options. S: Cant rememeber to take medication. B: HTN , smoking, family hx of MI (father). Lorsartan for HTN and glipizide for DM A: AxOx4, good eye contact, Home health consult for orientation answers questions Home Health sreening and medication adherance appropriately. strategies R: Home health consult for orientation sreening and medication adherance strategies S: Middle somach cramping pain that worsens after eating and activity. Reports feeling bloated and nauseous. Constipated and reports losing 5 lbs. B: Crohns disease and continuous stomach issues. Reports having surgery a few years ago but it didnt seam to Hospital help. Prednisone and azaethioprine. A: AxOx4, skin pale and guarding abd. R: Pt needs labs for nutrional def and possible FVE. Imaging for stomach issues and to rule out obsturction.

Pt needs labs for nutrional def and possible FVE. Imaging for stomach issues and to rule out obsturction.

Correct

Correct

Correct

Lou Hecker [email protected] Shoreline Community College Wednesday, April 14, 2021

Prioritization of Care 2 Report Friedrich Achenbach: Cardiac, Respiratory

S: L calf swollen and painful B: L knee replacement a year ago. A: AxOx4 in w/c with L calf red, tender, and wamr. R: Hospital for DVT assessment - labs, imaging.

Hospital

Hospital for DVT assessment - labs, Correct imaging.

S: Home from colostomy surgery for a week and cant seem to change the bag without spilling. B: hx colon cancer dx 2 years ago. radiation and chemo did Jyoti Patel: not work. Colosyomy bag and GI/GU, DM. Metformin Home health consult for ostomy Mental Health, A: AxOx4 but tearful and sad. Home Health maintainence and wound Dermatology/B husband present. assessment. urn Stomahealthy and pink, skin around stoma has slight redness and excoriation R: Home health consult for ostomy maintainence and wound assessment. S: Increased cofusion with worsening sx during the evening. B: arthritis. Pt does not remember but wife states George Zupan: meloxicam and omeprazole. home health consult for orientation Home Health Mental Health A: AxOx2, answers questions screening and UTI work up. and makes eye contact. R: home health consult for orientation screening and UTI work up.

Laurinda Nowak: Cardiac

S: Picc B: Colon cx for 6 th, PICC L arm for chemo. DM and frequent UTIs. glyburide DM and morphine for pain. A: AxOx4, PIcc red and edematous with bruising extending to wrist. R: Hoisptial for PICC

Hospital

Hoisptial for PICC

Correct

Correct

Correct

Level 2: Patient Prioritization by Department Rationale

Status

Score

Lou Hecker [email protected] Shoreline Community College Wednesday, April 14, 2021

Prioritization of Care 2 Report Home Health

Hospital

Risk for infection d.t opne wound.Risk for infection and other bowel issues d/t complexity of ostomy maintainence. Memory problems with BP meds and family hx of MIMild-severe pain managementConfusion and alzheimers Stroke can lead to MI or other CV issuesDVT can lead to PEHx of MI and cardiac workup needNG tube for bowel obstructionPICC line maintainence

Correct

5

Correct

5

Lou Hecker [email protected] Shoreline Community College Wednesday, April 14, 2021

Prioritization of Care 2 Report Level 3: Jail Level 3: Department Selections Patients/ Category

Notes

S: chest pain + sob B: heart disease, Peter Cage: hyperlipidemia Cardiac, A: Sob, diahphoretic, holding Drugs/Alcohol, chest. Mental Health R: chest pain work up

Telly Jorge: Cardiac, Drugs/Alcohol

Rationale

Status

Hospital

chest pain work up

Correct

Clinic workup

Correct

Jail Clinic

Jail clinic for HIV check up and infection screen. Pregnancy well being assessment.

Correct

Jail Clinic

Jail clinic for mental health assessment and substance abuse resources.

Incorrect

Jail Clinic

jail clinic for bronchodialators and resp workup.

Incorrect

S: Chest pain that comes and goes. B: Propranolol for HTN and Jail Clinic atorvastatin for high chol. A: AxOx4 good eye contact R: Clinic workup

S: urine frequency, and white discharge. B: HIV positive. IV drug user for 5 years, clean for Minerva pregnancy. Banner: A: AxOx4, pale, grimacing. Drugs/Alcohol, R: Jail clinic for HIV check up Reproductive and infection screen. Pregnancy well being assessment. S: Pt reports not wanting to live anymore. B: stomach aches Rocco Nelson: A: pacing, anxious, agitated GI/GU, R: Jail clinic for mental health Mental Health assessment and substance abuse resources.

Wendy Armstrong: Respiratory, Drugs/Alcohol

Selection

S: SOB and lungs on fire. B: Allergic to cats and dust. asthma. A: othopnea, audible wheezes, accessory muscles R: jail clinic for bronchodialators and resp workup.

Lou Hecker [email protected] Shoreline Community College Wednesday, April 14, 2021

Prioritization of Care 2 Report S: ETOH B: pain Kana Iver: A: AxOx4, diaphoretic, Drugs/Alcohol, agitated. GI/GU, R: Jail clinc for ETOH Mental Health withdrawals

Jail Clinic

S: PTSD B: shoulder px Hank Okar: A: AxOx4, does not make eye Drugs/Alcohol, Jail Clinic Mental Health contact R: Clinic

Gesa Zedler: Respiratory, Neurology Evander Lawrence: Drugs/Alcohol, GI/GU, Mental Health

S: head inj B: fatigue, sob A: AxOx4 R: CT

Hospital

S: heart pounding and shaking. B: u Jail Clinic A: pacing, anxious, grimacing. R: clinic

S: Back pain Dimitri Vakar: B: back pain Drugs/Alcohol, A: AxOx4, aggressive Mental Health R: Clinic for back pain

Jail Clinic

Jail clinc for ETOH withdrawals

Incorrect

Clinic

Correct

CT

Correct

clinic

Correct

Clinic for back pain

Correct

Level 3: Patient Prioritization by Department Rationale

Status

Score

Jail Clinic

chest paininfectiondangerous to othersanxietypain

Incorrect

0

Hospital

MITBIETOH withdrawalRespiratoryCocaine

Incorrect

2

Lou Hecker [email protected] Shoreline Community College Wednesday, April 14, 2021

Prioritization of Care 2 Report Level 4: Pregnancy (Obstetrics) Level 4: Department Selections Patients/ Category

Hyun Lee: Reproductive

Mya Secord: Reproductive

Notes

Selection

S: Feeling unwell for a week now - HA, stomach pain, and sleepiness. 24 wks pregnant increased thirst and frequency peeing (nocturia). Vaginal itching and thick white discharge a couple days ago. B: 39 y.o. Family hx of diabetes (mother). Prenatal Clinic vitamins. A: AxOx4, sking is dry and flushed. R: Clinic workup for GDM assessment and U/a + cultures. pre preg weight: 115 lbs Gestational age 24 (G1P0) 140 BPM FHT S: Pt reports she feels she has low BG. Almost passed out earlier today, felt very weak. Also believes she has a uti. B: type I DM dx at 14 difficulty controlling bg and remembering to take insulin. unplanned pregnancy. insulin and prenatal vitamins. C...