V Sim 07 - William Henry V sim clinical packet with answers PDF

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William Henry V sim clinical packet with answers...

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vSim for

CLINICAL REPLACEMENT PACKAGE

STUDENT RESOURCES

vSim for vSIM CLINICAL REPLACEMENT PACKET STUDENTS STUDENT I NSTRUCTIONS

FOR

FOR

Est. Time: 4-6 Hours

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 addition to this Clinical Replacement Activity Packet, submit for grading as instructed in your syllabus. L EARN FLOW - S TEP O NE  Finish    

the Suggested Readings, then complete the following four activities: Clinical Worksheet Plan of Care Concept Map Pharm4Fun Worksheet (one per medication) ISBAR Worksheet

L EARN FLOW – S TEP T WO  Take the Pre-Simulation Quiz  Student may take several times using the answer key to provide immediate remediation prior to the virtual simulation. Quiz is recorded as complete. L EARN FLOW – S TEP T HREE  Launch the virtual simulation  Suggest student complete the vSim Tutorial prior to launching Step Three.  Each clinical experience in the simulation lasts a maximum of 30 minutes.  Student is to complete the simulation as many times as it takes to meet an 80% benchmark. L EARN FLOW – S TEP F OUR  Complete the Post-Quiz  The answer key is not visible to the student until after they have submitted the quiz.  The quiz grade is recorded as a percentage L EARN FLOW – S TEP F IVE  Document  The student documents the clinical events that occurred during the simulation using the information contained in step five.  If using DocuCare, the instructor assigns the same vSim patient which can be found in DocuCare cases. L EARN FLOW – S TEP S IX  Reflection Questions Last Updated 8/2/2021

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

Last Updated 8/2/2021

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vSim for CONCEPT MAP/ PLAN

OF

Est. Time: 30 Minutes

CARE

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

Last Updated 8/2/2021

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vSim for CONCEPT MAP WORKSHEET DESCRIBE DISEASE PROCESS AFFECTING PATIENT (Include Pathophysiology of Disease Process)

Chronic Obatructive Pulmonary Disease (COPD)- is a preventable and treatable slowly progressive respiratory disease of airflow obstruction involving the airways, pulmonary parenchyma or both. The airflow limitation or obstruction in COPD is not fully reversible. Most patients with COPD present with overlapting signs and symptoms of emphysema or chronic bronchitis, which are two distince disease processes. COPD is the chronic destruction of the lungs resulting in decreased gas exchange, leading to chronic air trapping and high CO2 in the body. In Emphysema damage to the alveoli result in loss of lung elasticity and loss of inflammation of lung tissue, resulting in loss of lung recoil and air trapping. In Chronic Bronchitis inflammation of the bronchi and excessive mucus production results in a chronic hacking cough and recurrent infections. COPD accentuates and accelerates these phyiologic changes. DIAGNOSTIC TESTS (Reason for Test and Results) Pulmonary function studies are used to help confirm the diagnosis. Spirometry is used to evaluate airflow obstruction. ABG lab test will show baseline oxygenation and gas exchange. Chest x-ray is maintained to exclude alternative diagnosis. CT is not routine but may be obtained in diagnosis of COPD but High resolution CT may help differential the diagnosis. Screening for alpha1

PATIENT INFORMATION Henry Williams, 69 yo retired engenieer. Only son died 10 years ago, Married. History of smoking, recurrent colds, bronchitis, asthma, COPD, HTN, Anxiety, Dyspnea, hyperlipidemia. Has active case manager/ social worker working with him for placement in an apartment with assistive living.

ANTICIPATED PHYSICAL FINDING Cyanosis from hypoxemia. Cough with productive sputum Unusual lung sounds- crackles, wheeses, rales Edema peripherally- due to poor cirucaltion

ANTICIPATED NURSING INTERVENTIONS Elevate HOB, teach oral hygiene before meals to wake up tastebuds, eat small frequent meals, eat high calorie and protein meals, avoid eating high amounts of carbohydrates, avoid exercise 1 hour prior to meals, conserve oxygen for chewing and swallowing, avoid gassy foods, no carbonated drinks, no high fiber foods (broccoli or beans). Increase fluid intake (8 glasses per day/ 2-3L/day) to thin mucus, avoid drinking while eating, Reportincreased sputum, fever, worsinging dyspnea. Vaccine Pneumococcal every 5 years, Flu every year. Educate Albuterol if short of breath to vasodilate the lungs and allow more airflow. For heavy mucus: Before bed mobilize secretions, take Guaifenesin, use a cool mist humidifeier at tnight to make breathing easier. Breathing: pursed lip breathing: inhale 2 seconds via nose (closed mouth) exhale 4 seconds with pursed lips. Educate on Huff Cough Technique: 1. Sit upright in a chair, feet shoulder width apart and lean forward 2. Deep slow inhalation through mouth using diaphragm muscle, 3.Hold breath for 2-3 seconds and then forcefully exhale.

Last Updated 8/2/2021

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vSim for Est. Time: 30-60 Minutes

ISBAR ACTIVITY

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. S TUDENT LEARNING O UTCOMES 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.

Last Updated 8/2/2021

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vSim for VSIM

ISBAR ACTIVITY

INTRODUCTION

Student Worksheet

Jenn Phinney, RN, Respiratory Unit

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

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

Henry Williams, 69 year old male, Admitted durning the night for shortness of breath, O2 was 82% on room air, Hx of COPD, hard of hearing- O2 88% on 2L via nasal cannula respirations between 24-30/min bp- 134/88, rr- 28, hr-112 ALLERGIES: PCN

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

COPD, admitted during the night, orders bed rest with bathroom privileges, regular low fat diet, I & O, Respiratory Treatment- Albuterol nebulizer treatment 2.5 mg, ipratropium bromide 0.5mg in 3 ml of normal saline q 20 min X3, followed by albuterol 2.5mg, ipratropium bromide 0.5mg in 3L normal saline q2 hours (decrease frequency as tolerated). Oxygen per nasal cannula 2L/min. Lactated Ringers IV at 50 ml/h, CBC, BNP, BMP, ABG’s, Chest xray,

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

There is increased respiratory effort, other than that there is nothing to find on head to toe assessment. There is normal skin turgor, other than that his skin is cool and he is very sweaty. Lung sounds= a lot of audible wheezes bilaterally, heart sounds normal, bowel sounds active Vital signs= Temp= 99.0, BP= 132/90, RR= 29, HR= 111- regular, SPO2= 82% via n/c

RECOMMENDATION

Recommend sitting up, keeping head of bed elevated at or above 30 degrees, conserving energy to eat, resting, increasing fluid intake to thin mucus, take medications as ordered by physician, call physician if symptoms worsen

Any orders or recommendations you may have for this patient

Est. Time: 30 Minutes (per medication)

PHARM4FUN Last Updated 8/2/2021

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vSim for 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 area of the suggested reading section. S TUDENT L EARNING 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 reading area.

4.

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.

5.

Submit for review..

Last Updated 8/2/2021

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vSim for PATIENT EDUCATION WORKSHEET NAME OF M EDICATION , C LASSIFICATION AND I NCLUDE P ROTOTYPE MEDICATION: ALBUTEROL SULFATE

CLASSIFICATION: ALBUTEROL SULFATE = ADRENERGIC BETA 2 AGONIST

PROTOTYPE: ALBUTEROL SULFATE IS THE PROTOTYPE DRUG FOR ADRENERGIC BETA 2 AGONIST

SAFE DOSE OR DOSE R ANGE , S AFE R OUTE Albuterol= aerosol metered-dose inhaler- 90mcg (base)/actuation (equivalent to 108mcg albuterol sulfate) powder metered-dose inhaler- 90mcg (base)/actuation (equivalent to 108mcg albuterol sulfate); ProAir RespiClick powder metered-dose inhaler with electronic module- 90mcg (base)/actuation (equivalent to 108mcg albuterol sulfate); ProAir Digihaler- tablet- 2mg & 4mg- tablet, extended release- 4mg & 8mg- nebulizer solution- 1.25mg/3mL (contains 1.50 mg albuterol sulfate/3 mL)- 0.63mg/3mL (contains 0.75 mg PURPOSE FOR TAKING THIS MEDICATION Albuterol is used to prevent and treat difficulty breathing, wheezing, shortness of breath, coughing, and chest tightness caused by lung diseases such as asthma and chronic obstructive pulmonary disease (COPD; a group of diseases that affect the lungs and airways). Albuterol inhalation aerosol and powder for oral inhalation is also used to prevent breathing difficulties during exercise. Albuterol inhalation aerosol (Proair HFA, Proventil HFA, Ventolin HFA) is used in adults and children 4 years of age and older. Albuterol powder for oral inhalation (Proair Respiclick) is used in children 12 years of age and older. Albuterol solution for oral inhalation is used in adults and children 2 years of age and older. Albuterol is in a class of medications called bronchodilators It works by relaxing and opening air passages to the

PATIENT EDUCATION W HILE TAKING THIS M EDICATION

Warn patient about risk of paradoxical bronchospasm and advise patient to stop drug immediately if it occurs. Teach patient to preform oral inhalation correctly. If prescriber orders mor than 1 inhalation, tell patient to wait at least 2 minutes before repeating procedure. Tell patient that use of spacer device with appropriate inhaler may improve drug delivery to lungs. If patient is also using corticosteroid inhaler, instruct patient to use bronchodilator first and then to wait about 5 min before using corticosteroid. Tell patient to remove canister and wash aerosol inhaler with warm soapy water at least once a week. Advie patient ot genly wipe it with dry cloth or tissue. Advise patient not to use more than prescribed and not to increase dose or frequency without consulting physician. Fatalities have been reported from excessive use. Instruct patient to report worsening symptoms. Advise patint not to chew or crush extended release tablets or mix them with any food.

Last Updated 8/2/2021

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vSim for 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. S TUDENT L EARNING OUTCOMES At the end of this, 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.

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.

Last Updated 8/2/2021

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vSim for VSIM Criteria Content Knowledge

Critical Thinking

5 Points

4 Points

• Follows all requirements for the assignment. • Major points of topic are • Conveys well-rounded mostly covered in the knowledge of the topic. required assignment • Content well organized, areas. logical. • Content organized, logical • Easy to read and flow. understand throughout all • Easy to read and of worksheet. understand through most of worksheet.

• Follows all requirements for the assignment.

3 Points

2 Points

Total Points

1 point

• Knowledge of topic is • Knowledge of topic is partially covered. general in more than three areas of the worksheet. • Key information is missing from 2 or more assignment • One or more areas of areas. worksheet left blank. • Worksheet difficult to follow • Content unorganized in two or more areas. throughout worksheet. • Information is incomplete • Difficult to understand in two or more areas. content of paper.

• 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.

• Major aspects of the • Few aspects of the content content areas are areas presented. presented, but content • Few insights presented, • Analyzes information, • Presents information about lacks insight and analysis. lacking analysis. connects data points to the topic. • Few data points connected • Data points not connected provide accurate, concise to provide information. • Some analysis, insight to information provided. information. present, some data points • Little Understanding gained • Scholarly work. threaded together. from information presented. • Scholarly work.

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

• Some minor errors (1-3 • Frequent errors (4-5 errors) with spelling, errors) with spelling, grammar and/or sentence grammar and/or sentence • Grammar, readability, and structure, not consistent structure. sentence structure is error throughout worksheet. free. • Errors do not interfere with • Errors effect ability to comprehend information the readability or present on worksheet and comprehension of readability. information.

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

• Concisely explains each content area.

Writing Composition • An occasional spelling (Spelling, Grammar, Sentence Structure)

WORKSHEETS GRADING RUBRIC

error present.

• Explains each content area.

• Numerous errors (5-6 errors) with spelling, grammar and/or sentence structure throughout worksheet.

• Difficult to understand • Unable to understand information presented due to • information presented in the numerous errors. worksheet.

TOTAL POINTS: _____ Last Updated 8/2/2021

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vSim for CLINICAL WORKSHEET Dat 07/06/2021 e: Initia HW ls: Ag 69 yo e: M/ male F: Code Status: does not say

Student Jennifer Phinney Name:

Diagnosis:

HCP:

Isolation:

COPD exacerbation

Does not say

None

Length of Stay:

Assigned vSim:

Henry Williams Part 1

IV Type:

Critical Labs:

Other Services none

Fall Risk:

Location:

pH- 7.34 pco2-50 hco3-27 pco288 wbc-11,800 hgb-10

Does not say

Consults:

moderate

Right wrist/upper hand

Allergies: Penicillian

None noted

Transfer: None noted

Fluid/Rate: Lactated ringers 50ml/hr

Consults Needed: Respiratory therapy for patient educatin

Why is your patient in the hospital (Answer in your own words and include the History of present illness)? From shortness of breath due to complications from COPD. He is unable to exchange gas the way his body needs and is trying to over compensate for the inadequate oxygen exchange. He has a history of COPD, chronic bronchitis, asthma, colds and is a former k History/Comorbi...