V Sim Rashid Ahmed - This is a vSim PDF

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STUDENT

CLINICAL REPLACEMENT PACKET

Student Resources

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 addition to the Clinical Replacement Activity Packet (worksheets included in this document), submit the worksheets, in one document, for grading in the assignment dropbox. Before beginning any vSim, please review all worksheets and rubrics, at the bottom of this document, to ensure you complete activities fully and accurately. NOTE: All paperwork required below has been provided to you in a separate document titled “Worksheets Template for Clinical vSim Assignments.” Please fill that document in to complete your assignment, which you will then submit to your assignment dropbox in your course. LEARN FLOW - STEP ONE

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

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 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

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 Launch the virtual simulation o Student is to complete the simulation as many times as it takes to meet a 100% benchmark. LEARN FLOW - STEP FOUR

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 Complete the Post-Quiz, you must achieve 100% o If you do not achieve 100% you must go back and re-do the simulation exercise and then retake the quiz LEARN FLOW - STEP FIVE

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 Document o The student documents the clinical events that occurred during the simulation using docuCare. o The same vSim patient will be assigned to you in your DocuCare cases, so it will directly align with your vSim experience. LEARN FLOW - STEP SIX  Reflection Questions and Lasater Evaluation o Students are to complete the reflection questions, which are included in the vSim. You will download the word document to answer the questions and then paste your questions and answers into the worksheet template. o Students are to complete the Lasater Evaluation on each vSim. This document can be found in your worksheets template. You are to score yourself on the rubric provided in the worksheet template.

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CONCEPT MAP/ PLAN OF CARE

ASSIGNMENT

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

ASSIGNMENT 1. Log into thePoint and launch the assigned vSim, following all instructions contained in this document. 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, to the course dropbox.

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

Hypokalemia: Deficient serum potassium levels (less than 3.5m Eq/L). Hypokalemia usually occurs as a result of increased potassium secretion, or a shift of potassium from extracellular to intracellular space. Potassium imbalance can lead to muscle weakness and flaccid paralysis because of an ionic imbalance in neuromuscular tissue excitability. Dehydration: occurs when an individual loses too much fluid and water from the body. The body needs water and other elements called electrolytes to function properly. The daily loss of fluid each day happens through sweat, urine, bowel movements, and breathing. However, if the water and electrolytes are not replaced it will lead to dehydration. (Lippincott Advisor, 2020) DIAGNOSTIC TESTS ANTICIPATED PHYSICAL FINDINGS PATIENTINFORMATION (REASON FOR TEST AND RESULTS) -Rashid Ahmed  Weak, irregular pulse - 50-year-old  Tachycardia, tachypnea BMP- Potassium level is less - Race: White  Arrhythmias, including than 3.5mEq/L premature atrial and - Male ventricular beats, - DOB: 7/12/1970 bradycardia, paroxysmal ABG- elevated HCO3- and pH - Adm on: 3/16/2021 atrial or junctional levels. - Dx: Dehydration and tachycardia, atrioventricular hypokalemia block, ventricular tachycardia -NKA Urinalysis- potassium to or ventricular fibrillation, and -73.5kg torsades de pointes creatinine ratio is less than 13  Orthostatic hypotension -180cm mEq/L. (Lippincott Advisor, 2020) -Immunizations up to date. ANTICIPATED NURSING INTERVENTIONS 

       

Administer prescribed drugs. o If administering potassium chloride IV, administer it slowly, at a rate not greater than 10 mEq/hour and with a concentration not exceeding 40 mEq/L. Use a saline solution instead of dextrose to prevent insulin release (due to dextrose infusion), which in turn would cause more potassium to enter the cells. If possible, administer it via central venous access, which allows up to 40 mEq in 100 mL to be given over 1 hour; check your facility's guidelines for administration. Institute continuous cardiac monitoring if the patient is receiving an IV potassium replacement or is exhibiting cardiac effects due to hypokalemia. Obtain specimens for laboratory testing, including frequent serum potassium levels. Insert an indwelling urinary catheter, as indicated; assess urine output hourly. Implement safety measures. Inspect the abdomen and auscultate for bowel sounds. Report any changes. Ensure that bathroom facilities are readily available and assist with perianal care as necessary. Provide high-potassium foods. Enlist the aid of a dietitian to assist with meal planning and food choices. Be alert for signs of hyperkalemia after treatment (Lippincott Advisor, 2020)

vSim 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 SBAR report.

ASSIGNMENT 1. 2. 3. 4. 5.

Log into thePoint and launch the assigned vSim, following all instructions included in this document. 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 suggested reading. Navigate and fill out the data in the following document using the patient information provided in the suggested reading area. Submit for review, to the course dropbox.

vSim ISBAR ACTIVITY INTRODUCTION

STUDENT WORKSHEET Hello, my name is Laura Alvarez RN in the medical surgical unit 0730.

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

Mr. Rashid Ahmed is a 50-year-old Middle Eastern male who was admitted to our unit at 0600 this morning after being admitted to the ED at 0400 with a diagnosis of dehydration and hypokalemia. We are monitoring his fluid and electrolyte status closely. I have just received admission orders. The patient’s primary diagnosis is dehydration and hypokalemia, and the date of admission is 03/16/2021. Current orders: Vital signs q4h and prn. Daily weights. Activity: bed rest, up with assistance. Diet: Clear liquids, progress to regular as tolerated. IV: 1000mL dextrose 5% in normal saline with 20mEq KCL at 125mL/hr. Intake and Output, record every 8 hours. Medications: trimethoprim/sulfamethoxazole 160/800 mg orally every 12 hrs. Potassium chloride (KCL) 40 mEq PO once, then recheck potassium in 6 hours. The patient is AAO x3. Breath sounds are clear and equal bilaterally. The skin is warm, dry, and exhibits tenting. Reduced muscle strength in both arms and legs. There is normal sensation. Output: 70mL of dark amber urine Diagnostics: pH- 7.31 (L), HCO3- 15 (L), HCT- 55 (H), WBC- 21(H),K+- 2.9 (L), Na+- 130 (L), CL-97 (L), BUN- 26 (H) Vital Signs: HR and rhythm: Irregular, 120/min Pedal Pulse: Irregular, 120 bpm Temperature: 101 F, Tympanic SpO2- 96% Respiratory rate: 29/min BP:100/72 4/10 pain

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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. ASSIGNMENT 1. 2. 3. 4. 5.

Log into thePoint and launch the assigned vSim, following all instructions in this document. 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.

PHARM-4-FUN PATIENT EDUCATION WORKSHEET NAME OF MEDICATION and CLASSIFICATION MEDICATION: Sulfamethoxazole-trimethoprim Potassium chloride Ondansetron CLASSIFICATION: Sulfamethoxazole-trimethoprim: antibiotics Potassium chloride: potassium supplements Ondansetron: Antiemetics

SAFE DOSE OR DOSE RANGE, SAFE ROUTE Sulfamethoxazole-trimethoprim: 160/800 PO Potassium chloride: 40mEq PO Ondansetron: 4mg PO

PURPOSE FOR TAKING THIS MEDICATION Sulfamethoxazole-trimethoprim: traveler’s diarrhea Potassium chloride: To prevent or treat hypokalemia Ondansetron: To prevent nausea and vomiting

PATIENT EDUCATION WHILE TAKING THIS MEDICATION Sulfamethoxazole-trimethoprim: Tell patient to take drug as prescribed, even if feeling better. Potassium chloride: Teach patient signs and symptoms of hyperkalemia and tell patient to notify prescriber if they occur. Ondansetron: Caution patient to contact health care provider immediately for signs and symptoms of abnormal HR or rhythm, such as palpitations, dyspnea, or dizziness.

(Lippincott Advisor, 2020)

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.

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 Date:3/16/2021

StudentName: Laura Alvarez

Assigned vSim: Rashid Ahmed Initials:

R.A

Diagnosis: Dehydration and hypokalemia

HCP: Dr. Stephen Smith

Length of Stay: 0.2 days

Consults:

Age:50 M/F:M Allergies: NKA Code Status: Full Code

Isolation: Standard Fall Risk: High Transfer: N/A

Why is your patient in the hospital (Answer in your own words and include the H Mr. Rashid Ahmed is in the hospital because he has been experiencing abdominal c

Health History/Comorbidities (that relate to this hospitalization): Patient was diagnosed with dehydration and hypokalemia.

Shif Goals/ Patient Education Needs: 1. Patient will explain the importance of I&Os. 2. Patient will report a pain level of 0 by the end of shift. 3. Patient will be educated on activities, safety, and fall risk.

4. Patient will not exhibit symptoms of hypokalemia or dehydration by the end of s Path to Discharge:  Evaluate how the patient's current illness will affect the patient's independe  Assess the patient's level of independence before admission.  Determine the appropriate posthospital setting to which the patient will be

Clinical Worksheet Managem Path to Death or Injury: - If untreated: ent of Cardiac arrest, cardiac arrythmias, Ileus, Rhabdomyolysis, Respiratory failure may occur. Care: What Alerts: What are you on alert for with this patient? (Signs & Symptoms) 1. Palpitations 2. Tachycardia 3. Tachypnea What Assess ments will focus on for this patien t? (How will I identif y the above signs &Sym ptoms ?) 1.

2.

Vi ta l Si gn s A us cu lta

3.

4.

tion of the lungs Auscult ation of the heart Neurol ogical assess ment

needs to be done for this

6.

Start IV infusion

7.

Educate patient

What aspects of the patient care can be Delegated and who can do it? (Lippincott Advisor, 2020) Vital signs can be delegated to an LPN after the RN has established a baseline for the patient. The UAP can let the nurse know when the patient feels the urge to void or when they void so that the nurse can go record the output volume, and characteristics.

Patient (Lippincott Advisor, 2020) Today? 1. Vital signs

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

2. Assess pain level 3. Auscultate the heart

1.

Cardiac arrythmia

2.

Cardiac Arrest

3.

Respiratory Failure

4. 5. 6. 7. 8.

4.

Ileus

Auscultate lung sounds Neurological Assessment Administer medication Start IV infusion Educate patient on medications, dehydration, I&Os, activities, safety, and fall risk.

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

Priorities for Managing the Patient’s Care Today 1. Vital signs

1. Auscultate heartbeat and rhythm 2. Auscultate lung sounds 3. Monitor I & O’s 4. Vital signs q4h

2.

Assess pain level

3.

Auscultate lung sounds

4.

Auscultate heart sounds

5.

Administer medication

Reflection Questions

Opening Questions How did the simulated experience of Rashid Ahmed’s case make you feel? The simulated experience of Rashid Ahmed’s case made me feel a little more confident when providing patient care, because I was able to understand the concepts better in this simulation than in the others. Talk about what went well in the scenario. Giving the medications went very well along with educating the patient on the medications being administered. I was also able to tell what to perform first based on the priorities of the current orders Reflecting on Rashid Ahmed’s case, were there any actions you would do differently if you were to repeat this scenario? If so, how would your patient care change? Put on gloves, and wash hands before and after giving medication to help protect the patient from infections. Scenario Analysis Questions PCC What priority problem(s) did you identify for Rashid Ahmed? What information led to identification of the priority problems? Mr. Ahmed has an electrolyte imbalance specific due potassium and sodium due to his dehydration. All his labs showed signs of electrolyte imbalance and dehydration. When I assessed Mr. Ahmed, he was experiencing tachycardia, high temperature, and a low blood pressure. He complained of dizziness, stomach pains, and a headache (pain 4/10). His skin presented warm, dry, and tenting occurred. PCC Complete the following table related to the causes and assessment findings specific to Rashid Ahmed’s fluid imbalance.

Cause of fluid deficit



Vomiting and Diarrhea

Assessment Findings

Cause of assessment changes

Skin tenting

Fluid imbalance due to dehydration

Urine dark and amber color

Not enough water for the kidneys to excrete which causes the concentrated urine.

Weakness

Potassium deficiency can lead to muscle weakness since contraction depends on it.

Elevated Temperature

Body temperature is controlled by the fluid in the body through methods like sweating. However,

if there is not enough fluid circulating it can cause the body to improperly regulate the body temperature allowing it to rise. PCC What potential problems could arise if the identified fluid and electrolyte imbalances are not corrected? If electrolyte imbalance is not corrected potential problems that can occur include cardiac arrythmias, cardiac arrest, respiratory failure, ileus, and rhabdomyolysis. EBP Identify the rationale for weighing Rashid Ahmed at the same time each day wearing the same clothing. Wearing the same clothes every day to be weighed will allow for more accurate results, and he would be weighed every day to assess whether the fluid that is being given to him is being retained or it is being excreted. EBP Discuss the rationale for infusion of 0.9% normal saline. It is the same concentration of solutes as it is inside of the blood. S Identify potential patient safety issues Due to Mr. Ahmed complaints of dizziness and weakness he is at greater risk for fall. His more fall scale score is a 70. He also has an IV in place which puts him at risk for skin issues. T&C What other interprofessional team members should be involved in Rashid Ahmed’s care? Other interprofessional team members that should be involved include dietitians to make sure that he is getting the proper nutrients to make up for his electrolyte imbalance. His PCP because they would have a better medical history for Mr. Ahmed and be more familiar with the pt. Concluding Questions Describe how you would apply the knowledge and skills that you obtained in Rashid Ahmed’s case to an actual patient care situation. In an actual patient care situation, I would be more aware of the clinical manifestations of hypokalemia and dehydration. I would know who to collaborate to treat the patient diagnosed with the same problems as Rashid Ahmed. Finally, I will always implement education into my patient care.

Clinical Judgement Components Scoring: Exemplary = 4 point Accomplished = 3 points Developing = 2 points Beginning = 1 point Noticing:

Score: vSim 1

Focused Observation: EAD B Recognizing Deviations from Expected Patterns: EAD B Information Seeking: EAD B

4

Total for category:

4 4 12

Interpreting: Prioritizing Data: Making Sense of Data:

EAD B EAD B

4 4

Total for category: 8 Responding: Calm, Confident Manner: EAD B Clear Communication: EAD B Well-Planned Intervention/Flexibility: EAD B Being Skillful EAD B

4 4 4 4

Total for category: 16 Reflecting: Evaluation/Self-Analysis: EAD B Commitment to Improvement: E A D B

4 4

Total for category: 8

Score: vSim 2

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