V Sim Worksheets - Carl Shapiro PDF

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DESCRIBE DISEASE PROCESS AFFECTING PATIENT (INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS) A myocardial infarction (MI), also known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. Prolonged lack of oxygen to the heart muscle cause ischemia and eventually leads to tissue necrosis. DIAGNOSTIC TESTS (REASON FOR TEST AND RESULTS) 

12 lead ECG



Lab tests for biomarkers (CK-MB, Troponin).

PATIENT’S INFORMATION 54 years old patient was admitted with complain of chest pain. He also experienced diaphoresis and shortness of breath. Patient took aspirin and two tablets of nitroglycerin. His vitals were stable upon admission. He reported that he currently doesn’t experience chest pain.

ANTICIPATED PHYSICAL FINDINGS Myocardial Infarction characterized by diaphoresis, SOB, cool pale and moist skin, ST elevation on ECG, jugular vein distention, heart rate and respiratory are faster than normal. Patient also may experience anxiety and restlessness. ANTICIPATED NURSING INTERVENTIONS Monitor continuous ECG, perform pain assessment, administer nitroglycerin and other pain medications as needed. vSim ISBAR ACTIVITY WORKSHEET INTRODUCTION

STUDENT , med surg 2

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

SITUATION

Carl Shapiro. 54 years old who complain of chest pain.

Patient’s name, age, specific reason for visit

BACKGROUND

He was admitted today. Diagnosis: angina. The current orders: N/S at

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

25 ml/hour, Morphine Iv push PRN. There is an order for a continuous ECG and SpO2 monitoring. There is also an order for a chest x-ray and labs showed elevated tropoinin (2) and CKMB (20).

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

Vital sings: BP 124/74, HR 82, O2 98%. T 99. Respirations 12. Patient denied chest pain. Lung and heart sounds are clear. Patient developed V-fib, his heart stopped. The code team arrived and defibrillator patient’s heart.

RECOMMENDATION

Continue to monitor patient

ASSESSMENT

Any orders or recommendations you may have for this patient

PHARM-4-FUN PATIENT EDUCATION WORKSHEET NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE MEDICATION: Morphine – opioid analgesics. Aspirin – analgesic, pyretic. Nitroglycerine - nitrates

SAFE DOSE OR DOSE RANGE, SAFE ROUTE Morphine IV dose 4-10mg q 4, Oral dose 10-20mg q 4, SQ/IM – 5-20 q 4. V Aspirin PO, doses 50-325mg Nitroglycerine, doses 0.3-0.6 mg SL q5min up to 3 times

PURPOSE FOR TAKING THIS MEDICATION Morphine and nitroglycerin – opioid, pain medication. Aspirin is used for pain and prevention of blood clots.

PATIENT EDUCATION WHILE TAKING THIS MEDICATION Morphine should be taken with water, never crashed or break. The nitroglycerin pills go under the tongue, don’t chew or crash a tablet. Take maximum of there pills with 5 minutes interval between each of them. Aspirin should be taken with water. Common side effects: drowsiness, dizziness, tiredness, constipation, sweating. Call the doctor if you start to experience allergic reaction, slow heart rate, shallow breathing, chest pain.

Clinical Worksheet Date: 4/19/20 Initials :CS Age:54

Student Name: Assigned vSim: Diagnosis: Myocardial HCP: Infarction Length of Stay1 day Allergies: None Consults:N/A

M/F:M

Isolation:No

FallRisk

IVType: Location :right AC

Critical Labs: CKMB-20 Troponin-2.2 HCO3-18

Other Services:N/A

Consults Needed:N/A :No

Fluid/Rate:N/S 25mL/H

Code Status:Full Transfer

No

Why is your patient in the hospital (Answer in your own words and include the History of present Illness)?: Patient was admitted with the chest pain. Later on he developed V-fib and went to a cardia arrest. The code team resuscitate the patient. Health History/Comorbities (that relate to this hospitalization):N/A Shift Goals/ Patient Education Needs: 1. Monitor ECG 2. Pain management 3. Review labs for biomarkers 4. Monitor O2 levels 5. Provide patient education. Path to Discharge: Normal biomarkers levels, absents of chest pain, regular heartbeat.

Path to Death or Injury:N/A

Alerts: What are you on alert for with this patient? (Signs & Symptoms) 1. Cardia Ischemia 2. Acute pain 3. Cardiac arrest

Management of Care: What needs to be done for this Patient Today? 1. Administer pain medications 2. Monitor ECG 3.Monitor lab biomarkers results 4. Check for proper oxygen level 5. Provide patient education

4. SOB What Assessments will focus on for this patient? (How will I identify the above signs &Symptoms?) 1. Patient stated that he experiences chest pain

Priorities for Managing the Patient’s Care Today 1. Monitor continuous ECG and O2 levels 2. Draw labs 3. Pain assesemnt.

2. ECG changes 3. Monitor lab results List Complications that may occur related to dx, procedure, comorbidities: 1.Miocardiac infarction from prolonged ischemia 2.V-fib 4. Cardiac arrest What nursing or medical interventions may prevent the above Alert or complications? 1. Contact HCP immediately 2. Call for code team in the event of cardiac arrest 3. Start to perform CPR

What aspects of the patient care can be Delegated and who can do it? CPA can check vital sings, can help patient change position in bed if needed, can collect blood/ urine samples

Clinical Worksheet

Reflection Questions Paste your reflection questions in the box below

1. How did the scenario make you feel? I felt comfortable to provide care to this patient.

2. What could have been the causes of Carl Shapiro’s ventricular fibrillation? Prolonged ischemia, elevated CK-MB and Troponin as well as inadequate blood flow to the heart could cause V-fb. 4. When performing CPR for Carl Shapiro, what are quality indicators you are performing resuscitation correctly? Call the code team, use the compression board under the patient, do 30 deep fast compressions with 2 breaths in between sets of 30. Make sure nothing is touching the bed or the patient while using electrical shock. 5. Discuss safety aspects during defibrillation. You must say clear and make sure everyone step back.

6. If Carl Shapiro would have had return of spontaneous circulation (ROSC), what would your next interventions be? Identify the cause and make sure circulation is good enough for organ perfusion. 7. What key elements would you include in the handoff report for this patient? Handoff should be performed using ISBAR format, the admitting details, current pain level, vitals, labs and other MI symptoms such as diaphoresis, SOB. The current orders should be discussed during patient handoff. The test results should be reviewed. 8. If Carl Shapiro’s family members had been present at the bedside during the arrest, describe what you could have done to support them during this crisis. Educate family on patient’s condition and current status, provide emotional support and keep them updated on the situation. 9. What would you do differently if you were to repeat this scenario? How would your patient care change? I would provide same care to the patient.

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

Score: vSim 1

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

EAD B EAD B EAD B

Total for category: Interpreting: Prioritizing Data: Making Sense of Data:

EAD B EAD B

Total for category: Responding: Calm, Confident Manner: EAD B Clear Communication: EAD B Well-Planned Intervention/Flexibility: EAD B Being Skillful EAD B Total for category: Reflecting: Evaluation/Self-Analysis: EAD B Commitment to Improvement: E A D B

Total for category:

Score: vSim 2

Score: vSim 2...