Passport Based on Simulation via VSim

HANSEN STUDENT PASSPORT FOR MIDSEMESTER SIMULATION SCENARIO PREP Please complete this prior to your simulation . This must be brought to your simulation day. Learning objectives : Identifies the primary nursing diagnosis Implements patient safety measures Evaluates patient assessment information including vital signs Implements therapeutic communication Implements direct communication with multidisciplinary team members Demonstrates effective teamwork Prioritizes and implements physician orders appropriately Recalls indications ,contraindications, and potential adverse effects of prescribed medications Implements the “rights” of medication administration Implements appropriate diabetic teaching Identifies metabolic imbalance as evidenced by lab values Report to the students : Time : 0700 Day three of admission Skylar is an 18-year-old female who was brought in by ambulance to the emergency department in diabetic ketoacidosis , three days ago. She has spent the last two days in the intensive care unit receiving IV fluids and IV insulin. She was transferred to our unit last night after having surgery to remove her appendix . Her IV is now a saline lock in his right forearm . His electrolytes and blood sugars have stabilized . Urinary catheter has been discontinued last PM. She is voiding without difficulty. Output during the night was 700ml. The incisions are intact with no redness or drainage . Skylar complains of minor discomfort . She reports her pain scale 3/10. Her mother has been with her since she was admitted, and Mom is very worried for her. I have not given any morning medications. Have a good shift . Patient information card Name: Skylar Hansen MR#: 3561031118 Gender: female Weight : 70 kg Race : Caucasian Religion: NA DOB : 03/11/xxxx Age : 18 Height : 72 inches Activity of daily living: Independent up at liberty Fall precautions : no Prior medication history: He has no significant past medical history and takes no Advanced directives : full code History : no significant past medical history Allergies: NKDA Immunizations: current Diet: regular ADA Social history: Active in sports; denies smoking or illicit drug use ; mother reports son Isolation : none medications Recent medical history: Reports fatigue , hunger and frequent urination that began 2-3 weeks ago and has becoming progressively worse. Complins of right sided tenderness. Home medications : Patient takes no medications Medication administration : Maintain IV access : Cefazolin 1 gm IVPB q6h 0700 NPH 22units sq Novolog 6 units sq 1200 NovoLog 6units 1700 NPH 8 units Novolog 6 units Physicians orders Patient name : Skylar Hansen DOB: 3/11/xxxxx. MR#: 3561031118 Age: 18 gender : male Height : 72 inches weight : 70 kg No known allergies Date Today Time Now has come home drunk a couple times last year . he states that he occasionally drinks alcohol ; lives with parents and siblings Diagnostic studies : Labs: Finger sticks AC & HS Monitoring : Vital signs q shift SpO2 with vitals Titrate to keep O2 92 % Discharge planning Schedule diabetic educator for patient teaching Diagnosis : new onset diabetes , s/p appendectomy Physician : Keith Thomas MD No sensitivities Admit to the medical unit Condition stable Code status : full code Vital signs : every shift Call for BP< 100 pulse >120 RR>16 SpO2 with vitals Titrate to keep O2 92 % I&O q shift Diet : regular ADA Finger sticks AC & HS Medications: 0700 NPH 22units sq Novolog 6 units sq 1200 NovoLog 6units 1700 NPH 8 units Novolog 6 units IV access: saline lock Cefazolin 1 gm IVPB q6h Sliding Scale Regular Insulin (Moderate Dose Scale) For Blood Sugar AC and HS 70-130= 0 units 131-180= 4 units 181-240= 8 units 241-300=10 units 301-350= 12 units 351-400= 16 units >400= 20 units and call MD MEDICATION ADMINSTRATON RECORD Patient name : Skylar Hansen DOB: 3/11/xxxxx. MR#: 3561031118 Age: 18 gender : male Height : 72 inches weight : 70 kg No known allergies MEDICATION NPH insulin 22 units Novolog insulin 6 units Novolog insulin 6 units Novolog insulin 8 units Novolog 6 units Sliding Scale Regular Insulin (Moderate Dose Scale) For Blood Sugar 70-130= 0 units 131-180= 4 units 181-240= 8 units 241-300=10 units SCHEDULE 0700 Diagnosis : new onset diabetes Physician : Keith Thomas MD No sensitivities TODAY DAY 2 DATE TODAY DAY 2 DATE 0700 1200 1700 1700 0730 1130 1630 2100 301-350= 12 units 351-400= 16 units >400= 20 units and call MD Cefazolin 1 gm IVPB q6h – 10 cc syringe, needle, sterile water, cefazolin power, 2 alcohol wipes INITIALS 0800 1400 2000 0200 PRINT NAME SIGNATURE DATE 1. What is the pathophysiology for Type 1 Diabetes? An autoimmune disease where there is a destruction of beta cells of the islets of Langerhans in the pancreas which leads to a lack of insulin resulting in hyperglycemia and diabetic ketoacidosis when severe. Electrolytes are altered resulting in hyperglycemia, acidosis, dehydration, hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia, and hypophosphatemia. If diabetic ketoacidosis persists, hyperglycemic hyperosmolar nonketotic syndrome (HHNS) may evolve and cause symptoms such as, tachycardia, hypotension, marked dehydration, and neurological manifestation such as seizures, and hemiparesis. 2. Based on your review of the information concerning this client , what are two possible nursing concerns? Concern #1 : Risk for Fluid Volume Deficit AEB frequent urination Concern #2 : Risk for Infection AEB altered electrolytes during diabetic ketoacidosis 3. After obtaining report , reviewing the physicians orders , and labs. What will you do first when you enter the client’s room? Wash my hands, introduce myself, identify the patient, take vital signs, blood glucose, administer medications, assess neuro cardio resp, monitor pt closely, provide pt education, attach 3 lead ecg 4. What vital signs will you obtain ? BP, HR, RR, o2, temp 5. What task from the physicians orders needs to be done before meals and at bedtime? write a brief summary of how this is performed . - Take blood sugar checks/sticks, ACHS which is Q4. The first blood sugar check should be taken 1 hour before breakfast, so @0730. The next one at lunch @1130, and dinner @1630. The one taken before bedtime is done @2030. The pt is prescribed Novalog or known as Asparat which is a rapid acting insulin with an onset of 5-10min and peak within 1-3 hours, which is why it makes sense to give this 30min before blood sugar check since food will arrive within the hour and a half which is when the peak occurs while the pt is eating. Another insulin the pt is prescribed is NPH which is an intermediate acting insulin with an onset of 1-3 hours and peak of 6-8 hours and is given with the novalog during breakfast. 6. Based on the physicians orders , what medication(s) may be needed? You will need to be prepared to obtain needed supplies , verbalize how it is drawn up and administered. What are the patient safety issues regarding this medication ? does this medication dosage need to be double checked with another nurse? Novalog (Aspart), and NPH. Pt safety is regarding making sure to eat meals on time after insulin is given. Another safety issue involves monitoring the pt’s BP for hypotension and dehydration as hypovolemia may occur since the pt was urinating a lot. Make sure blood glucose numbers is appropriate to unit doses by looking at the reference in the med orders above. Do not administer insulin if blood glucose is below 70 as it creats a risk for hypoglycemia. 7. State each medications you will be administering, their dose, their onset of action , duration , peak , side effects and contraindications . Novalog (Aspart): DoseOnsetDurationPeakSEContraindicationsNPH: DoseOnset- DurationPeakSEContraindications-