Sim Olivia Jones

vSim CLINICAL REPLACEMENT PACKET for STUDENTS EST. TIME: 6 HOURS 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 additon to this Clinical Replacement Activity Packet, submit for grading as instructed in your syllabus. LEARN FLOW - STEP ONE 1  Finish the Suggested Readings, then complete the following four activities: o Clinical Worksheet o Plan of Care Concept Map o Pharm4Fun Worksheet (one per medication) o ISBAR Worksheet LEARN FLOW - STEP TWO 2  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 3  Launch the virtual simulation o Suggest student complete the vSim Tutorial prior to launching Step Three. o Each clinical experience in the simulation lasts a maximum of 30 minutes. o Student is to complete the simulation as many times as it takes to meet an 80% benchmark. LEARN FLOW - STEP FOUR 4  Complete the Post-Quiz o The answer key is not visible to the student until after they have submitted the quiz. o The quiz grade is recorded as a percentage LEARN FLOW - STEP FIVE 5  Document o The student documents the clinical events that occurred during the simulation using the information contained in step five. o If using DocuCare, the instructor assigns the same vSim patient which can be found in DocuCare cases. LEARN FLOW - STEP SIX  Reflection Questions o Students are to complete the reflection questions and submit to instructor post clinical replacement (see syllabus for details). o The quiz grade is recorded as a percentage 6 CONCEPT MAP/ PLAN OF CAREEST. TIME: 30 MINUTES This activity creates an opportunity for you to organize the nursing care required for the patient presented in your assigned vSim. STUDENT LEARNING OUTCOMES 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. CONCEPT MAP WORKSHEET DESCRIBE DISEASE PROCESS AFFECTING PATIENT (INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS) Preeclampsia  Preeclampsia refers to a blood pressure higher than 140/90 mm Hg after 20 weeks of gestation.  Preeclampsia is a multisystem, vasopressive disorder that affects the cardiovascular, hepatic, renal, and central nervous systems  It can be classified as mild or severe  Pathologic changes include pulmonary edema, oliguria, seizures, thrombocytopenia, and abnormal liver enzymes  Several research studies have concluded that calcium, magnesium, and zinc supplements, salt restrictions, diuretic therapy, or fish oil have not proved to prevent this condition DIAGNOSTIC TESTS (REASON FOR TEST AND RESULTS)              CBC – to get an accurate answer in regards to the number of RBCs, WBCs and platelets that the patient has. BUN and creatinine – to check for kidney damage Hepatic enzyme levels – to check for elevated ALT and AST Urine protein - to check for elevated protein in the urine PATIENT INFORMATION      Olivia Jones, 23 y.o. African American female G1P0 at 36 weeks of gestation Diagnosed with preeclampsia at her 30 weeks visit when her BP was 140/92 mm Hg Patient has been at bedrest since her last prenatal visit, but symptoms have worsened Currently she is experiencing a headache, nausea, fatigue, epigastric pain, visual changes, and chest tightness         ANTICIPATED PHYSICAL FINDINGS Weight gain Swelling of face (edema) Headache Visual disturbances Oliguria SOB Epigastric pain Nausea and vomiting ANTICIPATED NURSING INTERVENTIONS Weight patient regularly Check for edema Monitor for signs of excessive/ intensified edema, headache, epigastric pain, nausea and vomiting Assess and monitor VS Head-to-toe assessment Obtain ultrasound Administer medications as ordered Implement fall and seizure precautions Educate and comfort the patient IS AREST TIMEMIN This SBAR actvity 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. STUDENT LEARNING OUTCOMES 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. 2. 3. 4. 5. Log into the Point and launch the assigned vSim, following all instructions posted on your learning management system (LMS). 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 ssuggested reading. Navigate and fill out the data in the following document using the patient information provided in the suggested reading area. Submit for review. vSim ISBAR ACTIVITY INTRODUCTION STUDENT WORKSHEET  Good morning. My name is Dora, and I am an RN on the labor and delivery unit.  I have a patient, Ms. Olivia Jones 23-year old patient who was admitted at 36 weeks of gestation for assessment and surveillance of preeclampsia.  She had an uneventful pregnancy until her office visit at 30 weeks of gestation when her BP measured 146/92 mm Hg, she had proteinuria, and mild preeclampsia symptoms. Although the patient has been at bedrest ever since, her symptoms have worsened, thus she came to the ED. She has gained 3 lbs since her last OB visit 1 week ago. Current orders include: bedrest, check VS following provider’s instructions, O2 per NRB 10 L, Lactated Ringer’s 100 mL IV 125 mL/hr infusion, Magnesium Sulfate 20 g in 500 mL sterile water at 50 ml/ hr. 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  Olivia’s latest VS are as follow: HR:112, BP: 176/105 mm Hg, Resp: 22, O2: 89%, Temp: 37C, FHR: 167. There is a moderate to severe pitting edema graded to +3. There is no obvious airway obstruction. There is normal elasticity of the skin. Her skin is cool and she is very sweaty. The deep tendon reflexes were very brisk, hyper reflexive, and with clonus. Graded to +4. Patient reported epigastric pain 4/10 and a headache 5/10. There are crackles at the bases of both lungs. My recommendations would be: - Monitoring the vital signs as ordered - Continue with the head-to-toe assessments as ordered - Provide patient education and comfort measures PHARM-4-FUN EST. TIME: 30 MIN (PER MEDICATION) 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. STUDENT LEARNING OUTCOMES At the end of this activity, student will be able to: 1. 2. Explain purpose for taking the identified pharmacological agents. 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). Review the information contained in the patient information. 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. 2. 3. PATIENT EDUCATION WORKSHEET NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE MEDICATION: Magnesium sulfate CLASSIFICATION: Therapeutic class: Electrolyte replacements Pharmacologic class: Minerals PROTOTYPE: Magnesium Sulfate SAFE DOSE OR DOSE RANGE, SAFE ROUTE Depending on the reason of treatment (please see below).   PURPOSE FOR TAKING THIS MEDICATION Mild hypomagnesemia: 1 g IM every 6 hours for four doses, depending on magnesium level Symptomatic severe hypomagnesemia, with magnesium level of 0.8 mEq/L or less: 5 g IV in 1 L of D5W or NSS over 3 hours Magnesium supplementation in total parenteral nutrition (TPN): 8 to 24 mEq IV daily added to TPN solution. Seizures in preeclampsia and eclampsia: Initial dose: 10 to 14 g IV. Give 4 to 5 g IV in 250 mL of solution and simultaneously give up to 10 g IM (5 g or 10 mL of the undiluted 50% solution in each buttock.     PATIENT EDUCATION WHILE TAKING THIS MEDICATION    Explain the use and administration of the medication to the patient. Stress the importance of keeping lab appointments Advise patient to report all adverse effects which include: diarrhea, diaphoresis, hypotension, flushing, drowsiness, stupor, paralysis. Clinical Worksheet 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 patien prioritize interventions, and identify aspects of care that could be delegated. STUDENT LEARNING OUTCOMES 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 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. Clinical Worksheet 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 vSim Worksheets Grading Rubric Criteria 5 Points 4 Points Content Knowledge -Follows all requirements for the assignment. -Conveys well-rounded knowledge of the topic. -Content well organized, logical. -Easy to read and understand throughout all of worksheet. -Follows all requirements -Knowledge of topic is for the assignment. partially covered. -Major points of topic are -Key information is missing mostly covered in the from 2 or more assignment required assignment areas. areas. -Content organized, logical -Worksheet difficult to follow flow. in two or more areas. -Easy to read and -Information is incomplete in understand through most two or more areas. of worksheet. Critical -Concisely explains each content area. -Analyzes information, connects data points to provide accurate, concise information. -Scholarly work. -Explains each content -Few aspects of the -Information is basic. area. -Presents information about the topic. -Some analysis, insight present, some data points threaded together. -Scholarly work. content areas presented. Few insights presented lacking analysis. -Data points not connected to information provided. -Little understanding gained from information presented. -No aspects of the content present in worksheet. -Lacks insight, and conclusions. -No understanding the content -An occasional spelling error present. -Grammar, readability, and sentence structure is error free. -Some minor errors (1-3 errors) with spelling, grammar and/or sentence structure, not consistent throughout worksheet. -Errors do not interfere with the readability or comprehension of information. -Numerous errors (5-6 errors) with spelling, grammar and/or sentence structure throughout worksheet. -Difficult to understand information presented due to numerous errors. -Excessive errors (>6 errors) occur with spelling, grammar and/or sentence structure, throughout information the worksheet. Thinking Writing Composition (Spelling, Grammar, Sentence Structure) 3 Points -Frequent errors (4-5 errors) with spelling, grammar and/or sentence structure. -Errors effect ability to comprehend information present on worksheet and readability. 2 Points 1 point - Knowledge of topic is general in more than three areas of the worksheet. - 1 or more areas of worksheet left blank. -Content unorganized throughout worksheet. -Difficult to understand content of paper. -Knowledge of topic general throughout entire worksheet, and/or does not all the required assignment areas. -Two or more areas blank on worksheet. -Unable to follow worksheet. Total Points Clinical Worksheet Initials OJ Diagnosis: Preeclampsia HCP: Dr. Sarah Anderson Isolation: Standard Age: 23 M/F: F Length of Stay: 1 day Allergies: No known Code Status: Full Fall Risk: 25 (low risk) IV Type Peripheral Location: Left wrist Fluid/Rate: LR 1000 mL IV 125mL/hr Critical Labs: Platelets: Other Service 98, RBC:5, MCH: 28, MCHC:12, Creatinine: 2.6, BUN: 32, ALT: 40, AST: 42, LDH: 220, Consults Nee Triglycerides: 180, Creatinine clearance: 154 Why is your patient in the hospital (Answer in your own words and include the History of present Illness):  Ms. Jones’s preeclampsia symptoms have gotten worse. She is currently experiencing headache, nausea, fatigue, epigastric pain, visual changes and chest tightness. Health History/Comorbities (that relate to this hospitalization):  None Shift Goals/ Patient Education Needs: 1. Administer O2 as ordered to keep O2 levels over 92%. 2. Maintain vital signs within normal limits throughout the shift. 3. Determine optimal timing of delivery. 4. Maintain proper perfusion to fetus. Path to Discharge: Although she has preeclampsia, the patient’s BP will decrease to manageable levels and the patient will be able to carry out the pregnancy to 40 weeks of gesta Path to Death or Injury: The patient’s preeclampsia will not be able to be managed, and the patient will suffer either a brain, liver, or kidney injury which could cause clotÝng problems edema, seizures, and even death of both the patient and her baby. Clinical Worksheet Alerts: What are you on alert for with this patient? (Signs & Symptoms) Management of Care: What needs to be done for this Patient Today? 1. High BP. 1. Attempt to manage BP, otherwise prepare for preterm delivery. 2. Seizure precaution 2.Initiate fall and seizure precautions. 3. Headache, nausea, fatigue, epigastric pain, visual changes, and chest tightness. 3.Administer medications as ordered to manage symptoms. What Assessments will focus on for this patient? (How will I identify the above signs &Symptoms?) Priorities for Managing the Patient’s Care Today 1. Attempt to manage BP, otherwise prepare for preterm delivery. 4. 5. 6. Ask the provider for an order for NIBP to continuously monitor her BP. Pad the side rails of the bed, remove all hazardous items from her surroundings. Head-to-toe assessment and patient interview. 2.Initiate fall and seizure precautions. 3.Administer medications as ordered to manage symptoms. List Complications may occur related to dx, procedure, comorbidities: 7. 8. 9. Inability to manage the BP and need for preterm delivery. Patient will have a seizure before the appropriate Inability to manage symptoms and need for preterm delivery. What nursing or medical interventions may prevent the above Alert or complications? 10. Nothing can prevent early delivery. 11. Pad the side rails of the bed, remove all hazardous items from her surroundings. 12. Administer medications as ordered by the provider. What aspects of the patient care can be Delegated and who can do it? 1. Obtaining vital signs. – CNA Grading Rubric for DocuCare Entry: vSim Purpose: This rubric analyzes the components of the electronic health record that students would utilize when documenting the care of a patient during a simulated event. Components: Each criterion contains performance criteria to demonstrate the critical thinking and clinical reasoning utilized during a simulated patient care encounter. The performance criteria describe the traits that are linked to a level of performance. There are four levels of performance as well as a “not applicable” column. The levels of performance indicate the degree to which the student documented the events of the simulated patient care situation. Using the Rubric:  Students: Prior to the simulation experience, the students can use the rubric to prepare for the documentation requirements associated with a simulated experience. The emphasis on thorough, systematic documentation of the nursing care provided during the simulation will facilitate clinical reasoning and critical thinking development. The student can utilize the rubric to perform a self-assessment of their documentation of the simulated events prior to submitting their DocuCare assignment. The rubric provides transparency related to the expectations for documentation and the grading of the student’s submitted work.  Faculty: The simulation documentation is only graded in whole numbers. The minimum accepted score is an 80%. The student will need to resubmit the simulation documentation if the total percentage is less than 80%. The student receives one attempt to remediate and edit their documentation. Rubric for Grading vSim Clinical Worksheet 5 Patient Information: 3 Medical History: Why patient is in the hospital, History of present Illness, Past Medical/Surgical History, Comorbidity Factors Patient Education/Goals: Shift Goals, Patient Education Needs Disease Progression: Pathway to Death or Injury Pathway to Health AACIP: Alerts, Assessments, Complications, Interventions and Prevention Nursing Care Plan: Management of Care, Priorities for Patient Care, Delegation 1 0 All documented areas 100% complete and provide thorough information. Three listed areas completed OR documented areas 75% complete. Less than three listed areas completed OR documented areas less than 50% completed. Patient information area 100% of HPI, Past Medical/Surgical History and Comorbidity Factors completed with thorough, relevant information. 75% of HPI, Past Medical/Surgical History and Comorbidity Factors completed. Information relevant to scenario. 50% of HPI, Past Medical/Surgical History and Comorbidity Factors completed. Information basic and lacks relevancy. 25% of HPI, Past Medic History and Comorbidity completed. Information or content areas left bla Thorough and detailed patient education. Patient shift. goals are SMART, relevant, and detailed goals. 100% of worksheet area is complete. Provides patient education but lacks thoroughness or details. Patient shift goals missing 1-2 components of SMART goals. 75% of information needed for worksheet area present. Patient education lacks thoroughness and details. Patient shift goals missing 3 – 4 components of SMART goals. 50% of the information needed for worksheet area present. Pathway to death and health is identified with detail. Information is concise, relevant, accurate and portraits appropriate timeframe for occurrence. 100% of the information needed for worksheet present. Pathway to death and health is identified. Information is relevant and accurate. Missing timeframe for occurrence. 75% of information needed for worksheet area present. Missing over 50% of needed information for worksheet area present. Pathway to death and health identified but content either not relevant or accurate for situation present in scenario. Missing patient educatio patient shift goals. Patie goals lack all componen SMART goals. 25% of th information needed for w area present. Pathway to death and h contains information not accurate to the scenario left blank. Alerts, Assessments, Complications and Interventions/Preventions identified thoroughly. Answers relevant to scenario. 100% of the information needed is present. Alerts, Assessments, Complications and Interventions/Preventions identified. Most answers relevant to scenario. 75% of the information needed for worksheet area present. Missing 2 – 3 areas on worksheet. Answers not relevant to scenario. 50% of the information needed is present. Missing 4 or more areas worksheet. Answers not scenario. 25% of the inf needed for worksheet a present. Management of Care relevant to case scenario and detailed. Priorities for scenario identified. Identifies all aspects of care that can be delegated and identifies appropriate personnel to delegate activities to. Answers detailed, Critical thinking evident. Management of Care, Priorities or delegation sections relevant to scenario. Answers generic to situation. Some evidence of critical thinking present. Missing relevant data in one or more categories (management of care, prioritization, delegation). Answers basic without detail. Little to no evidence of critical thinking present. Information provided no to scenario. Answers ar without detail. No eviden critical thinking. Missing one or more area. Demographics, Diagnosis, Allergies, Provider, Consults, Isolation, Fall Risk, Intravenous Therapy, Critical Labs, Services and Needed Consults TOTAL POINTS