Neurological Deficit Simulation

Clinical Simulati on Documentation Fall 2021 1. i-Human Patient Name: Student Name: 2. Date simulation completed: November 14, 2021 Date posted to Moodle: November 14, 2021 3. Patient Report/Data Age: 48 Allergies: NKA Date of admission: November 14, 2021 AdmitÝng diagnosis: Neurological Deficit Admission related co-morbidities/history: (if available): Hx Hypertension and Hypercholesterolemia 4. Abnormal Lab Values (if listed for your I-Human patient) Abnormal Lab Value Normal Lab Value Comments-What do you think is causing the abnorma lab value? HcG UA Drug Toxicity Urine BAC BMP CBC aPTT PT/INR POC 5. Procedures/date/results: (if available): N/A 6. Patient Medications: (Include in chart below all medications administered by student. Also include all patient’s ordered MAR IV fluids, flushes, tube feeding, TPN, O2, etc.) Trade/Generic Name of Drug or IVs/Tube feeding/TPN/02, etc. Simvastatin Dosage, Route, Frequency 40 mg PO nightly Therapeutic Classification HMG-CoA reductase inhibitors (statins) Medication Status: Home/New/Hospital Protocol/STAT dose Home Indications for use (Why are you administering this medication?) Slows production of cholesterol in the body to decrease the Nursing Considerations when administerin this medication to this patient Assess cholesterol at 6 weeks. Carry out lipid panel Perform liver amount of cholesterol that may build up in the walls of the arteries and block blood flow to the heart, brain, and other body parts Metoprolol 50 mg PO BID Beta Blocker Home Acetaminophen 650 mg PO PRN for pain Analgesics Home Ondansetron 4 mg Q 8hrs for nausea or vomiting Serotonin 5HT3 Receptor antagonist New Normal Saline (0.9%) 5mL IV Q8hrs Crystalloid Fluid Normal Saline (0.9%) 5-10mL IV PRN for medications/flush Crystalloid Fluid Hospital Hospital function test within first year. Discontinue if of rhabdomyolys with increased muscle tenderness and creatine phosphokinase Relaxing blood Take as vessels and instructed sam slowing heart time daily. rate to improve Monitor BP blood flow and prior to decrease blood administration pressure. monitor neonates for women Changes the No more than way the body 4000 mg a day senses pain only take one and cooling product the body containing this product, monitor for liver disease Blocking the Monitor for action of headaches, and serotonin, a fatigue. natural Monitor for substance that fluid and may cause electrolytes nausea and imbalance vomiting Hydration Assess patient clinical and laboratory asses Help relieve Assess patient wheezing and clinical and breathing laboratory difficulty asses Citations for additional resources: Plan of Care Section 7. Focused patient assessment: (Include focused patient assessment information that will support and explain your priority nursing diagnosis/problem. You will pull this from your iHuman assessment) 48-year-old African American female presented to ER with husband with neurological deficit and left side weakness. PT has never been hospitalized and has a history of hypertension and hypercholesterolemia. Patient is Alert and Oriented x 3. No Known allergies and full code. During head-to-toe assessment noted left side facial drooping, left sided weakness in arms and legs. Moderate dysarthria present and slurred speech. Good respiratory effort, lungs clear in all fields, chest expansion symmetric. NIH Stroke Scale score of 11. Patient is not agitated or hostile towards others. VS- T 98.6, BP 184/106, P 110, R-22, O2 97% (RA). 8. Priority nursing diagnosis/problem: Impaired physical mobility related to hemiparesis 9. Measurable outcome: (Time frame=during my clinical. shift: this is different than being in clinical for 12 hours) By the end of the patients stay patient will perform physical activity independently or within limits of stroke patients without complaint. Patient demonstrates the use of adaptive devices to increase mobility. 10. Intervention(s): (List 3-4 interventions you Evaluation: (Explain how the interventions would help meeting would implement to help meet your measurable outcome) 1. Teach methods for turning and moving, using the stronger extremity to move the weaker extremity. 2. Protect the impaired arm with a sling. 3. Encourage the patient to make a conscious attempt to look at extremities and check position before moving. the outcome.) 1. These measures help maintain some independence and strength in unaffected extremity. 2. The sling will support that arm and shoulder when the patient is out of bed. 3. These safety measures prevent falling. It reminds patient to make conscious effort to lift and then extend the foot when ambulating. Student Comments: Journal Score: ______ Instructor Comments: Grading Rubric for Simulation Journal Timeliness:  2 points Journal posted on time and spent 2 hours or more in simulation   1 point Journal posted after due date OR spent less than 2 hours in simulation. Criteria:  4 points Clinical Journal criteria met (all 10 categories satisfactorily addressed and posting provides exemplar evidence that student has researched and applied material accurately)  3 points Clinical Journal criteria partially met (8-9 of the categories satisfactorily addressed and/or posting provides adequate evidence that student has researched and applied material accurately) 0 points Journal not submitted 2 points Clinical Journal criteria partially met (6-7 of the categories satisfactorily addressed and/or posting provides limited evidence that student has researched and applied material accurately)  0 points Clinical Journal criteria not met (<6categories satisfactorily addressed and/or no evidence that student has researched/applied material accurately)