NSG 430 Simulation

Welcome to NSG 430 Simulation

This is a three-part simulation consisting of a pre sim activity, the simulation scenario and self-reflection exercise and a zoom debriefing.  If you complete all three parts satisfactorily, you will receive 10 clinical hours.

Part I (below) – this is a submission via moodle.  It is due Feb. 14.  No late submissions will be accepted.

Part II will open Feb. 15 and is due Feb. 22 via moodle submission.  No late submissions will be accepted.

Part III is a 1 hour zoom meeting the week of Feb. 23 TBA in which we will discuss the scenario and your answers.

 

PART I – Code Blue Scenario

Read the following scenario.

SCENARIO:

Admission Date:  2/1/21

Today’s Date: 2/2/21

Name:  John Bower

DOB 4/1/1991

Gender:  Male         Age:  30

Race: Caucasian

Weight: 133 kg     Height 178 cm

Religion:  catholic    Major Support:  Wife

Phone:  xxxxxxx

Allergies:  NKA

Immunizations:  Flu last September

Attending Physician:  Hospitalist

Past Medical History:  HTN; Hyperlipidemia; past fractures of ribs, left arm and right ankle MVA accident 2 years ago

Medications:

  • HCTZ 25 mg QD
  • Lipitor 20 mg QD

Social History:  15 year heavy smoker, drinks alcohol a few times a week.  Works for IT department remotely; sedentary lifestyle lives with wife and their cat

Primary medical Diagnosis: Closed Fracture of R femur from MVA.  Surgery scheduled for this morning; admitted 2000 on the previous day.

Scenario Overview:

Patient admitted to your unit at 2000; for scheduled surgery r/t to an MVA yesterday when he obtained a closed R femur fracture.

Physician’s Orders:

VS Q 4H

Start IV

0.9% NSS IV at 50 ml/hr

Telemetry monitor

IV morphine 1 mg Q2H for pain

HCTZ 25 mg PO daily

Lipitor 20 mg PO daily

2 gm low sodium diet

NPO after midnight for surgery in a.m.

Electrolytes, CBC, Type and Screen 2 units PRBC in a.m.

Activity as tolerated

Nursing notes:

VS on admission:  BP 145/89; HR 80; RR 20; Temp 98.7; pain 6/10; A&O x 3

PIV in L AC; 0.9% NSS infusing at 50 mL/hr

1 mg morphine given at 2000, 2300, 0100, 0400

2348:  VS 148/90; HR 84; RR 26; Temp. 99.0; pain 6/10 A&O x 3 patient resting

0400: VS 146/88; HR 90; RR 30; Temp. 100.4; pain 6/10; patient sleeping

You are the charge nurse coming on at 0700.  After receiving report from the night nurse, you go in to assess Mr. Bower:

0730: VS 146/88; HR 120; RR 38; Temp. 102.2; restless, lethargic, A&O x 2; petechial rash on trunk, bilateral crackles ULL

Your critical thinking skills tells you that here is a concern.

 

 

First part of your assignment: 

Submit your answers for this part in APA paragraph form.  Use scholarly references.

  • Identify the disease process that may have occurred to this patient.
  • Identify the risk factors associated with this.
  • Identify the nursing interventions that could have been implemented earlier and those that will be implemented for this disease process

 

Second part of the assignment:

Since you know there is something wrong with this patient you will call the MD.

Complete an SBAR as to what you will say.

After your call to the MD and before the MD arrives, you go back into the patient’s room and find him unresponsive.  You call a Code Blue.

This section can be in bullet form or outline form but be inclusive. Show me what happens during a code.  Does not need APA format.

  • Outline the steps you would do as the initial responder in a Code Blue in the correct order
  • Discuss the main roles of the team members
  • Discuss interdisciplinary team members’ roles
  • Discuss the cardiac rhythm you may see and how you will treat it
  • Discuss possible medications used
  • Bower’s wife is in the room; discuss how you will handle that
  • Discuss why communication is important during a CODE
  • Provide a nursing diagnosis for this patient
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