Assignment

1. IV NS at 150mL/Hr

1. Insulin injection twice each day – dose dependent upon sliding scale

1. Hypoglycemia standing orders as needed

RESOURCES

1. NPO (except medications)

1. Initiate Saline lock

1. Oxygen to maintain SpO2 greater than 94%

1. Activity as tolerated

National Patient Safety Goals (Hospital) Effective January 1, 2015. The Joint Commission

Client will require insulin injection as indicated by blood glucose level and sliding scale, this will require the mixing of insulin and the administration of a subcutaneous injection.

A simulated 30 minutes will pass and the confederate will call for help as the client becomes semi-conscious and nearly unable to respond to noxious stimuli. This will require the student to determine the situation as an adverse reaction to the previous insulin injection and require the reconstitution of glucagon and an intramuscular injection.

Accessed online: http://www.jointcommission.org/standar

1. Parent

1. Nurse

1. Client

1. Student will prepare and administer medications appropriately

1. Student will recognize the signs and symptoms of an adverse reaction to insulin

1. Student will interact with parent and client in a professional manner

RESOURCES

1. Adult manikin with bandage wraps on extremities

1. Appropriate vials and syringes for medication administration noted in scenario progression

SCENARIO FOCUS

Recognition and initial actions taken given signs and symptoms of an allergic reaction to a prescribed medication

OBJECTIVES

1. Use two ways to identify the client (2015 Joint Commission NPSG.01.01.01)

1. Recognize signs and symptoms related to a possible medication reaction

1. Formulate an accurate report to a healthcare provider in SBAR format

1. Analyze assessment data to appropriately prioritize the client’s triage category according to an established criteria scheme

REALTED COURSE OBJECTIVES

NUR3371

1. Demonstrate timely and accurate documentation of administration of medications, including any adverse responses or reactions

PATIENT DEMOGRAPHICS

NAME: Josie Lancaster

AGE: 20 years old

DOB: May 11, XXXX

WEIGHT: 128 pounds (58kg)

HEIGHT: 66 inches (168cm)

PAST HISTORY

Sexually active in last 12 months

CASE HISTORY

Josie Lancaster is a 20 year old healthy female.

She is presenting to the triage desk at an outpatient care facility (urgent care) complaining of itching, runny nose and a rash over most of her body. She was seen about 18 hours ago in the primary care clinic and diagnosed with pelvic inflammatory disease. She was prescribed:

Ceftriaxone 250 mg IM in a single dose (Given at PCC) Doxycycline 100 mg orally twice a day for 14 days Metronidazole 500 mg orally twice a day for 14 days

She states that her first dose of oral medications was taken about 4 hours ago.

INITIAL (ER) VITAL SIGNS

BP 148/90

HR 112

RR 24

TEMP 99.7

SpO2 96% (Room air)

EKG Sinus rhythm

Patient is: Alert and Oriented but anxious

CURRENT MEDICATIONS

1. See CASE HISTORY

1. Birth Control pill (compliant)

PROVIDER ORDERS

1. Triage for admission to clinic

SCENARIO PROGRESSION

Client will remain stable throughout scenario. Focus is on recognition and appropriate reporting of signs and symptoms of a drug reaction. In this case, anaphylaxis secondary to antibiotic.

ROLES

1. Nurse

2. Client

STUDENT CRITICAL BEHAVIORS

1. Student will recognize and accurately triage the client’s condition

1. Student will recognize the signs and symptoms consistent with medication reaction

1. Student will provide a report in SBAR format

SIMULATION SET UP

1. Adult manikin with moulaged rash over upper chest, “runny nose”

1. Adult female standardized patient with same moulage

SCENARIO TITLE: ADVERSE DRUG REACTION: CHRONIC OPIATE USE

SCENARIO FOCUS

Recognition and initial management of the side effects of opiate use

OBJECTIVES

1. Use two ways to identify the client (2015 Joint Commission NPSG.01.01.01)

1. Recall and discuss the effects of chronic opiate use on the gastrointestinal system

1. Perform a client assessment of current medications (2015 Joint Commission NPSG.03.06.01)

1. Perform a client assessment of current overall health

1. Interpret data from assessments to form a treatment plan

1. Recommend a course of action to address side effects of current medications

CLIENT DEMOGRAPHICS

NAME: Mary Lancaster

AGE: 65 years old

DOB: June 18, XXXX

WEIGHT: 160 pounds (73kg)

HEIGHT: 61 inches (155cm)

PAST HISTORY

Client has hypertension that is well controlled by medication

Has had chronic back pain for over 20 years, client states, “It was all that work at our restaurant that ruined my back.”

CASE HISTORY

Mary Lancaster is an obese 65 year old and was born in Wales and moved to the US with her husband when she was in her 20s. They owned a restaurant until her husband died 10 years ago. She then moved in with her son, Bob, who is her only living child. Mary likes “the old ways” even though she enjoys the life she has led in the US. She feels that she should be taking care of Bob and his family now that she lives with them. She finds it hard to take of them because of her “back problems” which are chronic as they happened when she was working in the restaurant. She takes medication for it but sometimes it is just not enough to handle the pain.

She says that two weeks ago she hurt her back while cooking, she bent over to pick up a dropped utensil, and she felt something pop and had sudden severe pain. She was seen at an urgent care center and was given a new pain pill.

She states she has not been regular with her bowel movements for about three days. She complains of lower abdominal pain but denies nausea.

She has been “feeling blue” over the last several months as her grandchildren are beginning to go out on their own.

INITIAL (ER) VITAL SIGNS

BP 144/78

HR 74

RR 20

TEMP 98.8

SpO2 97% (RA)

EKG Sinus rhythm

Patient is: Alert and Oriented.

See scenario progression for changes

CURRENT MEDICATIONS

1. Lisinopril 20mg once at night

1. Metoprolol ER 150mg once per day

1. Hydrochlorothiazide 20mg once per day in the morning

1. Acetaminophen 650mg twice per day (Now discontinued)

1. Percocet 20mg every 4-6 hours as needed for pain

PROVIDER ORDERS

1. Perform an in-home assessment of the client

1. Report findings

1. Make recommendations for future treatment

SCENARIO PROGRESSION

Ms. Lancaster will be a pleasant client who is cooperative.

She will exhibit some signs of depression but not to the point of distraction. She will say that her back pain is significantly better after seeing the NP at urgent care and getting the new medication. She thinks she even feels in a little better mood as well.

She usually does not like to take stronger pain medications as she is afraid of becoming dependent like her husband did during his cancer treatments.

ROLES

1. Nurse

1. Client

STUDENT CRITICAL BEHAVIORS

1. Student will recognize symptoms consistent with opiate side effects

1. Student will recognize symptoms related to client’s change in mood as it relates to opiate use

1. Student will educate client on the proper use and side effects of opiate pain medications

1. Student will educate the client on conservative ways to address the side effect

1. Student will analyze information provided to form a nursing diagnosis

1. Student will provide a report in SBAR format to the client’s provider

SIMULATION SET UP

1. With the use of a SP, no special set up should be required

1. It would be best if the SP could be an older female