Transcript CENE – Scenario Planning Worksheet

SCH – Scenario Planning Worksheet
Adapted from:
CENE – Scenario Planning Worksheet
Your Name: Meg Lagunas
Department: CENE
Date: Spring 2013
Scenario Title: Rapid Response of a Female stroke patient
Location: CENE- Inpatient
Estimated Scenario Time: 15 minutes
Facilitator/Debrief: TA or Faculty
Estimated Debriefing Time: 15 minutes
Content Expert: yes
Teaching Assistant:
Target Groups and Roles requested:
Target groups are BSN and ABSN students enrolled in NCLIN 411. Roles requested will be RN, charge nurse, and rapid response team
(2 students: MD and one ICU charge RN), transport RN.
Brief summary (presenting problem and circumstance, intervention, conclusion):
During a mid shift assessment elderly female, admitted yesterday for new onset Atrial Fibrillation, is observed to have new onset right
sided weakness. Student must recognize weakness, perform a neurological assessment, and activate rapid response team.
Why is this important (Educational Rationale):
Strokes are a time sensitive medical emergency, RNs are expected to recognize the symptoms of a stroke and respond accordingly.
SCH – Scenario Planning Worksheet
Adapted from:
Learning Objectives
UW SON Objectives
 Use Universal precautions at all times
 Demonstrate safety check
 Use effective communication skills
 Demonstrate safe medication practice
 Demonstrate correct procedure to get help
Scenario Specific
Assessment: Demonstrate ability to perform
both a basic assessment and a focused
neurological exam.
 Washes/Gels Hands
 Gloves worn
 Identify patient using 2 identifiers
 Emergency equipment at bedside
 Introduces self, explains role
 SBAR
 5 Rights performed for all meds
 Call out loud
 Provide correct location
Metrics
 Sharps Disposal
 Appropriate PPE
• Bed in lowest position
• Call light accessible
 Summary sentences
• Assure patient safety
Metrics
•Student will conduct full assessment and focused neurological assessment
•Student will recognize change in LOC
•Student will recognize change in VS
•Student will perform a detailed neurological assessment
Skills: Demonstrate ability to keep patient safe. •Student will stay with patient or delegate someone to stay with patient
•Understand importance of “golden hour” for stroke survival (to CT <25 min)
Critical Thinking: Identify when to call an RRT.
Role: Demonstrate understanding of RN Role in
RRT.
• Student calls out loud to activate RRT.
• Student verbalizes reason for RRT: change in mental status(SBAR).
• Provide information about the patient to the RRT.
• Coordinate patient care with RRT & charge RN.
• Provide transition report if patient is transferred.
• Ensure other patients are receiving attention.
SCH – Scenario Planning Worksheet
CENE – Scenario Planning Worksheet
Adapted from:
Patient Description
Name:
Emily Landson
Age:
72
Weight:
57 kg
Setting:
Emily was admitted yesterday afternoon after presenting to urgent care with “funny feeling her
chest.” Pt found to be in rapid A.Fib (HR 130-140’s) with stable vitals and labs. Her
echocardiogram showed no cardiomegaly, and no left ventricular hypertrophy. She received
flecainide bolus IV 2mg/kg and converted to sinus rhythm briefly. IV diltiazem drip was started
at 10 mg/hr with good rate control (HR 90-100’s) and she was started on aspirin 325 mg PO
daily.
Emily had an uneventful stable night but has been in and out of A.Fib. After am MD rounds, TEE
was ordered to evaluation prior to possible cardioverison , first PO dose of diltiazem was
ordered to transition pt off IV. Emily is alert and fully interactive with staff and already has
walked around the unit twice by 1500.
Height:
5’5”
Gender:
female
Background: Emily is a retired librarian who self-reports as a healthy happy individual. She lives alone with her cat Mittens but speaks
daily with her son who lives in Virginia.
Patient Information: History: Hypertension, Osteoporosis Current medications: see attached orders. Allergies: NKDA Code: Full Code
Admission Orders: (see attached list)
CENE – Scenario Planning Worksheet
Adapted from:
Correct Treatment Outline
(EVENT LIST)
#1: 1500: New Shift—RN receives verbal report and performs bedside safety check. Emily is alert, interactive and pleasant. RN
performs routine assessment with nothing out of the normal range.
#2: 1700: RN enters to give evening medication. Emily drops glass of water and states she feels “funny”—If RN performs a neuro
assessment generalized right sided weakness will be seen. RRT will be called and pt taken for a head CT (RN will give verbal report to
transport RN and RRT staff)
SCH – Scenario Planning Worksheet
CENE – Scenario Timeline and Specifics
1. Initial Stage (TA/Tech)
HR
98 A.Fib
Spo2
97 RA
BP
120/69
RR
16
Temp
36.7
2. (TA/Tech) Act 2
HR
Spo2
BP
RR
Temp
105 A.Fib
96 RA
150/76
18
36.8
Technician Notes:
Emily is alert & oriented X4.
Stable vitals , physical
assessment wnl.
Objectives:
Safety Check,Physical
assessment, vital signs. IV
medication and IV line check.
Facilitator Notes
If student doesn’t perform a
complete bedside and
medication check—TA will
prompt them.
Technician Notes:
Emily is AxOx4 and willing to take
medication but drops cup and
has a shaky right hand. When
asked, states she “feels funny”
but can not explain. If pill is
given, pt will struggle to swallow
and will have water dribble out
-If neuro assessment is
performed—pt will be positive
for right sided weakness
-If neuro assessment is NOT
performed—pt will
1)Develop right sided facial
droop and slurred speech
2) Decreased mental status
Objectives:
Recognize change in pt’s
condition, perform neuro
assessment, vital signs. Activate
RRT, SBAR given, prepare pt for
stat head ct.
Facilitator Notes
If student is struggling with neuro
assessment, have the charge
nurse step in and assist. Student
should report to RRT and MD
exact time when pt was last
witnessed as symptom free.
SCH – Scenario Planning Worksheet
CENE – Scenario Planning Worksheet
Adapted from:
Equipment/Prop Checklist (Check all that apply)
x
Stethoscope
x
IV fluid: Dilatiazem drip
x
Oxygen Source
x
IV Equipment
x
Medications (see attached)
x
O2 Delivery device: nasal
cannula
Suction
x
Ambu Bag
x
VS station
x
Lab Reports (attached):
x
Penlight
x
Feeding supplies
Monitor Configuration and Initial Settings (Check all that apply)
x
ECG: HR = 98 with a-fib
SPO2: 97 in room air
RR: 16
BP: 120/69
x
x
x
x
Mannequin Directions at Set-up (check if abnormal setting is needed) (Check all that apply)
Lung sound-Normal
x
TA will need to verbally stimulate right-sided weakness
x
Cardiac sounds-Normal
x
Pulses-Normal
Scenario Documentation Plan
Video Recording
x
Attendance Record
CENE – Scenario Planning Worksheet
Admission ORDERS
Vitals Q4 hours and PRN
Telemetry at all times
Maintain IV access
Titrate O2 to keep saturation >94%
Activity as tolerated
Heart Healthy Diet
IS and cough and deep breathe Q2 and PRN while awake
I&O Q shift
Q AM CBC and BMP
Notify provider Temp > 38.0 C, HR>120, SBP <90, SBP >160
SCDs if not ambulating
Admission LABS: see attached results
Adapted from:
Adapted from:
Medications
Diltiazem 125 mg/100ml D5W at 10 ml/hour (1mg=1ml)
MVI POdaily
Metoprolol 25mg PO BID
Calcium 500mg PO BID
Fish oil 2 g PO daily
Aspirin 325 mg PO daily
Biochemistry Results
Laboratory Report
Name: Emily Landson
Lab ID: 210045678
NRIC:
Request Date:
Age/Sex: 72 yrs/F
Reported Date
Tests
Normal Range
Result
Na+
140
mEql/L
136-144 mEql/L
K+
3.4
mEql/L
3.7 – 5.2 mEql/L
CI -
97
mEql/L
96-106 mEql/L
CO2
30
mEql/L
20-29 mEql/L
BUN
7
mg/dL
7-20 mg/dL
Creatinine 0.9
mg/dL
0.8-1.4 mg/dL
Glucose
106
mg/dL
70-100 mg/dL
Ca++
9.9
mg/dL
8.5-10.9 mg/dL
Mg++
1.2
mg/dL
1.7-2.2 mg/dL
Low
PO4
4.2
mg/dL
2.4-4.1 mg/dL
High
CRP
---
mg/L
< 0.8 mg/L
Low
High
High
/ /
/ /
Hematology
Laboratory Report
Name: Emily Landson
Lab ID: 210045678
NRIC:
Request Date:
Age/Sex: 78 yrs/F
Reported Date
Tests
Normal Range
HgB
14
g/dL
13.8-17.2 M, 12-15.6 F
Hct
42
%
41-50% M, 35-46% F
WBC
4.5
X10³ µL
3.8-10.9 X10³ µL
Neutrophils 47
%
45-54 % of WBC
Lymphocytes 33
%
16-33 % of WBC
Platelets
110
X109µ
150-450 X109µ
INR
---
ratio
0.9-1.2
APPT
---
seconds
18-28 seconds
g/L
2-4 g/L
Fibrinogen ---
Blood Group
Result
/ /
/ /
Biochemistry Results
Name: Emily Landson
Laboratory Report
Lab ID: 210045678
NRIC:
Request Date:
Age/Sex: 72 yrs/ F
Reported Date
Tests
Normal Range
Result
Miscellaneous
Trop 1
---mcg/L
0 – 0.08 mcg/L
CK
---U/L
20-180 U/L (F) 20-200 U/L(M)
CKMB
---ng/mL
0-3ng/ml
T4 total
5.8 ng/ml
5.5-12.3ng/mL
Normal
TSH
2.2 U/ml
0.4-4.5 U/ml
Normal
Digoxin
---ng/mL
0.8-2.0 ng/mL
Acetaminophen
---mcg/mL
10-25mcg/mL (therapeutic)
Salicylates
---mcg/mL
100-250 mcg/mL
Ethanol
---g/dL
0 (>0.4 g/dLcritical)
Phenytoin
--- mcg/mL
10-20 mcg/mL
Carbamazepine
---mcg/mL
5-12 mcg/mL
Valproate
--- mcg/mL
50-100 mcg/mL
Lithium
---mEq/L
0.8-1.2 mEq/L
/ /
/ /
CENE – Scenario Planning Worksheet
Adapted from:
Student Roles
Nurse: You are the bedside nurse for this patient; your jobs is to get report, assess and then care for them as you
would any other patient. If you need help just ask (a NA, nurse, charge, MD, RT or whatever will magically appear
to assist) but remember to give them SBAR
Helper/Charge Nurse: If requested by the nurse you may assist the nurse with whatever they request, if needed
ask for SBAR
Rapid Response Team member: If you are called and the TA indicates that you should enter the “room” ask for
SBAR from the nurse, make sure you ask when the last time the patient was seen at her neurological baseline, feel
free to make any care suggestions you may have or indicate that orders you make need from the MDs to continue
patient’s care (for example head CT)
CENE – Scenario Planning Worksheet
TA Role
Ideally this scenario is run with 2 TA’s---one to be the patient and one to run the scenario
If there is only 1 TA—they must be the patient, having a student be the patient does not work
Adapted from:
CENE – Scenario Planning Worksheet
Adapted from:
Frequently asked Questions or Topics and Hints for Debriefing