MD1
SIM DAY 1
(Turing a patient with a hip fracture-Edith Jacobson)
THE BELOW ACTIVITIES ARE REQUIRED TO BE COMPLETED BEFORE YOU ARRIVE TO THE SIMULATION.
If this is not completed, you will not be allowed to participate in the simulation (please be advised that simulations are limited, so make-up is not guaranteed. If the simulation is not completed for this course NUR2356 Multidimensional Care 1, you will fail to meet the objectives and not pass this course-both lecture and clinical).
1. Go To “My ATI” Apply Skills Modules 3.0 Mobility (1hr)
a. Complete the pretest (if you have not taken it yet), review the lesson, and finish with the posttest for Mobility (screenshot posttest results showing 95% or greater and showing 1 hour spent in module).
i. (place screenshot here)
2. Complete the Osteoporosis Pathophysiology diagram below by using the ATI Med/Surg ebook, [“My ATI” Learn RN eBook Library RN Adult Medical Surgical Nursing Edition 11.0 (this is the ebook you will need to complete the below diagram) start on page 463]) (1hr)
3. Complete the table below (1hr)
Complete the table below on medications using a Drug eBook. You can use any drug book, the below picture is an example of one book. You could use Rasmussen Library to search for a drug book.
Drug Name Indications Pharmacokinetics Contraindications/Precautions Nursing Implications Implementation Patient/family teaching
Assessment
Enoxaparin • Acute coronary syndromes such as ST-elevation myocardial infarction, Non-ST elevation myocardial infarction, and unstable angina.
• Deep venous thrombosis (DVT) treatment.
• Deep venous thrombosis (DVT) prophylaxis.
• Treatment for pulmonary embolism (PE)
• Venous thromboembolism secondary to malignancy.
The absorption of enoxaparin is proportional to the dose, demonstrating linear absorption. The average maximum plasma anti-Xa activity is reached 3 to 5 hours after a subcutaneous injection. • Known hypersensitivity to enoxaparin (urticaria, anaphylactic reactions) or any heparin products.
• Active major bleeding such as gastrointestinal bleed.
• History of heparin-induced thrombocytopenia within the past 100 days.
• Active gastric or duodenal ulcers.
• Hemorrhagic cerebrovascular accident.
Assess for signs of bleeding and hemorrhage, including bleeding gums, nosebleeds, unusual bruising, black/tarry stools, hematuria, and a fall in hematocrit or blood pressure. Notify physician or nursing staff immediately if enoxaparin causes excessive anticoagulation. Enoxaparin is used to prevent deep venous thrombosis, a condition in which harmful blood clots form in the blood vessels of the legs. Make sure your patient recognizes the significance of informing their healthcare providers, including dentists, that they are taking Lovenox. Instruct them to check with their physician if they notice any possible side effects such as: Bruising or bleeding, especially prolonged bleeding. Bloody or black, tarry stools.
Docusate Sodium Docusate is often used when straining to have a bowel movement should be avoided (e.g., after a heart attack or surgery). Docusate is a stool softener. It works by increasing the amount of water the stool absorbs in the gut, making the stool softer and easier to pass. Docusate sodium is a laxative and an anionic detergent that supposedly promotes incorporation of water and fats into stool through a reduction in surface tension, resulting in softer fecal mass 6,4. Docusate’s onset of action is 6-72 hours orally and 2-15 minutes rectally 6,7. • Hypersensitivity reaction to any of the docusate ingredients.
• Avoid concomitant use of mineral oil. …
• Nausea or vomiting. …
• Intestinal obstruction, symptoms of appendicitis, acute abdominal pain, fecal impaction, especially in children.
Evaluate therapeutic response (decreased constipation). – Drug should be discontinued if cramping, rectal bleeding, nausea or vomiting occur. – Administer alone for better absorption. – Do not administer within one hour of other drugs, antacids or milk Docusate is a type of medicine called a laxative. It helps to soften your poo and makes your bowel movements easier if you have problems pooing (constipation). Swallow tablets whole, do not chew them. – Health education: other possible means of avoiding constipation. – Inform that normal bowel movements do not always occur daily. – Do not use in the presence of abdominal pain, nausea, vomiting.
Morphine Sulfate Morphine sulfate injection is indicated for the relief of moderate to severe pain. Morphine sulfate injection is used especially in pain associated with cancer, myocardial infarction and surgery. Morphine also helps to relieve the anxiety and insomnia which may be associated with severe pain. After an oral dose, about 60% is excreted in the urine in 24 hours, with about 3% excreted as free morphine in 48 hours. After a parental dose, about 90% is excreted in 24 hours, with about 10% as free morphine, 65 to 70% as conjugated morphine, 1% as normorphine and 3% as normorphine glucuronide. morphine may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. Monitor patient’s respiratory rate prior to administration. Reassess pain after administration of morphine. Monitor for respiratory depression and hypotension frequently up to 24 hours after administration of morphine. Place call light signal close to patient. This medication is used to treat severe pain. Morphine belongs to a class of drugs known as opioid analgesics. It works in the brain to change how your body feels and responds to pain. • instruct patient on how and when to ask for and take pain medication.
• May cause drowsiness or dizziness. Caution patient to call for Helpance when ambulating or smoking and to avoid driving or other activities requiring alertness until response to medication is known.
• Advise patient that morphine is a drug with known abuse potential. Protect it from theft, and never give to anyone other than the individual for whom it was prescribed. Store out of sight and reach of children, and in a location not accessible by others.
4. Complete the table below (1hr)
Complete the table below on lab values using the Lab and diagnostic ebook (example below).
Lab Name Rationale Normal Range (Adult)
Hgb If a hemoglobin test reveals that your hemoglobin level is lower than normal, it means you have a low red blood cell count (anemia) Female : 12 or higher
Male : 13 or higher
HCT A hematocrit test is needed to check for the proportion of red blood cells. For men, 38.3 to 48.6 percent. For women, 35.5 to 44.9 percent
WBC These cells help fight infections by attacking bacteria, viruses, and germs that invade the body. White blood cells originate in the bone marrow but circulate throughout the bloodstream. 4,500 to 11,000
Platelets Platelets stop bleeding by clumping and forming plugs in blood vessel injuries. from 150,000 to 450,000 platelets per microliter
Sodium (Na+) Sodium is essential for cellular homeostasis and physiological function. 135 and 145 milliequivalents per liter
Potassium (K+) Potassium is an electrolyte that’s essential for proper muscle and nerve function. Even minor increases or decreases in the amount of potassium in your blood can result in serious health problems. 3.6 to 5.2 millimoles per liter (mmol/L).
Chloride (CL) electrolyte that helps balance the amount of fluid inside and outside of cells. It also helps maintain blood volume, blood pressure, and the pH of body fluids. 96 to 106 milliequivalents per liter (mEq/L)
BUN A BUN test can reveal whether your urea nitrogen levels are higher than normal, suggesting that your kidneys may not be working properly. 6 to 24 mg/dL (2.1 to 8.5 mmol/L )
HCO3 a byproduct of your body’s metabolism. Your blood brings bicarbonate to your lungs, and then it is exhaled as carbon dioxide. 22 to 28
Creatinine High levels of creatinine may indicate that your kidney is damaged and not working properly men, 0.74 to 1.35 mg/dL (65.4 to 119.3 micromoles/L) For adult women, 0.59 to 1.04 mg/dL (52.2 to 91.9 micromoles/L)
Glucose Glucose is either metabolised to produce energy or is stored in the muscles and liver as glycogen less than 140 mg/dL (7.8 mmol/L)
Prothrombin time The most common reason for PT tests is to monitor your blood levels if you are taking the blood-thinner warfarin. 10 to 13 seconds
INR The INR test helps balance the risk of internal bleeding against the risk of blood clotting. 2.0 to 3.0
aPTT It measures how long it takes your blood to form a clot. 20 to 35
YOU HAVE NOW COMPLETED THE PREP WORK FOR SIM
STOP HERE! DO NOT UPLOAD
(I will be looking at the above as you walk into the classroom, so please have it ready for me to review)
You will hand in the worksheet at the end of the SIM day. This is why the due date is on the course calendar
Simulation: This is the rotation for the SIM day, keep as a reference for the SIM day
Time SIM (Room1) Chart/EHR (Room2) Skills (Room3) Activity (Room4)
0900-0945 Group A Group D Group B Group C
0945-1030 Group D Group A Group C Group B
1030-1115 Group C Group B Group D Group A
1115-1200 Group B Group C Group A Group D
Group Debrief
1200-1230
LUNCH
(bring your lunch)
1230-1315 Group A Group D Group B Group C
1315-1400 Group D Group A Group C Group B
1400-1445 Group C Group B Group D Group A
1445-1530 Group B Group C Group A Group D
Group Debrief
Student Instructions/Worksheet for SIM Day
Room Number Activity
Room 1-SIM Caring for Edith Jacobson
Room 2 Morning session: Activity- look through patient chart-develop “nursing brains.” Fill out print-off.
Afternoon session: Activity-in small groups, develop an SBAR from the morning session-will discuss in group debrief-practice reading this with a partner. Fill out print off of SBAR
Room 3 Morning session: Review proper patient alignment and the importance of repositioning the patient. Activity- with a partner, practice repositioning using appropriate body mechanic techniques and appropriate use of various supplies to Help with proper body alignment. Activity-Identify Morse Fall Risk Scale-Read handout and fill out Morse Fall Scale after reviewing given scenario. Activity-Using a mannequin to identify different lung sounds.
Afternoon session: Activity-Perform focused Musculoskeletal Assessment on a partner (check muscle strength and ROM, assess skin, assess warmth, check pedal pulses and capillary refill). View video before going through the assessment: https://www.youtube.com/watch?v=t6hE_ntz4Ho
Musculoskeletal Assessment
Inspect and palpate extremities for edema, tenderness, temperature, deformities & lesions
Check capillary refill of fingers and toes
Inspect gait and balance (Romberg test)
Assess range of motion of neck, arms, & legs (at least 3 directions for each)
Assess strength in all extremities
Assess the following deep tendon reflexes: patellar, plantar, triceps, Achilles, biceps, & brachioradialis.
Locate and palpate radial, brachial, popliteal, posterior tibial, and dorsalis pedis pulses, assessing for symmetry and strength.
-Activity- Chart findings from partner in EHR. Follow directions on how to chart in EHR.
-EHR Tutor: (may need to use Chrome)
-Go To ATI My ATI EHR Tutor Folder SIM Day 1 MD1Musculoskeletal Assessment
To access this activity, you must “add a course” then enroll in the course by using the code below.
Code: 3SWGPSE
THERE IS NOTHING TO HAND IN FOR EHR. THE INSTRUCTOR WILL LOOK AT YOUR CHARTING THROUGH EHR.
Room 4 Morning session- Research the proper techniques for using a walker/cane -make sure you identify the difference between these tools and the difference each has, for example, a wheeled walker or a 3-point cane. Activity- Practice educating others on the proper usage of a walker/cane (student nurse to demonstrate proper usage of devices).
Afternoon session- Activity -Develop a Quizlet game using the above information (patho map/medication and lab information). You and a partner will develop a total of 10 questions. Each question should have the correct answer WITH rationale. Be sure to use evidence-based information. This will be presented in a large group debrief. Place link to Quizlet game here:
-If you have additional time- Practice giving report to another nurse
If spare time is noted at any time throughout the day, students should complete the application questions at the end of the Med/Surg book in ATI on osteoporosis. Writing down the answers to each question (1-5).
Or
ATI Individual Quizzing
(Fundamentals)
Post-SIM Activity
Nursing Care Plan
Article review: Please locate a peer-reviewed article published within the past 5 years that pertains to today’s SIM (examples: workplace injuries due to poor body mechanics, osteoporosis, hip surgery, etc.). Include a one-half to a one-page discussion of the article and how it relates to patient care.
Patient education: Complete in a narrative format exactly how you would educate a patient on post-hip surgery; this can include, but is not limited to medication, possible complications associated with wounds, nutrition, activity. Include 4 narrated sentences.
Complete care plan: Using information from today’s SIM, you will complete the care plan below. Make sure you are writing a problem nursing diagnosis. DO NOT USE “RISK FOR” as the start of your nursing diagnosis. I am looking for keywords such as related to and as evidence by in your nursing diagnosis.
A- Assessment P- Planning (outcome-specific and measurable goal). This should be a SMART goal I-Interventions-
(evidenced-based). This needs to be working towards your goal. Placing the call light next to the bed is not an intervention, Rationale (why are you doing the intervention?)
S (what the pt says):
O (Information-assessment, lab/diagnostic): 1.
2.
3.
4.
5.
1.
2.
3.
4.
5.
Outcome: Critical Thinking: Self-assessment:
Self-reflect on how your simulation experience correlates with what you have learned in this lecture. Objectives are located in the course under each module and are helpful in completing this section.
Outcome: Caring
Identify one example from your simulation day in which you observed, participated in, or provided some aspect of caring for the provision of psychosocial and/or cultural diversity needs. How did you inspire or make a difference in your patient’s life today?
Create individualized quizzing checking Fundamentals.
Take a screenshot of quiz made and how many questions answered (60 questions should be completed) (below is an example of the screenshot I want copy and paste to this worksheet)
References
(Do not forget to put in-text citations within your worksheet)
—–
MD1 SIM DAY 1
(Turing a patient with a hip fracture-Edith Jacobson)
THE BELOW ACTIVITIES ARE REQUIRED TO BE COMPLETED BEFORE YOU ARRIVE TO THE SIMULATION.
If this is not completed, you will not be allowed to participate in the simulation (please be advised that simulations are limited, so make-up is not guaranteed. If the simulation is not completed for this course NUR2356 Multidimensional Care 1, you will fail to meet the objectives and not pass this course-both lecture and clinical).
1. Go To “My ATI” Apply Skills Modules 3.0 Mobility (1hr)
a. Complete the pretest (if you have not taken it yet), review the lesson, and finish with the posttest for Mobility (screenshot posttest results showing 95% or greater and showing 1 hour spent
