BridgeportHospitalSchool of Nursing

Simulation Case Scenario

Scenario Title: Level I Maxwell Edison
Scenario Focus: / Contact Precautions
Objective(s): /
  1. Demonstrate effective communication with clients, family and other members of the health care team.
  1. Implement fundamental standards of care including principles of medical asepsis, appropriate patient identification and providing patient privacy.
  1. Ensure a safe patient care environment and perform a basic patient assessment.
  1. Develop beginning critical thinking skills.
  1. Emulate core behaviors of professional nursing practice.

Case History: / Maxwell Edison is a 69 year old male patient with a diagnosis of insulin dependent diabetes. He was admitted to the hospital two days ago for a MRSA wound infection. He is on contact precautions.
He has just received his meal tray and has asked for assistance with his meal.
His wife is coming to visit him in the hospital.
Assessment Data: / BP 152/84
P 86
R 20
T 100.6
BS 144
Current Medications: / Lantus 25 Units subcutaneously every day at bedtime
Lispro sliding scale coverage for BS as follows:
70 – 150 0 Units
151 – 200 2 Units
201 – 249 4 Units
250 – 300 6 Units
300 – 350 8 Units
Call MD for BS < 70 or > 350
Vancomycin 750 mg IVPB every 12 hours
Unasyn 3 gm IVPB every 8 hours
MD/NP Orders: / Contact precautions
Dressings to right leg daily with zinc oxide
Right leg elevated
Scenario Progression: /

The student nurses receive report from the staff nurse and are instructed to assist Mr. Edison with his meal tray.

Mr. Edison is in bed with one leg elevated on a pillow in semi Fowlers position. The tray is on the over bed table with the urinal next to it.
Student Roles: / 2 Student Nurses
Wife
Student Critical Behaviors: /
  1. Perform standards of care.
  2. Greet patient and communicate with both patient and wife in a therapeutic manner.
  3. Use appropriate PPE:
  4. Don gown and gloves in the correct order
  5. Remove and dispose of gown and gloves in the appropriate receptical
  6. Assist patient to sitting position, remove urinal from over bedtable and arrange tray so that patient is able to eat meal.

Simulation Set Up Information: / VitalSim/ALS manikin set up with PVD leg in bed with hospital gown.
Dressing to R. lower leg.
R leg elevated on pillow.
Urinal and meal tray positioned on over bed table.
Tray to have food items and a slip with the patient’s name and diet choices.
Precautions sign and PPE available on cart outside room.
Instructor to act as a staff nurse and give report to students.

Staff Nurse Report:

Maxwell Edison is a 69 year old patient of Dr. Leary. He was admitted yesterday with a wound infection of his lower right leg. It tested positive for MRSA and is on precautions. His has a history of insulin dependent diabetes. He is on IV antibiotics and we are dressing his leg with zinc oxide. He is on Lantus and insulin coverage. His last blood sugar was 144 and he did not need coverage for that this morning. He is on an 1800 calorie diabetic diet and he just received his meal tray. He just rang his bell for assistance. Can you go into his room to help him?

Debriefing Questions:

  1. What information in the staff nurse’s report was critical prior to entering Mr. Edison’s room?
  2. What standards of care did the student nurses use prior to and upon entering the room?
  3. What communication skills did the student nurses use with the patient and his family?
  4. What principles of medical asepsis did the student nurses use in caring for this patient?
  5. What assessment did the student nurses make of the patient and the patient’s environment?

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