Second Year Consolidation May 2008
Your Day will begin at 8:30 am and last until 4:30 pm. Please come prepared as you would for a clinical day i.e. having researched your patients’ conditions, medications, dressed in uniform, wearing ID, with stethoscope …The following information will help you prepare for this simulated clinical experience.
Medical-Surgical Suite
· Each station 40 minutes
· 20 min break after 2 stations
· 15 minute wrap up—care planning
· 15 minute reflective journal
· Wellness and illness diagnoses at each station
· Documentation at each station
Assessment Station—
Students will be expected to complete an assessment on their post-op hip patient in front on their clinical instructors. Students should be prepared to complete a head to toe assessment. All students will be expected to complete a set of vital signs on the mannequin (particularly a BP using either the one or two-step technique)
Sterile Dressing Station:
Students will be expected to perform a sterile dressing as per the physician orders. Any student who is not able to perform the the sterile dressings clinical performance review will be provided with a remediation slip with the requirement for extra lab practice with lab manager or designate.
Using the chart for Zia Canceladm students will be request to complete a post-op surgical dressing. The dressings are as follows:
§ Post-op hip dressing to be cleansed with NS and apply dry gauze
§ Cleanse L great toe ulcer with Ns and apply dry dressing daily
Students will be expected to –assess of the wounds and drainage
- hemovac or JP drain—dressing change and output measurement
-review dressing options—at end of this station if time permits
Medication Administration Station:
Using the chart for Zia Canceladm students will be request to administer medications:
Any student who is not able to perform the medication administration CPEs will be provided with a remediation slip with the requirement for extra lab practice with lab manager or designate
-po, IM, SQ, IV medication with calculations
(CPE: IM, SQ, IV priming, IVPB
-include pump as well as gravity drip if possible
-6 rights of med administration
-3 checks
Intake & Output:
Any student who is not able to perform the catheterization CPEs will be provided with a remediation slip with the requirement for extra lab practice with lab manager or designate
Using the chart for Zia Canceladm students will be request to insert a sterile cather and monitor intake and output and record the fluid balance in the chart.:
-foley catheter insertion (CPE)
-measuring intake and output
-discontinuing a foley
-intermittent catheterization
-obtaining a urine sample (from catheter and from a voided specimen)
Wrap up— Facilitate by the Clinical Instructor
With 15 minutes remaining in the day the group would come together with the clinical instructor to develop a care plan for the patient and identify the priorities for Zia
-identify client strengths and risk factors
-identify the priority diagnoses (2 or 3)
-3 short term goals and 1 long term goal for each dx
-identify interventions and rationale for each goal
-how would you evaluate?
Student Preparation:
Students are expected to come prepared as they would for a clinical day. Students will be provided with general information to prepare (posted on their site). However students should be reviewing the patients’ charts prior to arriving for their sim day. Charts will be available to be reviewed in the nursing lab. Since all students have successfully completed the CPE skills in labs they should be prepared to demonstrate all second year CPE skills including dressing changes, medication administration (all routes), catheterization as well as assessment of a post op client and documentation of care. References have been provided to help students prepare.
Medical Surgical History/Information provided to the student for the Post-op hip scenario
An 83 year old widowed woman was brought into the Emergency Department after slipping and falling while visiting her friend in a nursing home. She underwent a total right hip replacement two days ago. The patient lives alone in a two-story house with her dog, Renny, which she adores.
Allergies:
PCN and Cephalosporin
Weight: 100 kg
Past Medical History:
History of Hypertension since 1990
Cataracts removed in 2005
Family History:
Mother: died of old age
Father: died in World War II
Medication List:
Altace 10 mg po OD
Norvasc 5 mg po OD
Simvastatin 20 mg po @ hs
ASA 81 mg po OD
Zyprexa 5 mg po TID
Cefazolin 1 gram IV q 8 hrs X 24 hours
Insulin Orders:
Novorapid SQ 6 units at breakfast
Novorapid SQ 4 units at lunch
Novorapid SQ 9 units at dinner
Lantus SQ 12 units at hs
Follow sliding scale for insulin ac meals and hs as follows:
Notify MD if blood sugar is < 4mmol/L or > 18mmol/L.
If blood sugar < 8 mmol/L give 0 units of insulin
If blood sugar is < 10mmol/L five 2 units of Novorapid SQ
If blood sugar is < 12 mmol/L give 3 units of Novorapid SQ
If blood sugar is < 14 mmol/L give 4 units of Novo rapid SQ
If blood sugar is < 16mmol/L give 5 units Novorapid SQ
If blood sugar is < 18mmol/L give 6 units of Novorapid SQ
PRN Medications:
Morphine 5 - 10 mg IM q 3h prn
Morphine 2.5 mg IV q 1 hr prn
Tylenol #3 П mg po q4 hr prn
Acetaminophen 650 mg po q 4hr prn
Colace 100 mg PO BID prn
Milk of Mag. 30 cc PO BID prn
Gravol 25 mg IV q 6 hr prn
Gravol 50 mg po q4h prn
Learning Objectives for the Medical/Surgical Professional
- Relate the significance of the patient’s symptoms and assessment findings.
- Appropriately administers oral medications.
- Demonstrates care and removal of a urinary catheter.
- Demonstrates a sterile wet to dry dressing change.
- Interprets pain appropriately and administers medication correctly.
- Records assessment findings, procedures and patient outcomes accurately.
- Performs a functional assessment of the patient
- Utilizes appropriate teaching strategies in regards to the post-operative hip replacement patient.
Questions that a Medical/Surgical Professional May Choose to Ponder in Preparation for the Simulated Clinical Experience
1. What are the steps to complete a physical assessment?
2. What assessments are highest priority for a patient who has had an
Open Reduction Internal Fixation of the hip two days ago?
3. Describe normal and abnormal lung sounds.
a. What are common causes for each abnormal sound?
b. What is the pathophysiology causing each of these abnormal
sounds?
4. Describe normal and abnormal heart sounds.
a. What are common causes for each abnormal sound?
b. What is the pathophysiology causing each of these abnormal
sounds?
5. Prioritize five assessments you believe would be most important for
this patient. Why did you choose these and prioritize them in this way?
6. What is the difference between abnormal and significant findings?
7. What is the correct technique for the insertion, care and removal of a urinary catheter?
8. What are the correct steps when preparing and administering oral medications?
9. What are the correct steps when preparing and administering IM and SQ injections
10. What are the differences between rapid, short, intermediate and long-acting insulins?
11. What are the signs and symptoms of hyperglycemia and hypoglycaemia? How would each be treated?
12. What are the principles of sterile technique?
13. What is the procedure for performing a wet to dry sterile dressing change?
14. What supportive emotional measures can the nurse provide a
hospitalized patient?
15. What are the components of a functional assessment? Why is this
important for this patient?
16. Do you think this patient will be able to return home and care for
herself? Why or why not?
References:
Canadian Diabetes Association (2007). Your Guide to Diabetes Medications. Retrieved October 1, 2007 from http://www.diabetes.ca/files/diabetesmedssupplementmarch2006.pdf
Cheung, A., Feig, D.S., Kapral, M., Diaz-Granados, N. & Dodlin, S., and The Canadian Task Force on Preventitive Health Care (2004). Prevention of osteoporosis and osteoporotic fractures in postmenopausal women: Recommendation statement from the Canadian Task Force on Preventative Health Care. Canadian Medical Association Journal, 170 (11), 1665-1667.
Chilov, M. N., Cameron, I. D., and March, L. M. (2003). Evidence-based guidelines for fixing broken hips: An update. The Medical Journal of Australia, 9, 489-493.
Jarvis, C. (2004) Physical examination of health assessment (4th ed.). St. Louis: Saunders.
McGee, S. (2001). Evidence-based physical diagnosis. Philadelphia: Saunders.
Potter, P. A., and Perry, A. G. (2005). Fundamentals of nursing (6th ed.). St. Louis: Mosby.
Registered Nurses’ Association of Ontario (2005). Prevention of falls and fall injuries in the older adult. Toronto: Registered Nurses’ Association of Ontario.
Springhouse. (2003). Best practices: A guide to excellence in nursing care. Philadelphia: Lippincott Williams and Wilkins.
MO13 Catherization and Urinary Care Video
Labour and Delivery Suite
½ day
Consists of 1 hour 15 minute L& D scenario where students will perform health teaching with a standardized patient “Dad”
10 minute break
2 hour Post-partum scenario
Students will have the opportunity to rotate through two stations in the labour and delivery suite. In one station the student nurses will participate in a maternal assessment and birth. Students will be expected to interpret and understand fetal heart strips and provide care for the birthing Mom and her husband. Following the birth of the baby, students will have the opportunity to provide care for the newborn and provide health teaching on the newborn bath and maternal and baby care to the Dad and birthing mannequin. In the second station students will assess and provide care for the post-partum Mom.
Birthing Station:
History/Information
Noelle Kringle is a 23 year old female, gravida 1 para 0 abortion 0 living 0 who arrived at the hospital at 2300 hours experiencing strong regular contractions every 4 -7 minutes lasting 30-45 seconds. At the time of her arrival she was 2 cm dilated and 20% effaced. She has been labouring through the night and remains 2-3 cm dilated and 20% effaced. She has been experiencing some elevated blood pressure readings 138/90, 142/88 with trace urine protein noted. She was group B streptococcus positive at 36 weeks. She is hoping for a ‘natural’ delivery and is supported by her husband Kris.
Past Medical History:
Apparently healthy young women who has been married for two years. She denies surgery or previous health problems. She denies smoking, recreational drug use, or alcohol use. No known drug allergies.
Family History:
Mother: hypertension and adult onset diabetes.
Father: myocardial infarction at age 58.
Father of Baby: medical history is unremarkable.
Medications:
IV Ns at 125 cc/hr
Morphine 3 mg IM q3 h prn
Dimenhydrinate 50 mg IM/Iv/PO q 4h prn
Oxytocin (synthocinon) Protocol
Cefazolin (Ancef) 2 gm IV X1, then 1 gm IV q 8 h
Learning Objectives for the labour and Delivery Period
1. Performs basic physical assessment of the labouring Mom.
2. Identifies signs and symptoms of the stages and phases of labour.
3. Identify fetal heart rate patterns and determines the likely cause of changes in fetal heart rate changes.
4. Performs appropriate nursing management interventions for the woman experiencing hypotonic labour.
5. Perform basic physical assessment of the newborn.
6. Identifies abnormal findings in the assessment of the newborn.
7. Performs appropriate interventions as needed for newborn and evaluates the effectiveness of the interventions.
8. Perform health teaching on newborn care to the Mom/Dad.
Questions that a you May Choose to Ponder in Preparation for the Simulated Clinical Experience
1. What complications are woman at risk for during the labouring period?
2. What key elements are included in a nursing assessment of a labouring Mom?
3. What key elements are included in a nursing assessment of a newborn?
4. What is the normal range for capillary blood glucose in a newborn infant on the first day of birth and thereafter?
5. What is the normal range of vital signs in the newborn?
6. What newborn health teaching is essential prior to discharge?
Post-partum Station:
History/Information
Noelle Kringle is a 23 year old female, gravida 1 para 1 abortion 0 living 1. Her blood type is A positive. It is two hours post normal spontaneous vaginal delivery of a male baby at 41 weeks gestation. The patient experienced onset of gestational hypertension during early labour with blood pressure readings reaching 140/90 and trace urine protein noted. This condition resolved following delivery and there was no further therapy initiated. Lab values prior to delivery were within normal limits. The patient experienced hypotonic labour and oxytocin augmentation of labour was instituted. She declined epidural anaesthesia, due to a desire to experience a more natural childbirth. Sixteen hours following onset of labour, she progressed to a spontaneous vaginal delivery of a male infant, with a cephalic presentation. The baby weighed 9 lbs and 8 oz. She had an episiotomy with partial third degree extension that was repaired following delivery of an intact placenta. Estimated blood loss following delivery was < 500 ml. The patient tested GBS positive. The physician ordered Ancef 2gm IV x 1 then 1 gm IV q 8h. Two doses have been given.
The postpartum recovery period was within normal limits. There were no episodes of unusual bleeding or clots. The patient’s husband, Kris, is at her bedside. Following a complete newborn assessment by the paediatrician, the baby is brought to Noelle’s room by the nursery staff. The patient informs you that she plans to breastfeed and desires future fertility.
Past Medical History:
Apparently healthy young women who has been married for two years. She denies surgery or previous health problems. She denies smoking, recreational drug use, or alcohol use. No known drug allergies.
Family History:
Mother: hypertension and adult onset diabetes.
Father: myocardial infarction at age 58.
Father of Baby: medical history is unremarkable.
Allergies:
NKDA
Medication List:
Cefazolin (Ancef) 2 gm IV X1, then 1 gm IV q 8 h (2 doses have been given)
S.A.M. Kit (Self Administration Medication Kit)
PRN Medications:
Acetaminophen 325 mg tabs 1-2 q 3 h po prn OR