MAPPING OUT SCENARIO NURS 4231 PEDIATRIC CYSTIC FIBROSIS & ISOLATION

Objectives:

  1. Identify and implement infection control (isolation) and safe patient care environment
  2. Develop and implement developmentally appropriate care for a school-aged child with chronic illness (pediatric cystic fibrosis) after age-appropriate assessment
  3. Utilize therapeutic communications with all team members involved

Pre-Simulation Exercises:

  1. Describe the pathophysiology of cystic fibrosis.
  2. What are the effects of CF on the respiratory and GI systems?
  3. What are the primary interventions in the management of respiratory distress in CF?
  4. What is the affect of chronic conditions, such as CF, on the growth and development of the school-aged child?

Post-Simulation Exercises:

  1. Reflective journal

Evaluation of Learner: Formative Assessment SLS Observer Evaluation Rubric

Evaluation Tool of Simulation: METI SET Tool and Leighton-CLECS tool

Facilitation: Participant Led with verbal cueing

Minimal Number of Participants: 1Maximum Number of Participants: 2

Scenario Time: 10-15 minPrebrief Time: 2-5 minSimulation Time: 30- 40 min (3 groups prebrief together, simulation in groups of 2, then debrief together for 1 hour time)

Debriefing Time: 15-20 minVideo Recording: Will recording be retained:

Designers: T. Gore (Sim Coordinator), K. Renfroe (Lab Coordinator), and J. McLeod (SME-Pediatrics)

Validation and Peer Review:

You arrive to precept with your nurse at Baptist East today. You are assigned to Jason Bright, a 9 year old male patient diagnosed with Cystic Fibrosis and was admitted to the Progressive Care Unit with pneumonia yesterday. He presented with fever (max 102.6), dehydration, and increased secretions (thick greenish). His WBC is 13.3, O2 saturation 90% on 4 l/min and has blood and sputum cultures pending. CXR reveals RLL pneumonia. Other labwork is within normal limits. He is receiving Vancomycin every 12 hours with pharmacy calculating dosage based on Ht 4’5” and wt. 62#. He is on unit dosed nebulizer treatments, IPPB, CPT every 6 hours per respiratory therapy. He is currently on isolation pending culture results. His mother has left the room to get something to eat.

State #1 / Interventions / State #2 / Interventions / State #3
  1. Admitted 1 day with Pneumonia and cystic fibrosis.
  2. Patient sitting with HOB elevated, O2 not applied (worn appropriately)
  3. HR 110, BP 104/68, RR 30 and labored (short of breath when talking), SaO2 90%, & Temp 99.8 (T max 102.6)
  4. If monitor available, ST without ectopy
  5. RLL crackles and wheezing throughout
“NURSE, HELP ME!!
I am short of breathe some. What are you going to do for me?”
“I don’t like to wear the oxygen.”
“Just make it better, do you know what you are doing?”
“I want my mom.”
“You are not my parent and I don’t have to do what you say!” /
  1. Conduct an appropriate assessment and evaluate findings
  2. Recognize abnormal findings
  3. (If students asks) cap refill 4 seconds
  4. Respiratory toilet (HOB elevated, O2 reapplied, consult Respiratory therapy for CPT and breathing treatment using ISBARR via phone or intercom with Unit Secretary)
  5. Utilization of PPE and appropriate hand hygiene
  6. Uses isolation stethoscope, BP cuff, thermometer
  7. Using developmentally appropriate therapeutic communication w/pt
/
  1. Pt must be talked into cooperating through developmentally appropriate interventions.
  2. Vital signs unchanged
  3. If appropriate interventions, improving shortness of breathe.
  4. If not, continue uncooperative and SOB with RR up to 38/min and O2 Sat 88%
  5. Phone call for sputum culture results pseudomonas and WBC 15.4, if student doing appropriate developmental intervention. If not, then concentrate on not cooperating until
  6. Use ad lib communication depending on students’ comments and interventions
/
  1. Continues to monitor and interact with patient to increase oxygen saturation level
/
  1. HR 108, BP 102/68, RR 24, SaO2 93%, Temp 99.8
  2. “I am feeling a little better.”
  3. “Thanks.
  4. Black light room and students hands/clothing to see contamination using glitter bug

Props / Props / Props / Props / Props
Pediatric manikin to 9- year old male, Jason Bright.
Boys PJs, wig, baseball cap, shorts, socks, stuffed animal & football or other toys in the bed.
Saline Lock
O2 nasal cannula & venti-mask, neb tx
Isolation cart with PPE, stethoscope, BP cuff, & thermometer
Pulse oximeter
Handwashing/hygiene equipment
Urinal w/ dark concentrated urine
Suction equipment
Call light
Hi caloric protein snacks
Glitter Bug on siderails, door handle, patient, football, stuffed animal, and miscellaneous areas.

Debriefing: (Ask at least one from each section)

Aesthetic Questions:

“I would like each of you to talk to me about the problem(s) Jasonwas experiencing today.

“What was your main objective during this simulation?”

“How did patient safety and isolation issues affect the patient care you provided?”

Personal Questions:

“How did this scenario make you feel?”

“What made you chose the actions/interventions/focus you chose for Jason?”

Empirical Questions:

“I would like for each of you to talk with me about the knowledge, skills, attitudes(KSA) and previous experiences that provided you the ability to provide evidence-based care to Jason.”

Ethical Question:

“Talk to me about how your personal beliefs and values influenced the care provided to Jason.”

Reflection:

“Will each of you tell me how you knew what to do for a CFpatient with pneumonia and isolation and why?

If we could re-do this scenario now, what would you change and why?

How will you use this in your professional practice?”

Kim Leighton, BryanLGH College of Health Sciences2008 and Teresa Gore, Auburn University 2011