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Simulation Scenario: Group 21. Include a minimum of (4) references from peer-reviewed journal within the last seven years that include evidenced based learning/teaching techniquesLearning Articles:Galloway, S. J., (May 31, 2009) "Simulation Techniques to Bridge the Gap Between Novice and Competent Healthcare Professionals" OJIN: The Online Journal of Issues in Nursing, Vol. 14, No. 2, Manuscript 3.Hood, K., Cant, R., Leech, M., Baulch, J., Gilbee, A., & GradCertHlthProfEduc. (2014). Trying on the professional self: nursing students' perceptions of learning about roles, identity and teamwork in an interprofessional clinical placement. Applied Nursing Research, 27(2), 109-114. doi:10.1016/j.apnr.2013.07.003McAllister, M., Levett-Jones, T., Downer, T., Harrison, P., Harvey, T., Reid-Searl, K., & ... Calleja, P. (2013). Snapshots of simulation: Creative strategies used by Australian educators to enhance simulation learning experiences for nursing students. Nurse Education In Practice, 13(6), 567-572. doi:10.1016/j.nepr.2013.04.010?McAllister, M., Levett-Jones, T., Downer, T., Harrison, P., Harvey, T., Reid-Searl, K., & ... Calleja, P. (2013). Snapshots of simulation: Creative strategies used by Australian educators to enhance simulation learning experiences for nursing students. Nurse Education In Practice, 13(6), 567-572. doi:10.1016/j.nepr.2013.04.010?Waxman, K. (2010). The development of evidence-based clinical simulation scenarios: guidelines for nurse educators. Journal of Nursing Education, 49(1), 29-35. doi:10.3928/01484834-20090916-07Simulation lab article.pdfReference articlesBateman, L., et al. (2012). Medical management in the acute hip fracture patient: A comprehensive review for the internist. The Ochsner Journal, 12(2), 101–110.Cervellin G, Comelli I, Lippi G. Rhabdomyolysis: historical background, clinical, diagnostic and therapeutic features. Clin Chem Lab Med. Jun 2010;48(6):749-56Judge, N. L. (2007). Neurovascular assessment. (Cover story). Nursing Standard, 21(45), 39-44.Papavasiliou, A. V., & Bardakos, N. V. (2012). Complications of arthroscopic surgery of the hip. Bone & Joint Research, 1(7), 131–144. Williams, L. S., & Hopper, P. S. (2011). Nursing Care of Patients Having Surgery. In Williams, L. S. (4th Eds.), Understanding Medical Surgical Nursing (pp196-229). Philadelphia: F.A. Davis Company2. Give a detailed explanation of the expectations of the student nurse based on the patient's condition.Learning Objectives: After completing this section of the course the student will be able to: Appropriately assess the following in?a postoperative hip?patient including:neurovascular respiratory cardiovasculargastrointestinalgenitourinarymusculoskeletalintegumentarypainiv/tubes/drains/dressingequipmentI+O The student will be able to assess for, recognize, and apply the appropriate interventions for the following complications:respiratory depressionhemorrhageDVT/PEpain inability to voidconstipationdislocation of jointimpaired circulationatelectasis/pneumoniadelirium infectionpressure ulcersrhabdomyolysiscompartment syndromeDiscuss ways to prevent postoperative complications in hip surgery patients through nursing interventionsmaintaining the patient in a neutral positionmonitoring for complications, such as hemorrhage, anemia, hypoxia, VTE, rhabdomyolysis, and compartment syndromeproviding pain reliefrecognizing and treating deliriumpreventing infectionsproviding adequate nutritionimproving the patient's mobilitymonitoring vital signs and urinary intake and outputassessing orientation status3. Describe the mental, physical, and social conditions of the patient.????Brief history of problem, vital signs, diagnostic study results, psychosocial issues, spiritual condition, family support, script of sample dialoguePatient History and Assessment **(also shift report in script)History of problem/Family Support/Psychosocial issues/Spiritual condition: “Mrs. Jones, a 75 year old Caucasian female that is one day post an ORIF of the right hip. She tripped over her cat in the night while walking to the bathroom.? She lives alone, both children reside out of state.? Her neighbor came to pick her up for a scheduled outing?yesterday afternoon and became concerned when she was unable to get an answer at the door.? She walked around the house knocking on windows and heard the patient calling from her bedroom.? She then called 911 and they broke in and found the patient laying on the floor of the bedroom.? The patient estimates she had been laying there about sixteen hours and states she tried to crawl to the phone but it "hurt to bad".? Patient has been emotional and crying.? Her daughter is calling frequently to get updates from a close family friend that is staying with the patient in her room. The daughter is trying to make arrangements to come be with her mother. Diagnostic study results/Vital Signs: Xray showed an acute intertrochanteric fracture proximal right femur.? There has been fixation of the intertrochanteric fracture of the right hip with a short intramedullary rod.? The patient currently has a foley catheter due to be discontinued tomorrow.? Physical and Occupational therapy have been ordered with weight bearing as tolerated.? Lovenox, TED hose, and SCD’s have been ordered for DVT prophylaxis.? Respiratory therapy has been ordered for incentive spirometer training.? The patient received Ancef prior to procedure and has one more dose scheduled.? Current pain management includes 1mg Morphine q3h prn and hydrocodone 5-10/325 q 4 hours prn.? Social service consult?has been ordered for discharge planning.? Her current set of vital signs are b/p 138/88, resp. 20, temp. 98.8°F, HR 98, O2 Sat 98%.”4. Include learning exercises that promote clinical reasoning skills through multiple ways of knowing. ?Include supplies, timing, skills evaluation check list Pre-requisite knowledge/activities: Clinical Case Information fixation care and management.docx?Oxygen administration.docx? system.docx article.pdf Syndrome Article.pdf system.docxPsychomotor Skills Required Prior to SimulationPhysical assessment skills Pain assessmentGiving and receiving report using SBARQ methodTaking vital signsDocumentationLab Set-upEstimated set up time 30 minutesPatient simulator/Task trainer:1.SimMan in hospital bed2.Put the call light out of reach from the patient.3.Place the SCD’s off of patient and place at the bottom of the bed. 4.Put the affected limb in an unaligned position, perhaps close to crossing midline..5.Moulage the affected limb with a reddened area on the back of the calf under the TED hose.6.Dressing to right hip with hemovac in place with moderate fake blood7.Foley with a couple hundred ml’s clear yellow urine8. Saline lock on patients left forearm with iv pole with empty Ancef hangingLab staff needed day of simulation:Clinical Instructor (pm nurse & manikin voice), actor (close friend),Equipment, supplies & prop list:SCD’s, HemovacFoley CatheterNasal CannulaDressing (abd, 4x4’s, tape)TED hosehospital gownblanketBlood pressure cuff or dinamap Doppler for pulsesIV pole ID bandBedside chairAbduction pillowSecondary for Ancef and tubing capped offSaline lock and tapeStudent Equipment:Stethoscope, penlight, paper, pen, watchDocumentation Forms: Standard chart (paper or computerized)Physician ordersMedication administration recordFlow Sheets: Vital signs, I+O’sNurses notesH&P???Scenario Guide and Script: Complications with ORIF of the right femur Timing (approximate)Manikin ActionsExpected InterventionsMay use the Following CuesFaculty/Staff Notes3-5 minPM nurse give the following report to student: “Mrs. Jones, a 75 year old Caucasian female that is one day post an ORIF of the right hip. She tripped over her cat in the night while walking to the bathroom. She lives alone, both children reside out of state. Her neighbor came to pick her up for a scheduled outing yesterday afternoon and became concerned when she was unable to get an answer at the door. She walked around the house knocking on windows and heard the patient calling from her bedroom. She then called 911 and they broke in and found the patient laying on the floor of the bedroom. The patient estimates she had been laying there about sixteen hours and states she tried to crawl to the phone but it "hurt to bad". Patient has been emotional and crying. Her daughter is calling frequently to get updates from a close family friend that is staying with the patient in her room. The daughter is trying to make arrangements to come be with her mother. Diagnostic study results/Vital Signs: Xray showed an acute intertrochanteric fracture proximal right femur. There has been fixation of the intertrochanteric fracture of the right hip with a short intramedullary rod. The patient currently has a foley catheter due to be discontinued tomorrow. Physical and Occupational therapy have been ordered with weight bearing as tolerated. Lovenox, TED hose, and SCD’s have been ordered for DVT prophylaxis. Respiratory therapy has been ordered for incentive spirometer training. The patient received Ancef prior to procedure and has one more dose scheduled. Current pain management includes 1mg Morphine q3h prn and hydrocodone 5-10/325 q 4 hours prn. Social service consult has been ordered for discharge planning. Her current set of vital signs are b/p 138/88, resp. 20, temp. 98.8°F, HR 98, O2 Sat 98%.” (outside of room) Student will listen and/or write notes or take hand off communication sheet.10-15 minManikin PresentationOnce done receiving report call light is cue to enter room. Friend at bedside and very attentive and identifies selfPatient, “My leg is still really hurting! I just can’t get comfortable.”Manikin lying in semi-fowlers in bed with call light out of reach from the patient SCD’s are off of patient and placed at the bottom of the bed. Along with the abduction pillow on floor beside the bed.Right leg affected limb in an unaligned position, close to crossing midline.“My right calf is very tender too and feels a little tight”Unable to palpate a right pedal pulse.“Well, am I going to live?”Student enters room introduces self, hand hygiene is done, and identifies patient and acknowledges visitor in room. Turns off call light. Assesses pain.Student focuses on pain and does a complete assessment maintaining patient modesty.Student places call light within reach.Student will recognize that the SCD’s are off and inquires how long they have been off. Student will proceed to do a thorough head to toe assessment. Noticing misaligned right leg and reddened, swollen right calf.6/7. Student assesses limb by doing a neurovascular check, realigns limb, places abductor pillow in place, and educates patient and family in laymen terms. Does not put SCD back on right calf. Student reassures patient while being truthful, without diagnosing and then will notify team-leader (physician) of findings ASAP.1.“My kids live too far away to be here.”2.Patient can state that close friend can stay in room ”we’re like sisters”4.“I haven’t had them on all night. I couldn’t sleep with them on so my friend helped me take them off.”5.Giving appropriate answers to assessment questions. Impromptu 7.Needs to use Doppler to find pedal pulse. “What’s that for?”5-10 minDebriefingExplain actions and rational, planned interventions, and document patient assessment and encounter. Standard post op care- complete head to toe assessment, not just focus assessment, neurovascular, checks, TCDB, incentive spirometer, what these smaller complications could lead to if not found, the importance of proper post op care.5.Evaluate: Review the principles of Clinical Evaluation Tool by Caputi in Appendix C then Include a sample tool with expected?answers?depending on your?clinical scenario (see Oermann p. 355 Tool: Predict and Manage Potential Complications) using the following questionsScenario Events and Expected Actions and Grading RubricPerformance CriteriaSatisfactory(able to clearly and accurately identify all questions on tool)Needs Improvement(able to clearly and accurately identify some but not all questions on tool)Unsatisfactory(unable to clearly and accurately identify all questions on tool)1. Able to identify potential problems:DVTDisplaced hip jointSafety-Call light out of reachAble to identify and monitor important assessment findings for this patient.Weak pedal pulseElevated v/spoor body alignmentswollen, red, & painful calfAble to identify all factors influencing the most important data to monitor. Swollen, red, painful calf- DVTAbsent pedal pulses-DVT and/or hip dislocationUnrelieved pain- DVT/hipAssess respiratory statusCoagulation labsVital signsAble to prioritize planned plete assessmentRealign right leg and appropriate use of SCD, TED hose, & abduction pillowNotify physician STAT and team leaderFrequent neurovascular checksEducate patient and visitor.Safety-bedrails, bed height, call light.Able to plan actions to take if complications occur.Notify physicianAnticipate pre-op measures (npo, patent large bore iv status, anticipate iv fluids)Frequent monitoring including respiratory status (PE/MI)Supplemental OxygenAble to demonstrate effective preventative measures for potential complicationsTurn, cough and deep breathSCD’sMedicationsSafety monitor and keep dressing site cleanKeep drains empty and functionalincentive spirometerproper body alignmentmonitoring for complications, such as hemorrhage, anemia, hypoxia, VTE, compartment syndrome, rhabdomyolysisproviding pain reliefrecognizing and treating deliriummonitor for signs of infectionsproviding adequate nutritionmonitoring vital signs and intake and outputidentifying abnormal lab valuesKey Words:Post-operative care, ORIF Hip, DVT, hip dislocation ................
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