DETERIORATING PATIENT SIMULATION: ELDERLY …

DETERIORATING PATIENT SIMULATION: ELDERLY UROSEPSIS

LEARNER PREPARATION PACKAGE

BRIEF SUMMARY OF CASE

82 year old male/female encountered in the ER department upon transfer from a long-term care (LTC) facility, with foley catheter in situ, and wrist restraints tied to bed/stretcher rails. PSW accompanying patient describes a 2 day onset of increasing confusion & agitation. Patient is a previously stable elderly woman who has lived in a LTC facility for 8 months following a stroke that left him/her with right-sided weakness and inability to walk or perform ADL without assistance. Patient has had incontinence since his/her stroke and had Foley catheter inserted in the LTC facility. Patient has no residual speech or memory deficits.

PRE-SCENARIO LEARNER ACTIVITIES

Prerequisite Competencies Knowledge

Care of patient with UTI/urosepsis/septic shock

Pharmacology of antibiotics

Intravenous therapy

Care of patient with delirium

Pathophysiology, risk factors & treatment of UTI/urosepsis/septic shock

Skills/ Attitudes SBAR communication

Administration of antibiotics Safe intravenous administration Communication with acutely ill, agitated patients

Learner Instructions 1. Review the case summary, learning objectives/competencies, patient profile and healthcare provider

orders prior to your upcoming simulation session.

2. Prior to the simulation use the pre-simulation assessment rubric to evaluate your own confidence/ability to meet the learning objectives/competencies for the simulation scenario

3. Based on your self-assessment you may choose to review any materials to prepare you to meet the expected competencies: course lectures/notes, textbook readings and/or clinical practice guidelines

4. To enhance your preparation you may also complete the attached case study and/or the virtual simulation game found at:

5. Following the simulation reflect on your performance during the simulation and re-evaluate your own confidence/ability to meet the learning objectives/competencies using the post-simulation rubric

Competency

Collaborates with team members to deliver efficient and effective nursing care

Comments

PRE-SIMULATION LEARNING OUTCOME ASSESSMENT RUBRIC

Demonstrated attributes align with

Demonstrated attributes need

Demonstrated attributes need

required competency

some improvement to align with

major improvement to align with

required competency

required competency

Ensures all relevant tasks are assigned to appropriate team members

Ensures some relevant tasks are assigned to appropriate team members

Never assigns relevant tasks to appropriate team members

Never ensures relevant tasks are

Ensures tall relevant tasks are completed in a timely manner

Shares knowledge and skill with

Ensures some relevant tasks are completed in a timely manner

Sometimes shares knowledge and skill

completed in a timely manner Never shares knowledge and skill with

other team members

other team members as required Requests assistance from other team

members as required

with other team members Sometimes requests assistance from

other ream members

Never requests assistance from other team members

Deliver essential data to physician or NP in an urgent situation to convey the need for timely assistance to effectively diagnose and treat the patient's deteriorating condition.

Comments

? Immediately recognizes assessment findings indicate a need to get help ? SBAR is used in a manner that effectively allows the physician/NP to make timely decisions regarding care ? Data used accurately reflects the patient's current condition ? Reports evidence in a way that promotes the urgency of the situation

? Has difficulty recognizing assessment findings indicate a need to get help ? SBAR is used in a manner that somewhat allows the physician/NP to make timely decisions regarding care ? Data used somewhat accurately reflects the patient's current condition ? Reports evidence in a way that somewhat promotes urgency of situation

? Does not recognize assessment findings indicate a need to get help ? SBAR is not used or used in a manner that does not allow the physician/NP to make timely decisions regarding care ? Data used does not accurately reflect the patient's current condition ? Does not report evidence in a way that promotes the urgency of the situation

Perform appropriate emergency measures in an urgent situation to prevent further deterioration of the patient's condition until help arrives

Comments

? Resources accessed demonstrate a thorough understanding of urosepsis ? Implemented Interventions are likely to be effective in helping to treat urosepsis ? Interventions are carried out in a way that reflect the urgency of the situation ? Interventions are implemented with a regard for patient safety

? Resources accessed demonstrate some understanding of urosepsis ? Implemented Interventions may be effective in helping to treat urosepsis ? Interventions are carried out in a way that somewhat reflect the urgency of the situation ? Interventions are implemented with some regard for patient safety

? Resources accessed do not demonstrate an understanding of urosepsis ? Implemented Interventions are not likely to be effective in helping to treat urosepsis ? Interventions are carried out in a way that do not reflect the urgency of the situation ? Interventions are implemented with no regard for patient safety

Recognize unsafe practices and conditions within the patient's environment to prevent near misses or errors that could cause further complications in an already compromised patient. Comments

? Consistently demonstrates a regard for routine and universal infection control practices ? Care consistently demonstrates the need to minimize and remove human error

? Demonstrates a regard for routine and universal infection control practices some of the time ? Care sometimes demonstrates the need to minimize and remove human error

?Does not demonstrate a regard for routine and universal infection control practices ? Care does not demonstrate the need to minimize and remove human error

Communicate therapeutically with the patient and their family to decrease anxiety and promote cooperation with care

? Uses language that effectively allows the patient and their family to understand the situation ? Collaborates with the patient and their family to allow them to operate within their values and beliefs structure ? Respects the patient's/family's right to informed decision-making

? Uses language that somewhat allows patient and their family to understand the situation ? Allows the patient and their family to sometimes operate within their values and beliefs structure ? Shows some respect for the patient's/family's right to informed decision-making

Comments

? Does not use language that effectively allows the patient and their family to understand the situation ? Does not collaborate with the patient and their family to allow them to operate within their values and beliefs structure ? Does not respects the patient's/family's right to informed decision-making

POST-SIMULATION LEARNING OUTCOME ASSESSMENT RUBRIC

Patient/ Client Role

Nurse Practitioner Part 1 Nurse Part 1 Nurse Part 1 Nurse Part 1 PSW from LTC Part 2 Nurse Part 2 Nurse Part 2 Nurse Part 2 Family member/s

SCENARIO ROLES X High fidelity simulator

Brief Descriptor

Stay with patient until family member arrives (see script)

Son or daughter/s (see script)

Instructor/Learner Instructor Learner #1 Learner #2 Learner #3 Learner #4 Learner #5 Learner #6 Learner #7 Learner #8

PATIENT PROFILE/HISTORY

Last name:

Thompson

First name:

Bruce/Betty

Gender: M

Age: 82

Ht: 182 cm Wt: 74.8 kg

Code Status: Not determined

Spiritual Practice: Unknown

Ethnicity: Caucasian

Primary Language spoken: English

1. Past history

Previously stable elderly gentleman/woman who has lived in a LTC facility for 8 months following a stroke that

left him/her with right-sided weakness and inability to walk or perform ADL without assistance. Patient has had

incontinence since his/her stroke and had Foley catheter inserted in the LTC facility. Patient has no residual

speech or memory deficits.

Primary Medical Diagnosis Confusion NYD

2. Review of Systems (From Long-Term Care Chart/Transfer Note)

CNS

Alert but disoriented, active, spontaneous movement of 4 extremities (weaker on R side),

does not follow simple instructions, communicates inappropriately, behaviour agitated

Cardiovascular

Heart rate & rhythm regular, absence of peripheral edema, skin warm & dry, dorsalis pedis

& posterior tibial pulses present, V/S: 37.8, 88, 18, 144/84

Pulmonary

Respirations regular & unlaboured, air entry equal to bases with no adventitious sounds,

no evidence of dyspnea or orthopnea, 02 sat: 94% on room air

Renal/Hepatic

Foley catheter in situ, draining scant amount of dark amber, cloudy urine

Gastrointestinal Has not been eating or drinking much since onset of confusion and agitation, last bowel

movement two days ago, abdomen soft and non-tender, mouth and tongue dry

Endocrine

N/A

Heme/Coag

N/A

Musculoskeletal R-sided weakness, requires assistance to walk or perform ADL

Integument

Skin warm and dry

Developmental Hx Normal

Psychiatric Hx

None reported, 2 day onset of increasing confusion and agitation

Social Hx

Widowed; Two grown children (1 son, 1 daughter) each live about an hour away.

Alternative/ Complementary Medicine Hx

None

Medication allergies:

Penicillin

Reaction:

Hives & itching

Food/other allergies:

Reaction:

3 . Curre

n t medic ations

Drug Aspirin Telmisartan

Dose 81 mg 40 mg

Route P.O. P.O.

Frequency Daily Daily

4. Laboratory, Diagnostic Study Results

Na: 151 mmol/L

Ca: Hgb: 180 g/L PT ABG-pH: VDRL:

K: 3.5 mmol/L

Mg: Hct: 58% PTT paO2: GBS:

Cl: 115 mmol/L HCO3:

BUN: 18

Cr:

140

mmol/L

umol/L

Phos:

Glucose: 8.4

HgA1C:

Plt: 250 x 109/L WBC: 25 x 109 /L ABO Blood Type: O+

INR

Troponin:

BNP:

paCO2:

HCO3/BE:

SaO2:

Herpes:

HIV:

Cxr:

EKG

HEALTH CARE PROVIDER ORDERS

Patient Name: Thompson, Bruce/Betty

Diagnosis:

DOB:

Confusion NYD

Age: 82 yrs

MR#:

No Known Allergies Allergies & Sensitivities: Date Time

HEALTH CARE PROVIDER ORDERS AND SIGNATURE

XX

XX

V/S q2h

CBC, lytes, BUN, Cr, glucose, blood cultures

Urinalysis, urine C & S

Remove Foley catheter and reinsert catheter prior to obtaining urine

specimens

IV N/S 100 cc/hr

Ampicillin 2 g IV stat & q6h

Gentamycin 160 mg IV stat

Signature

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