SIMULATION ADMISSION TICKET: Diabetes Type II
Name: Nadine Cruz Vega Date: August 26th, 2025 Instructor: Amy Beachy
Simulation Learning Objectives:
1. Complete focused assessment(s) & reassessment(s) to include, but not limited to: cardio-
respiratory; neurological; integumentary; genitourinary; abdominal; etc…;
2. Prioritize & perform interventions based on patient’s problems/needs and provider orders;
3. Evaluate effectiveness of interventions and revise the plan of care as indicated by patient
condition
Patient Overview:
Client Name: Amy Reynolds Gender: Female Race: Caucasian Age: 57
Weight: 205 lbs Height: 5’4” Location: Med Surg Physician: Dr. James
Client Information: Ms Reynolds was a direct admission from her provider’s office 3 days ago for
complaints of “feeling tired” and a “HIGH” glucose reading on her home glucometer. On admission she
was experiencing dysuria, frequency, fever of 102.6°F, vomiting, diarrhea, and a blood glucose level of
425 on her meter. She had been taking oral hypoglycemic agents along with diet monitoring prior to
this hospital admission to control her Type 2 diabetes but will be discharged home on insulin in addition
to her oral hypoglycemic agent. After 3 days in the hospital, she is being discharged today.
Past Medical History: Diabetes Type II, Hypertension, GERD
Allergy: NKDA
Social History: Works at local grocery store as cashier. Two grown children that both live outside of
the home. No history of tobacco or recreational drug use. Occasional alcohol use.
Surgeries/Procedures: None
Possible Skills during scenario: Bedside glucometer; diet education to include carb-counting & 15-
15 rule; insulin administration; insulin pen education; patient teaching.
Home Medication List: metformin PO, hydrochlorothiazide PO, omeprazole PO, captopril PO
Initial lab work:
CBC: WBC-17, RBC-4.30, Hgb-12.8, Hct-38, MCV-8.8, MCH-29.7, MCHC-34, RDW-12.5,
Platelets-325, Bands-2, Segs-85, Lymph-10, Mono-3
CMP: Na+-138, K+-3.6, Cl--102, CO2-25, BG-432, BUN-25, Creatinine-1.2, Ca+-8.8, AST-32, ALT-44,
ALK Phos-65, Total Bili-0.02, Total Prot-6.0, Albumin-3.5
Hb A1C – 9.9%
UA: Color-Dk Amber, Appearance-Hazy, Spec Gravity-1.040, pH-8.2, GL- > 800, Ketones-positive,
Blood-,positive; Nitrates- positive; Protein-35; Bili-negative; UroBili-0.2; Bacteria-4+; Leukocyte-Pos;
Casts-Present; RBC-5-10; Crystals-Pos; WBC-tntc
AM labs: in electronic medical record
Reviewed & revised: 01/2025; 02/2025; 06/2025
, On the day of simulation, the student will provide a screenshot of submission
confirmation but will not need to provide a printed paper copy of the ticket to the center.
If the student wishes to print the ticket for their own use during the simulation
experience that is optional OR the student may bring hand-written notes for reference.
Please answer the following questions as part of preparation for simulation. Utilize
evidence-based resources, i.e. textbooks, websites such as UpToDate, research articles,
governing bodies, etc…
1. Compare & contrast Type 1 diabetes & Type 2 diabetes. Identify, in your own
words, the biggest differences between the types;
Type 1 Diabetes: An autoimmune disease caused by the destruction of the
pancreatic beta cells, which prevents them from producing insulin. Requires
insulin for life and is usually diagnosed at a young age.
Type 2 Diabetes: A result of insulin resistance, which prevents the secretion
of insulin. It’s a disease more commonly seen in adults caused by obesity, a
sedentary lifestyle, or family history.
The most significant difference between Type 1 Diabetes and Type 2
Diabetes is that in Type 1 Diabetes, the body is unable to produce insulin. In
contrast, in Type 2 Diabetes, the body can produce insulin, but it is not
appropriately utilized.
2. Define the signs & symptoms of hypoglycemia and hyperglycemia. How will you
educate your patient on what needs to be reported to the HCP?
Hypoglycemia is considered when a patient’s blood glucose is below
65mg/dL. The causes are either excessive insulin, excessive oral
hypoglycemic agent, inadequate food intake, or excessive physical activity.
The patient may present symptoms of shakiness, irritability, anxiety,
headache, lightheadedness, double vision, hypotension, tachycardia, and
cool & clammy skin. The patient needs to be educated on the 15 to 15 rule,
which means that whenever they are experiencing a hypoglycemic episode,
they should intake 15g of sugar and recheck their sugar level in 15 minutes.
If it remains low, repeat the process.
Hyperglycemia is considered when a patient’s blood glucose levels are
above 200mg/dL. Symptoms will be increased thirst, frequent urination,
fatigue, blurred vision, fruity breath, nausea, vomiting, and abdominal pain.
The patient needs to be educated in reporting their doctor about consistently
high blood sugar levels that are above 300mg/dL, which is a dangerous
finding that could lead to ketoacidosis.
Reviewed & revised: 01/2025; 02/2025; 06/2025
Name: Nadine Cruz Vega Date: August 26th, 2025 Instructor: Amy Beachy
Simulation Learning Objectives:
1. Complete focused assessment(s) & reassessment(s) to include, but not limited to: cardio-
respiratory; neurological; integumentary; genitourinary; abdominal; etc…;
2. Prioritize & perform interventions based on patient’s problems/needs and provider orders;
3. Evaluate effectiveness of interventions and revise the plan of care as indicated by patient
condition
Patient Overview:
Client Name: Amy Reynolds Gender: Female Race: Caucasian Age: 57
Weight: 205 lbs Height: 5’4” Location: Med Surg Physician: Dr. James
Client Information: Ms Reynolds was a direct admission from her provider’s office 3 days ago for
complaints of “feeling tired” and a “HIGH” glucose reading on her home glucometer. On admission she
was experiencing dysuria, frequency, fever of 102.6°F, vomiting, diarrhea, and a blood glucose level of
425 on her meter. She had been taking oral hypoglycemic agents along with diet monitoring prior to
this hospital admission to control her Type 2 diabetes but will be discharged home on insulin in addition
to her oral hypoglycemic agent. After 3 days in the hospital, she is being discharged today.
Past Medical History: Diabetes Type II, Hypertension, GERD
Allergy: NKDA
Social History: Works at local grocery store as cashier. Two grown children that both live outside of
the home. No history of tobacco or recreational drug use. Occasional alcohol use.
Surgeries/Procedures: None
Possible Skills during scenario: Bedside glucometer; diet education to include carb-counting & 15-
15 rule; insulin administration; insulin pen education; patient teaching.
Home Medication List: metformin PO, hydrochlorothiazide PO, omeprazole PO, captopril PO
Initial lab work:
CBC: WBC-17, RBC-4.30, Hgb-12.8, Hct-38, MCV-8.8, MCH-29.7, MCHC-34, RDW-12.5,
Platelets-325, Bands-2, Segs-85, Lymph-10, Mono-3
CMP: Na+-138, K+-3.6, Cl--102, CO2-25, BG-432, BUN-25, Creatinine-1.2, Ca+-8.8, AST-32, ALT-44,
ALK Phos-65, Total Bili-0.02, Total Prot-6.0, Albumin-3.5
Hb A1C – 9.9%
UA: Color-Dk Amber, Appearance-Hazy, Spec Gravity-1.040, pH-8.2, GL- > 800, Ketones-positive,
Blood-,positive; Nitrates- positive; Protein-35; Bili-negative; UroBili-0.2; Bacteria-4+; Leukocyte-Pos;
Casts-Present; RBC-5-10; Crystals-Pos; WBC-tntc
AM labs: in electronic medical record
Reviewed & revised: 01/2025; 02/2025; 06/2025
, On the day of simulation, the student will provide a screenshot of submission
confirmation but will not need to provide a printed paper copy of the ticket to the center.
If the student wishes to print the ticket for their own use during the simulation
experience that is optional OR the student may bring hand-written notes for reference.
Please answer the following questions as part of preparation for simulation. Utilize
evidence-based resources, i.e. textbooks, websites such as UpToDate, research articles,
governing bodies, etc…
1. Compare & contrast Type 1 diabetes & Type 2 diabetes. Identify, in your own
words, the biggest differences between the types;
Type 1 Diabetes: An autoimmune disease caused by the destruction of the
pancreatic beta cells, which prevents them from producing insulin. Requires
insulin for life and is usually diagnosed at a young age.
Type 2 Diabetes: A result of insulin resistance, which prevents the secretion
of insulin. It’s a disease more commonly seen in adults caused by obesity, a
sedentary lifestyle, or family history.
The most significant difference between Type 1 Diabetes and Type 2
Diabetes is that in Type 1 Diabetes, the body is unable to produce insulin. In
contrast, in Type 2 Diabetes, the body can produce insulin, but it is not
appropriately utilized.
2. Define the signs & symptoms of hypoglycemia and hyperglycemia. How will you
educate your patient on what needs to be reported to the HCP?
Hypoglycemia is considered when a patient’s blood glucose is below
65mg/dL. The causes are either excessive insulin, excessive oral
hypoglycemic agent, inadequate food intake, or excessive physical activity.
The patient may present symptoms of shakiness, irritability, anxiety,
headache, lightheadedness, double vision, hypotension, tachycardia, and
cool & clammy skin. The patient needs to be educated on the 15 to 15 rule,
which means that whenever they are experiencing a hypoglycemic episode,
they should intake 15g of sugar and recheck their sugar level in 15 minutes.
If it remains low, repeat the process.
Hyperglycemia is considered when a patient’s blood glucose levels are
above 200mg/dL. Symptoms will be increased thirst, frequent urination,
fatigue, blurred vision, fruity breath, nausea, vomiting, and abdominal pain.
The patient needs to be educated in reporting their doctor about consistently
high blood sugar levels that are above 300mg/dL, which is a dangerous
finding that could lead to ketoacidosis.
Reviewed & revised: 01/2025; 02/2025; 06/2025
