PAIN VR SIM
SBAR
Situation:
Your patient is a 54 year-old male named Mr. Morton. He is 2 days postoperative from a total left hip arthroplasty due
to joint deterioration from a work injury 5 years ago. His surgery was performed without any complications. Mr.
Morton is frequently complaining of 10/10 left hip and lower back pain, despite receiving 1 mg of I' hydromorphone
every 3 hours. The night shift nurse contacted the provider about Mr. Morton's pain and his hydromorphone dosage
was increased to 2 mg, which he received 30 minutes ago. Mr. Morton is upset about his pa and has asked his
daughter, Jenny, to bring in his prescription pain pills from home. Both the provider and night shift nurse told him it is
against hospital policy to take his home pain medications. Jenny is currently at his bedside.
Background:
Mr. Morton is a retired firefighter. He has a history of chronic low back pain and left hip pain for the pas years since
falling off a 15 foot ladder while fighting a fire. His chronic pain is managed by his primary care provider at home he
takes prescription hydrocodone/acetaminophen 7.5/325 mg every 6 hours as needed. He also has a hist of
hypertension, hyperlipidemia, and type 2 diabetes. He takes lisinopril 20 mg daily, simvastatin 40 mg daily, and
metformin 500 mg BID.
Assessment:
The last set of vitals taken by the night shift nurse 30 minutes ago were as follows: HR 98; RR 18; BP: 146/82; Sp02
96% on room air, T 98.2 F (36.8 C) oral. His left hip surgical incision is covered by a clean, dry, and int dressing. Incision
is well approximated, sutures intact, draining a small amount of serosanguinous fluid, with no sign: infection. He has a
normal saline IV lock in his left arm that is soft and patent.
Recommendation:
You are entering the room. Assess the patient and implement provider orders as appropriate. Nc the provider as
needed for changes in the patient's condition
1
, Preceptor Hospital Day Assignment
Chief Complaint/History of Present Illness: (Write a couple of sentences r/t client’s chief complaint/hx.
Of present illness: when did symptoms begin, describe symptoms etc.)
Pt has unrelieved pain to the lower back and left hip presented by frequent complaining of pain rated
10/10 on a pain scale. Despite recievinb 1mg of hydromorphone every 3 hours.
What data from the chief complaint (CC) and history of present illness (HPI) is RELEVANT that must
be recognized as clinically significant to the nurse?
RELEVANT data from CC/HPI: Rationale:
Pain from 2 days post op total hip Recent surgical procedure resulting in new onset of acute pain
arthroplasty.
Hx of chronic low back pain and left
Pt has a long hx of pain, meaning pt could have a higher tolerance for
hip
pain
Has a rx from
Pt currently takes pain medication at home for chronic pain, meaning
hydrocodone/acetaminophen
pt may not need additional interventions for pain then the average
7.5mg/325mg q6 hrs.
adult.
Hs of htn
Elevated BP could be a sign of his current htn diagnosis as well as a
sign of increased pain.
Past Medical History:
Htn, hyperlipidemia, type 2 diabetes, chronic lower back and left hip pain.
Nursing Assessment:
Allergies: NSAIDS
Code Status: FULL CODE
V/S (provide numbers & analyze trends):
HR 98, RR18, BP 146/82, SPO2 96% ON RM AIR, T 98.2F ORAL- Would anticipate BP to be slightly
above the normal limits given pt has a hx of htn. I would anticipate pt temp to remain wnl, HR to remain
wnl unless pain continues to be uncontrolled in that case I would see a elevated HR.
2
SBAR
Situation:
Your patient is a 54 year-old male named Mr. Morton. He is 2 days postoperative from a total left hip arthroplasty due
to joint deterioration from a work injury 5 years ago. His surgery was performed without any complications. Mr.
Morton is frequently complaining of 10/10 left hip and lower back pain, despite receiving 1 mg of I' hydromorphone
every 3 hours. The night shift nurse contacted the provider about Mr. Morton's pain and his hydromorphone dosage
was increased to 2 mg, which he received 30 minutes ago. Mr. Morton is upset about his pa and has asked his
daughter, Jenny, to bring in his prescription pain pills from home. Both the provider and night shift nurse told him it is
against hospital policy to take his home pain medications. Jenny is currently at his bedside.
Background:
Mr. Morton is a retired firefighter. He has a history of chronic low back pain and left hip pain for the pas years since
falling off a 15 foot ladder while fighting a fire. His chronic pain is managed by his primary care provider at home he
takes prescription hydrocodone/acetaminophen 7.5/325 mg every 6 hours as needed. He also has a hist of
hypertension, hyperlipidemia, and type 2 diabetes. He takes lisinopril 20 mg daily, simvastatin 40 mg daily, and
metformin 500 mg BID.
Assessment:
The last set of vitals taken by the night shift nurse 30 minutes ago were as follows: HR 98; RR 18; BP: 146/82; Sp02
96% on room air, T 98.2 F (36.8 C) oral. His left hip surgical incision is covered by a clean, dry, and int dressing. Incision
is well approximated, sutures intact, draining a small amount of serosanguinous fluid, with no sign: infection. He has a
normal saline IV lock in his left arm that is soft and patent.
Recommendation:
You are entering the room. Assess the patient and implement provider orders as appropriate. Nc the provider as
needed for changes in the patient's condition
1
, Preceptor Hospital Day Assignment
Chief Complaint/History of Present Illness: (Write a couple of sentences r/t client’s chief complaint/hx.
Of present illness: when did symptoms begin, describe symptoms etc.)
Pt has unrelieved pain to the lower back and left hip presented by frequent complaining of pain rated
10/10 on a pain scale. Despite recievinb 1mg of hydromorphone every 3 hours.
What data from the chief complaint (CC) and history of present illness (HPI) is RELEVANT that must
be recognized as clinically significant to the nurse?
RELEVANT data from CC/HPI: Rationale:
Pain from 2 days post op total hip Recent surgical procedure resulting in new onset of acute pain
arthroplasty.
Hx of chronic low back pain and left
Pt has a long hx of pain, meaning pt could have a higher tolerance for
hip
pain
Has a rx from
Pt currently takes pain medication at home for chronic pain, meaning
hydrocodone/acetaminophen
pt may not need additional interventions for pain then the average
7.5mg/325mg q6 hrs.
adult.
Hs of htn
Elevated BP could be a sign of his current htn diagnosis as well as a
sign of increased pain.
Past Medical History:
Htn, hyperlipidemia, type 2 diabetes, chronic lower back and left hip pain.
Nursing Assessment:
Allergies: NSAIDS
Code Status: FULL CODE
V/S (provide numbers & analyze trends):
HR 98, RR18, BP 146/82, SPO2 96% ON RM AIR, T 98.2F ORAL- Would anticipate BP to be slightly
above the normal limits given pt has a hx of htn. I would anticipate pt temp to remain wnl, HR to remain
wnl unless pain continues to be uncontrolled in that case I would see a elevated HR.
2
