CLINICAL REPLACEMENT PACKAGE STUDENT RESOURCES revision questions and answers

STUDENT INSTRUCTIONS FOR VIRTUAL CLINICAL REPLACEMENT This activity packet is intended to be used with your assigned virtual patient found in vSim. The Six Step learn flow in vSim is to be followed as instructed below. Once you have completed the Six Steps, in addition to this Clinical Replacement Activity Packet, submit for grading as instructed in your syllabus. LEARN FLOW - STEP ONE ⦁ Finish the Suggested Readings, then complete the following four activities: ⦁ Clinical Worksheet ⦁ Plan of Care Concept Map – Not included will be sent on 9/30/202 ⦁ Pharm4Fun Worksheet (one per medication) ⦁ ISBAR Worksheet LEARN FLOW – STEP TWO ⦁ Take the Pre-Simulation Quiz ⦁ Student may take several times using the answer key to provide immediate remediation prior to the virtual simulation. Quiz is recorded as complete. LEARN FLOW – STEP THREE ⦁ Launch the virtual simulation ⦁ Suggest student complete the vSim Tutorial prior to launching Step Three. ⦁ Each clinical experience in the simulation lasts a maximum of 30 minutes. ⦁ Student is to complete the simulation as many times as it takes to meet an 80% benchmark. LEARN FLOW – STEP FOUR ⦁ Complete the Post-Quiz ⦁ The answer key is not visible to the student until after they have submitted the quiz. ⦁ The quiz grade is recorded as a percentage LEARN FLOW – STEP FIVE ⦁ Document ⦁ The student documents the clinical events that occurred during the simulation using the information contained in step five. ⦁ If using DocuCare, the instructor assigns the same vSim patient which can be found in DocuCare cases. LEARN FLOW – STEP SIX ⦁ Reflection Questions ⦁ Students are to complete the reflection questions and submit to instructor post clinical replacement (see syllabus for details). ⦁ The quiz grade is recorded as a percentage This activity creates an opportunity for you to organize the nursing care required for the patient care presented in your assigned vSim. STUDENT LEARNING OUTCOMES At the end of this activity, student will be able to: ⦁ Describe pathological events associated with the patient’s disease process or condition. ⦁ Create a plan of care and prioritized nursing interventions based on patient care needs. ⦁ Identify anticipated diagnostic and physical assessment findings related to the identified condition or disease process. ASSIGNMENT ⦁ Log into thePoint and launch the assigned vSim, following all instructions posted on your learning management system (LMS). ⦁ Review the information contained in the patient information. ⦁ Review the smart sense links associated with Nursing Care, Diagnostics, and Pharmacology found in the suggested reading area. ⦁ Create the following “concept map”. List the pathophysiology associated with the patient’s disease process or condition, the anticipated physical assessment findings, vital signs, diagnostics, specific nursing interventions, and other patient information associated with the patient situation. ⦁ Utilize the smart sense links throughout the vSim to complete the worksheet. ⦁ Submit your concept map for review. CONCEPT MAP WORKSHEET DESCRIBE DISEASE PROCESS AFFECTING PATIENT (Include Pathophysiology of Disease Process) The patient is experiencing Postpartum hemorrhage. This is evident in the client losing more than 500ml of blood after a vaginal birth. The two main complication that can occur are hypovolemic shock and anemia. “With uterine atony, the relaxed muscles allow rapid bleeding from the endometrial arteries at the placental site. Bleeding continues until the uterine muscle fibers contract to stop the flow of blood.” (McKinney et al, 2018) DIAGNOSTIC TESTS (Reason for Test and Results) ⦁ Hgb and Hct – test to see how much blood has been loss. ⦁ Coagulation profile (CP)- test clotting factors. ⦁ Blood type and crossmatch- If the patient needs a blood transfusion from the amount of blood loss it is important to know their blood type. PATIENT INFORMATION Fatime Sanogo (F) DOB – 23 years old Induction of labor secondary to postdates(41 4/7 weeks) No pain medication during labor Delivered 9 lbs. baby Urine retention Allergies NKA ANTICIPATED PHYSICAL FINDING A uterus that does not contract or does not remain contracted Large gush or slow, steady trickle, ooze, or dribble of blood from the vagina Saturation of one peripad per 15 minutes Severe, unrelieved perineal or rectal pain Tachycardia ANTICIPATED NURSING INTERVENTIONS Firmly massage the uterine fundus Monitor vital signs Assess for source of bleeding: Assess fundus for height, firmness, and position. If uterus is boggy, massage fundus to increase muscle contractions Assess lochia for color, quantity, and clots Assess for clinical findings of bleeding from lacerations, episiotomy site, or hematomas Assess bladder for distention. Insert an indwelling urinary catheter to assess kidney function and obtain an accurate measurement of urinary output Maintain or initiate IV fluids to replace fluid volume loss with IV isotonic solutions, such as lactated Ringer’s or 0.9% sodium chloride; colloid volume expanders, such as albumin; and blood products (packed RBCs and fresh frozen plasma). Provide Oxygen at 2 to 3 L/min per nasal cannula, and monitor oxygen saturation Elevate the client’s legs to 20 to 30-degree angle to increase circulation to essential organs This ISBAR activity assists you in building the skill of communicating pertinent information when caring for a patient. Appropriate actions you should do to complete this activity include finding appropriate data to provide a thorough ISBAR report. STUDENT LEARNING OUTCOMES At the end of this activity, student will be able to: ⦁ Identify pertinent data from the patient information area of the vSim suggested reading section. ⦁ Communicate pertinent information for a patient using ISBAR. ASSIGNMENT ⦁ Log into thePoint and launch the assigned vSim, following all instructions posted on your learning management system (LMS). ⦁ Review the information contained in the patient information area of the suggested reading section. ⦁ Review the smart sense links found within the Nursing Care, Diagnostics and Pharmacology areas of the suggested reading. ⦁ Navigate and fill out the data in the following document using the patient information provided in the suggested reading area. ⦁ Submit for review. VSIM ISBAR ACTIVITY Student Worksheet INTRODUCTION Nurse, Maternity Nursing Care Your name, position (RN), unit you are working on SITUATION Fatime Sanogo is a 23-year-old primiparous female from Mali in her first hour after vaginal delivery. Patient’s name, age, specific reason for visit BACKGROUND The patient was admitted yesterday at 0600 hours for oxytocin induction of labor secondary to postdates (41 4/7 weeks). She is experiencing hemorrhage and urinary retention. Patient is being transferred back to labor and delivery. She needs to be monitored for hemorrhage and urinary output. Patient’s primary diagnosis, date of admission, current orders for patient ASSESSMENT Assess Vitals Sings - - HR 107. Pulse: Present, BP 98/50 mmHg, Respiration 19 Conscious and Appropriate, SpO2 97%, Temp: 37 C Pain Assessment – pain at 5 Admin butorphanol 2 mg Check peritoneum, monitor for blood, lochia, or fluid a. Change pads & weigh Palpate the fundus a. Check bladder status b. Fundal Massage Place patient in Trendelenburg position Assess IV site & active infusion Called the provider Admin oxytocin 500 mL/hour. Verify & flush IV Admin O2 (10L nonrebreather mask) Admin fluid bolus 500 mL Lactated Ringer IV a. Check compatibility with fluids Performed straight catherization – emptied bladder of 300 mL of urine Reassess vitals & pain - HR 124. Pulse: Present, BP 85/47 mmHg, Respiration 22 Conscious and Appropriate, SpO2 95%, Temp: 37 C Administered 800 mcg misoprostol Administered morphine Assess vital signs - HR 125, Pulse: Present, BP 98/48 mmHg, Respiration 22 Conscious and Appropriate, SpO2 99%, Temp: 37 C Current pertinent assessment data using head-to-toe approach, pertinent diagnostics, vital signs. RECOMMENDATION Perform medication as ordered. Continue Vital Sign assessment and respond This activity provides you with the opportunity to create pertinent patient education on the pharmacological agents associated with the vSim activity. You will utilize this worksheet for each drug listed under the pharmacology area of the suggested reading section. STUDENT LEARNING OUTCOMES At the end of this activity, student will be able to: ⦁ Explain purpose for taking the identified pharmacological agents. ⦁ Discuss pertinent patient education related to all the listed pharmacological agent. ASSIGNMENT ⦁ Log into thePoint and launch the assigned vSim, following all instructions posted on your Learning Management System (LMS). ⦁ Review the information contained in the patient information. ⦁ Review the smart sense links associated with the Pharmacological agents found in the suggested reading area. ⦁ Use the smart sense link to complete the following “patient education” worksheet for each pharmacological agent listed in the Pharmacology are of the suggested reading section. ⦁ Submit for review.. PATIENT EDUCATION WORKSHEET NAME OF MEDICATION, CLASSIFICATION AND INCLUDE PROTOTYPE MEDICATION: OXYTOCIN POSTPARTUM 500 ML/HR CLASSIFICATION: OXYTOCIC PROTOTYPE: Neuropeptide derivative SAFE DOSE OR DOSE RANGE, SAFE ROUTE Induction: 0.5-1 milliunits/min; increase by 1-2 milliunits/min q 30-60 min until desired contraction pattern established. Postpartum hemorrhage: 10 units infused at 20-40 milliunits/min. 10 units after delivery of placenta PURPOSE FOR TAKING THIS MEDICATION Induction of labor, and prevention of hemorrhage. PATIENT EDUCATION WHILE TAKING THIS MEDICATION Inform patient in this situation oxytocin used to stop or treat bleeding that happens after a birth Report vomiting or nausea Inform patient of importance of being monitored Report severe vaginal bleeding or increase in lochia PATIENT EDUCATION WORKSHEET NAME OF MEDICATION, CLASSIFICATION AND INCLUDE PROTOTYPE MEDICATION: BUTORPHANOL TARTRATE 2 MG IV CLASSIFICATION: opioid analgesics/ opioid agonists/antagonists PROTOTYPE: SAFE DOSE OR DOSE RANGE, SAFE ROUTE DOSAGE: (IV) 0.5 mg - 2 mg (IM) 1mg - 4 mg q 3-4 hr as needed PURPOSE FOR TAKING THIS MEDICATION Pain after vaginal birth and related postpartum hemorrhage PATIENT EDUCATION WHILE TAKING THIS MEDICATION Instruct patient on when and how to ask for pain medication. Explain to the client that the medication will cause drowsiness. Instruct the client to request assistance with ambulation. PATIENT EDUCATION WORKSHEET NAME OF MEDICATION, CLASSIFICATION AND INCLUDE PROTOTYPE MEDICATION: BOLUS OF 500 ML LACTATED RINGER IV CLASSIFICATION: Crystalloid Solution PROTOTYPE: SAFE DOSE OR DOSE RANGE, SAFE ROUTE 500 mL by IV PURPOSE FOR TAKING THIS MEDICATION Fluid and electrolyte replenishment PATIENT EDUCATION WHILE TAKING THIS MEDICATION Lactated Ringer's solution is generally safe and well-tolerated but may cause swelling and edema if overused PATIENT EDUCATION WORKSHEET NAME OF MEDICATION, CLASSIFICATION AND INCLUDE PROTOTYPE MEDICATION: Misoprostol 800 mcg rectally CLASSIFICATION: Prostaglandin Cytotec PROTOTYPE: SAFE DOSE OR DOSE RANGE, SAFE ROUTE 600 - 800 mcg PO or PR, may repeat as needed to control bleeding. PURPOSE FOR TAKING THIS MEDICATION To control bleeding after vaginal delivery PATIENT EDUCATION WHILE TAKING THIS MEDICATION report black tarry dark stool and abdomen pain avoid alcohol and foods increasing GI upset PATIENT EDUCATION WORKSHEET NAME OF MEDICATION, CLASSIFICATION AND INCLUDE PROTOTYPE MEDICATION: Morphine 5 mg IV CLASSIFICATION: opioid analgesic PROTOTYPE: SAFE DOSE OR DOSE RANGE, SAFE ROUTE intermittent injection of 5 mg/day, if relief not obtained in 60 min 1-2 mg increments not to exceed 10 mg/day & continous infusion 2-4 mg/24 hr, IV PURPOSE FOR TAKING THIS MEDICATION Pain relief PATIENT EDUCATION WHILE TAKING THIS MEDICATION Advise patient to change positions slowly to minimize orthostatic hypotension. Caution patient to avoid concurrent use of alcohol or other CNS depressants with this medication. Report any symptoms of CNS changes, allergic reactions. Tell patient to report withdrawal symptoms: nausea, vomiting, cramps, fever, faintness, anorexia. CLINICAL WORKSHEET This activity creates an opportunity for you to prepare for a virtual clinical experience. This activity provides you with the opportunity to manage patient care, prioritize interventions, and identify aspects of care that could be delegated. STUDENT LEARNING OUTCOMES At the end of this, student will be able to: ⦁ Describe pathological events associated with the patient’s disease process or condition. ⦁ Create a plan of care that is prioritized and is based on the patient’s care needs. ⦁ Identifies path to healing or health and path to death or injury. ⦁ Describes aspects of care that can be delegated and appropriate personnel to complete delegated tasks. ASSIGNMENT ⦁ Log into thePoint and launch the assigned vSim, following all instructions posted on your learning management system (LMS). ⦁ Review the information contained in the patient information. ⦁ Review the smart sense links associated with the Nursing Care, Diagnostics, and Pharmacology, found in the suggested reading area. ⦁ Complete all areas of the attached clinical worksheet. ⦁ Submit the completed worksheet.