Surgeries/Procedures & Dates CABG – four vessel 4/13/08 Area of Focus: Cardiac output Dysrhythmia Pain Learning Objectives: Patient Centered Care Knowledge: Identify common complications and priorities related to the care of a post cardiac surgery patient. Skill: Perform targeted post-CABG assessment. Attitude: Value the patient’s health concerns. Safety Knowledge: Integrate understanding of universal medication safety strategies and utilization of SBAR. Skill: Demonstrate effective use of medication safety strategies. Demonstrate effective use of SBAR. Attitude: Value nursing role in preventing errors. Teamwork and Collaboration Knowledge: Describe own strengths, limitations, and values in functioning as a member of a team. Discuss effective strategies for communicating with patient, family members, and members of health care team. Skill: Implement therapeutic communication techniques with client. Communicate with team members, adapting own style of communicating to needs of team and situation. Attitude: Value the importance of cardiac monitor, telephone, patient chart, paper/pens and other supplies to simulate nurses station Mode for Simulation (manual or programmed): Low-fidelity manikin used. Faculty played role of patient and physician using wireless microphone from hidden location. Simulator Programming: Temperature 98.8 Blood Pressure 120/70 Breathing Rate 28 Abdominal sounds - Hypoactive Equipment needed to be attached to manikin: IV tubing with primary line__D5LR @ TKO__Fluids running at __________ml/hr FoleyCatheter__100ml___output cl amber urine IVPB with Cefazolin 1g___at _____50ml @ 100_ml/hr O2__3_________L ID Band Allergy Band Position__supine HOB elevated 30 degrees_____________ Pulse Ox Other___Telemetry attached________ Documentation Forms: Physician Orders Admit Orders Flow Sheet Medication Administration Record Kardex Graphic Record Shift Assessment Triage Forms Code Record Anesthesia/PACU Record Standing orders Transfer orders Other___________________
Timing (Approximate) Manikin Actions (Faculty respond via wireless mic/hidden location, manikin programmed for VS, LS, BS) Expected Interventions Key Concepts Primary nurse enters room to hang IV antibiotic/ Charge nurse at nurses station reviewing chart 5 - 7 min Responds to questions from student Manikin: Dyspneic VS: T – 98.8F, P 78, BP 120/70, R 28 Student introduces self, checks patient identification Asks appropriate questions about patient’s condition. Administers scheduled medication safely. Patient identification Focused assessment Alarm sounds at nurses station (Faculty cue alarm, atrial fib rhythm strip placed on “cardiac monitor”) Next 3 minutes “I don’t feel quite right” Charge nurse/Student #2 responds to alarm, interprets dysrhythmia, goes to assess patient Identification of dysrhythmia Therapeutic communication with patient, family, team Charge nurse and primary nurse consult Next 5 – 7 minutes Responds to questions Wife becomes agitated/anxious, asks questions about what is happening Students should perform focused assessment, obtain VS Notify physician using SBAR (uses telephone at nurses station) Receives new orders from physician (faculty Recognition of common complication Therapeutic communication Use of SBAR Safe documentation of new orders
member acting as physician): Initiate Amiodarone drip. Give a loading dose of 150 mg in 10 minutes followed by a drip at 1 mg/minute. Primary contacts pharmacy regarding new orders Next 5 minutes Responds to questions Wife asking multiple questions about what is happening/ Anxious Educates patient and spouse regarding atrial fib, new medication Therapeutic communication Patient teaching Primary nurse prepares to hang Amiodarone drip. Consults with charge nurse as needed. Next 10 – 15 minutes Patient and spouse ask questions regarding afib, new med Researches new medication Recognizes and need for separate IV site Calculates drip rate correctly Performs appropriate assessment during administration of drug Answers questions regarding afib, new medication Medication safety Communication