Medical-Surgical Simulation: Caring for Post-CABG Patient Topic/Lab: Caring for Post-CABG Patient Expected Simulation Run Time: 30 minutes Debrief /Guided Reflection Time: 30 minutes Admission Date: 4/13/08 Today’s Date: 4/15/08 Patient Description: Name: James Timmins Age:65 Gender: Male Race: Caucasian Date of Birth: 10/13/41 Weight:_85.5__kg. Height: 5’7” Religion: Catholic Phone: 605-123-4567 Major Support/Contact Person: Spouse Katherine Timmins Physician: Dr. Jackson/Surgeon, Dr. Moore/ Cardiologist Allergies: NKA Immunizations: Flu shot 10/07, Past Medical History: CAD – MI in 2003 with 3 stents in RCA, angioplasty in 2000 Hypercholesterolemia, Type II DM, Hypertension, Past surgical history – appendectomy History of Present Illness: Chest pain with exertion/relief with nitro X4 in past two months. Angiogram 4/6/08 – multiple blockages in RCA and LCA. Social History: History of smoking, quit 2006, occasional drink Primary Medical Diagnoses: S/P Coronary Artery Bypass Graft Psychomotor Skills Required prior to simulation: *Adult Post-Surgical Assessment *IV Medication Administration *Identify Common Dysrhythmias *Communication Cognitive Activities Required prior to Simulation: *Physical Assessment *Focused Cardiac Assessment *Communicating with Patients, significant others *Communicating with members of the healthcare team *Patient/significant others teaching *Dosage calculation *Assurance of patient safety Props/Equipment Required: Fluids – D5LR @ TKO on pump Incentive Spirometer at bedside IV Start kit – supply area IV tubing – supply area IVPB tubing – supply area IV pump - bedside Medication Cart – Nurses Station Nurse’s Station O2 Delivery Device - NC Clothing for student in role of patient’s spouse Labels for Patient medications Patient Medical Record with completed forms (MAR, lab results, physician orders, patient assessment forms Other: Nurses station setting with laptop or other prop representing
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