University of South Dakota Vermillion, South Dakota Department of Nursing. Simulation Scenario Infection: Post Anesthesia Care Unit (Part 1) Overview

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1 Title: To cite this reference: University of South Dakota Simulation Scenario Infection: Post Anesthesia Care Unit (Part 1) Overview Post Anesthesia Care Target Group: First Year Concept: Infection Unit (Part 1 of 2) Nursing Students Tesch, C. (2010). Simulation scenario; Infection: Post anesthesia care unit (part 1). Unpublished manuscript., University of South Dakota at Vermillion. Time Allotment (each simulation is designed to be run in a two hour block of time which equals four clinical hours): Prep: Campus specific (see preparation requirements). Prebriefing: Campus specific (first year students should be longer than second year students according to evidence-based practice [EBP] standards). Simulation: minutes (no longer than 30 minutes). Debriefing: Campus specific (first year students shorter than second year students according to EBP standards). If the simulation episoderuns less than two hours faculty should consider running the simulation again, creating concept maps, creating teaching plans, performing webquests, or implementing other activities that would be beneficial to the students' learning. DocuCare Information: This is a post-cholecystectomy patient who is in PACU and needs a post-op assessment and interventions.

2 Infection: Post Anesthesia Care Unit (Part 1) 2 AACN Essentials: IX Curriculum Alignment Population: Middle Age Caucasian female Concepts: Exemplar: Infection (and Oxygenation as a related concept) Peri-operative patient Knowledge Skills Attitudes Objectives and Outcomes Area Scenario Objectives Course Outcomes Demonstrates understanding of possible post-operative complications. Performs appropriate post-operative assessment. Values the importance of therapeutic communication and appropriate education to the patient and family. 1.1, 2.1, , , 5.3 Student Preparation Prerequisite assignment (the following information should be sent to the students prior to the scheduled simulation). Send the attached to students approximately one week prior to the simulation. Students are expected to bring their laptop, drug book, primary textbook, and completed prep to simulation. Post Anesthesia Care_Student Prep

3 Simulation Setup Infection: Post Anesthesia Care Unit (Part 1) 3 Manikin Settings: Initial Vital Signs Pulse: 80 Blood pressure: 135/82 Pulse ox: 89% Respiratory rate: 16 Temperature: 97.0 PO Cardiac rhythm: SR Lung sounds: Clear Bowel sounds: Absent Other: Pain 8/10 Change in Vital Signs How many minutes until change? Pulse: Blood pressure: Pulse ox: Respiratory rate: Temperature: Cardiac rhythm: Lung sounds: Other: Will increase or decrease based on whether or not student applies O2 Scenario Setting: Setting: Surgical Center PACU Time of day of scenario: 1200 (noon) Patient Condition Clothing: Hospital gown Props: Moulage: Roles for Students Primary nurse Secondary nurse Observers OR nurse (gives report) Patient s spouse Recording nurse Physician Clipboard Chart Blanket/blanket warmer Nurses station - phone, lab book, computer Three 4 x 4 dressings on abdomen- all dry & intact Student Names (faculty) Documents Nursing assessment flow sheet Surgical post-op orders Medication administration record (not included) Equipment List Vital sign equipment Pulse oximeter Incentive spirometer Emesis basin The following should be attached to manikin: Lactated Ringers at 125 ml/hr Foley catheter (60 ml light yellow urine) Patient ID band Nasal 3 L. O2 3 dressings on abdomen (4 x 4s)

4 Infection: Post Anesthesia Care Unit (Part 1) 4 Medication Dosage Route Morphine 4 mg/ml IVP syringe Demerol syringe 50 mg/ml IVP Ondansetron Vial labeled 2 IVP Vial mg/ml Naloxone Vial labeled IVP Vial 0.4 mg/ml 3 ml syringes ga needles Concentration Package See above

5 Infection: Post Anesthesia Care Unit (Part 1) 5 Patient Demographics Last Name: Smith Patient Background First Name: Margaret Gender: Female Age: 48 Ht: 5 5 Wt: 175 lbs Ethnicity: Caucasian Religion: Catholic Language: English English Proficiency: Yes Other: History of present illness: Post-op Cholecystectomy. Pt diagnosed with Cholelithiasis six months prior. Primary Medical Diagnosis: Central nervous system Cardiovascular Pulmonary Renal/Hepatic Gastrointestinal Musculoskeletal Integument Developmental history Psychological history Social history Alternative/ Complementary Hx of hypertension, obesity Smokes three to five cigarettes/day when she is feeling stressed out Cholelithiasis diagnosed six mo ago, c/o indigestion at night C/O night sweats C/O some stress Married with 3 children. Works FT as a bank teller. Mother-in-law recently moved into house. Medication allergies PCN Reaction: Food/other allergies Reaction: Home medications Lisinopril 10 mg PO daily Multivitamin daily Calcium 1200 mg PO daily

6 Prebriefing Infection: Post Anesthesia Care Unit (Part 1) 6 Give students the opportunity to discuss their feelings and fears (can use the round table approach) and then have discussion. The following are SUGGESTIONS/IDEAS for the prebriefing discussion: Read the introductory scenario and then ask the students to reflect and write their answers on a sheet of paper. Discuss their answers. 1. How is a laparascopic Cholecystectomy different than an Open Cholecystectomy, and what are the advantages and disadvantages of each? 2. What size of IV and type of fluid do you expect to see infusing, and why? 3. What assessments are required to adequately determine the respiratory and airway status of a post-op patient? INTRODUCTORY SCENARIO to be read out loud to students (shortened version): Margaret Smith is a 48 year old white female who was brought to the hospital this morning for scheduled laparascopic Cholecystectomy. It is now 1200 and the patient is being transferred from the OR to the post-anesthesia care unit. She is groggy, has pain, has an IV, and has dressings on her abdomen. She also has a foley cath in place. Pair up students and ask them to discuss the key parts of the prep and how they tie into the scenario. This can include: labs & diagnostics, medications, diagnosis, etc. Ask the following: - What is the patient at greatest risk for now, in 12 hrs, and in 24 hrs, and why? - What complications are you on alert for now and in 24 hrs, and why? - Considering this is a fresh post-op patient in recovery; what do you expect to find when you enter the room (patient status, equipment, etc)? The above items are listed to assist faculty in leading a prebriefing discussion with students. Feel free to use some or all of the items depending on the needs of the student group.

7 Infection: Post Anesthesia Care Unit (Part 1) 7 Scenario Introductory Scenario (read to entire group by faculty): Margaret Smith is a 48-year old white female who was brought to the hospital this morning for scheduled laparoscopic Cholecystectomy. It is now 1200 and the patient is being transferred from the OR to postanesthesia care unit (PACU). She is groggy and rates her pain a 7-8 on a scale of She was given 4 mg Morphine before leaving the OR. She snores in between being awakened by the nurse for assessments. She has a maintenance IV. She has three 4 x 4 dressings on her abdomen, which are all dry and intact. She has a foley catheter draining clear yellow urine. The OR nurse transferring the patient will be giving a complete report to the primary nurse in PACU. Timing Nurse/patient actions Expected interventions May use the following cues: Approx. 10 minutes Initial postop vital signs: *BP 135/82 *P 80 *R-16 *T 97.0 PO *O2 sat 89% on 2 L. O2 via nasal cannula *Pain 8 out of 10 Patient: *Lying flat in bed *IV attached to arm *Groggy/groaning and sleeping in between interactions *Complains of nausea *Lung sounds clear *Bowel sounds absent Students perform initial post-op assessment when patient arrives in unit and chart their findings. Student should raise head of bed, and instruct patient to take deep breaths. Can have her use incentive spirometer as well. Raise O2 to 3L. Student puts blanket on patient. Role member providing cues: Spouse: She seems very groggy. Why is that? Margaret: I m cold. Can you get me a blanket?

8 Infection: Post Anesthesia Care Unit (Part 1) 8 Approx. 10 minutes Approx. 5 minutes Patient assessment: *O2 sats 94% with interventions Patient Re-assessment: *Pain at 4 out of 10 *Nausea has subsided slightly *Groggy Student should reassess O2 saturation. Student administers Zofran IV. Student asks about level of pain. Student administers Morphine. Student reassesses pain level and nausea Student gives information to spouse regarding when patient will be moved to the floor based on the Post-Anesthesia discharge scoring criteria. Margaret: I m very nauseous and think I m going to vomit. (VOMITS) Margaret: It hurts so much. 8 out of 10. Spouse: Now what are you giving her? Margaret: That helped a lot. My pain is much better. I m still nauseous but I don t feel like I m going to vomit right now. Spouse: What s going to happen next? When will she be moved to the hospital floor?

9 Debriefing Infection: Post Anesthesia Care Unit (Part 1) 9 Start by asking students about their feelings/thoughts related to the experience. It is alright to let the students lead the discussion at first. Utilize the questions below at your discretion. Debriefing / Guided Reflection Questions for this Simulation: Start out by having the students each state how they are feeling Background: 1. Was there information that was missed in the communication between the OR nurse and the PACU nurse that would affect Margaret s care? 2. What nursing interventions were carried out for Margaret? Which was the priority? Noticing: 1. What assessments are important in identifying potential problems in the areas of: -oxygenation: -pain: -thermoregulation: -safety: -mobility: 2. How were the vital signs affected by the problems Margaret experienced? Interpreting: 1. Did the nurses have sufficient knowledge/skill to manage the situation? 2. Margaret had issues with oxygenation, pain, thermoregulation, and nausea. How did you know how to prioritize interventions? Should any interventions have been done in a different order? 3. Why is strict I&O important? What complications will this alert the nurse to? 4. What risk factors does Margaret have that may affect her recovery? 5. Was the patient teaching appropriate? Was there other information that should have been taught to the patient/family that wasn t?

10 Infection: Post Anesthesia Care Unit (Part 1) 10 Responding: 1. Was the correct information given to Margaret about her surgery and potential postop complications? 2. What patient education should be given to the family about the prevention of infection? What about how to identify whether an infection is occurring? 3. What information would be especially important for the PACU nurse to relay to the surgical floor nurse? 4. Was therapeutic communication used with the patient and family? 5. What criteria does Margaret need to pass before she will be transferred out of the PACU? See the Post-anesthesia discharge scoring criteria at the website listed in the Supporting Documents. Evaluating: 1. Did you have sufficient knowledge and skills to manage Margaret s care in this situation? 2. What went well in this simulation, and what would you do differently if you could run this simulation again? FINAL THOUGHTS: Allow to students to share final thoughts/feelings if they want to. The above items are listed to assist faculty in leading a debriefing discussion with students. Feel free to use some or all of the items depending on the needs of the student group.

11 Infection: Post Anesthesia Care Unit (Part 1) 11 Supporting Documents Forms Patient Chart Information/Forms Post Anesthesia Care_Charts Scripts/Roles Post Anesthesia Care_Script Recommendations For Online Use This simulation could be performed in the mobile simulation unit and streamed to distance students. Students at a distance could participate in the pre-briefing and debriefing sessions using webinar.

University of South Dakota Vermillion, South Dakota Department of Nursing. Simulation Scenario Safety: Patient Safety. Overview

University of South Dakota Vermillion, South Dakota Department of Nursing. Simulation Scenario Safety: Patient Safety. Overview Simulation Scenario Safety: Patient Safety Overview Title: Patient Safety Concept: Safety Target Course: First Year Nursing Students To cite this reference Dreke, C. (2012). Simulation scenario; Safety: