Lloyd Bennett post vSim.WELL EXPLAINED WITH VERIFIED ANSWERS GRADED A.

CLINICAL REPLACEMENT PACKAGE STUDENT RESOURCES This activity packet is intended to be used with your assigned virtual patient found in vSim. Once you have completed your instructor led vSIM please ...

CLINICAL REPLACEMENT PACKAGE STUDENT RESOURCES This activity packet is intended to be used with your assigned virtual patient found in vSim. Once you have completed your instructor led vSIM please complete this Clinical Replacement Activity Packet, submit for grading as instructed in your course calendar/Bb. LEARN FLOW - STEP ONE ➢ Review the Suggested Readings, then complete the following four activities: ❖ Clinical Worksheet ❖ Plan of Care Concept Map ❖ Pharm4Fun Worksheet (one per medication) – NOT REQUIRED FOR vSIM #1 ❖ ISBAR Worksheet LEARN FLOW – STEP TWO ➢ Complete the Post-Quiz ❖ The quiz grade is recorded as a percentage LEARN FLOW – STEP THREE ➢ Document ❖ If using DocuCare, the instructor assigns the same vSim patient which can be found in DocuCare cases. LEARN FLOW – STEP FOUR ➢ Reflection Questions ❖ Students are to complete the reflection questions and submit to instructor post clinical replacement. ❖ 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: 1. Describe pathological events associated with the patient’s disease process or condition. 2. Create a plan of care and prioritized nursing interventions based on patient care needs. 3. Identify anticipated diagnostic and physical assessment findings related to the identified condition or disease process. ASSIGNMENT 1. Log into thePoint and launch the assigned vSim, following all instructions posted on your learning management system (Bb). 2. Review the information contained in the patient information. 3. Review the smart sense links associated with Nursing Care, Diagnostics, and Pharmacology found in the suggested reading area. 4. 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. 5. Utilize the smart sense links throughout the vSim to complete the worksheet. 6. Submit your concept map to Bb. CONCEPT MAP WORKSHEET DESCRIBE DISEASE PROCESS AFFECTING PATIENT (Include Pathophysiology of Disease Process) Post-operative hip arthroplasty – this is also known as a total hip replacement. The surgeon removes the unhealthy portion of a joint and replaces this damaged, diseased or unhealthy joint with either metal or synthetic materials. LB fractured his left femoral head two days ago (9/13) as a result of a fall. The damaged femoral head and/or hip bone and socket (acetabulum) is removed and replaced with a prosthetic typically stainless steel, titanium or cobalt and high-density polyethylene components as the socket. Blood transfusion – a hip arthroplasty leads to tissue being exposed for an extensive amount of time due to the surgery. Because of this, bleeding is a common complication with this surgery. “Blood transfusions are common in total hip arthroplasty because of preoperative anemia and perioperative blood loss,” (Carling, Jeppsson, Eriksson, & Brisby, 2015). There are 7 blood transfusion reactions and they are as follows: febrile nonhemolytic reaction, acute hemolytic reaction (most common), allergic reaction, transfusion associated circulatory overload, bacterial contamination, transfusion related acute lung injury and delayed hemolytic reaction. It is believed that LB experienced an acute hemolytic reaction. This happens when the donor blood isn’t compatible with the recipient. The antibodies that are present in the recipient’s plasma combine with antigens on the donor red blood cells thus destroying the red blood cells. This type of reaction is preventable and usually happens due to an error in labeling and/or patient identification. Signs and symptoms include fever, chills, flank pain, nausea, chest tightness, difficulty breathing and anxiety. Hemoglobin in the urine, hypotension, bronchospasm and vascular collapse can also occur. If this reaction occurs, the transfusion needs to be stopped immediately. This is why we monitor vital signs and patient reaction so closely in the first 10-15 minutes of the transfusion (Hinkle & Cheever, 2018). DIAGNOSTIC TESTS (Reason for Test and Results) PATIENT INFORMATION ANTICIPATED PHYSICAL FINDING CBC to monitor hemoglobin and hematocrit Hemoglobin – 7 g/dL Hematocrit – 23 Both of these results are low. We monitor them because hemoglobin and hematocrit are helpful in diagnosing anemia. Lloyd Bennet A&O x 4 76-year-old male Admitted on 9/13 for femoral head fx caused by a fall Pt underwent left hip arthroplasty on 9/13 – 2 days ago LB complained of fatigue and can’t tolerate position changes without dizziness. BP: 104/68 mm Hg HR: 95 bpm and strong Temp: 99 F RR: 17 breaths per minute – no accessory muscle use Dressing clean, dry, intact All drains have been removed Elevated BP Flank pain Shortness of breath Rash Chills Fever Anxiety Dressing and incision on left hip ANTICIPATED NURSING INTERVENTIONS STANDARD PROTOCOL – INTRODUCTION, HAND WASHING, PATIENT VERIFICATION AND ASSESS FOR ALLERGIES ASSIST WITH EARLY AND OFTEN AMBULATION PATIENT HISTORY OF BLOOD TRANSFUSIONS (THIS WAS NOT AN OPTION IN THE VSIM BUT IT IS VITAL IN TRANSFUSIONS) MONITOR VITAL SIGNS BLOOD TYPE AND CROSS – VERIFICATION WITH ANOTHER HCP EDUCATE PATIENT ON BLOOD TRANSFUSION AD SIGNS AND SYMPTOMS TO REPORT IMMEDIATELY MONITOR FLUID BALANCE – MONITOR INTAKE AND OUTPUT AUSCULTATE LUNG AND HEART SOUNDS OBTAIN INFORMED CONSENT FOR BLOOD TRANSFUSION MONITOR LEVEL OF CONSCIOUSNESS MONITOR EDEMA, PALE, COOL SKIN AND PEDAL PULSES BILATERALLY PAIN CONTROL ASSESS WOUND AND DRESSING ASSESS AND FLUSH IV PRIOR TO TRANSFUSION BEGIN TRANSFUSION AT 100 ML/HR AND MONITOR PT CLOSELY FOR THE FIRST 15 MINUTES (LIPPINCOTT, 2019) 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: 1. Identify pertinent data from the patient information area of the vSim suggested reading section. 2. Communicate pertinent information for a patient using ISBAR. ASSIGNMENT 1. Log into thePoint and launch the assigned vSim, following all instructions posted on your learning management system (Bb). 2. Review the information contained in the patient information area of the suggested reading section. 3. Review the smart sense links found within the Nursing Care, Diagnostics and Pharmacology areas of the suggested reading. 4. Navigate and fill out the data in the following document using the patient information provided in the suggested reading area. 5. Submit your concept map to Bb. VSIM ISBAR ACTIVITY Student Worksheet INTRODUCTION Katelyn Geyer, BSN student, St. Alphonsus Boise, orthopedic unit, floor 4 Your name, position (RN), unit you are working on SITUATION Lloyd Bennet, 76-year-old male who underwent a left hip arthroplasty and was admitted on 9/13/2020 Patient’s name, age, specific reason for visit BACKGROUND LB was admitted to St. Alphonsus Boise on 9/13/2020 with left femur head fracture. He is post-op day 2. The patient has orders for ambulation with physical therapy, vital signs q 4 hours, transfuse 2 units of packed red blood cells and recheck hemoglobin and hematocrit one hour after the second unit of packed red blood cells is transfused. Vitals prior to transfusion were: Pt hemoglobin 6.9 g/dL BP: 106/68 Hematocrit 23% SpO2: 94% RA A & O x 4 RR: 17 Temp: 99 F HR 93 beats per minute Pain 0/10 Patient’s primary diagnosis, date of admission, current orders for patient ASSESSMENT Upon starting the transfusion, about 45 seconds in, the patient complained of flank pain. The transfusion was stopped immediately. Lung and heart sounds were normal Vitals were as follows and within normal limits BP: 116/70 RR: 18 HR: 90 SpO2: 96% Temp: 99 F Current pertinent assessment data using head-to-toe approach, pertinent diagnostics, vital signs. RECOMMENDATION The patient showed signs of reaction to the blood transfusion. The transfusion Any orders or recommendations you was stopped immediately. The blood bank should be notified immediately. Normal saline infusion should be started, and repeat CBC should be ordered. may have for this patient 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: 1. Explain purpose for taking the identified pharmacological agents. 2. Discuss pertinent patient education related to all the listed pharmacological agent. ASSIGNMENT 1. Log into thePoint and launch the assigned vSim, following all instructions posted on your Learning Management System (Bb). 2. Review the information contained in the patient information. 3. Review the smart sense links associated with the Pharmacological agents found in the suggested reading area. 4. 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. 5. Submit your concept map to Bb. PATIENT EDUCATION WORKSHEET NAME OF MEDICATION, CLASSIFICATION AND INCLUDE PROTOTYPE MEDICATION: CLASSIFICATION: PROTOTYPE: SAFE DOSE OR DOSE RANGE, SAFE ROUTE PURPOSE FOR TAKING THIS MEDICATION PATIENT EDUCATION WHILE TAKING THIS MEDICATION 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: 1. Describe pathological events associated with the patient’s disease process or condition. 2. Create a plan of care that is prioritized and is based on the patient’s care needs. 3. Identifies path to healing or health and path to death or injury. 4. Describes aspects of care that can be delegated and appropriate personnel to complete delegated tasks. ASSIGNMENT 1. Log into thePoint and launch the assigned vSim, following all instructions posted on your learning management system (Bb). 2. Review the information contained in the patient information. 3. Review the smart sense links associated with the Nursing Care, Diagnostics, and Pharmacology, found in the suggested reading area. 4. Complete all areas of the attached clinical worksheet. 5. Submit your concept map to Bb. VSIM WORKSHEETS GRADING RUBRIC Criteria 5 Points 4 Points 3 Points 2 Points 1 point Total Points Content Knowledge • Follows all requirements for the assignment. • Conveys well-rounded knowledge of the topic. • Content well organized, logical. • Easy to read and understand throughout all of worksheet. • Follows all requirements for the assignment. • Knowledge of topic is partially covered. • Knowledge of topic is general in more than three areas of the worksheet. • One or more areas of worksheet left blank. • Content unorganized throughout worksheet. • Difficult to understand content of paper. • Knowledge of topic is general throughout entire worksheet, and/or does not cover all the required assignment areas. • Two or more areas • Left blank on worksheet. • Unable to follow flow of worksheet. • Major points of topic are mostly covered in the required assignment areas. • Content organized, logical flow. • Easy to read and understand through most of worksheet. • Key information is missing from 2 or more assignment areas. • Worksheet difficult to follow in two or more areas. • Information is incomplete in two or more areas. Critical Thinking • Concisely explains each content area. • Analyzes information, connects data points to provide accurate, concise information. • Scholarly work. • Explains each content area. • Presents information about the topic. • Some analysis, insight present, some data points threaded together. • Scholarly work. • Major aspects of the content areas are presented, but content lacks insight and analysis. • Few data points connected to provide information. • Few aspects of the content areas presented. • Few insights presented, lacking analysis. • Data points not connected to information provided. • Little Understanding gained from information presented. • Information is basic. • No aspects of the content present in the worksheet. • Lacks insight, analysis, and conclusions. • No understanding from the content presented. Writing Composition (Spelling, Grammar, Sentence Structure) • An occasional spelling error present. • Grammar, readability, and sentence structure is error free. • Some minor errors (1-3 errors) with spelling, grammar and/or sentence structure, not consistent throughout worksheet. • Errors do not interfere with the readability or comprehension of information. • Frequent errors (4-5 errors) with spelling, grammar and/or sentence structure. • Errors effect ability to comprehend information present on worksheet and readability. • Numerous errors (5-6 errors) with spelling, grammar and/or sentence structure throughout worksheet. • Excessive errors (>6 errors) occur with spelling, grammar and/or sentence structure, throughout worksheet. • Difficult to understand • Unable to understand information presented due to numerous errors. • information presented in the worksheet. TOTAL POINTS: Dat 9/15/2020 Student Katelyn Geyer Assigned Lloyd Bennet e: Name: vSim: Initia ls: LB Diagnosis: Postoperative hip arthroplasty HCP: Name not provided Isolation: N/A IV Type: Peripheral Critical Labs: Hct 23% (low) HGB 6.9 g/dL (low) Other Services N/A Ag e: 76 M/ F: M Length of Stay: Day 2 post op Fall Risk: Yes Location: Right AC Code Status: Consults: Physical therapy Consults Needed: Physical therapy for ambulation and positioning Full Code Allergies: NKDA Transfer: 2 person assist Fluid/Rate: 100 mL/hr Why is your patient in the hospital (Answer in your own words and include the History of present illness)? - Lloyd Bennett fell while outside on 9/13. He was admitted to the hospital as a result of a left femur head fracture. The patient had a left hip arthroplasty on 9/13. When PT came to assist with ambulation the patient was complaining of fatigue and dizziness when changing positions. Upon further assessment, we found Lloyd’s hematocrit to be at 23% and hemoglobin at 6.9 g/dL, both of which are low. The patient required a blood transfusion of two units packed red blood cells. Health History/Comorbidities (that relate to this hospitalization): - The patient fell while outside on 9/13 1. Educate patient on signs and symptoms of blood transfusion reactions and to report them immediately 2. Monitor lab values for signs of bleeding and infection 3. Educate patient on self-care, proper positioning, safety and ambulation post hip arthroplasty 4. Maintain patient safety to prevent falls or further injury Path to Discharge: The patient will need to show stabilization of labs, especially blood volume. The patient will need to have no further signs or symptoms of transfusion reaction. The patient’s pain will need to be managed and there should be no sign of infection. The patient will need to participate in physical therapy, show ability to perform activities of daily living and experience Path to Death or Injury: The patient would be on the path to death if he did not notify the nurse of his signs and symptoms of the transfusion reaction. The patient’s path to injury could be not reporting fatigue or dizziness during his physical therapy consult. If the patient experienced a fall it could result in additional blood loss, infection and neurological deficits. CLINICAL WORKSHEET Alerts: What are you on Alert for with this patient? (Signs & Symptoms) 1. Decreased hemoglobin and hematocrit 2. Fever, chills, sweating 3. Hypotension 4. Flank Pain 5. SOB, decrease in SpO2 6. Increase in WBC 7. Anxiety 8. Hemoglobinuria 9. Monitor kidney labs What Assessments will you focus on for this patient? (How will I identify the above signs & symptoms?) 1. Monitor lab values Hgb, Hct, WBC, BUN, urinalysis Management of Care: What needs to be done for this Patient Today? 1. Type and cross patient’s blood and verify with second nurse 2. Urine culture 3. Educate pt on s/s of transfusion reactions 4. Frequently assess pain 5. Monitor LOC and any changes 6. Assess cardiac and respiratory systems and compare to baseline 3. Assess cardiac and respiratory function 4. Assess pain List Complications may occur related to dx, procedure, comorbidities: 1. Blood transfusion reaction 2. Bleeding 3. Infection 4. DVT or Pulmonary embolism 5. Dislocation What nursing or medical interventions may prevent the above alert or complications? 1. Check, recheck and verify blood type and cross and assess patient and family hx of blood transfusions 2. Monitor lab values – Hgb and Hct, urinalysis 3. Monitor WBC and vital signs 4. Monitor peripheral pulses and capillary refill. Use of compression devices. 5. Correct positioning – limited hip flexion, abduction and neutral rotation Priorities for Managing the Patient’s Care Today 1. Vital signs 2. ABC – airway, breathing, circulation 3. Patient education on s/s of reaction and possible complications of procedure 4. Monitor lab values – Hgb, Hct, WBC, urinalysis What aspects of the patient care can be Delegated and who can do it? 1. Ambulation can be delegated to physical therapy 2. Activities of daily living can be delegated to UAP 3. Vital signs can be delegated to UAP 4. Repositioning can be delegated to physica