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• Livan Martell

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Virtual Clinical Replacement Student Requirements 1. 2. 3. 4.

Students must wear uniform. Students must have camera on during the entire session. Student must be on camera during the session free of noise and distractions. Clinical Replacement Packets must be submitted in its entirety by 11:59PM within 24 hours of the clinical via Blackboard. If packet is not turned in, student will not get credit for clinical.

CONCEPT MAP/ PLAN OF CARE This activity creates an opportunity for you to organize the nursing care required for the patient care presented in your assigned vSim. Student Learning Outcome 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 priori zed 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 the instructions posted on your learning management system (LMS) or given by your clinical instructor. 2. Review the information contained in the patient information. 3. Review the smart sense links associated with the Nursing Care, Diagnostics, Pharmacology found in the suggested reading area. 4. Create the follow concept map. List 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 on associated with the patient situation. 5. Utilize the smart sense links throughout the vSim to complete the worksheet. 6. Submit your concept map for review.

2 Adapted from vSim for Nursing Wolters Klewur

Concept Map Worksheet Describe Disease Process Affecting Patient (include pathophysiology of disease process) Appendicitis- It is a mucosal ulceration that triggers inflammation that temporarily obstructs the appendix. The obstruction causes mucus outflow increasing pressure in the distended appendix it then contracts, fluids and mucus continue to be secreted and stagnate. Bacteria multiply and the inflammation increases restricting blood flow causing thrombus, abdominal pain, and ischemia to the wall of the appendix. If left untreated continued inflammation, pressure, and fluid collection can lead to the rupture of the appendix causing a spillage of the appendicular contents into the peritoneal cavity. Appendicitis can occur at any age but affects more people age 11 to 20 years old

Patient Information

Diagnostic Tests (Reason for test and results)

Patient’s name: Sara Lin Gender: Female Age: 18-years-old DOB: 01-04-2002 Weight: 56 kg Height: 165 cm Allergies: No Known Adm on: 09-21-2020

Patient had an open appendectomy for a ruptured appendix

Anticipated Physical Findings Bowel sounds active as patient has transitioned to regular diet and is eating small amounts. Pain on the incision area and the abdomen is soft, tender to touch

Anticipated Nursing Interventions    

Assess the incision site Encourage use of spirometer Transition patient to oral antibiotics and pain medication Provide discharge patient education on incision care, pain medication and antibiotics, sighs of postoperative infection, activity restrictions, and surgical follow up.

3 Adapted from vSim for Nursing Wolters Klewur

ISBAR ACTIVITY This SBAR 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 SBAR 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 the Point and launch the assigned vSim, following all instructions posted on your learning management system (LMS). 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 for review.

4 Adapted from vSim for Nursing Wolters Klewur

vSim ISBAR Activity Introduction Your name, position (RN), unit you are working on

Situation Patient’s name, age, specific reason for visit

Background Patient’s primary diagnosis, date of admission, current orders for patient

Assessment Current pertinent assessment data using head to toe approach, pertinent diagnostics, vital signs

STUDENT WORKSHEET I am the Nurse (RN) Livan Martell from Surgical Unit. I will be your nurse today.

Sara Lin is an 18-years-old female patient who had an emergency appendectomy. It has been two days from her surgery. Sara Lin is expected to be discharge late this afternoon. Her IV antibiotics have been discontinued and she will be getting oral medications today. Primary diagnosis is open appendectomy with ruptured appendix. Date of Adm: 09-21-20 Current orders are: transition patient to oral antibiotics and pain medications. Provide discharge patient education on incision care, pain medication and antibiotics, sighs of postoperative infection, activity restrictions, and surgical follow-up.

Patient is currently awake, alert, and oriented to person, place, and time. She appears to be discomfortable and was moaning. On the scale on 0-10 patient stated pain is “is pretty bad; I would give it a 5”. Temperature at the ear is 99F Radial Pulse is strong, 100 per min and regular SPO2 is 97, her breathing is 21 breaths per min, chest is moving equally Dressing is clean, dry, and intact.

Recommendation



Any orders or recommendations you may have for this patient

 



5 Adapted from vSim for Nursing Wolters Klewur

Medication administration for oral antibiotics and oral pain medication as needed. Patient education for managing pain at home after discharge. Focused pain assessment, in collaboration with the patient, to decide the most appropriate pain intervention. Education on incision care, antibiotics, signs of postoperative infection, activity restrictions, and surgical follow up.

PHARM-4-FUN 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 are 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 the Point and launch the assigned vSim, following all instructions posted on your learning management system (LMS). 2. Review the information contained in the patient information. 3. Review the smart sense links associated with the Pharmacological agents found in the suggested 4. reading area. 5. Use the smart sense link to complete the following “patient education” worksheet for each 6. pharmacological agent listed in the Pharmacology are of the suggested reading section. 7. Submit for review.

6 Adapted from vSim for Nursing Wolters Klewur

PATIENT EDUCATION WORKSHEET Name of Medication, Classification, and Include in Prototype MEDICATION:

 

Oxycodone Hydrochloride Acetaminophen

* Levofloxacin

CLASSIFICATION: Oxycodone: Therapeutic class-opioid analgesic/pharmacology class: opioids/controlled substance schedule II Acetaminophen: Therapeutic class-non-opioids analgesic

PROTOTYPE:

Oxycodone- opioid agonist Acetaminophen- analgesic and antipyretic Levofloxacin- quinolone antibiotic agent Safe Dose or Dose Range, Safe Route Oxycodone- 5mg oral every 4h as needed for pain Acetaminophen- 325mg oral every 4h as needed for pain

Purpose for Taking this Medication Oxycodone- Treatment for pain Acetaminophen- Treatment for pain Patient Education While Taking this Medication Oxycodone: Advise patient that drug increases risk of opioid addiction, abuse, and misuse, which can lead to overdose and death. Teach patient proper use of drug. Instruct patient to take drug before pain is intense. Explain assessment and monitoring process to patient and family. Instruct them to immediately report difficulty breathing or other signs or symptoms of a potential adverse opioid-related reaction. Tell patient to take drug with milk or after eating. Caution patient or caregiver of patient taking an opioid with a benzodiazepine, CNS depressant, or alcohol to seek immediate medical attention if patient experiences dizziness, light-headedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. Acetaminophen: Educate the patient about dosage. It is important to avoid combinations of drugs. It not recommended taking the medication more than 10 day. Patient should report difficulty breathing rash. Levofloxacin: Ensure proper use and hydration. Stop if hypersensibility reaction occurs. Separate from antacids by at least 2h. Patient should avoid sun exposure. Report any muscle/ tendon pain, weakness, numbness/ tingling, urine/ stool color changes.

7 Adapted from vSim for Nursing Wolters Klewur

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 activity, student will be able to: 1. 2. 3. 4.

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 1. Log into the Point and launch the assigned vSim, following all instructions posted on your learning management system (LMS). 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 the completed worksheet.

8 Adapted from vSim for Nursing Wolters Klewur

Clinical Worksheet Date: 09-23-2020 Initials: SL

Diagnosis: Appendectomy

Student Name: Madelyn Delgado HCP: N/A

Isolation: No

Age: 18-years-old M/F: F

IV Type: Peripheral

Critical Labs: N/A

Other Services: N/A

Location: Right Fall Risk: Yes

Length of Stay: 2 days Consults: N/A

Code Status: Full Code

Assigned vSim: Sara Lin

Allergies: No known

Fluid/Rate: N/A

Consults Needed: N/A

Transfer: N/A

Why is your patient in the hospital? (Answer in your own words and include History of present illness) Patient is in hospital due to an open appendectomy for a rupture appendix.

Health History/ Comorbidities (that relate to this hospitalization): Prior to admission to the ED, patient had a 2- day history of nausea, vomiting, and increasing pain

Shift Goals/ Patient Education Needs: 1. Perform a focused pain assessment. 2. Use of incentive spirometer to help patient improve breathing after the surgery. 3. Provide discharge patient education on incision care, pain medication and antibiotics, signs of postoperative infection, activity restrictions, follow-up, and the use of incentive spirometer. 4. Perform a focused pain assessment. Path to Discharge: Patient is schedule for discharge. She must understand the importance of affective pain management, medication and adherence, wound care, activity restrictions and comply with the surgical follow up in Dr. Patel’s office in a week. Patient must understand no heavy lifting, no driving, patient may shower, must cover incision with dry dressing

Path to Death or Injury: N/A

Clinical Worksheet Alerts:

Management of Care: What needs to be done for this patient today?

What are you on alert for with this patient? (Signs & Symptoms)

1. Focused pain assessment

1. Increased Temperature

2. Give antibiotics and pain medication as needed

2. Increase of Pain

3. Assessment of incision site

3. Increased in BP and RR

4. Discharge patient education

4. Secretion from the incision site

5. Use of spirometer Priorities for managing the patient’s care today

What assessments will focus on for this patient? (How will I identify the above signs and symptoms?) 1. Focused on pain assessment 2. Assess incision site and dressing

1. Assessment of pain 2. Transition to oral antibiotics and pain medication 3. Discharge patient education on incision care, pain medication and antibiotics, signs of postoperative infection, activity restrictions, and surgical follow-up

3. Vital sighs monitoring

List complications that may occur related to dx, procedure, comorbidities:

What aspects of the patient care can be delegated and who can do it?

1. Nausea, vomiting and acute pain

Patient’s vital checkups can be delegated to the LPN once the baseline had been obtained by the RN.

2. Wound infection 3. Alterations in temperature and blood pressure

What nursing or medical interventions may prevent the above Alert or complications? 1. Pain Assessment 2. Assessment of incision site 3. Vital sign monitoring 4. Encourage use of spirometer

10 Adapted from vSim for Nursing Wolters Klewur

vSim Worksheets Grading Rubric (Not used for Clinical Worksheet) Criteria Content Knowledge

5 Points

4 Points

Follows all requirements for the assignment.

Follows all requirements for the assignment.

Conveys well-rounded knowledge of the topic. Content well organized, logical.

Major points of topic are mostly covered in the required assignment areas.

Easy to read and understand throughout all of worksheet.

Critical Thinking

Concisely explains each content area. Analyzes information, connects data points to provide accurate, concise information. Scholarly work.

Writing Composition (Spelling, Grammar, Sentence Structure)

An occasional spelling error present. Grammar, readability, and sentence structure is error free.

Content organized, logical flow. Easy to read and understand through most of worksheet.

3 Points Knowledge of topic is partially covered. 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.

Explains each content area. Presents information about the topic. Some analysis, insight present, some data points threaded together.

2 Points Knowledge of topic is general in more than three areas of the worksheet. 1 or more areas of worksheet left blank. Content unorganized throughout worksheet. Difficult to understand content of paper.

Few aspects of the content areas presented. Few insights presented, lacking analysis. Data points not connected to information provided.

Scholarly work.

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.

Little understanding gained from information presented. Numerous errors (5-6 errors) with spelling, grammar, and/or sentence structure throughout the worksheet Difficult to understand information presented due to numerous errors

1 Point

Total Points

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.

Information is basic. No aspects of the content present in the worksheet. Lacks insight, analysis, and conclusions. No understanding from the content presented.

Excessive errors (>6 errors) occur with spelling, grammar and/or sentence structure, throughout worksheet. Unable to understand information presented in the worksheet.

Total Points: __________________

11 Adapted from vSim for Nursing Wolters Klewur

Rubric for Grading vSim Clinical Worksheet 5 Patient Information: Demographics, Diagnosis, Allergies, Provider, Consults, Isolation, Fall Risk, Intravenous Therapy, Critical Labs, Services and Needed Consults Medical History: Why patient is in the hospital, History of present Illness, Past Medical/Surgical History, Comorbidity Factors Patient Education/Goals: Shift Goals, Patient Education Needs

Disease Progression: Pathway to Death or Injury Pathway to Health

AACIP: Alerts, Assessments, Complications, Interventions and Prevention Nursing Care Plan: Management of Care, Priorities for Patient Care, Delegation

3

1

0

All documented areas 100% complete and provide thorough information.

Three listed areas completed OR documented areas 75% complete.

Less than three listed areas completed OR documented areas less than 50% completed.

Patient information area blank.

100% of HPI, Past Medical/Surgical History and Comorbidity Factors completed with thorough, relevant information.

75% of HPI, Past Medical/Surgical History and Comorbidity Factors completed. Information relevant to scenario.

50% of HPI, Past Medical/Surgical History and Comorbidity Factors completed. Information basic and lacks relevancy.

25% of HPI, Past Medical/Surgical History and Comorbidity Factors completed. Information not relevant, or content areas left blank,

Thorough and detailed patient education. Patient shift. goals are SMART, relevant, and detailed goals. 100% of worksheet area is complete.

Provides patient education but lacks thoroughness or details. Patient shift goals missing 1-2 components of SMART goals. 75% of information needed for worksheet area present.

Patient education lacks thoroughness and details. Patient shift goals missing 3 – 4 components of SMART goals. 50% of the information needed for worksheet area present.

Missing patient education and/or patient shift goals. Patient shift goals lack all components of SMART goals. 25% of the information needed for worksheet area present.

Pathway to death and health is identified with detail. Information is concise, relevant, accurate and portraits appropriate timeframe for occurrence. 100% of the information needed for worksheet present.

Pathway to death and health is identified. Information is relevant and accurate. Missing timeframe for occurrence. 75% of information needed for worksheet area present.

Missing over 50% of needed information for worksheet area present. Pathway to death and health identified but content either not relevant or accurate for situation present in scenario.

Pathway to death and health contains information not relevant or accurate to the scenario or section left blank.

Alerts, Assessments, Complications and Interventions/Preventions identified thoroughly. Answers relevant to scenario. 100% of the information needed is present.

Alerts, Assessments, Complications and Interventions/Preventions identified. Most answers relevant to scenario. 75% of the information needed for worksheet area present.

Missing 2 – 3 areas on worksheet. Answers not relevant to scenario. 50% of the information needed is present.

Missing 4 or more areas on worksheet. Answers not relevant to scenario. 25% of the information needed for worksheet area is present.

Management of Care relevant to case scenario and detailed. Priorities for scenario identified. Identifies all aspects of care that can be delegated and identifies appropriate personnel to delegate activities to. Answers detailed; Critical thinking evident.

Management of Care, Priorities or delegation sections relevant to scenario. Answers generic to situation. Some evidence of critical thinking present.

Missing relevant data in one or more categories (management of care, prioritization, delegation). Answers basic without detail. Little to no evidence of critical thinking present.

Information provided not relevant to scenario. Answers are basic without detail. No evidence of critical thinking. Missing answers in one or more area.

Total Points:

12 Adapted from vSim for Nursing Wolters Klewur