Oxy/Perf: CHF Simulation – Charles Jones 

Student Scenario Handout

I.	General Objectives for Clinical Simulation.
II.	Objectives for today’s experience include but are not limited to: 
The student will be able to, 

•	Identify the client’s primary nursing diagnoses.
•	Identify relevant patient history information.
•	Implement patient safety measures
•	Explain physical assessment and diagnostic findings related to patient condition
•	Implements clinician orders appropriately
•	Implements nursing interventions based on clients needs and assessment findings
•	Prioritizes nursing interventions
•	Identifies indications, contraindications, and potential adverse effects of prescribed medications.
•	Demonstrates correct medication administration
•	Provides relevant patient/family education and teaching
•	Demonstrates therapeutic and confidential communication
•	Demonstrates direct and accurate communication with the interprofessional team members
•	Demonstrates effective teamwork.

III.	Scenario specific:
•	Implements a focused cardiac and respiratory assessment.
•	Summarizes the nursing interventions related to orthostatic conditions
•	Demonstrates appropriate nursing interventions in a patient with congestive heart failure (CHF). 

IV.	Orientation
•	Orientation to Simulation Lab:
•	Maniken
•	Support systems: phone, computer, assistant nurse
•	Roles & Observer Forms and Expectations

Patient Information:
Name: Charles Jones	Age: 68	DOB: 02/19/1942	180 pounds  	         Ht: 72 in
Race: African American		Religion: Baptist	Major Support: Wife
Allergies: NKDA

Social History:
Mr. Jones lives with his wife and they both retired 3 years ago. He worked as a school maintenance supervisor. Mr. Jones has three adult children who are very supportive. 

Past Medical History:
Mr. Jones has had hypertension for the past 10 years, and was diagnosed with atrial fibrillation and congestive heart failure 5 years ago. He has hyperlipidemia. Has a 10-year history of depression; onset after the traumatic death of his oldest son. Intermittent bouts of anxiety relieved with anxiolytics. He has been smoking 1 pack a day for 20 years, but quit smoking 2 years ago. He is a social drinker only. No known drug allergies, immunizations current with annual flu vaccine expected asap.

Recent medical history:
Mr. Jones presents to you in the Emergency Department for Phase I of this simulation clinical experience. He complains of dyspnea, orthopnea, fatigue, and a weight gain of 10 pounds as well as ankle edema (“my feel are swollen”). His appetite is poor, he complains of slight nausea, but has not vomited. Patient’s emergency physician orders include Lasix 80 mg IVP STAT as well as straight cath for extended, palpable bladder only. Two saline locks are to be placed in this patient as Cardiac Standing Orders. Last lung auscultation by EMT-Ps included fine rales in the bases bilaterally, no cough, and 2+ edema in the lower extremities. 

Phase I: The Emergency Department: REPORT TO Students 	8:45AM
Charles Jones, a 68 year old male with a history of congestive heart failure (CHF) who presents with shortness of breath, fatigue, weight gain, and lower extremity edema. An echo was performed and results are should be available soon. However, the STAT ER CXR shows bilateral congestion to lower lungs. Mr. Jones is to have IV Lasix and should begin to urinate soon and be transferred to the medical unit. Please complete the ER admission and call the floor for a bed.

STOP HERE: Assign roles, begin action phase of scenario. Then, Debriefing: ____________

OBSERVERS LOG: document fulfillment of learning objectives, good techniques or skills, communication, or other nursing assessment, intervention, or evaluation that you feel was demonstrated or was missing from the scenario performers.

You many continue on the back of this page for this phase…..
Phase II: The Medical-Surgical Unit	11:00a – 11:20	

ER Nurse to Medical-Surgical Floor Nurse Report:
Mr. Jones has arrived on the medical unit. Report is to be given to the nurse as well as new physician orders. The report includes:

The echo report finally came in, it shows an EF of 35%. Despite the 80 mg of IV Lasix we gave he has only lost 2 pounds and remains short of breath. He will require oxygen, I believe there are standing orders for O2 @ 2l/min via N/C to keep his saturation > 92%. By the way, he complains of lightheadedness when standing and has required assistance when out of bed. 
You better get on giving him his morning meds, we didn’t have time, sorry, see you later, lunch?
Debriefing……

OBSERVERS LOG: document fulfillment of learning objectives, good techniques or skills, communication, or other nursing assessment, intervention, or evaluation that you feel was demonstrated or was missing from the scenario performers.

You many continue on the back of this page for this phase…..

Phase III: Transfer to ICU/CCU

The supervisor enters and asks for a report because Mr. Jones is not doing well. The report for 2:00pm includes:

Mr. Jones was admitted directly from his MD office via the Emergency Department this morning with the diagnosis o severe decompensated heart failure (DHF). Upon admission he had severe dyspnea and orthopnea. Auscultation of the lungs revealed rales/crackles that are noted ½ of the posterior lobes bilaterally. The patient is now on oxygen 4 L/min and the saturation is on average 92-94%. The patient is allowed to receive his other dose of Lasix 80 mg IV over 20  mins IVPB. His total urine output has been 800 mL over the past 4 hours. His BP seems stable at 102/78 and he has 3+ bilateral lower extremity edema. His cardiologist saw him and did a repeat Echo which indicated an EF of 20%. Mr. Jones remains AA and Oriented X3. He denies any pain.

Action phase:	Student roles and assessment ensue. 
Debriefing:

OBSERVERS LOG: document fulfillment of learning objectives, good techniques or skills, communication, or other nursing assessment, intervention, or evaluation that you feel was demonstrated or was missing from the scenario performers.

You many continue on the back of this page for this phase…..