Fluent Essays

full patient document and instructions are attached.  PLEASE FOLLOW THE INSTRUCTIONS TO EARN FULL POINT APA FORMAT DOUBLE LINE SPACING 6 PAGES outside cover page PNCI MS - Chest Pain Management of a Telemetry Patient Medical Surgical (MS) Medical Surgical - PNCI v6 Chest Pain Management of a Telemetry Patient © 2018 CAE Healthcare 1 Overview The physiological values documented in this Simulated Clinical Experience (SCE) indicate appropriate learner actions and timely interventions. If learners do not act as anticipated, differences will be encountered. Best practices have been included in this SCE, but since interventions may vary by region, you may wish to include medications, treatments, and standards of care that reflect current practice in your region. No intentional errors, such as incorrect treatments or medication doses, were included in this SCE. Since preparation is key to a successful simulation experience, you should read through the SCE in its entirety before beginning the simulation. You will find suggestions in the Facilitator Notes to assist you in setting up the environment and moulaging the simulator. Your facilitative approach should be learner-centric and driven by the objectives, learner knowledge and/or level of experience and the expected outcomes. It is important to role model professional and ethical integrity and to maintain a safe learning environment, where the learner(s) are encouraged to speak up, share thoughts, and ask for help as needed. • It is important to prebrief the learner(s) prior to the simulation to review the learning objectives, set expectations, establish ground rules and a fiction contract. • Be sure to orient the learner(s) to the space, equipment, simulator, roles, and time allotment. • Determine the method of learner(s) evaluation (formative, summative, or high- stakes) and communicate this to learners prior to the SCE. A. Zerby Age: 44-years-old Weight: 79.5 kg Height: 160 cm PNCI MS - Chest Pain Management of a Telemetry Patient Medical Surgical (MS) Medical Surgical - PNCI v6 Chest Pain Management of a Telemetry Patient © 2018 CAE Healthcare 2 Synopsis The learner(s) will be caring for a 44-year-old individual with a six-year history of hypertension, gastroesophageal reflux, and elevated cholesterol and triglycerides. The scenario starts when the patient arrives on the Medical-Surgical floor at 1600 hours after an angiogram and the learners assume care. Past history this episode includes: • Admission to the hospital for coronary artery disease (CAD) • Initially presented to primary healthcare provider yesterday with complaints of shortness of breath that occurs with minimal activity • Symptoms are relieved with rest • Denied any chest, arm or jaw pain, but did have some diaphoresis with one or two episodes • The patient failed exercise tolerance test today with ST segment depression, shortness of breath and a drop-in blood pressure • The patient was taken directly to the Cardiac Catheterization Lab. Findings revealed three- vessel disease. Angioplasty and stent placement were not performed • Admitted to the Medical-Surgical Unit following cardiac catheterization and is scheduled for a coronary artery bypass graft (CABG) tomorrow • Troponin, creatinine phosphokinase (CPK), and isoenzymes were normal and a myocardial infarction was ruled out This Simulated Clinical Experience (SCE) consists of seven states that transition manually at the facilitator’s discretion. State 1 Initial Assessment: Vital Signs: • HR in the 80s • BP in the 120s to 130s/60s to 70s • RR in the teens • SpO2 in the high 90s on room air • Temperature of 37C Other Assessment Findings: • Pupils are equal, round and reactive to light and accommodation • Breath sounds are clear • Cardiac rhythm is sinus with audible S1 and S2 • Bowel sounds are normoactive in all four quadrants • Skin is pale, warm and dry with no edema • Alert and oriented to person, place and time, but complains of left groin discomfort rated 2 out of 10 • The patient is lying flat in bed • The patient is moderately anxious with many questions about the upcoming surgery PNCI MS - Chest Pain Management of a Telemetry Patient Medical Surgical (MS) Medical Surgical - PNCI v6 Chest Pain Management of a Telemetry Patient © 2018 CAE Healthcare 3 Synopsis Continued • Denies chest pain and shortness of breath • Spouse is present and very quiet • The neurovascular status of left lower extremity is intact and the peripheral pulses on the left lower extremity are 2+ out of 4 • The dressing on the left groin has a 2 cm by 2 cm area of dried red blood • IV fluids are infusing at 100 mL/hr in the right arm and the site is without redness or swelling State 2 Complains of Chest Pain: Vital Signs: • HR in the 110s to 130s, Irregular rhythm • BP in the 140s to 150s/80s to 90s • RR in the 20s • SpO2 in the low 90s on room air • Temperature of 37C Other Assessment Findings: • Cardiac rhythm is sinus tachycardia with occasional premature ventricular contractions (PVCs) • Breath sounds are clear • Peripheral pulses on the left lower extremity are 2+ out of 4, and there is no increase in bleeding from the left groin site • Alert and oriented to person, place and time and is taking fluids without problems • Skin is pale, warm and slightly diaphoretic on forehead • Complaining of “tight” pain that rates 6 out of 10 in the mid chest region • Anxious and is complaining of mild shortness of breath • The Spouse continues at the bedside and demonstrates concern When the learner(s) apply the oxygen, the facilitator should select Oxygen: Nasal Cannula 2 LPM in the software. When the learner(s) administer the first dose of nitroglycerin, the facilitator should select Nitroglycerin 0.4 mg SL in the software. PNCI MS - Chest Pain Management of a Telemetry Patient Medical Surgical (MS) Medical Surgical - PNCI v6 Chest Pain Management of a Telemetry Patient © 2018 CAE Healthcare 4 Synopsis Continued State 3 Complains of Continuing Chest Pain: Vital Signs: • Irregular HR in the 100s to 130s • BP in the 130s to 160s/90s to 100s • RR in the teens to 20s • SpO2 mid 90s with oxygen at 2 LPM per nasal cannula • Temperature of 37C Other Assessment Findings: • Breath sounds are clear • Cardiac rhythm is sinus tachycardia with occasional PVCs • Alert and oriented to person, place and time • Skin is pale, warm and slightly diaphoretic on her forehead • Continues to complain of “tight” pain that she rates 4 out of 10 in the mid chest region • Anxious and says it is difficult to take a deep breath • Continues to voice concerns about surgery The SCE should be manually transitioned to State 4 Chest Pain Continues five minutes after the nitroglycerin is administered. When the learner(s) apply and/or titrate oxygen therapy, the facilitator should select Oxygen: Nasal Cannula 4 LPM in the software. When the learner(s) administer the second dose of nitroglycerin, the facilitator should select Nitroglycerin 0.4 mg SL in the software. State 4 Chest Pain Continues, the patient becomes very anxious and starts to panic. Vital Signs: • Irregular HR in the 110s to 130s • BP in the 90s to 110s/60s to 70s • RR in the teens to 20s • SpO2 in the mid 90s on oxygen at 4 LPM per nasal cannula • Temperature of 37C Other Assessment Findings: • Breath sounds are clear • Cardiac rhythm is sinus tachycardia with occasional PVCs • Rates chest pain as 3 out of 10 in the mid chest region PNCI MS - Chest Pain Management of a Telemetry Patient Medical Surgical (MS) Medical Surgical - PNCI v6 Chest Pain Management of a Telemetry Patient © 2018 CAE Healthcare 5 Synopsis Continued The SCE should be manually transitioned to State 5 Condition Worsens five minutes after the third dose of nitroglycerine is administered When the learner(s) administer the third dose of nitroglycerin, the facilitator should select Nitroglycerin 0.4 mg SL in the software State 5 Condition Worsens, five minutes have passed since the third dose of nitroglycerin. Vital Signs: • Irregular HR in the 120s to 130s • BP in the 80s to 100s/60s to 70s • RR in the 20s • SpO2 in the mid 90s on oxygen at 4 LPM per nasal cannula • Temperature of 37C Other Assessment Findings: • Breath sounds are clear • Cardiac rhythm continues to show sinus tachycardia with occasional PVCs • Alert and oriented to person, place and time • Skin is pale and warm with increased diaphoresis • pain is rated as 3 out of 10 When the learner(s) administer the medications, the facilitator should select Morphine 2mg IV and Metoprolol 5 mg in the software. State 6 Pain Free, it has been 10 minutes since the patient has received morphine sulfate and metoprolol. The patient’s condition improves. Vital Signs: • HR in the 100s to 110s • BP in the 110s to 120s/70s to80s • RR in the 10s to 20s • SpO2 in the high 90s on oxygen at 4 LPM via nasal cannula • Temperature remains at 37C Other Assessment Findings: • Breath sounds are clear • Cardiac rhythm is sinus tachycardia with PVCs • Skin is pale, warm and dry with no diaphoresis present • There is no increase in bleeding from the left groin site • Alert and oriented PNCI MS - Chest Pain Management of a Telemetry Patient Medical Surgical (MS) Medical Surgical - PNCI v6 Chest Pain Management of a Telemetry Patient © 2018 CAE Healthcare 6 Synopsis Continued • Denies chest pain, shortness of breath, feelings of light-headedness and nausea • States anxiety has decreased The vital signs in State 7 Stable 1 Hour Later have been programmed to reflect the patient’s response to interventions. Therefore, the facilitator does not need to administer subsequent doses of metoprolol in the software as the learners administer them at the bedside. State 7 Stable 1 Hour Later, the patient’s condition continues to improve. Vital Signs: • HR in the 80s • BP in the 110s to 120s/70s to 80s • RR in the high teens • SpO2 in the high 90s on oxygen at 4 LPM via nasal cannula Other Assessment Findings: • Breath sounds are clear • Cardiac rhythm is sinus rhythm • Skin is pink, warm and dry • Alert, oriented and asking questions about surgery • Anxiety has decreased and denies chest pain • Oral intake is 1250 mL since returning to the room This SCE prepares the learner for the following items of the NCLEX-RN test format: NCLEX-RN Test Plan: X Safe and Effective Care Environment X Management of Care Safety and Infection Control X Health Promotion and Maintenance X Psychosocial Integrity X Physiological Integrity X Basic Care and Comfort X Pharmacological and Parenteral Therapies Reduction of Risk Potential Physiological Adaptations PNCI MS - Chest Pain Management of a Telemetry Patient Medical Surgical (MS) Medical Surgical - PNCI v6 Chest Pain Management of a Telemetry Patient © 2018 CAE Healthcare 7 Synopsis Continued This SCE addresses the following QSEN Competencies: X Patient-Centered Care X Teamwork and Collaboration X Evidence-Based Practice Quality Improvement X Safety Informatics Authors Original: Kathleen Gendron, Fox Valley Technical College - Appleton, WI. Reviewed by: Cathleen M Deckers, California State University - Long Beach, CA, and Diane Mathe, CAE Healthcare, Sarasota, FL 2018. PNCI MS - Chest Pain Management of a Telemetry Patient Medical Surgical (MS) Medical Surgical - PNCI v6 Chest Pain Management of a Telemetry Patient © 2018 CAE Healthcare 8 Background Patient History Past Medical History: • Obesity • Gastroesophageal reflux • Elevated cholesterol 252, HDL 46, LDL 180, triglycerides 140 • Hypertension • Situational anxiety • Total abdominal hysterectomy six years ago • Right carpal tunnel surgery two years ago Allergies: • NKDA Medications: • Atenolol • Ranitidine Code Status: • Full code Social/Family History: • Married with three healthy children ages 14 to 18 • Spouse at bedside • Employed fulltime as a paralegal • Reports tobacco and caffeine use • Denies alcohol use • Mother had a myocardial infarction at 55 and died at 66 secondary to complications of coronary artery bypass graft • Older sister died at 54 from sudden cardiac death • Father recently had a stroke • Has two younger brothers who are alive and well PNCI MS - Chest Pain Management of a Telemetry Patient Medical Surgical (MS) Medical Surgical - PNCI v6 Chest Pain Management of a Telemetry Patient © 2018 CAE Healthcare 9 Handoff Report The learners are expected to notify the healthcare provider of abnormal assessment findings where appropriate and necessary. The report should follow the SBAR format and include: Situation: • This patient is a 44-year-old individual who is being transported back to the room from the Cardiac Catheterization Lab • The patient was sent to the Cardiac Catheterization Lab for possible angioplasty and stent placement, but the physician was unable to perform these interventions secondary to findings of three-vessel disease and poor coronary anatomy • Scheduled for a CABG tomorrow and she is aware of this • Medicated with lorazapam 2 mg two hours ago • Tolerated the procedure with no complications • Vital signs have been stable • Patient is anxious about the impending surgery • Spouse is at the bedside Background: • The patient initially presented to the primary healthcare provider yesterday with complaints of recent episodes of shortness of breath that occur with minimal activity and with increased stress • Symptoms are relieved with rest • Denied any chest, arm or jaw pain but did have some diaphoresis with one or two episodes • Cardiac enzymes were normal and an MI was ruled out • Past medical history includes obesity, gastroesophageal reflux, elevated cholesterol 252, HDL 46, LDL 180, triglycerides 140, hypertension, a total abdominal hysterectomy six years ago and right carpal tunnel surgery two years ago • Attributed her symptoms of shortness of breath to smoking one pack per day for the past 20 years and situational anxiety since mother’s death following complications of a CABG Assessment: Vital Signs: • HR 80 • BP 128/70 • RR 16 • SpO2 98\% on room air • Temperature 37C General Appearance: • Obese • Appears stated age PNCI MS - Chest Pain Management of a Telemetry Patient Medical Surgical (MS) Medical Surgical - PNCI v6 Chest Pain Management of a Telemetry Patient © 2018 CAE Healthcare 10 Handoff Report Continued Cardiovascular: • Sinus rhythm with audible S1 and S2 • Left lower extremity pulse is 2+ out of 4 Respiratory: • Breath sounds clear GI: • Normoactive in all four quadrants GU: • Voiding clear, yellow urine Extremities: • Left leg straight • Full ROM of ankle and toes Skin: • Warm, dry, pale with adequate turgor • Intact left groin dressing with small amount dried red blood present Neurological: • Alert and oriented to person, place and time • Pupils equal, round, reactive to light and accommodation • Left lower extremity neurovascular status is intact IVs: • 20-gauge in the right arm with D5 ½ NS infusing at 100 mL/hr • Site patent and non-reddened Labs: • Preoperative labs ordered Fall Risk: • High-risk Pain: • Denies pain Recommendations: • Complete admission orders • Monitor for bleeding • Implement preoperative teaching for CABG PNCI MS - Chest Pain Management of a Telemetry Patient Medical Surgical (MS) Medical Surgical - PNCI v6 Chest Pain Management of a Telemetry Patient © 2018 CAE Healthcare 11 Orders Initial Healthcare Provider’s Orders: • Admit to Telemetry Unit • Diagnosis: Unstable angina; CABG in AM • Telemetry monitoring with pulse oximetry • Full code • Low cholesterol, low-fat diet • Encourage oral fluids • Post procedure angiography orders for the next eight hours: o Bedrest for eight hours then bathroom privileges o Bed flat with left leg straight for four hours; then 30-degree elevation for two hours; then progress to 45-degree elevation prior to bathroom privileges o Vital signs every 15 minutes for one hour, then every 30 minutes times four, and then hourly until stable o Assessment of left groin site for pulsatile mass, bruit, and bleeding, along with left lower extremity pulses and neurovascular checks on same schedule as vital signs • Notify healthcare provider with acute changes • Oxygen per nasal cannula to keep SpO2 greater than 90\% • Dressing location: Left groin occlusive transparent dressing • Dextrose 5\% in ½ normal saline at 100 mL/hr • Atorvastatin calcium 10 mg by PO daily • ALPRAZolam 0.5 mg PO every six hours prn anxiety • Nitroglycerin 0.4 mg SL every five minutes prn chest pain; if pain unrelieved after 3 doses notify healthcare provider • Aspirin 81 mg chewable prn chest pain • Morphine 2 mg IV push up to a total of 8 mg repeated at 5 minute intervals for chest pain unrelieved by nitroglycerin and beta blockers • If chest pain unrelieved by 3 nitroglycerin tablets then give metoprolol 5 mg IVP every 5 min to maximum dose of 15 mg or desired heart rate of 60-100; Do not give if systolic BP less than 98 • Aluminum hydroxide and magnesium hydroxide 30 mL PO prn indigestion • Acetaminophen 650 mg PO every four hours prn pain • 12-lead ECG for acute chest pain • Preoperative education for coronary artery bypass graft surgery • Preoperative labs for CABG: CBC with differential, electrolytes, BUN, creatinine, Glucose, ALT, AST, Pre-Albumin and Albumin, Bilirubin, Troponin Orders Received in State 5: • Notify healthcare provider if chest pain not relieved by morphine sulfate or further drop in BP PNCI MS - Chest Pain Management of a Telemetry Patient Medical Surgical (MS) Medical Surgical - PNCI v6 Chest Pain Management of a Telemetry Patient © 2018 CAE Healthcare 12 Preparation Learning Objectives • Identifies the risk factors associated with coronary artery disease (REMEMBERING) • Formulates a nursing plan of care for the patient with cardiac vascular disease (CREATING) • Prioritizes nursing management of a patient having acute chest pain (APPLYING) • Evaluates outcome of nursing interventions for the patient having chest pain (EVALUATING) • Identifies the causes of preoperative anxiety and takes measures to decrease it (UNDERSTANDING) • Creates and organizes a nursing plan of care to prepare a patient for a CABG (CREATING) • Develops a teaching plan for education of the CABG patient and family (CREATING) Learner Performance Measures Essential Performance Measures for the SCE: • Reviews patient’s medical record • Performs hand hygiene before and after patient contact • Demonstrates appropriate use of personal protective equipment • Introduces self to patient • Verifies patient identity with two identifiers • Conducts basic environmental safety assessment and maintains safety measures • Uses therapeutic communication to establish rapport and reduce patient anxiety • Calculates and administers medications safely according to the Six Rights • Provides developmentally appropriate education • Evaluates effectiveness of communication • Evaluates effectiveness of education • Documents all findings, interventions and patient responses State 1 Initial Assessment: • Performs a comprehensive physical assessment • Establishes ECG monitoring and interprets cardiac rhythm • Assesses neurovascular status of left extremity • Monitors IV site and infusion • Assesses the left groin for signs of bleeding • Monitors neurovascular status of the lower extremities • Offers oral fluids • Places sign on head of bed (HOB) regarding bedrest and lying flat with HOB not greater than 30 degrees PNCI MS - Chest Pain Management of a Telemetry Patient Medical Surgical (MS) Medical Surgical - PNCI v6 Chest Pain Management of a Telemetry Patient © 2018 CAE Healthcare 13 Learner Performance Measures Continued State 2 Complains of Chest Pain: • Performs a focused assessment • Recognizes abnormal findings: o Chest pain o Decreased oxygen saturation levels o Occasional premature ventricular contractions • Applies oxygen at 2 LPM per nasal cannula • Monitors pulse oximetry • Identifies cardiac rhythm • Orders a STAT 12-lead ECG • Administers 1 dose of nitroglycerin 0.4 mg sublingually according to the Six rights • Administers chewable aspirin 81mg according to the Six Rights • Correctly administers alprazolam 0.5 mg according to the Six rights • Anticipates and monitors for effectiveness and side effects of medications • Communicates appropriately with patient and husband State 3 Complains of Continuing Chest Pain: • Performs a focused assessment • Reassesses vital signs • Monitors pulse oximetry • Monitors cardiac rhythm • Titrates oxygen to 4 LPM via nasal cannula • Administers second dose of nitroglycerin according to the Six Rights • Communicates appropriately with patient and husband State 4 Chest Pain Continues: • Performs a focused assessment • Reassesses vital signs • Monitors pulse oximetry • Monitors cardiac rhythm • Reassesses pain level • Administers third dose of nitroglycerin according to the Six Rights State 5 Condition Worsens: • Performs a focused assessment • Reassesses vital signs • Monitors pulse oximetry • Monitors cardiac rhythm • Reassesses pain level • Administers morphine sulfate and metoprolol according to the Six Rights • Notifies healthcare provider of unrelieved chest pain following nitroglycerin administration PNCI MS - Chest Pain Management of a Telemetry Patient Medical Surgical (MS) Medical Surgical - PNCI v6 Chest Pain Management of a Telemetry Patient © 2018 CAE Healthcare 14 Synopsis Continued State 6 Pain Free: • Performs a focused assessment • Reassesses vital signs • Monitors pulse oximetry • Monitors cardiac rhythm • Reassesses pain level • Continues giving metoprolol IV push every five minutes until the heart rate is between 60 and 100 beats per minute or a maximum dose of 15 mg is achieved State 7 Stable 1 Hour Later: • Performs a focused assessment • Reassesses vital signs • Monitors pulse oximetry • Monitors cardiac rhythm • Reassesses pain level • Discontinues oxygen • Provides preoperative teaching, to include: o Surgical procedure o Postoperative course o ICU environment o Incentive spirometry o Cough and deep breathing with splinting o Antiembolic stockings o Mobility and activity o Pain management o Coping strategies o Nutrition • Identifies patient health promotion needs: diet, cholesterol, exercise, smoking, risk factors, blood pressure medication, effects of caffeine on the heart, relaxation techniques and social support • Displays sensitivity when providing education • Discusses cardiac rehabilitation • Evaluates effectiveness of education PNCI MS - Chest Pain Management of a Telemetry Patient Medical Surgical (MS) Medical Surgical - PNCI v6 Chest Pain Management of a Telemetry Patient © 2018 CAE Healthcare 15 Preparation Questions • Describe the pathophysiology of CAD. • Discuss risk factors for CAD and health promotion measures for the patient with CAD. • What are the classic and non-classic symptoms of chest pain? How are they different in men and women? • What is the difference between stable and unstable angina? • Review the 2014 ACC-AHA & 2016 ESC guidelines for management of NSTEMI acute coronary syndromes. • Discuss the precautions that are to be taken with oxygen, morphine and nitroglycerin in the management of chest pain in the patient with acute coronary syndrome. • Discuss the following medications: nitroglycerin, morphine sulfate, aspirin, atenolol, aluminum hydroxide/magnesium hydroxide, alprazolam, atorvastatin calcium and lorazepam. Include indications, actions, contraindications, side effects, normal dosage and nursing implications. • Discuss the nursing and medical management of the patient post cardiac angiogram- particularly with regard to post procedure complications. • Describe how to intervene and care for the patient with chest pain and anxiety. • Outline and discuss the preoperative education plan for a patient and family for coronary artery bypass graft surgery. This should include preoperative education, instruction on the surgical procedure, postoperative course and avoidance of complications. • Discuss the basic components of cardiac rehabilitation. PNCI MS - Chest Pain Management of a Telemetry Patient Medical Surgical (MS) Medical Surgical - PNCI v6 Chest Pain Management of a Telemetry Patient © 2018 CAE Healthcare 16 Equipment and Supplies This list is considered a starting point for managing the SCE. Supplies should be added to or taken away from this list depending upon what is currently used in patient management following local and regional protocols. IV Supplies Saline lock IV pump tubing (2) IV pump (2) Distilled water 1000 mL IV bag (labeled Dextrose 5\% in 0.45\% Sodium Chloride) Distilled water 30 mL vial (labeled 0.9\% Sodium Chloride) 3 mL syringe (3) Medication Supplies Simulated oral medication labeled: • ALPRAZolam 0.5 mg • Aspirin 81 mg • Atorvastatin calcium 10 mg • Acetaminophen 325 mg • Nitroglycerin 0.4 mg Bottle of water 20 mL labeled: • Aluminum hydroxide/Magnesium hydroxide • Metoprolol 1 mg/1 mL Sterile water 10 mL vial (labeled Morphine sulfate 1 mg/mL) Bottle of Aspirin 81 mg chewables 3 mL syringe (2) Oxygen, Airway and Ventilation Supplies Nasal cannula Oxygen flowmeter Oxygen source Pulse oximeter probe Genitourinary Supplies Bedpan Dressing Supplies 4” x 4” gauze (4) 5”x 9” dressing (2) Tape PNCI MS - Chest Pain Management of a Telemetry Patient Medical Surgical (MS) Medical Surgical - PNCI v6 Chest Pain Management of a Telemetry Patient © 2018 CAE Healthcare 17 Equipment and Supplies Continued Miscellaneous Patient chart Patient identification band Stethoscope BP cuff adapted for use with simulator Nonsterile gloves (1 box) Audio and visual recording devices Sharps container 12-lead ECG tracing depicting greater than 1 mm ST depression Telemetry monitoring strip depicting sinus tachycardia and occasional PVCs Sign indicating the patient should be lying flat with head of bed not greater than 30 degrees Preoperative educational materials Red food coloring Emergency Code Blue Cart Female / Male wig Simulated breasts (optional) Petroleum jelly Talcum powder Monitors Required ECG NIBP SpO2 PNCI MS - Chest Pain Management of a Telemetry Patient Medical Surgical (MS) Medical Surgical - PNCI v6 Chest Pain Management of a Telemetry Patient © 2018 CAE Healthcare 18 Notes Facilitator Notes You can adjust the complexity of the SCE depending on the level of learners by modifying the Learning Objectives and Learner Performance Measures. This SCE may be supplied with custom Patient Record files (Lab Reports, Ultrasounds, Xrays etc.) and can be displayed on the TouchPro monitor or printed and used for this SCE. (See User Guide for instructions on importing patient records). Learners should perform an appropriate physical exam. The facilitator or patient should verbalize the physical findings the learners are seeking but are not enabled by the simulator (such as pain on palpation). … Chamberlain College of Nursing NR324 Adult Health I NR324 Case Study Presentation.docx Revised 05/7/2013 CIS 1 Required Uniform Assignment Guidelines: Case Study Presentation PURPOSE The purpose of this assignment is to help students build communication skills, utilize evidence-based research relevant to nursing practice, and apply concepts of safety and quality in nursing care of adults. The goals of this assignment are to: • foster teamwork and collaboration through effective communication • utilize research evidence to promote safe and quality nursing care for adults in acute care settings. COURSE OUTCOMES This assignment enables the student to meet the following course outcomes: CO 1. Provide effective professional nursing care for adult patients and their families in acute care settings using the nursing process. (PO#1) CO 3. Demonstrate effective communication skills necessary for collaboration with other health care team members and for providing professional nursing care to adult patients and their families. (PO #3) CO 4. Apply critical thinking strategies to make good clinical decisions in the adult patient clinical setting. (PO#4) CO 8. Utilize nursing research literature while providing care to adult patients and their families in acute care settings. (PO #8) DUE DATE: See Course Calendar. TOTAL POINTS POSSIBLE: 100 POINTS REQUIREMENTS AND DIRECTIONS The student group must develop a case study based on an actual or potential clinical-based situation on the adult health topics presented during the 8-week session. The student group must present the topic and literature for the case scenario. Chamberlain College of Nursing NR324 Adult Health I NR324 Case Study Presentation.docx Revised 05/7/2013 CIS 2 Students must include the following information in the case study presentation: A. Health History – age, gender, ethnicity, past and current medical history, chief complaint, and history of present illness on admission. B. Laboratory/Diagnostic Testing – describe the diagnostic tests ordered/completed, pertinent results (include normal and abnormal ranges), and rationales for each diagnostic test. C. Collaborative Management – provide list of medications, treatments, dietary prescriptions, and procedures that have been ordered, administered, completed, and/or pending. Additionally, provide an overview of members of the healthcare team involved in managing the person and family. Briefly list their role in the care provided and how nursing collaborates in meeting interdisciplinary goals. D. Nursing management – using the nursing process, develop two plans of care - 1 related to physiological nursing diagnosis and 1 related to psychosocial nursing diagnosis. Please include the following information in each plan of care: • Priority nursing diagnosis • 1 short and 1 long-term goal • 3 to 5 nursing interventions with rationale statements, • 3 to 5 evaluative statements based on interventions, and • A minimum of 3 teaching considerations. Assignment Submission Requirements: • Students must receive approval from the faculty on the selected topic for the case study presentation assignment. The faculty will facilitate selection of topics during class. • Each student in the group must contribute to the development of the case study information. • Students must submit a 1-page typed copy of the case study and a 1-page typed copy of the plans of care. Follow the criteria under the nursing management section. • Students may choose to submit a concept map instead of a plan of care. The concept map must incorporate the same information required for the plans of care. • Each student group must submit reference materials with the assignment. A minimum of at least three (3) references are required for this assignment. Student must use at least two (2) research or evidence-based practice (EBP) articles. Resources must be within 5 years of publication. • Each student group must give a 15 minute presentation and allow an additional 5 minutes for questions and answers on a topic relevant to their didactic content and/or clinical experience. Each group member must present a topic from the case study, plan of care or concept map. If a student in the group is absent the day of the presentation, the student group will not be penalized. • APA (6th ed.) format must be used for the assignment. Chamberlain College of Nursing NR324 Adult Health I NR324 Case Study Presentation.docx Revised 05/7/2013 CIS 3 Names of Students in Group: __________________________ _____________________________ ____________________________ __________________________ ____________________________ ___________________________ Topic: _______________________________________ Date of Presentation: ________________ GRADING CRITERIA Category Points \% Description Health History 10 10\% Presents pertinent and relevant information on: the person’s age, gender, ethnicity, past and current medical history, chief complaint, and history of present illness on admission. Laboratory & Diagnostic Testing 10 10\% Presents description of the ordered/completed diagnostic tests, pertinent results (including normal and abnormal ranges), and rationales for each diagnostic test. Collaborative Management 20 20\% Presents list of medications, treatments, dietary prescriptions, and procedures that have been ordered, administered, completed, and/or pending Additionally, provide an overview of members of the healthcare team involved in managing the person and family. Briefly list their role in the care provided and how nursing collaborates in meeting interdisciplinary goals. Nursing Management *Each plan of care is worth 15 points. 30 30\% Utilized the nursing process to develop two plans of care • 1 physiological and 1 psychosocial nursing diagnoses Included the following information in each* plan of care: • Priority nursing diagnosis • 1 short-term and 1 long-term goal • 3 - 5 nursing interventions with rationale statements • 3 - 5 evaluative statements based on interventions • A minimum of 3 teaching considerations Case Study Presentation 25 25\% • All components of the assignment guidelines included. • Information presented in a logical, interesting sequence which audience can follow. • Participation by all group members. • All presenters are professional and demonstrated appropriate presence throughout presentation. • Used presentation materials and methods effectively. • Responded appropriately to audience questions. APA Format & References 5 5\% • Used APA (6th ed.) format. • Used at least three (3) different sources, with at least two (2) from research literature. TOTAL 100 100\% Chamberlain College of Nursing NR324 Adult Health I NR324 Case Study Presentation.docx Revised 05/7/2013 CIS 4 GRADING RUBRIC Assignment Criteria Outstanding or Highest Level of Performance A (92–100\%) Very Good or High Level of Performance B (84–91\%) Competent or Satisfactory Level of Performance C (76–83\%) Poor, Failing or Unsatisfactory Level of Performance F (0–75\%) Case Study Information: Health History (10 points) • Comprehensively presents key/relevant Information accurately and in sufficient detail: person’s age, gender, ethnicity, past and current medical history, chief complaint, and history of present illness on admission. • Information presented in a clear, organized, and professional manner 10 points • One of the key/relevant Information not presented: person’s age, gender, ethnicity, past and current medical history, chief complaint, and history of present illness on admission. • Key/relevant information are accurate and presented in sufficient detail. • Information presented in a clear, organized, and professional manner 9 points • Two of the key/relevant Information not presented: person’s age, gender, ethnicity, past and current medical history, chief complaint, and history of present illness on admission. • Key/relevant information may be inaccurate and/or insufficient in detail. • Information presented in a clear, organized, and professional manner 8 points • 3 or more of the key/relevant Information not presented: person’s age, gender, ethnicity, past and current medical history, chief complaint, and history of present illness on admission. • Key/relevant information may be inaccurate and/or insufficient in detail. • Information is not clear, organized, or professional in appearance. 0–7 points Case Study Information: Laboratory & Diagnostic Testing (10 points) • Comprehensively presents key/relevant Information accurately and in sufficient detail: description of the ordered/completed diagnostic tests, pertinent results (normal and abnormal ranges), and rationales for each diagnostic test. • Information presented in a clear, organized, and professional manner • One of the key/relevant Information not presented: description of the ordered/ completed diagnostic tests, pertinent results (normal and abnormal ranges), and rationales for each diagnostic test. • Key/relevant information are accurate and presented in sufficient detail. • Information presented in a clear, organized, and professional manner • Two of the key/relevant Information not presented: description of the ordered/ completed diagnostic tests, pertinent results (normal and abnormal ranges), and rationales for each diagnostic test. • Key/relevant information are accurate and presented in sufficient detail. • Information presented in a clear, organized, and professional manner • 3 or more of the key/relevant Information not presented: description of the ordered/ completed diagnostic tests, pertinent results (normal and abnormal ranges), and rationales for each diagnostic test. • Key/relevant information may be inaccurate and/or insufficient in detail. • Information is not clear, organized, or professional in appearance. Chamberlain College of Nursing NR324 Adult Health I NR324 Case Study Presentation.docx Revised 05/7/2013 CIS 5 Assignment Criteria Outstanding or Highest Level of Performance A (92–100\%) Very Good or High Level of Performance B (84–91\%) Competent or Satisfactory Level of Performance C (76–83\%) Poor, Failing or Unsatisfactory Level of Performance F (0–75\%) 10 points 9 points 8 points 0–7 points Case Study Information: Collaborative Management (20 points) • Comprehensive discussion of collaborative management including: list of medications, treatments, dietary prescriptions, and procedures that have been ordered, administered, completed, and/or pending. • Complete overview of members of the healthcare team involved in managing the person and family; Listed ALL key/relevant roles in the care provided and how nursing collaborates in meeting interdisciplinary goals. • Information presented in a clear, organized, and professional manner. 19–20 points • Discussed collaborative management, but does not include 1of these items: list of medications, treatments, dietary prescriptions, and procedures that have been ordered, administered, completed, and/or pending. • Complete overview of members of the healthcare team involved in managing the person and family; Listed most of the key/relevant roles in the care provided and how nursing collaborates in meeting interdisciplinary goals. • Information presented in a clear, organized, and professional manner. 17-18 points • Discussed collaborative management, but does not include 2 of these items: list of medications, treatments, dietary prescriptions, and procedures that have been ordered, administered, completed, and/or pending. • General overview of members of the healthcare team involved in managing the person and family; Listed SOME key/relevant roles in the care provided and how nursing collaborates in meeting interdisciplinary goals. • Information is not presented in a clear, organized, and/or professional manner. 16 points • Poor/Minimal discussion of collaborative management which does not include 3 or more of these items: list of medications, treatments, dietary prescriptions, and procedures that have been ordered, administered, completed, and/or pending. • Poor/Broad overview of members of the healthcare team involved in managing the person and family; Listed SOME of key/relevant roles in the care provided and how nursing collaborates in meeting interdisciplinary goals. • Information is not presented in a clear, organized, and/or professional manner. 0–15 points Case Study Information: Nursing Management (30 points*) • Used the nursing process to develop a plan of care for physiological nursing diagnosis All information in the plan of • Used the nursing process to develop a plan of care for physiological nursing diagnosis Missing 1 item of information • Used the nursing process to develop a plan of care for physiological nursing diagnosis Missing 2 items of information • Used the nursing process to develop a plan of care for physiological nursing diagnosis Missing 3 or more items of Chamberlain College of Nursing NR324 Adult Health I NR324 Case Study Presentation.docx Revised 05/7/2013 CIS 6 Assignment Criteria Outstanding or Highest Level of Performance A (92–100\%) Very Good or High Level of Performance B (84–91\%) Competent or Satisfactory Level of Performance C (76–83\%) Poor, Failing or Unsatisfactory Level of Performance F (0–75\%) *Each plan of care is worth 15 points. care included: o Priority nursing diagnosis o 1 short-term and 1 long- term goal o 3 - 5 nursing interventions with rationale statements o 3 - 5 evaluative statements based on interventions o A minimum of 3 teaching considerations 14-15 points ------------------------------------ • Used the nursing process to develop a plan of care for psychosocial nursing diagnosis All information in the plan of care included: o Priority nursing diagnosis o 1 short-term and 1 long- term goal o 3 - 5 nursing interventions with rationale statements o 3 - 5 evaluative statements based on interventions o A minimum of 3 teaching considerations 14-15 points in the plan of care: o Priority nursing diagnosis o 1 short-term and 1 long- term goal o 3 - 5 nursing interventions with rationale statements o 3 - 5 evaluative statements based on interventions o A minimum of 3 teaching considerations 13 points ----------------------------------- • Used the nursing process to develop a plan of care for psychosocial nursing diagnosis Missing 1 item of information in the plan of care: o Priority nursing diagnosis o 1 short-term and 1 long- term goal o 3 - 5 nursing interventions with rationale statements o 3 - 5 evaluative statements based on interventions o A minimum of 3 teaching considerations 13 points in the plan of care: o Priority nursing diagnosis o 1 short-term and 1 long- term goal o 3 - 5 nursing interventions with rationale statements o 3 - 5 evaluative statements based on interventions o A minimum of 3 teaching considerations 12 points ------------------------------------- • Used the nursing process to develop a plan of care for psychosocial nursing diagnosis Missing 2 items of information in the plan of care: o Priority nursing diagnosis o 1 short-term and 1 long- term goal o 3 - 5 nursing interventions with rationale statements o 3 - 5 evaluative statements based on interventions o A minimum of 3 teaching considerations 12 points information in the care plan: o Priority nursing diagnosis o 1 short-term and 1 long- term goal o 3 - 5 nursing interventions with rationale statements o 3 - 5 evaluative statements based on interventions o A minimum of 3 teaching considerations 0-11 points ------------------------------------ • Used the nursing process to develop a plan of care for psychosocial nursing diagnosis Missing 3 or more items of information in the care plan: o Priority nursing diagnosis o 1 short-term and 1 long- term goal o 3 - 5 nursing interventions with rationale statements o 3 - 5 evaluative statements based on interventions o A minimum of 3 teaching considerations 0-11 points Chamberlain College of Nursing NR324 Adult Health I NR324 Case Study Presentation.docx Revised 05/7/2013 CIS 7 Assignment Criteria Outstanding or Highest Level of Performance A (92–100\%) Very Good or High Level of Performance B (84–91\%) Competent or Satisfactory Level of Performance C (76–83\%) Poor, Failing or Unsatisfactory Level of Performance F (0–75\%) Case Study Presentation (25 points) • ALL required assignment components are present. • Information is presented in a logical sequence; main ideas easy for the audience to follow. • Participation is by all group members. • Presenters are professional • Presenters maintained appropriate eye contact with audience and projected voices for all audience to hear. • Presenters addressed audience questions appropriately. • Used presentation materials and methods effectively. • Presenters stayed within allotted 20-minute timeframe. 23-25 points • ONE required assignment component is missing. • Information is presented in a logical sequence; main ideas easy for the audience to follow. • Participation is by all group members. • Presenters are professional. • Presenters have limited eye contact OR the audience has difficulty hearing the presenters. • Presenters addressed audience questions appropriately. • Used presentation materials and methods effectively. • Presenters stayed within allotted 20-minute timeframe. 21-22 points • 1-2 required assignment components are missing. • Information is not presented in a logical sequence, yet main ideas are still obvious. • Participation is by all group members. • Presenters are professional. • Presenters have limited eye contact OR the audience has difficulty hearing the presenters. • Presenters addressed audience questions appropriately. • Used presentation materials and methods effectively. • Presenters stayed within 5 minutes of the allotted 20- minute timeframe. 19-20 points • 3 or more required assignment components are missing. • There is no logical sequence to presentation of material; main ideas difficult to follow. • Some members did not participate. • Some or ALL presenters are unprofessional. • Presenters have limited eye contact OR the audience has difficulty hearing the presenters. • Presenters did not address audience questions appropriately. • Did not effectively use presentation materials and methods. • Presenters stayed within 5-10 minutes of the allotted 20 minute time frame. 0–18 points APA Format & References (5 points) • More than 3 references used, at least 2 are research articles • References submitted with assignment • Exactly 3 references used, at least 2 are research articles • References submitted with assignment • Citations and references are • Two (2) references used, at least 1 is a research article • References submitted with assignment • Citations and references are • One to Two references used, but are NOT research articles • References submitted with assignment • Citations and references are Chamberlain College of Nursing NR324 Adult Health I NR324 Case Study Presentation.docx Revised 05/7/2013 CIS 8 Assignment Criteria Outstanding or Highest Level of Performance A (92–100\%) Very Good or High Level of Performance B (84–91\%) Competent or Satisfactory Level of Performance C (76–83\%) Poor, Failing or Unsatisfactory Level of Performance F (0–75\%) • Citations and references are listed using APA format (6th ed.) and are free of errors. 5 points listed using APA format (6th ed.), but has one type of error. 4.5 points listed using APA format (6th ed.), but have two types of errors. 4 points listed using APA format for citations and, but have three or more types of errors. 0–3 points Total Points Possible = 100 points Points Earned = _______ points Purpose Course Outcomes Total Points Possible: 100 points Requirements and Directions Grading Criteria Grading Rubric