ir.ymlib.yonsei.ac.kr · 2020. 7. 3. · Pulseoximeter Tempmonitor/type...
Transcript of ir.ymlib.yonsei.ac.kr · 2020. 7. 3. · Pulseoximeter Tempmonitor/type...
- i -
- ii -
- iii -
- iv -
- v -
- 1 -
- 2 -
- 3 -
- 4 -
- 5 -
- 6 -
- 7 -
- 8 -
- 9 -
- 10 -
- 11 -
- 12 -
- 13 -
- 14 -
- 15 -
- 16 -
- 17 -
- 18 -
- 19 -
o 1 o 1 o 1 o 1 o 1 o 1 o 1 o 1 o 1 o 1
o 2 o 2 o 2 o 2 o 1 o 2 o 2 o 2 o 2 o 2
o 3 o 3 o 2 o 3 o 3 o 3
o 4 o 4 o 3 o 5 o 2 o 3 o 4 o 4
o 2 o 4 o 2 o 4 o 2 o 2 o 4 o 4
- 20 -
- 21 -
- 22 -
- 23 -
- 24 -
- 25 -
Dyspnea
Initial Assessment1. Check ABC, vital sign, SaO22. History taking : cardiac or pulmonary disease3. P/Ex : mental status, accessary muscle use, cyanosis, breath sound
Immediate Emergency Care1. Place in semi-fowler's position2. Administer O2 2-3L/min via nasal prong3. Maintain IV access4. Check ABGA, laboratory test5. Monitor EKG, NBP, SaO26. Check CXR, EKG
Start CPR
Prepare for intubation & positive ventilationSuction as neededAdminister medicationsPrepare for mechanical ventilator
AggravatedSaO2 90%≤RR 25, RR 8≥ ≤
Administer high O2(10L/min via reservior mask)Monitor respiratory failure1. SaO2 < 90% or2. RR > 35/min or3. PaO2 < 50mmHg or4. Cyanosis or5. Altered mental status or6. Exhaustion(weakness of respiration muscle)
- 26 -
Initial Assessment1. Check ABC, vital sign, SaO22. History taking : cardiac or pulmonary disease3. P/Ex : mental status, accessary muscle use, cyanosis, breath sound
Immediate Emergency Care1. Place in semi-fowler's position2. Administer O2 2-3L/min via nasal prong3. Maintain IV access4. Check ABGA, laboratory test5. Monitor EKG, NBP, SaO26. Check CXR, EKG
Dyspnea
Improved90%<SaO2 <100%8<RR<25
Additional Assessment1. Further history taking2. Further physical examination3. Check laboratory test4. Check image study
Cardiac Origin1. ABR2. MonitorEKG, BP, SaO2
3. Administer O24. Considerdiuretics,antihypertensive drug,nitroglycerin
5. Check I/O
- 27 -
Pulmonary Origin1. ABR2. MonitorEKG, BP,SaO2
3. Administer O24. Considerbonchodilator,antibiotics
5. Blow therapy,Suction
Initial Assessment1. Check ABC, vital sign, SaO22. History taking : cardiac or pulmonary disease3. P/Ex : mental status, accessary muscle use, cyanosis, breath sound
Immediate Emergency Care1. Place in semi-fowler's position2. Administer O2 2-3L/min via nasal prong3. Maintain IV access4. Check ABGA, laboratory test5. Monitor EKG, NBP, SaO26. Check CXR, EKG
Dyspnea
Improved90%<SaO2 <100%8<RR<25
Additional Assessment1. Further history taking2. Further physical examination3. Check laboratory test4. Check image study
- 28 -
Initial Assessment1. Check ABC, vital sign, SaO22. History taking : cardiac or pulmonary disease3. P/Ex : mental status, accessary muscle use, cyanosis, breath sound
Immediate Emergency Care1. Place in semi-fowler's position2. Administer O2 2-3L/min via nasal prong3. Maintain IV access4. Check ABGA, laboratory test5. Monitor EKG, NBP, SaO26. Check CXR, EKG
Dyspnea
Improved90%<SaO2 <100%8<RR<25
Additional Assessment1. Further history taking2. Further physical examination3. Check laboratory test4. Check image study
Other Cause1. ABR2. MonitorEKG, BP, SaO2
3. Administer O24. Others(Hypervaric,Transfusion,Hemodylisis)
- 29 -
- 30 -
- 31 -
- 32 -
*
Pulseless
Start CPRPrepare for intubation & positive ventilationSuction as neededAdminister medicationsPrepare for mechanical ventilator
yes
yes no
*
AggravatedSaO2 90%≤RR 25, RR 8≥ ≤
Improved90%<SaO2 <100%8<RR<25
Administer high O2(10L/min via reservior mask)Monitor respiratory failure1. SaO2 < 90% or2. RR > 35/min or3. PaO2 < 50mmHg or4. Cyanosis or5. Altered mental status or6. Exhaustion(weakness of respiration muscle)
Additional Assessment1. Further history taking2. Further physical examination3. Check laboratory test4. Check image study
Cardiac Origin1. ABR2. MonitorEKG, BP, SaO2
3. Administer O24. Considerdiuretics,antihypertensivedrug,nitroglycerin
5. Check I/O
Pulmonary Origin1. ABR2. MonitorEKG, BP, SaO2
3. Administer O24. Considerbonchodilator,antibiotics
5. Blow therapy,Suction
Other Cause *1. ABR2. MonitorEKG, BP, SaO2
3. Administer O24. Others(Hypervaric,Transfusion,Hemodylisis)
Dyspnea
Initial Assessment1. Check ABC, vital sign, SaO22. History taking : cardiac or pulmonary disease3. P/Ex : mental status, accessary muscle use, cyanosis, breath sound
Immediate Emergency Care1. Place in semi-fowler's position2. Administer O2 2-3L/min via nasal prong3. Maintain IV access4. Check ABGA, laboratory test5. Monitor EKG, NBP, SaO26. Check CXR, EKG7. Consider bronchodilator if bronchospasm(audible wheezing) *
no
- 33 -
Additional Assessment Guideline1. History takingOnset, duration, intensity of dyspneaAggravating factor, relieving factorAssociated symptom : cough, sputum, hemoptysis, PND, DOEPast history : preexisting medical condition, medication
psychiatric condition
2. Physical examination
Vital sign : tachypnea, hypopnea, tachycardia,hypotension, fever
Skin/nails : clubbing, pale skin/conjunctiva, rash,subcutaneous emphysema
Neck : JVDChest : barrel chestLung : wheeze, rale, rhonchi, diminshed breath soundHeart : gallop, murmur, muffles heart soundsExtremity : peripheral edema3. Laboratory findingBNP, cardiac biomarker, D-dimer
4. Image finding
CXR, EKG, CT, echocardiogram, bedside U/S
- 34 -
- 35 -
- 36 -
- 37 -
- 38 -
- 39 -
- 40 -
- 41 -
- 42 -
- 43 -
- 44 -
- 45 -
- 46 -
- 47 -
- 48 -
- 49 -
- 50 -
- 51 -
- 52 -
- 53 -
- 54 -
- 55 -
- 56 -
- 57 -
Introduction:
The Bay Area Simulation Collaborative (BASC) is comprised of representatives
from schools of nursing and hospitals in the ten Bay Area counties. The CINHC
provides leadership for the BASC. This project, which is the third component of the
Bay Area Nursing Resource Center, involves faculty development for nursing faculty
and hospital educators in the Bay Area.
Scenario development is the second component of the BASC project. The
BASC team is spearheading this new approach to education through developing
simulation scenarios
and curriculum. The BASC will facilitate training educators to write scenarios
in the BASC developed template; validate, test and ultimately, make scenarios
available to the BASC community.
Utilization of simulation in schools, hospitals and regional centers will
ultimately increase the quality of nursing education and practice. The overall goal is
the enhancement of patient safety.
The scenarios are the property of the BASC. The writers have agreed to release authorship
and waive any and all of their individual intellectual property rights surrounding all scenarios.
BAY AREA SIMULATION COLLABORATIVE
BASCSimulation Scenario Template
- 58 -
TABLE OF CONTENTS
SECTION I SCENARIO OVERVIEW
A. Evidence Base
SECTION II CURRICULUM INTEGRATION
A.
Learning Objectives
1. Primary
2. Secondary
3. Critical Elements
B. Pre-scenario learner activities
SECTION III SCENARIO SCRIPT
A. Case Summary
B. Key Contextual Details
C. Scenario Cast
D. Patient/Client Profile
E. Baseline patient/client simulator state
F. Environment / equipment / essential props
G. Case flow /triggers / scenario development
SECTION IV APPENDICES
A. PHYSICIAN ORDERS
SECTION V ADDENDUM
A. Addendum 1: Pre-scenario Learner checklist
BASC REV template (12/15/08 5/09)
- 59 -
SECTION I: SCENARIO OVERVIEW
Scenario title:
Original Scenario
Developer(s):
Date - original scenario
Validation date: Draft Pilot Approved
Revision Dates:
Estimated Scenario Time: (i.e. 15 minutes)
Debriefing time: (i.e. 30 minutes)
Target group:
Core case
Brief Summary of Case:
EVIDENCE BASE / REFERENCES
(List all references include complete citation, following APA guidelines)
- 60 -
SECTION II: CURRICULUM INTEGRATION
A. SCENARIO LEARNING OBJECTIVES
1. Learning Outcomes (Global)
1.
2.
3.
2. Specific Learning Objectives
1.
2.
3.
4.
5.
6.
7.
8.
3. Critical Elements
(Key points to observe to determine if scenario objectives are met)
1.
2.
3.
4.
5.
B. PRE-SCENARIO LEARNER ACTITIVIES
Prerequisite Knowledge
Required prior to participating in the scenario
Psychomotor Competencies Cognitive competencies:
q q
q q
q q
- 61 -
SECTION III: SCENARIO SCRIPT
A. Case summary
B. Key contextual details
C. Scenario Cast
Patient/ Client
q Human Patient Simulator(SimMan®, SimBaby®, ECS®, HPS®)
q Standardized Patient
q Low-mid fidelity manikin
q Hybrid (Blended simulator)
RoleBrief Descriptor
(Optional)
Confederate (C) or Learner
(L)
- 62 -
D. Patient/Client Profile
Last name: First name:
Gender: Age: Ht: Wt: BMI:
Ethnicity: Religion:
1. History of present illness
Primary Medical Diagnosis
Medication
allergies:Reaction:
Food/other
allergies:Reaction:
2. Review of Systems
CNS
Cardiovascular
Pulmonary
Renal/Hepatic
Endocrine
Heme/Coag
Musculoskeletal
Integument
Developmental
Hx
Psych History
Social History
Alternative/ Complementary
Medicine History
3. Current
medication
Drug Dosase Route Frequency
- 63 -
4. Laboratory, Diagnostic Study Results
Highlighted labs added at the suggestion of Maternal Child faculty template reviewer
Na: K: Cl: HCO3: BUN:
Cr: BS: HgA1C:
Hgb: Hct: Plt: WBC:
PT PTT INR
ABG-pH: paO2: paCO2: HCO3/BE: SaO2:
Ca: Mg: ABO Blood Type:
LFTs: Albumin: SGOT: SGPT: AlkPhos:
VDRL: GBS: Herpes: HIV: Herpes:
CXR: ECG:
CT: MRI:
- 64 -
E. Baseline Patient/Client Simulator State
This may vary from the baseline data provided to learners
1. Manikin physical appearance - Mark X next to item and/or describe
Gender:
Attire:
ID band present,
accurate information
ID band present,
inaccurate information
ID band absent or not
applicable
Allergy band present,
accurate information
Allergy band present,
inaccurate information
Allergy band absent or
not applicable
Alterations in appearance (moulage):
2. Initial Vital Signs Monitor display in simulation action room:
(Should be appropriate for the scenario setting)
No monitor
display
Monitor on, but no
data displayed
Monitor on,
standard display
BP: HR: RR: T: SpO2:
CVP: PAS: PAD: PCWP: CO:
AIRWAY:
FHR:
Lungs:
Sounds/mechanicsLeft: Right:
Heart:
Sounds:
ECG rhythm:
Other:
Bowel sounds: Other:
3. Intravenous lines - INITIAL manikin set up
Saline
lock #1
Site
:
IV patent
(Y/N)
IV #1 Site
:
Fluid
type:
Initial
rate:
IV patent
(Y/N)Main
Piggyback
IV #2Site
:
Fluid
type:
Initial
rate:
IV patent
(Y/N)Main
Piggyback
- 65 -
4. Non-invasive monitors INITIAL manikin set up–
NIBPECG
First lead:
ECG
Second lead:
Pulse oximeter Temp monitor/type
5. Hemodynamic monitors- INITIAL manikin set up
A-line
Site:
Catheter/tubing
Patency (Y/N)
CVP
Site:
PAC
Site:
6. Other monitors/devices
Foley catheter
Amount in
drainage
bag:
Appearance
of urine:
Epidural catheterInfusion pump
Pump settings:
Fetal Heart rate
monitor/tocometerInternal External
7. Digital images of initial manikin appearance
Insert digital photo of initial
manikin appearance here
Insert digital photo of initial
manikin appearance here
- 66 -
F. Environment, Equipment, Essential props
Standardized set ups for equipment/supplies for each commonly simulated environment is recommended
1. Scenario setting
Medical-Surgical Unit Patient Room
Pediatric Unit Patient Room
Perinatal Unit Room
ICU Patient Room
PICU Patient Room
NICU Patient Room
ED Bay
Trauma Bay (ED)
Labor & Delivery Room
Labor & Delivery Operating Room
Operating Room
Home Health
Out-patient clinic
Pre-Hospital
Other:
2. Confederate placement - INITIAL scenario set up
RoleGeneral instructions (Initial placement and disposition)
Key actions to implement triggers for learner
3. Equipment, supplies, monitors
(In simulation action room or available in adjacent core storage rooms)
Bedpan/
Urinal
Foley catheter
insertion kit
Straight
catheter kit
Incentive
spirometer
IV Infusion
pumpFeeding pump Pressure bag
Wall suction
apparatus
Nasogastric
tube
ETT suction
catheters
Oral suction
catheters
Chest tube
insertion kit
DefibrillatorCode Cart 12-lead ECG
machine
Chest tube
drainage equip
PCA infusion
pump
Epidural
infusion pump
Central line
Insertion Kit
Dressing change
equipment
IV fluid
Type:
IV fluid
Type:
Tubes/drains
Type:
Blood product
ABO Type:
- 67 -
4. Respiratory therapy equipment/devices
Nasal cannula Face tentSimple Face
MaskNon rebreather mask
BVM/Ambu bagNebulizer
treatment kit
Flowmeters
(extra supply)
5. Essential props/special effects
6. Documentation and Order Forms
H & P Consult reports Nurses notes
Admit Orders Vital Sign
recordTriage forms
Physician
ordersICU flowsheet Code Record
Progress notes
Medication
Administration
Record
Anesthesia/
PACU record
Laboratory
resultsGraphic record
Standing
(protocol)
orders
Medication
reconciliationActivity forms
Transfer
ordersShift assessment
Prenatal record
Actual medical record binder,
constructed per institutional
guidelines
Other
Describe:
7. Medications (to be available in sim action room)
- 68 -
G. Case Flow / Triggers/ Scenario Development StatesInitiation of Scenario :
State Patient Status Desired learner actions & triggers to move to next state
1. Baseline Learner Actions:Operator:
Triggers:
Teaching Points:
State Patient Status Desired actions & triggers to move to next state
2.
Learner Actions:
Operator:
Triggers:Teaching Points:
3. Learner Actions:
Operator:
Triggers:Teaching Points:
- 69 -
State Patient Status Desired Actions & Triggers to move to next state
4. Learner Actions:
Operator:
Triggers
Teaching Points
Scenario End Point:
Suggestions to increase or decrease scenario complexity:
- 70 -
Section . PHYSICIAN ORDERSⅤ
Patient Name:
DOB:
Age:
MR#:
Diagnosis:
No Known Allergies llergies & Sensitivities
Date Time PHYSICIAN ORDER AND SIGNATURE
Signature
- 71 -
Addendum 1: Pre-scenario LEARNER checklist
Last name: First name:
SIMULATION SCENARIO INFORMATION
Date: Time: Location:
Course
Number
Course
title:
Educational Activity
IMMEDIATE PRE-BRIEFING LEARNER CHECKLIST
q Simulator/equipment/environment orientation completed
q Simulation participation consent signed
q Understands guidelines and expectations for scenario
q Has accomplished all pre-scenario requirements
q All participants understand assigned roles
q Has been given timeframe expectations
q Other
Signature
(Faculty/Facilitator)Print last name Date
- 72 -
- 73 -
- 74 -
- 75 -
- 76 -
- 77 -