Description #
Sally Brown, a 76 year old retired white female of average height and weight was admitted to hospital with acute onset of nausea and vomiting. Patient history includes right medullary cerebrovascular accident with mild residual left-sided weakness, diabetes mellitus, hypertension, dysphagia, status post percutaneous endoscopic gastrostomy placement, urinary tract infection, and anemia. Sally has no known allergies and home medications include Amoxicillin, Pronestyl, Aldomet, Aggrenox, and NPH Insulin. Her mental status is within normal limits. She lives with her son in Victoria in a rancher with two steps and one handrail at the entrance. She denies alcohol or tobacco use.
The same patient history is used to move a group of students through small components of the scenario based on Sally developing a series of problems and complications during her hospital stay.
Each scenario is reported off to the next student.
The scenarios will take 20 minutes with 10 minutes for debriefing.
Scenario 1
The patient assessment is normal except for mild abdominal distention and hypoactive bowel sounds. Sally is scheduled for a CT scan. There are orders to start an IV and administer IV Phenergan for nausea.
Scenario 2
Sally’s nausea continues and is made NPO. The nurse receives orders to increase the IV fluids, call a GI physician for consult, place an NG tube and connect it to low suction, and give a pain med via the NG tube.
Scenario 3
The GI physician diagnoses GI bleed. Orders are written for a transfusion, and IV pain medication. Sally has a transfusion reaction.
Scenario 4
Sally deteriorates rapidly after the transfusion reaction and has to be intubated. IN this scenario she has a tracheostomy and needs suctioning. She has orders of IV antibiotics for pneumonia.
Scenario 5
The patient has increased abdominal pain. The physician writes orders to replace the NG tube. There are orders for IV pain medications.
Scenario 6
The patient had developed a fever and a UTI is suspected as well as a possible MRSA. There are orders for a urinalysis for culture and isolation.
Learning Objectives #
Demonstrate clinical knowledge competency as an entry level registered nurse through the assessment, and diagnosis of patient problems, the planning of nursing care and the evaluation of patient responses.
Demonstrate leadership skills through priority setting, delegation, decision making and communication.
Incorporate theoretical concepts and research findings into the delivery of quality nursing care.