Everything you are going to need is in the attachment with all the instructions and dont forget to do as it asks. Go over the rubric carefully and also samp

Running Head: SIMULATION FOR MARIA AND KEOLA 1

Multi-client simulation: Maria Hernandez and Keola Akana

Student’s Name

Institutional Affiliation

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SIMULATION FOR MARIA AND KEOLA 2

Multi-Client simulation: Maria Hernandez and Keola Akana

Maria Hernandez, 81, with urinary tract infection (UTI) and who visited

emergency room (ER) for acute confusion has these vital signs; temperature 101.6 oF,

heart rate 110, respiratory 20, and blood pressure 96/60. She is alert and oriented to

person and place only and has reported poor eating and drinking habits.

Keola Akana, 71, who was urgently brought in had an acute left sided heart

failure. He weighed 210 pounds from 217 pounds 2 days ago. Both scenarios happened

on Monday at 1400.

Priority assessments for left-sided heart failure patients and how to differentiate it

from the right-sided heart failure clients.

Left-side heart failure patients portrays increased heart rates, oxygen saturation

below normal, restlessness, confusion, fatigue, weakness, consciousness level change and

lung crackles may be heard. Dry coughs, breathing difficulties while lying down flat,

frothy sputum, pink-tinged sputum, urinating increased rates at night and alternating

weak and strong pulses may also be experienced (Thibodeau & Drazner, 2018).

Right-sided heart failure patients may exhibit ascites, murmurs and weight gain.

Liver enlargement, bilateral body edema, nausea, gastrointestinal area bloating and right

quadrant pain and jugular venous distention in the neck may also be noted neck (Gorter et

al., 2018).

Two common medication classes for left-sided heart failure patients and two nursing

considerations for each medication class.

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SIMULATION FOR MARIA AND KEOLA 3

Angiotension-Converting-Enzyme (ACE) inhibitors and Angiotension II Receptor

Blockers Enzyme (ARBs) medication classes can be used to treat left-sided heart failure

patients (Bateman et al.,2017). In ACE, stop medication after 3 to 4 days if patient is

using diuretic or monitor patient’s blood pressure 2 hours after starting the treatment

since ACE aids in widening blood vessels for ease of heart functioning. In ARBs, notify

the patient’s health care provider if swelling of the tongue is noted and also monitor

patient’s blood pressure (Bateman et al.,2017).

Cultural difference between the nurse and the patient may impact how nurses will

teach the patient on diet and nutrition. However, the nurse should teach with

consideration of the client’s cultural background, client choice of diet their availability to

the patient. Culture humility requires the nurse not to consider his or her culture values

and beliefs as superior to those of the patient (Obeng & Paul, 2019). The nurse should be

conscious of culture differences and be sensitive with patients on their cultures and

choices.

Two nursing considerations used when prioritizing and deciding placement location

for a peripheral intravenous in a heart failure client?

On placement and location for a peripheral intravenous in a heart failure client,

consider how the patient will tolerate injection in order to avoid blockage of his/her vital

senses since this can pose harm to the patient (Ziaeian & Fonarow, 2016). Also be

conscious of connection of the injection to the heart and how other organs can be

affected.

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SIMULATION FOR MARIA AND KEOLA 4

Common signs and symptoms of acute infection in older population and two priority

nursing interventions to use.

Older people with acute infections mostly shows signs and symptoms like fatigue,

confusion, fever, agitation and incontinences. Antibiotics use and frequent hydration is

recommended.

Four classes of antibiotics and nursing priority considerations to review when a

patient is using antibiotics.

Penicillin antibiotics taken at start of meals are aimed at weakening bacteria cell

walls. Patient should report any difficulty in eating due to mouth pain or allergies to stop

medication (Walsh & Wencewicz, 2016). Kidney functioning should be monitored also.

Tetracyclines antibiotics taken with non-dairy products are aimed at destroying

micro-organisms growth and curb protein synthesis. They work well when taken 2 hours

after meal or when patient has not eaten. Patients should be advised that these antibiotics

reacts with calcium and calcium containing foods.

Sulfonamides and trimethoprim antibiotics inhibit bacteria growth mostly in

urinary tract infections. Intake of 2500-3000 ml of water daily is recommended. They can

be taken with meals and potassium levels should be monitored. Acyclovir are antivirals

that prevents viral DNA from reproducing thus interruption replication of cells with HIV

& AIDS (Walsh & Wencewicz, 2016).

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SIMULATION FOR MARIA AND KEOLA 5

How does Advanced Directives impact the way nurses provides care to the patients?

Name some resources that can be used in completing and adhering to the client’s end of life

wishes?

Advanced Directives requires the nurses to handle the patients according to their

(patients) wishes. This hinders service delivery by nurses to their patients since a nurse

may wish to give more care, but he/she face limitation due to the advanced directives

from patients (Miller, 2017). This may make nurses become stressed since they are

basically following their patient’s wishes whereas their obligation may require extra

service delivery as per their assessment of the patient. Though nurses are obligated to

save lives, advanced directives may hinder their service delivery since ethical obligation

requires her to consider and act towards patient rights/wishes to self-determination

(Miller, 2017).

Nurses, health workers, social workers and health care providers are themselves

resources and should help the patients in completing and adhering to their patient’s end of

life wishes. Patient Self Determination Act (PSDA) is a legal act enacted to ensure

patients are provided with adequate information on advanced directives (Edozien, 2016).

PSDA also requires that patients are fully made aware that the decision to either accept or

reject treatment is solely theirs to make.

The Joint Commission is where the patient is expected to call and seek more

information about advanced directives (Edozien, 2016). American Bar Association is yet

another alternative resource that requires the patient to engage a legal consultant in

seeking information regarding his/her advanced directives. The patient can also visit The

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SIMULATION FOR MARIA AND KEOLA 6

Health in Aging offices at 40 Fulton St., 18th Floor New York, NY 10038 or call

212.308.1414 of Fax: 212.832.8646 for them to access advanced directives information.

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SIMULATION FOR MARIA AND KEOLA 7

References

Bateman, B. T., Patorno, E., Desai, R. J., Seely, E. W., Mogun, H., Dejene, S. Z., … & Huybrechts, K. F.

(2017). Angiotensin-converting enzyme inhibitors and the risk of congenital malformations.

Obstetrics and gynecology, 129(1), 174.

Edozien, L. C. (2016). Self-determination in Health Care: A Property Approach to the Protection of

Patients' Rights. Routledge.

fromhttp://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN

/TableofContents/Vol-22-2017/No3-Sep-2017/Articles-Previous-Topics/History-and-

Future-of-Advance-Directives.html

Gorter, T. M., van Veldhuisen, D. J., Bauersachs, J., Borlaug, B. A., Celutkiene, J., Coats, A. J., … &

Hill, L. (2018). Right heart dysfunction and failure in heart failure with preserved ejection

fraction: mechanisms and management. Position statement on behalf of the Heart Failure

Association of the European Society of Cardiology. European journal of heart failure, 20(1), 16-

37.

Miller, B. (2017). Nurses in the know: the history and future of advance directives. Retrieved

Obeng, O., & Paul, S. (2019). Understanding HIPAA Compliance Practice in Healthcare Organizations

in a Cultural Context.

Thibodeau, J. T., & Drazner, M. H. (2018). The role of the clinical examination in patients with heart

failure. JACC: Heart Failure, 6(7), 543-551.

Walsh, C., & Wencewicz, T. (2016). Antibiotics: challenges, mechanisms, opportunities. American

Society for Microbiology (ASM).

Ziaeian, B., & Fonarow, G. C. (2016). Epidemiology and aetiology of heart failure. Nature Reviews

Cardiology, 13(6), 368.

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NR 452 Multi-Client Simulation Student Instructions Revised 6.8.17 1

Student Instructions for Standardized Simulation

NR 452 Multi-Client Scenario

Client 1 of 2 Maria Hernandez

Client 2 of 2 Keola Akana

PURPOSE:

The following information is to be used in guiding your preparation and participation in the scenario for this

course. This document will provide applicable course outcomes in preparation for your simulation.

SCENARIO OVERVIEW:

Maria Hernandez:

Maria Hernandez is an 81yo UTI patient just admitted from the ER for acute confusion and altered vital signs.

101.6F-110-20-96/60. She is Ax0x2 to person and place only. Her daughter reports via phone she has not been

eating or drinking well. The scenario takes place on Monday at 1400.

Keola Akana:

Keola Akana is a 71 year old client who was directly admitted from his healthcare provider via urgent transport.

He arrives with an acute episode of left sided heart failure. Keola’s weight in the provider’s office was 217

pounds, his previous weight was 210 two days ago. The scenario takes place on Monday at 1400 about 45

minutes after arrival from the provider’s office.

STUDENT ROLES DURING SIMULATION:

During pre-briefing, you will be assigned one of these roles according to the description below to

participate in the simulation as a nurse.

Charge Nurse (Registered Nurse) (1):

The charge nurse is responsible for the overall organization of safe, quality client care. You are the team leader and serve as a resource to all interdisciplinary members and are responsible for appropriate delegation of duties. You will serve as the point person for communication and can anticipate speaking with the physician or other primary care provider, ancillary support services, and others directly involved with the

NR 452 Multi-Client Simulation Student Instructions Revised 6.8.17 2

care being provided. You must be knowledgeable about the client’s condition and able to dictate orders obtained and assist with implementation if needed. Additionally, be prepared to prioritize care and anticipate future needs.

Staff Registered Nurse (Assessment/Document/Medications) (1):

The staff nurse is responsible for overseeing a comprehensive assessment of the clients, recording of all client activities, and performing actions related to safe administration of medications. You will be prioritizing care, executing independent interventions, collaborating with interdisciplinary team members, anticipating the needs of the client/family, and re-assessing or continually monitoring the client for any changes in condition.

LPN (Licensed Practical Nurse) (1):

The licensed practical nurse is responsible for the safe and competent care of clients under the supervision of a

registered nurse. As a collaborative member of the interdisciplinary team, you will be responsible for the

administration of medication and treatment within the scope of LPN practice. You will not be able to perform

independent acts requiring the skill, judgment, and/or knowledge of a registered nurse. You will be asked to

collaborate with registered nurses and report abnormal findings. You will be asked to document your findings in

the appropriate charting format.

UAP (Unlicensed Assistive Personnel (1):

As unlicensed assistive personnel, you are responsible for providing safe and competent care to assigned clients.

You will function in a supportive role to the licensed personnel (i.e. RN, LPN) and perform care based upon their

direction and delegation. You will need to document your findings in the appropriate charting format and report

your findings to licensed personnel. You are unable to provide any nursing intervention that requires

independent, specialized knowledge, skill, or judgment.

Observer Nurse:

The observer is a non-participant role and will not communicate directly with the simulation team. The observer nurse will view the simulation in the briefing room through Learning Space as it is occurring. There may be multiple observer nurses in each scenario. The observer nurse will be given an observation guide to complete during the simulation. The data you collect will help the team during the debriefing process and facilitate an open and active discussion regarding the simulation experience. You will be an active participant in the debriefing and will be encouraged to share your observations and thoughts. Please keep in mind that your observations should be conveyed in a respectful, educational manner. The goal is to work together as colleagues in providing safe and effective care.

COURSE OUTCOMES:

The NR452 standardized simulation enables the student to meet the following priority course outcomes:

NR 452 Multi-Client Simulation Student Instructions Revised 6.8.17 3

 CO 2. Integrate communication and relationship skills in teamwork and collaboration functioning effectively with health team members and consumers of care (PO 3)

 CO 4. Integrate critical thinking, clinical reasoning skills, best current evidence, clinical expertise, and patient/family preferences/values in the implementation of the nursing process (PO 4)

 CO 6. Prepare for transition to the novice nurse role through experiential-based learning focused on safety both through individual performance and system effectiveness (PO 7)

**Although this scenario can address multiple course outcomes, faculty and students should focus

on the course outcomes listed above**

DUE DATE: The standardized simulation will be conducted during Units/Weeks 1-8 to ensure students are prepared to

meet the objectives. This scenario consists of two clients for a multi-client standardized simulation.

SIMULATION TIMING:

 Pre-brief: 30-40 minutes

 Run Time: 45 minutes (The first 5 minutes are allocated to hand-off report of both clients)

 Debrief: 80 minutes

REVIEW AND COMPLETE PRIOR TO THE START OF PRE-BRIEFING:

In order to prepare for the simulation, you should complete the assigned reading for the course. In addition, you

should be prepared to complete and document a thorough nursing assessment along with completing the

following skills:

 Identify and administer medications

 Prioritize nursing care

 Demonstrate cultural humility

 Perform a complete health history

 Perform an adequate assessment for elderly patients

 Prioritize the appropriate nursing interventions

 Demonstrate a safe, working knowledge of medications

Please keep in the mind the students will also be required to recognize a variety of signs and symptoms linked to

abnormalities in these skills.

Therefore, in order to prepare for the simulation, please review the Nurse Practice Act and Skill Sets below prior

to the simulation. You are required to complete the pre-briefing questions below and submit to the faculty

facilitating the simulation prior to the start of pre-briefing. If you do not complete the pre-briefing questions

NR 452 Multi-Client Simulation Student Instructions Revised 6.8.17 4

below and submit to faculty facilitating the simulation prior to the start of pre-briefing, you will not be permitted

to participate in the simulation.

1. What key priority assessment findings are usually seen in left-sided heart failure? How do these findings differ from right-sided heart failure?

2. Identify two common medication classes used to treat left-sided heart failure. What are two nursing considerations for each identified classification of medication?

3. How do cultural differences impact nurses in teaching diet and nutrition? What is cultural humility? 4. What are two nursing considerations in prioritizing and deciding placement location of a peripheral IV in

heart failure? 5. What are common signs and symptoms of acute infection in the elderly, and what two priority nursing

interventions would you employ? 6. Identify four different classifications of antibiotics. What priority nursing considerations should you

review when a patient is on an antibiotic? 7. What impact do Advanced Directives have on the nursing care of the patient? What resources are

available to assist with completion and adherence to a patient’s end of life wishes?

**Immediately following the completion of debriefing, you will complete the evaluation of the simulation within Learning Space**

NR 452 Multi-Client Simulation Student Instructions Revised 6.8.17 5

The Nurse Practice Act and Professional Skills Set The Nurse Practice Act (NPA) was enacted by the legislature of each state to protect patients’ safety and to

guide the scope of practice for all levels of nurses. Any change in the scope of nursing practice will be updated

in the NPA.

DEFINITION OF NURSE PRACTICE ACT (NPA)

The NPA represents all laws that regulate a nurse’s scope of practice in the state or states of America in which she (or he) is licensed to work. These laws protect patients from harm as well as lay the rules and regulations for the specific level of a nurse’s educational and licensure requirements.

FUNCTION

Provides professional regulation in protecting patient safety and rights and it establishes standards and codes of ethics for practitioners at different levels of expertise.

STATE REQUIREMENTS Each state in America has an NPA that is enacted by the state legislature that delineates the scope of proper nursing practice in that jurisdiction. This scope may vary from state to state so it is important for nurses to familiarize themselves with the rules and regulations of the state or states in which they are licensed to practice. Traveling nurses and those in the process of relocating to a different state need to pay particular attention to the local NPA.

SCOPE OF PRACTICE

The scope of practice is different for each field and is determined by specific educational requirements and licensure applicable to each job title and covers procedures and patient care practices limited to the specific titles.

INDIVIDUAL PROFESSIONAL RESPONSIBILITY

It is important for health care professionals to take the responsibility to keep abreast of the changes and developments inherent in remaining a safe patient care provider. They need to rely on the resources of professional organizations and information found in professional journals in conjunction with the standards of practice of each employer and the continuing educational unit requirements as their guides in this. Nurses need to perform the duties for which they have received specific training. Most importantly, each needs to be familiar with the stipulations of her (or his) Nurse Practice Act.

The Nurse Practice Act and Professional Skills Set

DEFINITION OF REGISTERED NURSE (RN)

A graduate nurse trained in the scientific basis of nursing to provide services that are essential to or helpful in the promotion, maintenance and restoration of health and well-being of individuals. The graduate nurse meets certain prescribed standards of education and clinical competence and is registered and licensed to practice by a State Board of Nursing or other state authority.

NR 452 Multi-Client Simulation Student Instructions Revised 6.8.17 6

SCOPE OF PRACTICE

• Direct and indirect patient care services that ensure the safety, comfort, personal hygiene and protection of patient; and the performance of disease prevention and restorative measures

• The performance of skin tests, immunization techniques and the withdrawal of blood from veins and arteries

• Observation of signs and symptoms of illness, reactions to treatment, general behavior or general physical condition and determining of whether the signs, symptoms, reaction, behaviors or general appearance exhibit

abnormal characteristics. Implementation of interventions based on observed abnormalities and appropriate reporting, or referral of changes in treatment regimen or the initiation of emergency procedures if necessary.

• The comprehensive nursing assessment of the health status of patients that addresses changes to patient conditions

• The development of a plan of nursing care to be integrated within the patient-centered health care plan that establishes nursing diagnoses and setting goals to meet identified health care needs, determining nursing interventions and implementation of nursing care through the execution of nursing strategies and regimens ordered or prescribed by authorized healthcare professionals

• The administration of medication or delegation of medication administration to licensed practical nurses

• Delegation of nursing interventions to implement the plan of care

• The provision for the maintenance of safe and effective nursing care rendered directly or through delegation

• Advocating for patients

• The evaluation of responses to interventions and the effectiveness of the plan of care

• Communicating and collaborating with other health care professionals

• The procurement and application of new knowledge and technologies

• The provision of health education and counseling

• Participating in development of policies, procedures and systems to support patient safety

The Nurse Practice Act and Professional Skills Set

DEFINITION OF LICENSED PRACTICAL NURSE (LPN)

NR 452 Multi-Client Simulation Student Instructions Revised 6.8.17 7

A graduate of a school of practical nursing whose qualifications have been examined by a state board of nursing and who has been legally authorized to practice as a licensed practical nurse. According to the role definition proposed as a model by the American Nurses’ Association, the definition of L.P.N. practice has been updated to include “the performance under the supervision of a registered nurse of those services required in observing and caring for the ill, injured or infirm, in promoting preventive measures in community health, in acting to safeguard life and health, in administering treatment and medication prescribed by a physician or dentist or in performing other acts not requiring the skill, judgment and knowledge of a registered nurse.”

SCOPE OF PRACTICE

• Direct and indirect patient care services under the supervision of a registered nurse (RN) that ensure the safety, comfort, personal hygiene and protection of patient; and the performance of disease prevention and restorative measures

• Medication administration

• Data collection on patients and contributions to the care plan

• Monitoring for changes in condition

• Vital sign checks, wound care and dressing changes, specimen collection, urinary catheter insertion and care, care of patients with ventilators and tracheostomies, ostomy site care and maintenance, CPR and finger stick blood sugar testing

• Documentation of nursing care

• Reinforcement of patient education

• Follow up assessment of patient conditions

NR 452 Multi-Client Simulation Student Instructions Revised 6.8.17 8

The LPN is a nurse with limitations and restrictions compared to the Registered Nurse

OUTSIDE OF THE LPN SCOPE OF PRACTICE

• Cannot do initial assessments of patient condition and complaints

• Cannot interpret patient clinical data or act independently on such data

• Cannot triage

• Cannot create, initiate or alter nursing goals or establish nursing care plans

• Cannot do initial patient education regarding patient condition, surgeries or complaints

• Cannot administer IV chemotherapy

• Cannot administer any direct IV fluid bolus or push medications except for saline and heparin flushes

NR 452 Multi-Client Simulation Student Instructions Revised 6.8.17 9

The Nurse Practice Act and Professional Skills Set

DEFINITION OF UNLICENSED ASSISTIVE PERSONNEL (UAP)

Healthcare workers who are not licensed but provide non-nursing custodial, health-related activities and/or clerical patient care services under the supervision of a registered nurse. Unlicensed assistive personnel include patient care technicians, nurses’ aides, certified nursing assistants and unit secretaries. Non-nursing functions are generally classified as housekeeping, clerical, transportation and dietary tasks. Health-related activities are direct patient care activities that are not within the legally protected scope of nursing practice and can be assigned to UAPs who have demonstrated competency. A health-related activity is one that does not require professional judgment or critical thinking.

SCOPE OF PRACTICE

OUTSIDE OF THE UAP SCOPE OF PRACTICE

• Activities of Daily Living (ADL’s) such as feeding, bathing, ambulating, turning and positioning, grooming, toileting, oral care, etc.

• Vital signs

• Measuring basic intake and output

With additional training and demonstrated competency, UAPs may also be permitted to:

• Taking EKGs

• Obtaining blood glucose levels using a glucometer

• Performing phlebotomy

FIVE RIGHTS OF DELEGATION

The RN uses critical thinking and professional judgment when following the Five Rights of Delegation, to be sure that the delegation or assignment is:

1. The right task

2. Under the right circumstances

3. To the right person

4. With the right directions and communication; and

5. Under the right supervision and evaluation