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 sample paper. Again go over the rubri

NR 446 Multi-Client Student Instructions Revised 6.8.17 1

Student Instructions for Standardized Simulation

NR 446 Multi-Client

Client 1 of 2: Janet Martin

Client 2 of 2: Margaret Stanton

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: Janet Martin:

Janet Martin is a 75 year old female. Her daughter called stating that Janet was complaining of coughing/not

feeling well and is unable to get off the couch because she is weak and fatigued. The daughter brought her into

the Emergency Department with c/o fever and chills for 2 days, decreased appetite, noted productive green

cough and fatigue. Janet was admitted to the telemetry unit with a diagnosis of bilateral pneumonia. Janet also

had an open wound on her left great toe that turned out to have MRSA after a wound culture was done. The

wound has closed.

Margaret Stanton:

Margaret Stanton is a 75 year old female admitted to the telemetry unit late last night for MVP (Mitral valve

prolapse) and is scheduled for surgery this morning at 0730.

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. Students are to stay together as a group through the simulation. There are two clients

you will be providing care for at the same time.

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

NR 446 Multi-Client Student Instructions Revised 6.8.17 2

primary care provider, ancillary support services, and others directly involved with the 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 NR 446 standardized simulation enables the student to meet the following priority course outcomes:

NR 446 Multi-Client Student Instructions Revised 6.8.17 3

 CO 2. Incorporate leadership theory and skill within the assumed nurse role during healthcare

interactions with a client and collaboration with the healthcare providers (PO 2)

 CO 3. Demonstrate ability to integrate communication and professional relationship skills when

interfacing with the consumer and the environment (PO 3)

 CO 7. Practice the leadership roles of the professional nurse as the manager of client nursing care

in the roles of client advocate, educator, investigator, communicator, and change agent under the

guidance of faculty and preceptors (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.

SIMULATION TIMING:

 Pre-brief: 30-40 minutes

 Run Time: 35 minutes (The first five (5) minutes are allocated to hand-off report of both clients)

 Debrief: 60 minutes

REVIEW AND COMPLETE PRIOR TO THE START OF PRE-BRIEFING: In order to prepare for the simulation, you should complete your 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:

 Prioritization and delegation

 Dimensional analysis math

 Infection control

 Effective communication

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

in these skills. You will also need to review The Nurse Practice Act and Skills Set located below, prior to the

simulation.

Therefore, in order to prepare for 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

NR 446 Multi-Client Student Instructions Revised 6.8.17 4

pre-briefing questions 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. The healthcare provider ordered 500mg Vancomycin Hydrochloride IVPB every six hours. The maximum

safe dose range is 40mg/kg/day. The client weighs 165 lb. What is the maximum therapeutic dose the

nurse will administer per day? ___mg/day (If needed, round to the nearest whole number)

2. What is the purpose of Vancomycin Hydrochloride and what are the side effects/administration

protocols?

3. What are some of the risks that diabetics face as a result of uncontrolled blood sugars? Explain the

difference between Type I & Type II Diabetes. Discuss a diet that is appropriate for a diabetic. How is it

different from a general diet?

4. What PPE is necessary for a patient who has MRSA?

5. What is the nurse’s role in providing client and family support for the recent loss of a family member?

6. Review the causes and treatment options used for MVP with regurgitation and how they can prevent

further heart failure.

7. List 5 nursing interventions a nurse is responsible for performing to ensure safety of the client when they

are assigned a client who is disoriented.

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

Learning Space**

NR 446 Multi-Client 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.EFINITION 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.TEE

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.OPE 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.ALRESPONSIBILITY

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.

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

NR 446 Multi-Client Student Instructions Revised 6.8.17 6

• 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)

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

NR 446 Multi-Client Student Instructions Revised 6.8.17 7

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 446 Multi-Client 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 446 Multi-Client 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 • 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

• Assessing, evaluating or problem solving

• Developing a nursing care plan

OUTSIDE OF THE UAP SCOPE OF PRACTICE

NR 446 Multi-Client Student Instructions Revised 6.8.17 10

• Performing sterile or invasive procedures or techniques

• Inserting urinary catheters

• Delivering nasogastric or gastrostomy tube feedings

• Administering oxygen

• Performing tracheal suctioning, tracheostomy care or respiratory care • Administering medications, immunizations or

blood or blood products of practice

Multi Client

1. The healthcare provider ordered 500mg Vancomycin Hydrochloride IVPB every six

hours. The maximum safe dose range is 40mg/kg/day. The client weighs 165 lb. What is

the maximum therapeutic dose the nurse will administer per day? ___mg/day (If needed,

round to the nearest whole number)

3,000mg/day

2. What is the purpose of Vancomycin Hydrochloride and what are the side

effects/administration protocols?

Vancomycin Hydrochloride is an antibiotic.

Side effects include Ototoxicity (auditory portion of eighth cranial nerve).

Urogenital: Nephrotoxicity leading to uremia. Body as a Whole:Hypersensitivity

reactions (chills, fever, skin rash, urticaria, shock-like state), anaphylactoid

reaction with vascular collapse, superinfections, severe pain, thrombophlebitis at

injection site, generalized tingling following rapid IV infusion. Hematologic:

Transient leukopenia, eosinophilia. GI: Nausea, warmth. Other: Injection reaction

that includes hypotension accompanied by flushing and erythematous rash on

face and upper body ("red-neck syndrome") following rapid IV infusion.

Protocol Give a single dose at a rate of 10 mg/min or over NOT LESS than 60 min.

Avoid rapid infusion, which may cause sudden hypotension. Monitor IV site closely;

necrosis and tissue sloughing will result from extravasation.

3. What are some of the risks that diabetics face as a result of uncontrolled blood

sugars?

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Explain the difference between Type I & Type II Diabetes. Discuss a diet that is

appropriate for a diabetic. How is it different from a general diet?

Complications of Uncontrolled Diabetes include:

 Diabetic retinopathy

 Glaucoma

 Kidney failure (diabetic nephropathy)

 Nerve damage (Diabetic neuropathy) which can lead to amputation of foot or

toes

 Diabetes Type I is insulin dependent diabetes because the pancreas does not

make insulin

 Diabetes Type II is insulin resistant diabetes because cells become resistant to

insulin or the pancreas does not produce enough

Diabetic Diet recommendations

Carbohydrates, which are found to the largest degree in grains, bread, pasta, milk,

sweets, fruit, and starchy vegetables, are broken down into glucose in the blood faster

than other types of food, which raises blood sugar, potentially leading to hyperglycemia.

Protein and fats do not directly impact blood sugar, but both should be consumed in

moderation to keep calories down and weight in a healthy range.Include fiber in the diet

to increase carbohydrate metabolism and to help control cholesterol levels.

4. What PPE is necessary for a patient who has MRSA?

Gloves and Gown

5. What is the nurse’s role in providing client and family support for the recent loss of a

family member?

 Assist the client in coping with suffering, grief, loss, bereavement

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 Support the client in anticipatory grieving

 Inform the client of expected reactions to grief and loss – ( Kubler Ross’s stages

of grieving: Denial, Anger, Bargaining, Depression, Acceptance)

 Provide resources to adjust to loss/bereavement-individual counseling, support

groups

 Evaluate coping and fears related to grief and loss

6. Review the causes and treatment options used for MVP with regurgitation and how

they can prevent further heart failure.

 Mitral valve prolapse: abnormality of the mitral valve leaflets and the papillary

muscles or chordae that allows the leaflets to prolapse or buckle back into the

LEFT atrium during systole. Most common valvular disease in U.S.

 MVP is usually benign but serious complications can occur.

 MVP etiology is unknown but some client have an increased family incidence

Treatment depends on how severe it is, is exhibiting sign and symptoms, condition

worsening, goal is to improve hearts function while minimizing s/s and avoid future

complications.

 medications: Beta adrenergic blocker to control palpitations, chest pain, diuretics,

blood thinners

 surgery to repair/replace valve, repair/replace may be needed even if no s/s are

being experienced since it may PREVENT complications (heart failure)

 healthy eating habits and avoid caffeine since it is a stimulant and may

exacerbate symptoms

 begin/maintain an exercise program to achieve optimal health

 Preventative measures to prevent heart failure.

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7. List 5 nursing interventions a nurse is responsible for performing to ensure safety of

the client when they are assigned a client who is disoriented.

 Respond to call lights in a timely manner-keep call light within reach

 Provide hourly rounding

 Keep assistive devices nearby (walkers, transfer devices, eyeglasses).

 Anticipate needs

 Possible bed/chair alarms

 Reorient client to room, time, place

 Clock on the wall

 Provide client with a daily schedule

 Request family to bring in personal items if possible ie photos

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1 Running head: Multi-client

Simulation Multi Client

Bernadette Mendoza

Chamberlain College of Nursing

NR 446: Collaborative Nursing

September, 2018

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2 MULTI CLIENT

1. The healthcare provider ordered 500mg Vancomycin Hydrochloride IVPB every six hours. The maximum safe dose range is 40mg/kg/day. The client weighs 165 lb. What is the maximum therapeutic dose the nurse will administer per day? ___mg/day (If needed, round to the nearest whole number)

2. What is the purpose of Vancomycin Hydrochloride and what are the side effects/administration protocols?

 Treatment of potentially life-threatening infections when less toxic anti-infectives are contraindicated. Particularly useful in methicillin-resistant staphylococcal infections. PO: Treatment of staphylococcal enterocolitis or pseudomembranous colitis due to Clostridium difficile.

 Adverse Reactions/Side Effects

 EENT: ototoxicity.

 CV: hypotension, massive histamine release called “red-man syndrome” with rapid IV infusion.

 GI: nausea, vomiting.

 GU: nephrotoxicity.

 Derma: rashes.

 Hematology: eosinophilia, leukopenia.

 Local: phlebitis.

 MS: back and neck pain.

 Miscellaneous: anaphylaxis, superinfection.

 Need to Know:

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3 MULTI CLIENT

 Culture and sensitivity tests are per- formed prior to initiating therapy.

 Monitor IV site closely to avoid extravasation.

 Monitor blood pressure and presence of skin flushing throughout IV infusion.

 Monitor intake and output and daily weight.

 Cloudy or pink urine may be a sign of nephrotoxicity.

 Assess bowel status.

 Monitor CBC with differential, and liver and renal function.

 Monitor peak and trough drug levels.

 Report subtherapeutic or toxic levels immediately.

 IV: Administer over at least 60–90 min to prevent “red-man syndrome” (massive histamine release).

 Look for Candida infections.

 Teach client:

 Oral forms are to be taken exactly as directed.

 Report tinnitus, rash, vertigo, or hearing loss.

 Report flushing of the skin, or dizziness.

3. What are some of the risks that diabetics face as a result of uncontrolled blood sugars? Explain the difference between Type I & Type II Diabetes. Discuss a diet that is appropriate for a diabetic. How is it different from a general diet?

 Risks as a result of uncontrolled blood sugars:

 Chronic health problems and early death

 Macrovascular complications include coronary artery disease, cardiomyopathy, hypertension, CVD and PVD

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