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Discussion

How do I do prep work for a SIM lab that I have to go to on Monday?

My adult health (Patho) clinical preceptor is making each of us go to a simulation experience at the nursing school, rather than the hospital, on a given Monday this semester. It just so happens that my Sim Lab experience is scheduled for the Monday that's 2 days from today.

Normally, when we go to the hospital on Mondays, we do prep work the day before on Sunday. We'll go to the hospital on Sunday, look up the patient's admitting diagnosis, history, and meds, and write all of that down on a client status report (CSR) form. Then we go home and look up the meds and diagnoses. That way, we sorta-kinda have an idea on what to do and what to really look at (I.e., assess) when we treat the patient ourselves on Monday.

However, with this SIM lab patient we obviously aren't going to get to go in the Sunday before (that is, tomorrow) to look up stuff on the mannequin. It's an unpleasant surprise that awaits us on Monday :(

The only "hint" that our nursing preceptor told us was that this SIM lab patient would have some sort of mental status change. The reason why she's making each of us go to the SIM lab and do this is because we may not be in a situation in this hospital this semester where our (real-life) patient has a mental status change.

But how am I supposed to know what to do if I don't know what the patient's diagnosis is?

If I could theoretically go in "the night before" and see on the SIM lab's patient charts "Admitting Dx: STROKE", then obviously I'd go home, look up "STROKE" in my med-surg textbook, and see what the nursing interventions are.

But with this SIM lab, it could be anything! What if it's a pulmonary embolism? Or a heart attack? Or a DVT? I didn't memorize the interventions for EVERY life-threatening condition out there! How am I supposed to respond to the SIM Man's status change?

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    Normally they do give you an idea but really the best part of SiM is performing on the fly. Communication and application is what it is all about. Use it as a learning experience, a chance to apply what you know as if you were the RN.

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    But I don't really know a lot, since the semester's barely started and I've only been to the hospital once. Is there a generalized framework that I can use to prep anyway?

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    The idea is not to prepare, but for it to be more like you're a real nurse in a real hospital. Just do what you would normally do. If this is your first SIM, odds are there will be a lot about communication, safety, and assessment.

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    Cute avatar pic!

    But I get graded on my performance :(

    So I still have to prepare SOMETHING. I think the basic rule of thumb is "What's gonna kill your patient". Maybe I should look up what to do in cases of stroke, or cardiac arrest, and a couple of other life-threatening conditions and see what the basic interventions are.

    I get thrown off when the interventions say "Administer O2 by nasal cannula", because in my mind I'm thinking, "Uhm... how MUCH O2 should I give?". Or "Raise HOB by 45 degrees". How am I supposed to keep the degrees straight in my head for each and every diagnosis?

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    \ said:
    Cute avatar pic!

    But I get graded on my performance :(

    So I still have to prepare SOMETHING. I think the basic rule of thumb is "What's gonna kill your patient". Maybe I should look up what to do in cases of stroke, or cardiac arrest, and a couple of other life-threatening conditions and see what the basic interventions are.

    I get thrown off when the interventions say "Administer O2 by nasal cannula", because in my mind I'm thinking, "Uhm... how MUCH O2 should I give?". Or "Raise HOB by 45 degrees". How am I supposed to keep the degrees straight in my head for each and every diagnosis?

    Thanks!

    It can't hurt to look stuff up! The more prepared you feel, the more comfortable you'll be!

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    \ said:
    But I don't really know a lot, since the semester's barely started and I've only been to the hospital once. Is there a generalized framework that I can use to prep anyway?

    Then remember ABCs, ADPIE, and SBAR. Use them.

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    Okay, so let's discuss ABCs for a second. Suppose that the SIM Man has a mental status change and blacks out.

    Here's what I would do:

    Raise the head of the bed to 45 degrees, open SIM Man's mouth (for expiratory purposes), and put the nasal cannula on the SIM Man. Then I'd crank up the oxygen flowmeter to 3 L/min (don't ask me why 3 L... because 3 just seems like a good number). After that, I'd put the leads of the cardiac monitor on SIM Man's body, and stick the pulse ox on one of SIM Man's fingers.

    Once I've gotten the vital signs, I'd pick up the phone (and using the SBAR sheet) call the doctor and tell him/ her what the vitals are.

    Is that a good game plan?

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    We do a SIM lab every semester and they aren't that bad. You will be surprised how much you actually know on the fly! They are not likely to use scenarios on subjects you haven't covered yet, so make sure you are studied up on your lectures up to this point. Never guess about things like O2. I would never start out with 3L. What if you have a COPD patient? Our protocol is nothing over 2L on this type of patient. I know we have the advantage of obtaining the info on our patients in the hospital the night before, but in the real world you will not have that option. This situation will be more true to life. Good luck and you will do GREAT!

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