Sim Lab questions

Hypotensive- put them in Trendelenburg, call MD, fluid bolus, look for what is causing hypotension- blood loss, sepsis, decreased cardiac output, hypovolemia, etc.

PVCs- generally you don't rush to the amiodorone. PVCs aren't uncommon in the older folks.

Resp failure- better be doing much more than some oxygen and repositioning if the patient is actually in failure. Call a rapid response or code, bag the patient, start compressions if no pulse. Now if you were referring to shortness of breath then oxygen, repositioning, nebs, and some steriods would be in order.

Heart failure- Lasix, fluid restriction, strict I and O, oxygen.

I don't know if it is because I was trained outside of the US but unless the pt already had orders for these medications you as a nurse cannot give them. Also while in school we had to have NURSING interventions that we used to assess or treat the pt.

Hypotension - elevate the end of the bed if they can drink encourage them to do so. Manual BP while calling you incharge or another nurse to call the doctor. Check what meds they have already had today which may account for the hypotension

PVC- again full set of vitals and call the doctor. Rest them in bed until reviewed.

Resp failure - O2 if not contra indicated, reposition to a high Fowler's if tolerated full vitals incl SaO2, listen to their lungs talk to the person calmy and slowly explain to them what you are doing, saline or atrovent nebs call a senior doctor or call a rapid response.

Heart failure - is it new or an exacerbation of a chronic condition? VS listen to their heart and lungs, is there a IDC (foley's)? what's their urine output been like? Signs of oedema? Call the doctor let your in charge know what is going on

Asystole - yell for help and for some one to call the code team, start compressions, the next person in clear the room of unnecessary items take the head of the bed away so you don't cause anyone to harm themselves. Get someone to call the family of the pt.

Arrythemia - full VS manual pulse call the doc.

While you will be giving medications these medical interventions and orders for you to carry out. Always do a full set of vitals manually on a pt if you are worried about them, check their pulse and listen to heart and lung sounds, This last part can done after you have called the doc. ALWAYS let your incharge know whats going on so that if a rapid response team comes running up the hall (s)he is not wondering what the heck is happening. (personal experience of hearing a code over the PA system on my ward) Ask for help from a colleague either to help you with your sick pt or to keep an eye on your other pt while you are caught up with the sick one.

Good luck!

It is good to memorize interventions for several types of patient problems but simulation is designed to have you think on your feet as each patient is different. In addition, it is a place to learn without putting patients at risk. The best thing to do is to prepare for the simulation before and though you made have had these certain ones, nearly anthiing can be simulated, not just medical emergencies.