Simulation lab NCAS-please suggest me the procedures for entry level nurses

[akaur212]

I am doing NCLEX RN this year but before that I need to go through simulation lab and computer based assessment through NCAS .i am so scared because there is no information about SLA .

i visited the college in person , where I am scheduled for SLA.THe staff gave no information except that it will be all for entry level nurses.

could anybody suggest me any procedures to prepare ?

there will be four parts :

medical surgical nursing

community health nursing

mental health nursing

gynaecology

I am not sure if that's correct becoz somebody gave me this above info .

MY question is -will I be expected to perform fundal examination on a pregnant women ?that sounds like a little advanced for a entry level nurse.

i have done advanced procedures in INdia as a RN ,but in Canada A nurse need certification to be a IV nurse , which was absolutely normal in my country .i did hundreds of IV's on real patients when I was only in second year of my nursing college ,only 20 years old .

I use to have a practical book which had all the procedures I have done in my nursing college but I am missing that one .can anybody help me with what to expect in the exam ?

[akaur212]

Hi Dishes

I am doing all what you have mentioned.Can we create a scenario on Hypertension for today?

[dishes, BSN, RN]

Hi Dishes

I am doing all what you have mentioned.Can we create a scenario on Hypertension for today?

I think we have to develop a scenario, then write the candidate instructions, then the standardized patient's script, then the examiner questions and evaluation tools.

For the scenario, what age is the patient? what sex? what is the setting the patient is being assessed in?

[akaur212]

The patient is 67 year old female and assessed in emergency after complaining about chest pain

[dishes, BSN, RN]

1. Your scenario needs to be more detailed so that the nurse knows what nursing steps are required. Consider adding details to the scenario such as MI and stroke were ruled out and hypertension is the medical diagnosis, the patient has been told by the doctor they have hypertension and will need to take medication and modify their diet. In the scenario you are meeting the patient for the first time what are the first steps you will take?

2. During the nursing history and physical assessment the patient asks you what is hypertension? What causes it? How will I check my blood pressure at home? How will I know if it is bad enough that I should go to the emergency department again? (in the role playing scenario these can be the patient actor's lines)

(look at nurselabs.com hypertension to get some ideas for hypertension nursing care management)

[akaur212]

hi Dishes,

I am done with my homework.Please check and see if something need to be modified or corrected?

my questions __

when patient is still complaining for headache, what need to be done at that moment? because the health teaching is not priority . May be add more to the scenario .

Case: Hypertensive Emergency

Synopsis:

67 year old patient headache.

Number of Participants:

one patient, nurse(you) and health care staff

Objectives:

Patient will be able to manage hypertensive urgency and it's complications.

Stem:

You are the Nurse working in the ER. A 67 year old patient with headache and hypertension is admitted to the Emergency. Patient's initial BP was 220/105. Patient is newly diagnosed with hypertension and was recently seen in the ER for workup for secondary causes of hypertension. The emergency physicians performed a CT head which was normal.

Roles:

Senior 67 year old female

Nurse

Script for Roles:

Nurse:Since arrive to ER you've placed the patient on monitor. Patient's had a CT head which the ER doc tells you that was normal. The patient continues to complain of a headache.

Patient - What is Hypertension and what causes it?

Nurse - Hypertension is a term used for high blood pressure. Blood pressure is the force of blood against your artery walls as it circulates through your body. Blood pressure normally rises and falls throughout the day, but it can cause health problems if it stays high for a long time. High blood pressure can lead to heart disease and stroke.

Patient - What are the signs and symptoms?

Nurse -Symptoms vary depending on the severity of the condition and progression of the disease. You may experience no symptoms, or your symptoms may include:

chest pain (angina)

tightness or pressure in the chest

shortness of breath

fatigue

pain in the neck, back, arms, or shoulders

persistent cough

loss of appetite

leg or ankle swelling

Patient - What are the risk factors associated with hypertension?

Nurse - I can tell you the risk factors which could be being overweight or obese, Intake of too much salt in your diet, too little potassium, not being physically active, drinking too much alcohol and stress. HTN can be caused due to certain drugs such as NSAIDS or cough and cold medications.

Patient - How can i check my blood pressure at home?

Nurse - You can purchase a manual or digital blood pressure monitor, follow the instructions in the booklet carefully.

There are certain factors you need to consider that can temporarily rise your blood pressure. For example - stress, smoking, cold temperatures, exercise, caffeine, and certain medications.

Try to avoid as many of these factors as you can when taking your blood pressure. Also, try to measure your blood pressure at about the same time each day. Your doctor may want you to check your blood pressure several times during the day to see if it fluctuates.

Patient - How is it treated ?

Nurse - If you have high blood pressure, your doctor may prescribe medication to treat it. Lifestyle changes can be just as important as taking medicines.

Patient - How should i know that i need to go to the Emergency?

Nurse - You need emergency care if your heart is suddenly beating rapidly or irregularly. Seek emergency care immediately or call 911 if you faint or have severe pain in your chest.

Regular physical exams will indicate whether you suffer from high blood pressure. If you do have high blood pressure, take extra care to look out for symptoms of heart disease.

[dishes, BSN, RN]

The problem with changing the scenario to hypertensive emergency is it will be a medical diagnosis that needs physician orders for stat medication and it will complicate the scenario. It might be better to keep it simple and make sure the scenarios focus on nursing assessment, planning, implementation, evaluation. I think this hypertension scenario should be that the patient is now stable enough, ie headache resolved and B/P stable enough to be discharged home from emerg but has knowledge deficit on how to monitor B/P, how to modify diet, medication etc. Otherwise your answers are on the right on track!

[akaur212]

Yes you are right.Or we can say that so and so medication was ordered by the physician and in nursing assessment we can say that the medication is administered and headache is resolved.

I think all other answers are good.

Moving on to new scenario and i will show it to you.Your role would be to design the questions for me according to the aspects on which i will be tested on during simulation lab test.I will answer all of them and submit :) :)

[dishes, BSN, RN]

Before we start on another patient scenario, there are still some missing components that need to be worked on for the 'hypertension discharge planning scenario'.

The nurse needs to do her own assessment when she first meets the patient, she cannot rely on the previous shift's assessment before she discharges the patient, as time will have lapsed and the nurse needs to ensure that the patient is still safe to discharge home. What physical assessments will the nurse do? What questions will the nurse ask the patient? what questions will help the nurse know if the patient has knowledge deficit?

In the discharge teaching what blood pressure parameters require the patient to do something? such as hold the medication, go to emerg, or contact the family physician?

How will the nurse evaluate if the patient understands the discharge teaching? (the Teachback method can give you some ideas how to evaluate patient learning)

After adding more details to the nurse's and patient's role, can you start creating the evaluator's role? Decide which entry-to-practice competencies are being assessed in the scenario, create a list of questions or statements include tick boxes and a marking scheme. The evaluator's role is to quietly observe the nurses actions and communication with the patient during the scenario and mark the nurse's evaluation. For example, the nurse needs to wash her hands before having contact with the patient (in the exam this will be on the evaluator's marking sheet for all scenarios but will not be written on the nurses role, it is assumed the nurse know she has to do this and will lose points for not doing it )

According to ncas, after interacting with the patient, the next step is the oral part of the test which is done with the evaluator and the nurse, can you look it up on ncas and write what you think the evaluator will ask and what the nurse should do for this part?

[akaur212]

hi dishes,

I have a question. If nurse need to do her own assessment then it means she cannot trust the other RN OR staff which was working previously? Please suggest what can be done in nurses own assessment.

Assessment for need of health teaching can be assessed by asking the patient if he is aware about the life style modifications to control hypertensive crisis. For example - if patient is a smoker then a nurse can help the patient to quit smoking by providing contacts of different counselling groups.

and then patient starts asking questions and answers them .

DISCHARGE PLANNING -

Teach the patient :

Hold the med when BP is 90/60 mm?hg

Go to the emerge when your systolic BP is over 180 after monitoring three times in a 30 minute period.

Contact the family physician when he notes in his log a continuos high BP or fluctuations and he is feeling symptoms of headache or dizziness .

Patient evaluation-asking him do you understand the risk and complications of not adhering to medication regimen and treatment plan ?

do you have any questions?

Patient - No i think i am ok .

and then start discharge procedure.

competencies tested in above scenario- Knowledge based practice

Ongoing comprehensive assessment

Health care planning

providing nursing care

[dishes, BSN, RN]

hi dishes,

I have a question. If nurse need to do her own assessment then it means she cannot trust the other RN OR staff which was working previously? Please suggest what can be done in nurses own assessment.

It isn't that you do not trust the other nurse's/staff's previous assessments, it is making sure the blood pressure is still in the stable range before discharge. You will want to ensure that their B/P hasn't rebounded back up high or dropped down to low, as it is unsafe to discharge them if their B/P is unstable.

The physical assessment should include retaking their blood pressure, prior to checking you should explain to the patient the safety reasons for rechecking the blood pressure and obtain the patient's verbal consent (informed consent is an entry-to-practice competency). When you check the B/P you should explain the steps in taking a manual B/P as you are being marked on this assessment (talking through each step shows the evaluator know what you are doing). Watch some nursing student videos to see how they explain each step while they are doing them, practice speaking the steps aloud while doing the actions.

Does your workplace have equipment to take manual B/Ps or do they use automatic B/P equipment? If they have manual equipment do you use it on patients? If not can you buy manual equipment? Also, do you have your own stethoscope?

The rest of your discharge teaching sounds good.

[dishes, BSN, RN]

akaur and lillianlou, have you two made plans to study together? If so, can you get one more person to join you? The third person doesn't have to be a nurse if they are going to role play the patient. If you have three, maybe you can test out the hypertension role playing scenario? Maybe write up the individual roles on large (5x8) index cards, for example the person playing the patient has an index card with a description of their symptoms and their lines, the evaluator has an index card with a description of the scenario and each step they expect the nurse to do, the nurse has an index card describing the patient scenario (it can contain some cues but it should not give specific instructions about what the nurse should do or say).

[ksamnani]

Hey everyone, I was reading through all the comments and its really very helpful. I m preparing myself for NCAS too, but I am still confused whether to go for LPN and RN both or just RN. If someone has registered for both, it would be great if you can guide me and help me out. Thanks