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Simulation today....advice needed please :)

Posted

Today is our third simulation of the semester. We are given patient hx, and doctor orders one day prior to the simulation in order to prepare. This "patient" is 75 yrs. old, admitted with fever, chest congestion and c/o SOB. Has a shiley trach, COPD, PVD, and is a smoker. Thick tan mucus from trach and on dressing. O2 92% on 2L O2 via trach collar, BP 160/90, P 92, T 101, R 22. HOB elevated 45 degrees. I am trying to figure out what to do upon entering the room. After checking orders and patient identification, I should check vitals. I am assuming that the patient will have decreased O2 levels because our simulations never have "normal" patients ;) So, my first action would be hyperventilation/suctioning trach since airway is my first priority. However, I was told by a couple junior year students that the patient dies during this simulation...so now I'm terrified! What do I do when my actions fail to help? It also states that the patient has a living will on file. The "patient's" wife will also be present in the room. I know this is a learning scenerio, and that I will learn from my mistakes. I just don't want to completly freeze up when this patient begins to decline and eventully die! Any advice on what actions I should take? I'm stressing out!!

Deep breath. You, not the patient. :) Remember the Fat Man's Laws: IV. The patient is the one with the disease. You have nothing to be terrified about. A little anxiety is good-- makes your eyes see better, sharpens your hearing, kicks out extra glucagon from your liver to support muscle activity and brain metabolism, all good things. "Terrified"? What on earth for? This is learning lab, silly, not being the only RN working nights in a real SICU. :) Chill. This can be fun.

Head to toe assessment-- General condition. Is he short of breath now, or is he at baseline for him? Listen to heart, lungs/SpO2, belly, urine, check peripheral pulses, BP, resp rate, ask about pain-- be careful to see about chest pain. (smoker, PVD, elevated BP, elevated resp rate, low SpO2 -- all could point to risk of impending MI). Good IV access in place, just in case you need it in a hurry?

If he can deep breathe and cough to get stuff out (ask "him") so much the better. If not, see if suctioning him will help. Be sure to hyperventilate ("him," not you) a bit first. Ask "wife" if she notices anything different. Is his BP higher/lower than usual? Prn meds for this? Prn meds for fever? "What would make you more comfortable, sir?"

Stephalump

Specializes in Forensic Psych. Has 2 years experience.

Little hint:

If you freeze and can't think of anything to do, start back at the beginning of the nursing process and assess. Physical assessment, safety, things like that. It's better than just standing there :)

It's awesome that you have so much info going in! They refuse to tell us anything before sim, and we can be expelled for sharing information. Makes it even more nerve wracking.

BeenThereDoneThat74, MSN, RN

Specializes in Pediatrics. Has 26 years experience.

It's awesome that you have so much info going in! They refuse to tell us anything before sim, and we can be expelled for sharing information. Makes it even more nerve wracking.

Agreed. You are going in with a lot of info. You just have to see what the patient does. I know students love to go into the sim and "do"; give meds, treat something... Anything!! But before you treat, you have to assess. Is he in the same condition now, as he was when you got your info? The wife is there for a reason. Sometimes the main objective of the sim is to assess your ability to communicate. I find this to be difficult for the students (if they are not comfortable around patients and family, because if lack of experience about the type of illness). If he has advanced directives to withhold certain treatments, you're obviously not going to do them. I know in sim that can be stressful, because students would rather keep busy by doing and not communicating. If the patient is going to die, there may be nothing you can do about it.

If you're expected to call the MD, better be prepared. I love being the doc during sim. I will purposely ask them questions that they do not have the answers to (not to trip them up, but to make them realize they have to be prepared with all data before picking up the phone i'll tell the student to call me back when they have everything (nicely, of course).

Most of all, try to have fun, and learn from the experience! Better to mess up here than in real life ;)

Thanks for the help everyone :) I had the SIM yesterday and everything went fine. The patient did NOT die, so the rumor I heard was just that...a rumor :)

BeenThereDoneThat74, MSN, RN

Specializes in Pediatrics. Has 26 years experience.

Thanks for the help everyone :) I had the SIM yesterday and everything went fine. The patient did NOT die' date=' so the rumor I heard was just that...a rumor :)[/quote']

That's how we like our patients! Even if they are only simulated ;)

Stephalump

Specializes in Forensic Psych. Has 2 years experience.

Thanks for the help everyone :) I had the SIM yesterday and everything went fine. The patient did NOT die' date=' so the rumor I heard was just that...a rumor :)[/quote']

Great!

I know in our program, the patient won't ever die. We deal with codes, but the patient will always come back.