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Vascular/Ischemic Stroke Simulation

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rebecca hand

on 4 February 2015

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Transcript of Vascular/Ischemic Stroke Simulation

Vascular/Ischemic Stroke Simulation

Estimated Scenario Time:
Estimated Debriefing Time:
Target Group:
Cognitive Skills Psychomotor Skills
Critical thinking skills
Basic nurse assessment
Knowledge of blood pressure control for post-op
Oxygen saturation
Cardiac rhythms
Familiarity with post-op medications
Name: Ronald McDonald
Age: 45
Weight: 285 lbs
Height: 5'9"
Gender: Male
Allergies: Percocet
Past medical history: Obesity, smoking, HTN, hypercholesterolemia, DM 2, and chronic back pain
Medications: ASA, Colace, Norvasc, Glucotrol, Lipitor, Lopressor, and Norco 5/325
PCP: Dr. Charles Burger
Learning Objectives
Recognition of post-op complication
Perform basic post-op surgery assessment
Perform advanced neurological assessment
Competency of PCA policy and guidelines
Familiarity with DVT prophylaxis- TEDS/SCDS
Assessment of NG tube placement/ IV Patency
Assessment of abdonminal binder and wound
Perform strict I&O
Presented by: Rebecca Hand BS RN-BC, Marlene Jones BS RN, & Aubrey McDermott BS RN
Vascular/Ischemic Stroke
20 min
30-40 min
Final Semester Nursing Students
Prerequisite knowledge items:
Recognition of post-op complications
Knowledge of stoke symptoms
Competent post-op nurse assessments and interventions
Demonstration of post-op vascular surgical assessment
Advanced neurological assessment
Assess pain control and management

Ronald McDonald is a Caucasian 45 year old patient, POD #1 Open AAA Repair. Transferred from the ICU to the third floor medical-surgical unit this morning. Currently NPO with NG tube to LWS, abdminal binder on, foley catheter, main iv fluid, and has a morphine PCA for pain control. You are an evening nurse finished getting report. Previous nurse states this patient has no complaints and that family is in the room.
Monitor Set Up and Equipment Checklist
Primary ECG
Medical records
Physician orders
Emergency med box
Accucheck glucometer
Reference material
PCA policy
Oxygen delivery adjunct
Normal saline 250ml
Amp D50
Preparation of Simulator
Dilated & fixed left pupil
Nasal cannula out of nose dangling
Left side has drool
Blood pressure reading elevated
Oxygen saturation low
Left arm hanging off the side of the bed and body slanted left
TEDs tied to bed railing, SCD sleeves on the floor
Patient holding NGT in right hand and pain button also near right hand.
IV lines intact
Primary RN
Student RN
Vascular PA
Family Member
Role of Participants
In the US:
Every 4 seconds someone has a stoke
Every 4 minutes someone dies of stroke
795,000 every year suffer from stroke
Risk Factors Include:
Family history
(Ennon & Beamon, 2012, p.924)
Ennen, K., & Beamon, E. (2012). Women and
stroke knowledge: Influence of age, race, residence location, and marital status.
Health Care for Women International, 33
(10), 992-942.
Signs and Symptoms
Weakness in extremities or face
Visual complaints
Loss of coordination
Difficulty speaking
(Ennen & Beamon, 2012, p. 926)
*These are important to be aware of so there is no delay in treatment. Simulation is ideal because these signs and symptoms can be an indication of other issues or problems*
First 5 Minutes:
1.) Mannequin Actions
Temp 98.8
HR 101
RR 14
BP 180/90
O2 sat 90% 2liters
No pain
Slurred speech
Arousal tactile simulations
2.) Expected Interventions
Wash hands
Introduce self
Identify patient
Gather equipment
Assess VS, LOC
Identify there is a problem
Place oxygen back on patient
Recycle BP
3.) MAY use following cues
Family member comes to nurses station and states "Ron just pulled that tube from his nose"
Next 5-10 Minutes:
1.) Mannequin Actions
RR decrease to 7
O2 sat increases to 91% 2L
Slurred speech
BP recheck 198/110
Blood glucose level 120
2.) Expected Intervention
Recognition of neuro change
Perform neuro assessment
Check blood glucose level
Turn off PCA pump and give Narcan
Wait for narcan to take affect and reassess neuro status
3.) Cues
Post narcan: patient mumbles "I can't move my left arm"
Final 15-20 Minutes
1.) Mannequin Actions
Unable to respond verbally
Left side flaccid
Left eye fixed dilated
Left side facial droop
2.) Expected Interventions
Notification of MD/Affiliate
Recognition of stroke vs. narcotic overdose and hypoglycemia symptoms
3.) Cues
Flaccid left side, favoring right.
Debriefing Questions
How do you feel the simulation went?
How confident did you feel in your assessment skills?
What were the key signs and symptoms leading you to think the patient was having a narcotic overdose?
What were the key signs and symptoms leading you to think the patient was having a stroke?
Was there a part of the simulations where you felt uncomfortable or uncertain?
Do you feel like you learned something new?
If you were able to do this simulation again, what would you have done differently?
Will this scenario help you in the future?
Full transcript