Acute Stroke - Simulation Design Template – Loyalist … · Web viewJarvis, C. (2009). Physical...

Simulation Design Template

Acute Stroke - Simulation Design Template – Loyalist College

Program: Nursing Course: NURS 2005 Review date:Original Author/year: Tammy Armstrong(O’Rourke)/2007,Reviewed 2009, Julie Rivers revision 2014

_X_Formative assessment ___Summative assessment or ___OSCE /High stakes assessmentPrep/Pre-meeting Time: 0 Expected Simulation Run Time: 15 min Debrief/Guided Reflection Time: 15 minAlternate Activity Location Required: No

Simulation Learning Objectives (Identify related Course Learning Outcome and Program Terminal Outcome by number only)

The Student group will:

1. Demonstrate understanding of assessment of a person experiencing CVA.(CLO 1,2,3 , PLO 1,2,3)a. Carry out a focused neurological assessment of a patient who has a stroke using the Canadian

Neurological Scale Toolb. Assess vital signs and patient’s symptoms/concernsc. Carry out appropriate interventions in response to assessment findingsd. Identify assessment findings which could lead to complications

2. Identify and consult appropriate resources while assessing, planning (including prior to lab), and implementing care. (CLO 1,2,3,6 PLO 1,2,3,6)

3. Respond appropriately to family member question(s) (CLO 1, 2, 3, 6 PLO 1, 2, 3, 6)

4. Participate in creating SBAR report at the end of the simulation (CLO 3, PLO 3)

Measurement of Objectives

1. During scenario, identified by handler events in debrief document for a-c. During debrief discussion for d.

2. During scenario, identified by handler events in debrief document and discussed in debriefing session3. During scenario identified by professor and discussed during debrief. 4. Written and verbal (time permitting) report at end of simulation.

Skills/Theory required prior to participation in simulation

o See Course Documentation for prerequisites and co-requisiteso Cardiovascular, neurological assessment and stroke (including use of CNS tool) lecture content of

NURS 2004o Familiarization with use of blood glucose meter

Simulation Design TemplateStudent Preparation for Simulation

Review and research pertinent patient information package provided - see Appendix A

Student preparation package to be distributed: See Appendix A Prior to Simulation - included in Blackboard course materials

References, Evidence-Based Practice Guidelines, Protocols, or Algorithms used for this scenario: (site source, author, year, and page)

Canadian Pharmacists Association. (2013). e-CPS. Ottawa, Ontario, Canada.Health Quality Ontario & Ministry of Health and Long-Term Care. (2013, September). Quality-Based

Procedures Clinical Handbook for Stroke. Retrieved from Ontario Ministry of Health and Long-Term Care: http://health.gov.on.ca/en/pro/programs/ecfa/docs/qbp_stroke.pdf

Jarvis, C. (2009). Physical examination & Health Assessment (1st Canadian ed.). Toronto: Saunders Elsevier.Lewis, S. H. (2010). Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems

(2nd Canadian ed.). Toronto: Elsevier Canada.Lewis, S., Ruff Dirksen, S., Howard, V., Heitkemper, M., Schumacher, L., Weberg, D., and Bucher, L. (2011).

Simulation Learning System for Lewis et al: Medical Surgical Nursing. (8th ed). Retrieved from https://evolve.elsevier.com/Courses/14402_jrivers12_1001

The Canadian Stroke Strategy. (2014). Retrieved from Canadian Best Practice Recommendations for Stroke Care: http://www.strokebestpractices.ca/index.php/about-us/

The Canadian Stroke Strategy. (2014) Retrieved from Canadian Best Practice Recommendations for Stroke Care: Hyperacute Stroke Care recommendations: http://www.strokebestpractices.ca/wp-content/uploads/2010/10/Ch3_SBP2013_Hyper-Acute-_23MAY13_EN_-FINAL5.pdf

pathophysiology notes re CVA BPG’s - RNAO Stroke Assessment across the continuum of Care 2011 Supplement found at url

http://rnao.ca/sites/rnao-ca/files/storage/related/7708_STROKE_Supplement_FA.PDF

Optional - Stroke Nurse Pocket guide provided by professor, need to order from Heart and Stroke

Lewis, S., Ruff Dirksen, S., Howard, V., Heitkemper, M., Schumacher, L., Weberg, D., and Bucher, L. (2011). Simulation Learning System for Lewis et al: Medical Surgical Nursing. (8th ed). Retrieved from https://evolve.elsevier.com/Courses/14402_jrivers12_1001. Simulation 20 Naomi Reed.

External Expert Review

2006, original co-author, Stroke Unit co-ordinator, Sue Kotel

December 2013, Melissa Roblin, RN, BScN - Stroke clinical resource Nurse Quinte Healthcare Corporation and Michelle Slapkauskas, RN, BScN, Stroke prevention clinic nurse, Quinte Healthcare Corporation

http://www.strokebestpractices.ca/wp-content/uploads/2010/10/Ch3_SBP2013_Hyper-Acute-_23MAY13_EN_-FINAL5.pdf



Brief Description of Patient:

Name: Mr(s). Sidney Smith Gender: M or F Bdate: 08/05/39Race: CaucasianWeight: 92kg Height: 175cmReligion: Major Support: spouse and children Phone:

Allergies: ASA & Penicillin Immunizations: UTD

Attending Physician/Team: Stroke team

Primary Diagnosis: Right MCA stroke

Surgeries/Procedures:

History of Present Illness: awoke with symptoms and is thus not eligible for tPA

Past Medical History: long-standing hypertension, acute MI 2years ago, CABG X 3 shortly thereafter.

Social History: smokes 1 pack of cigarettes per day

FidelitySetting/Environment

o Med-Surg

Simulator Manikin/s Needed:Patient actor or Sim Man

Equipment attached to Patient actor or Sim man:

o ID band _ Mr(s). Sidney Smitho Allergy band- ASA, Penicillino IV- N/S @75ml/hro Telemetry monitoro Glucose bubbles to Sim Man fingers,

or manikin hand for pt actoro Injectapad on abdomen

Equipment available in roomo Stethoscopeso Glucometero Med Carto Supply carto Pen light

Medications and Fluidso IV Fluids:

Normal Salineo Oral Meds:

Ramipril 5mg po dailyASA 81 mg po dailyAtorvastatin 20 mg po dailyNicorette gum 2 mgNicoderm 21 mg patchAcetaminophen 650mg PO/PR q4h prn for temperature > 37.5 or pain

o IM or SC:Regular Insulin Sliding Scale q4h

Diagnostics Availableo Glucometer q4h

Documentation Formso ER History and Physicalo ER neuro assessment recordo ECGo Head CT resultso Lab results

Simulation Design Templateo Computer for Edoc o Acute Ischemic Stroke Order set

o Sliding scale insulin order seto Canadian Neurological Scale

Observation Record and Canadian Neurological Scale Reference Sheet

o Edoc

Recommended Mode for Simulation:4 students with roles as assignedStudents to work independently from faculty

Roles / Guidelines for Roleso Primary Nurseo Secondary Nurseo Family membero Documenter/resource

Description of RolesPrimary nurse: Assess patient, follow stroke order set and carry out interventions as appropriate. Complete SBAR at end of simulation to report off duty.Secondary nurse: Assist primary nurse as appropriate and assist with SBAR report.Family member: Interact in simulation according to script and briefing.Documenter/resource: Document vitals and stroke assessment in Edoc. Provide cueing assistance to primary and secondary nurse as appropriate and assist with SBAR report

Critical Lab Values:ChemistryGlucose: 11.3 (H)– normal 3.5-10.0BUN: 4.6 - normal 3.5-7.5mmol/LCreatinine: 67- normal 50-120mmol/LSodium: 137- normal 135-145Potassium: 4.4- normal 3.6-5.2mmol/LChloride: 99- normal 99-108mmol/L

Hemoglobin 160 –normal 135-175Hematocrit 0.48 – normal 0.40-0.50

Student Information Needed Prior to Scenario:Prebrief:As with all scenarios:Speak out loud your observations and assessments and discuss with your partner as appropriateTreat the actor/simulator as a real patientCarry over all safety, infection control and communication skills you have previously learnedCall for assistance as neededWith this simulation the vitals will appear on the monitor and stay there for future reference. If you are rechecking a vital, please say it out loud so that your partner knows you have checked it and what the value is. The CNS tool and neuro assessment is on Edoc for the documenter/resource to refer to and complete. State your findings for the CNS assessment out loud so that your documenter can enter this on eDoc as you are completing it.

Report students will receive before simulation:S. I have just brought Sidney Smith up from ER. He/she is being admitted to your unit with a Dx of Rt MCA stroke.

B. He/She has been in emerg for 12 hours. His/her Hx is an acute MI 2 yrs ago and CABG x 3 soon after. (S)He has a long-

Simulation Design TemplateWBC 6.8 – normal 4.0-11.0

UrinalysisUrine Colour: YellowAppearance: ClearSpecific Gravity:1.025 – normal 1.003-1.030Glucose: negativeKetones: negativeBlood: negativepH: 5.5 (normal 5.0-8.0)Protein: negativeNitrites: negative

OtherLKCS: 9.6- normal 4.0-11.0ERCS: 3.75(L)- normal

Physician Orders: Acute Ischemic Stroke Orders filled out and on chart

standing Hx of hypertension and is a pack a day smoker. Sidney awoke with Sx of stroke and was ineligible for tPA. He/She is 70 years old. Sidney is allergic to ASA and penicillin. We have put him/her on telemetry and put a lock in and started N/S @ 75 cc/hr. CNS score in ER was 5.5

A. Last time I checked him/her vitals were OK, BP still elevated and sats low normal. We have been busy, so just time enough to start the IV since he/she got back from CT scan.

R. Sidney is on the standard stroke orders, and I think you have those already.

Scenario Progression Outline

Timing(approximate)

Patient Actions Expected Interventions May use the following Cues:

Time of Day for simulation is: Noon

First PhaseAssessment

Patient actor/Sim-Man’s initial condition:

Vitals on monitorT- 37.2P- 86R- 22BP- 185/90O2 sat- 94%-Pupils are equal bilaterally and react to light

Hand HygieneIntroduce self, explains what she/he is about to do

Assess vital signsTPR, BP, O2 sat

Assess pupil size and reaction to light

Assess Level of Consciousness

CNS assessment

Family member has script see Appendix B and will interact in simulation as per script and pre-brief instructions

Simulation Design TemplateLOC is alert to a bit drowsy

CNS responsesOrientation normal for place and time(month,year)

Receptive speech normal to close eyes answer yes to does a stone sink in water and point to ceiling with Right hand.

Expressive speech normal - can name 3 items and identify their useMotor function - Left facial droop. Left side unable to move except if asked to squeeze then very weak in left and can wiggle left toes

If asked how body feels respondMy entire left side – face, arm and leg feel kind of numb and heavy

OrientationLocation, month, year

Receptive speechClose eyesStone sink in waterPoint to ceiling

Expressive speechIdentify 3 items and purpose

Motor functionFace, proximal arm, distal arm, proximal leg, distal leg

Motor response to resistancearms, legs

CNS score should be 5.5

Student should identify deficits and may ask documenter how CNS score relates to previous CNS score

Second PhaseMedication administration andBlood Glucose

T-37.2 P-86 R-22 BP 185/100Sats 93%

Blood glucose 11.0

Recognize BP elevated and check orders or knows no prn treatment required according to BPG/orders

Check blood glucose with glucometer

Respond to patient question regarding blood glucose testing as body’s reaction to stress and pt is not diagnosed as diabetic

Check orders or ask resource

Role member providing cue:Pt Actor/SimManCue: Why have they been checking my sugar, nurse? I’m not diabetic.

Simulation Design Templatenurse what treatment parameters and if med needed

Administer Insulin as ordered

Third PhaseReporting of pertinent information

Gives written report in SBAR format to faculty member acting as nurse coming on duty to relieve teamSBAR should include: See Appendix C - CNS score and specific noted limitations VS including blood glucose, motor function/strength and sensation AND any interventions performed or complications to be monitoring for.

Debriefing / Guided Reflection for this Simulation:

1. What elements of the RNAO BPG Stroke assessment across the continuum of care were you able to implement during the simulation?

2. Were you able to use the CNS tool to assess this patient? What did the results indicate to you?3. What assessment findings were abnormal for this person, would you act on them and what would your

actions be4. Did you note any potential complication(s) of stroke with your assessment findings? If so what were the

findings and potential complication(s). If not what might some be?5. Can you identify members of the collaborative team for this patient and when their involvement would

start and end? During sim and beyond day 2 after a stroke.6. Tell me about your experience with preparing an SBAR report for this situation.7.

Optional Activity

Have the group remain after simulation and complete a concept map using SLS format for Naomi Reed case study

Simulation Evaluation Process

For Faculty - See Appendix E


For Students - See Appendix FAppendix A

Student preparation package for

ACUTE STROKE SIMULATION

LEARNING OBJECTIVESThe Student group will:

1. Demonstrate understanding of assessment of a person experiencing CVAa. Carry out a focused neurological assessment of a patient who has a stroke using the Canadian

Neurological Scale Toolb. Assess vital signs and patient’s symptoms/concernsc. Carry out appropriate interventions in response to assessment findingsd. Identify assessment findings which could lead to complications

2. Identify and consult appropriate resources while assessing, planning (including prior to lab), and implementing care.

3. Respond appropriately to family member question(s)

4. Participate in creating SBAR report at the end of the simulation

TOOLS FOR PRACTICE

Lab coat, notes for documenter/resource, Stroke nurse pocket guide, RNAO BPG Acute StrokeLab set up, equipment and medical supplies for simulation, Edoc, SBAR tool

STUDENT PREPARATION FOR SIMULATION:

Lewis et al. Chapter 59 Jarvis Chapter 23 review with specific focus on Stroke assessment and check Index Pathophysiology Notes: Cerebrovascular Accident Stroke Assessment Across the Continuum of Care: Summary of BPG Recommendations 2005 and

Supplement 2011 available at: http://rnao.ca/bpg/guidelines/stroke-assessment-across-continuum-care The Canadian Stroke Strategy. (2014) Retrieved from Canadian Best Practice Recommendations for

Stroke Care: Hyperacute Stroke Care recommendations: http://www.strokebestpractices.ca/wp-content/uploads/2010/10/Ch3_SBP2013_Hyper-Acute-_23MAY13_EN_-FINAL5.pdf

Stroke Nurse Pocket Guide, Heart and Stroke Foundation *Attention CNS tool (provided by professor) Review and research pertinent data related to brief description and Doctor’s orders of patient provided SLS for Lewis Medical Surgical Nursing navigate to Content home > Acute Stroke Simulation

Preparation > simulation 20 Naomi Reed and complete pre-simulation quiz and review SBAR report and make notes to help you prepare to produce SBAR report in the simulation experience



http://rnao.ca/bpg/guidelines/stroke-assessment-across-continuum-care


Brief Description of Patient:

Name: Sidney Smith Gender: F DOB: 08/05/1939Race: CaucasianWeight: 92kg Height: 175cmReligion: Catholic Major Support: daughter/son Allergies: ASA & Penicillin Immunizations: UTD

Attending Physician/Team: Stroke teamPrimary Diagnosis: Right Hemisphere mid cerebral CVAHistory of Present Illness: awoke with symptoms and is thus not eligible for TPAPast Medical History: long-standing hypertension, acute MI 2years ago, CABG X 3 shortly thereafter.Social History: smokes 1 pack of cigarettes per day

Lab Tests and ValuesChemistrySerum Glucose: 11.3 mmol/LBUN: 4.6 mmol/LCreatinine: 67 mmol/LSodium: 137 mmol/LPotassium: 4.4 mmol/LChloride: 99 mmol/LHemoglobin: 160 g/LHematocrit: 0.48WBC: 6.8

UrinalysisUrine colour: yellowAppearance: clearSpecific Gravity: 1.025Glucose: negativeKetones: negativeBlood: negativepH: 5.5Protein: negativeNitrites: negative

OtherLKCS: 9.6ERCS: 3.75


Stroke Standard Order set

ORDER AND SIGNATURE

Check box if order is to be followed and sign bottom of each pageVital signs monitoring

X Vital signs and Canadian Neurological Scale (for alert or drowsy patients)Q 1 h x 4, q 2h x8, q 4h then reassessVital signs and Glasgow Coma Scale (for stuporous patients)Q ½h x 4 h, q 2-4 h x 24 h, q 4-6 h x 48 h, then reassessNotify physician if:Systolic BP greater than _220_mmHg, or less than _90_mmHg orDiastolic BP greater than _120_mmHg, or less than _40_mmHg

*Guidelines suggest Antihypertensive therapy only if SBP>220 or DBP >120 of if stroke is accompanied by MI, acute renal failure or aortic dissection.ActivityBedrest for 24 h, then AAT

X AAT Physio to assessNutrition

X NPO until swallowing assessment completed. If patient passes swallowing screen order diet indicated below. If patient does not pass swallowing screen refer to speech language pathologyRegularDysphagia Modified textureNPO

X No added salt (if hypertensive)X Low cholesterol (if elevated)

Other diet: __________________Head of bed elevated (high fowler’s or upright) during and 1 h pc mealsWeigh if possibleOxygen Therapy

X O2 therapy orders: oxygen by nasal prongs @ 3L for SaO2 < 92 ____________________________________________________

Physician signature: K KochPrinted name: K Koch


Date and time: 0100 day of simulation

MonitoringX Cardiac monitoring x 24 hX Portable chest x-rayX Intermittent catheterization prn for urinary retentionX 12 lead ECGX Intake and output

InvestigationsX CT Head

EchocardiogramX Carotid Doppler studiesX Blood sugar by glucose meter q 4 h for 24 h, then QID for 2 days, then reassessX CBC, electrolytes, urea, creatinine, glucose, albumin, calcium, magnesium, CK, ALP, ALT, AST,

LDH, Total bilirubin, INR, PTT, total cholesterol, Cholesterol/HDL ration, triglycerides fasting in am, Hb A1COther investigations: ________________________________________________

Intravenous therapyX IV 0.9% sodium chloride at _75_ ml/h while NPO

IV 0.9% sodium chloride at ____ ml/h with ____ mEq KCl/L (20 mEq/L or 40 mEq/L)Iv saline lock, flush with 5 ml 0.9% sodium chloride BID and prnAntipyretic therapy

X Acetaminophen 650 mg PO/PR q4h prn for temperature >37.5 or painAntiplatelet therapyASA 650 mg sup PR dailyASA 325 mg PO daily

X ASA 81 mg PO dailyClopidrogel 75 mg PO dailyASA 25 mg/dipyridamole XR 200 mg (Aggrenox) 1 capsule PO bidSecondary prevention medications

X Atorvastatin _20_ mg PO dailyX Ramipril _5_ mg PO daily start date:_after swallowing screen if negativeX Nicotine replacement patch/gum: Nicorette gum 2mg, one piece of gum per hour as required

for nicotine cravings, if not effective then Nicoderm 21 mg patch, apply one patch q 24 h prn for nicotine cravings




ConsultsInternal medicine

X PhysiotherapyX Speech language pathology

Clinical nutritionX Occupational therapy

Social workContinuing stay coordinator



Simulation Design TemplateRole / Description

Nurse 1: Primary - assess patient, direct care and attend to patient, create an SBAR report at the end of the simulation

Nurse 2: Secondary - assist primary nurse during simulation and with SBAR report.

**It would also be helpful for Primary and Secondary nurse to make point form notes or a plan of action prior to lab and give to documenter/resource to use during simulation, and to have CNS in pocket for reference. Remember to research medications on Physician’s orders as preparation.

Documenter/Resource: Review MAR prior to simulation by using documents in student preparation package. You will have the Acute Stroke RNAO BPG guideline, Edoc and CNS Nurse Pocket Guide to refer to. The resource person is to help the primary or secondary nurse with information and/or prompts during the simulation. You will log in to Edoc, find this patient and document CNS assessment and vitals as the primary and secondary nurse complete them. Assist with SBAR report at the end of the simulation.

Family member: Will have a script and will participate in simulation as directed by faculty or sim specialist


Appendix B - Family member script

If asked if the patient responses are normal state yes.

As the nurses do the motor function testing ask what they are doing and why?

If the nurses take a blood sugar reading, ask what they are doing, why and if your relative is diabetic.

If activities are at a lull, ask if your relative will be able to walk again.

If activities are at a lull express concern about your relative’s ability to go home and how she will cope as you live out of town.


Appendix C - SBAR report expected at end of simulation

SituationMy name is……I am giving report about ….pt name

Background Sidney presented at emerg for 13 hours ago.Hx acute MI 2 yrs ago and CABG x 3 soon after. Sidney has a long-standing Hx of hypertension and is a pack a day smoker. Pt awoke with Sx of stroke and was ineligible for tPA. Sidney is __ years old.Pt is allergic to ASA and penicillin.Pt is on telemetry and has an IV with N/S @ 75 cc/hr. CNS score in ER was 5.5.CT scan in emerg revealed Rt MCA stroke, BP was high and sats low normal, otherwise vitals within normal limits.

Assessmentvitals on last check at noon were T- 37.8 P- 86 R- 22 BP- 185/90, O2 sat- 94% on room air, vitals are q 4h nowPt is on stroke protocol ordersIV 0.9% NaCl at 75 ml/hr, cardiac monitoring for another 11 hrs,CNS score at noon was 5.5 There is no muscle movement in L side and L facial droop. Language and orientation are normal except slurred speech due to L facial droopBG was -- and I gave….units of regular insulin at noonWe have kept pt NPO until speech therapist assesses, so PO meds have been held until now. Activity level is AATI did not give ASA as Sidney is allergic either I called Dr or in R will you call Dr.

Recommendation Could you assume her care and see when Speech therapist is due to visit and call the Dr about the po meds as I have not had a chance to do yet.

Simulation Design TemplateHSL HEALTH CARE

MEDICATION ADMINISTRATION RECORDPat: Sidney Smith MAR START DATE:ID #: 806372 Dx: Acute Stroke MAR START TIME:AGE: 74 BIRTHDATE: 08/05/1939 SEX: F WT:ADMITTED: PHYSICIAN: KK LOCATION:ALLERGIES: ASA, Penicillin

CHARTING LEGEND1 - Pt. REFUSED 2 - Pt. NPO 3 - HOLD 4 - NAUSEA/VOMITTING 5 - IV SITE OUT6 - Pt. OUT ON PASS 7 - HR < 60 8 - Pt. SLEEPING 9 - SELF MED PROGRAM 10 - ALTERNATE ROUTE GIVEN

****** STAT & NON - RECURRING ORDERS ******MEDICATION DOSE ROUTE DATE TIME INITIALS

******SCHEDULED MEDS******Rx# MEDICATION 0000 - 0729 0730 - 1529 1530 - 2359DRUG: ASADOSE: 81 mg 0800__3 J RROUTE: PR SIG: 0800

DIRECTIONS: OD

ORD DR: KK START: STOP:TRANSCRIBED BY: CP CHECKED BY: J R DATE/TIME:

0000 - 0729 0730 - 1529 1530 - 2359DRUG: RamiprilDOSE: 5 mg 0800__2 J RROUTE: PO SIG: 0800

DIRECTIONS: ODORD DR: KK START: STOP:TRANSCRIBED BY: CP CHECKED BY: J R DATE/TIME:

0000 - 0729 0730 - 1529 1530 - 2359DRUG: Insulin Regular-Sliding Scale 0800 J R/PM 1700____/_____

DOSE: 4.1 - 5 0 units GM 9.1 GM________

ROUTE: 5.1 - 8 0 units SIG: Q 4 H Dose 2 units Dose________

Subcutaneous 8.1 -10 2 units8.1 -10 2 units 1200___/_____ 2100____/_____

10.1-12 4 units GM_________ GM________12.1-15 6 units Dose_______ Dose________

15.1-22 8 units START: STOP: TRANSCRIBED BY: CP CHECKED BY: JR DATE/TIME:

0000 - 0729 0730 - 1529 1530 - 2359DRUG: Atorvastatin

DOSE: 20mgROUTE: PO SIG: 0800 0800 2 J RDIRECTIONS: OD

ORD DR: KK START: STOP:TRANSCRIBED BY: CP CHECKED BY: JR DATE/TIME:

0000 - 0729 0730 - 1529 1530 - 2359DRUG:DOSE:ROUTE: SIG:DIRECTIONS:ORD DR: START: STOP:TRANSCRIBED BY: CHECKED BY: DATE/TIME:


MEDICATION ADMINISTRATION RECORDPAT: Sidney Smith MAR START DATE:ID#: 806372 DX: Acute Stroke MAR START TIME:AGE: 74 BIRTHDATE: 08/05/1939 SEX: F WT:ADMITTED: PHYSICIAN: KK LOCATION:ALLERGIES: NKA


******CONTINUOUS INFUSIONS******Rx# MEDICATION 0000 - 0729 0730 - 1529 1530 - 2359IV SOLUTION 0.9% NaClRATE 75 ml/hr

*while NPODATE TIME RATE RN/RPN

TRANSCRIBED BY: CP CHECKED BY:BY: J R DATE/TIME:

0000 - 0729 0730 - 1529 1530 - 2359IV SOLUTIONRATE

DATE TIME RATE RN/RPN

TRANSCRIBED BY: CHECKED BY: DATE/TIME:0000 - 0729 0730 - 1529 1530 - 2359

IV SOLUTIONRATE

DATE TIME RATE RN/RPN

TRANSCRIBED BY: CHECKED BY: DATE/TIME:


MEDICATION ADMINISTRATION RECORDPat: Sidney Smith MAR START DATE:ID #: 806372 Dx: Acute Stroke MAR START TIME:AGE: 74 BIRTHDATE: 08/05/1939 SEX: F WT:ADMITTED: PHYSICIAN: KK LOCATION:ALLERGIES: ASA, Penicillin


******PRN MEDS******Rx# MEDICATION 0000 - 0729 0730 - 1529 1530 - 2359DRUG: Acetaminophen

DOSE: 650 mg

ROUTE: PO or PR SIG:

DIRECTIONS: Q 4 h PRN for temp> 37.5'C or for pain

ORD DR: KK START: STOP:TRANSCRIBED BY: CP CHECKED BY: J R DATE/TIME:

0000 - 0729 0730 - 1529 1530 - 2359DRUG:

DOSE:

ROUTE: SIG:

DIRECTIONS:

ORD DR: START: STOP:TRANSCRIBED BY: CHECKED BY: DATE/TIME:

0000 - 0729 0730 - 1529 1530 - 2359DRUG:

DOSE:

ROUTE: SIG:

DIRECTIONS:

ORD DR: START: STOP:TRANSCRIBED BY: CHECKED BY: DATE/TIME:

0000 - 0729 0730 - 1529 1530 - 2359DRUG:

DOSE:

ROUTE: SIG:

DIRECTIONS:

ORD DR: START: STOP:

TRANSCRIBED BY: CHECKED BY: DATE/TIME:

0000 - 0729 0730 - 1529 1530 - 2359DRUG:DOSE:ROUTE: SIG:DIRECTIONS:ORD DR: START: STOP:TRANSCRIBED BY: CHECKED BY: DATE/TIME:

Simulation Design TemplateAppendix E

Faculty Evaluation for Acute Stroke Simulation

Please select from Likert scale the extent to which you felt this group of students met the learning activity objectives.

1 2 3 4 5

< 50% met with < 50% met with > 50% met >75% met 90-100% met

Critical elements non critical elements

missed missed

1. Carry out a focused neurological assessment of a patient who has a stroke using elements of the RNAO BPG “ Stoke Assessment Across the Continuum of Care” and the Canadian Neurological Scale 1 2 3 4 5

2. Identify assessment findings which could lead to complications

1 2 3 4 5

3. Carry out appropriate interventions in response to assessment findings

1 2 3 4 5

4. Identify and consult appropriate resources while assessing, planning (including prior to lab), and implementing care.

1 2 3 4 5

5. Participate in group planning and decision making

1 2 3 4 5

6. Participate in analysis of group performance

1 2 3 4 5

Simulation Design TemplateAppendix F

Student Evaluation for Acute Stroke Simulation

Please select the appropriate response on the Likert scale to indicate the extent to which you felt this

simulation met the learning activity objectives.

Strongly Disagree ----------------Disagree ---------------------Agree -----------------Strongly Agree

1 2 3 4

1. The simulation provided my group the opportunity to carry out a focused neurological assessment of a

patient who has a stroke using elements of the RNAO BPG “ Stroke Assessment Across the Continuum of

Care” and the Canadian Neurological Scale

1 2 3 4

2. The simulation provided my group the opportunity to identify assessment findings which could lead to

complications

1 2 3 4

3. The simulation provided my group the opportunity to carry out appropriate interventions in response to

assessment findings

1 2 3 4

4. The simulation provided my group the opportunity to identify and consult appropriate resources while assessing, planning (including prior to lab), and implementing care.

1 2 3 4

1. The simulation provided my group the opportunity to participate in group planning and decision making

1 2 3 4

6. The simulation provided my group the opportunity to participate in analysis of group performance

1 2 3 4

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