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Simulation Perfusion Course : NUR __ __2025___ __...

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Simulation Perfusion Course : NUR __ __2025___ __...

Simulation Perfusion

Course: NUR ____2025_____ Concept/Exemplar: ___Heart Failure/Chronic renal insufficiency              Hours: 1.5

 

ScenarioIdentify the Top 3 client areas for the nurse to assess.

An 89-year-old female client is admitted to a telemetry unit with a diagnosis of heart failure exacerbation.  She reports a medical history of osteoarthritis, chronic renal insufficiency, and coronary artery disease including a myocardial infarction and coronary artery bypass surgery 22 years ago.  She is alert and her daughter is at her bedside.  The nurse's initial client assessment findings include:

  • Oriented to person only, follows simple commands
  • Clear speech
  • Sinus tachycardia
  • Respirations of 26 breaths/min
  • Oxygen saturation of 90% on room air
  • Breathing labored with use of accessory muscles
  • Productive cough with pink frothy sputum
  • Crepitus in bilateral knee joints
  • Enlarged body nodes on hands
  • Hemoglobin = 12.4 g/dL
  • Hematocrit = 39%
  • White blood cell count = 12,ooo mm3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Next GEN NCLEX: What matters most?  Noticing, Tanner's Clinical Judgement model

 

  1. Indicate which nursing action listed on the far left column is appropriate for each potential heart failure complication.  Note that not all actions will be used, but there is only one appropriate action for each complication and they can be used only once.

 

Nursing ActionPotential Heart Failure ComplicationAppropriate Nursing Action for each potential heart failure complication 
  1. Reduce sodium intake to 1g daily.
Acute pulmonary edema 
  1. Administer oxygen therapy
Fatigue 
  1. Weight the client each morning on the same scale
Hypokalemia 
  1. Administer furosemide 20 mg IV push.
Cardiac dysrhythmia 
  1. Encourage the client to drink at least 3L of fluid daily
Hypoxemia 
  1. Teach the client pursed-lip breathing techniques.
  
  1. Administer potassium supplements
  
  1. Monitor electrocardiogram, oxygen saturation, and serum electrolyte levels.
  
  1. Reposition every 2 hours while in bed.
  
  1. Consult a cardiac rehabilitation specialist.
  

 

Example: 

Complication 

Example: 

Appropriate actions for complication: #3

 

 

  1. Complete a Medication template for each of the following medications: (1) Potassium PO, (2) Furosemide IV push

 

Case Study Progress

The 80-year-old client will be discharged today and will move in with her daughter until she feels well enough to go home alone.  Which of the following discharge instructions will the nurse provide the client and her daughter? Select all that apply

  1. "Weight yourself each day at the same time on the same scale to monitor for fluid retention"
  2. Contact your primary health care provider if you experience cold symptoms lasting more than 3 days."
  3. Exertion can cause another episode of heart failure, so help your mother by assisting her with daily activities."
  4. Notify your primary health care provider if you experience shortness of breath or chest pain while resting."
  5. "Do not use table salt, avoid salty foods, and read labels on all food items to ensure your diet is low in sodium."
  6. "Do not take metoprolol if your heart rate is less than 60 beats per minute."
  7. "Heart failure is a chronic condition, so you don't need to be alarmed when you experience heart palpitations."

 

Case Study Progress

The client was discharged 2 weeks ago and is with her daughter for her follow up primary health care provider visit.  For each assessment finding, use an X to indicate whether the interventions are Effective (helped to meet expected outcomes), Ineffective (did not help to meet expected outcomes), or Unrelated (not related to the expected outcomes).

 

Assessment findingEffectiveIneffectiveUnrelated
States that she has had no shortness of breath since hospital discharge   
Has 2+ pitting edema in both ankles and feet   
Blood pressure of 134.76 mm Hg   
Has had no chest pain since hospital discharge   
Reports feeling like she has more energy now when compared with before her hospital stay   
Has new onset fungal skin infection    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Simulation Perfusion

 

Course: NUR ____2025_____ Concept/Exemplar: ___Heart Failure/Aortic stenosis           _                    Hours:       1.5

 

ScenarioIdentify the Top 3 client areas for the nurse to assess.
A 72-year-old male client is admitted to a telemetry unit after a fall at home.  The clients is experiencing severe weakness in his lower extremities and states, "I got out of bed at 0430 this morning, my legs gave out on my way to the bathroom, and I was unable to get up."  Emergency medical services transported the client to the hospital.  Past medical history provided by the client includes high cholesterol, aortic valve stenosis, and residual lower extremity muscle pain and weakness secondary to poliomyelitis as a child.  He saw his cardiologist and had an echocardiogram completed 3 weeks ago.   He also received his influenza and pneumococcal vaccines this year.  The client is married and has two adult children.  He lives in a single-story home, ambulates with a cane, and completes ADLs independently.  His echocardiogram reports moderate heart failure with an ejection fraction (EF) of 38%.  The client's wife provides a list of his current medications, but the list is not complete.  Choose the most likely options for the information missing from the paragraph by selecting from the lists of options provided.

 

 

 

 

 

 

 

 

 

 

 

 

 

Next GEN NCLEX: What matters most?  Noticing, Tanner's Clinical Judgement model

 

 

MedicationDose, Route, FrequencyDrug ClassIndication
aspirin1SalicylatePrevention of platelet aggregation
Atorvastatin20 mg orally once a dayStatin2
312.5 mg orally twice a dayBeta-adrenergic blockerManagement of hypertension and heart failure
Ibuprofen400 mg orally every 6-8 hr as neededNonsteroidal anti-inflammatory drug4
50.125 mg orally once a dayCardiac glycosideIncrease myocardial contractile force
lisinopril2.5 mg orally once a day6Management of heart failure

 

Options for 1Options for 2Options for 3
0.25 mg orally twice a dayManagement of anginacarvedilol
81 mg orally every 4-5 hr as needed for painTreatment of bronchospasmhydrochlorothiazide
200 mg subcutaneously every 8 hoursManagement of heart failurefurosemide
325 mg orally once a dayManagement of hyperlipidemianesiritide
1000 mg transdermal patch every 2 daysPrevention of pulmonary hypertensionverapamil
Options for 4                   Option for 5Option for 6
Treatment for decreased cardiac outputenalaprilAldosterone antagonist
Prevention of dyspneaspironolactoneAngiotensin-converting enzyme inhibitor
Management of extremity paindigoxinCalcium channel blocker
Treatment of pyrexialosartanHistamine blocker
Prevention of tachycardiametroprololThiazide diuretic

Case Study Progress

After completing the medication reconciliation with the patient's wife, the nurse completed the initial assessment.  The nurse's findings include:

  • Alert and oriented
  • Blurred vision
  • Reports lower extremity stiffness; Ambulates with crutches
  • Sinus rhythm with preventricular contractions (PVCs); Cardiac murmur
  • Reports dyspnea on exertion; Bilateral basilar crackles
  • Blood urea nitrogen (BUN) = 11 mg/dL and Creatinine kinases 1200 U/L
  • Potassium 5.3 mg/dL

 

Circle or place a check mark next to the assessment findings that require follow-up by the nurse.

 

Case Study Progress

The provider arrives to the telemetry unit to discuss the diagnosis and plan with the patient and wife. The client is diagnosed with rhabdomyolysis.  Prescriptions to place a large-bore intravenous catheter and administer normal saline 0.9% at 125 mL/hr are received.  Choose the most likely options for the information missing from the paragraph by selecting from the lists of options provided.

 

When caring for a client who has left ventricular dysfunction, the nurse assesses for _____1_____ related to inadequate cerebral perfusion, _____2______ related to inadequate myocardium perfusion, and _____3______

related to inadequate renal perfusion.  The nurse monitors a client who has heart failure closely for complications of pulmonary congestion when administering intravenous fluids.  Manifestations of pulmonary congestion include _____4_____, _____5_____, and _____6_____.  If the client experiences acute pulmonary edema, the nurse would place the client in a sitting position and administer _____7_____ and _____8_____. 

 

Options for 1, 2, and 3Options for 4, 5, and 6Options for 7 and 8
ConfusionCracklesAlbuterol nebulizer
Chest painDyspneachest percussion
nauseaFatigueLorazepam orally
oliguriaJugular vein distentionMorphine intravenous push
orthopneaStridorNitroglycerin sublingual
pallorTachypneaSupplemental oxygen
polyuriaWeight gainFurosemide intravenous push

 

 

 

 

 

Answer & Explanation

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Answered by ichinicholas on coursehero.com
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