SIMULATION. SKILL FOCUS: Administering a nebulizer DISCIPLINE: Medical Assistant LEVEL: 4 PEDIATRIC ASTHMA. Patient Name: Patrick Armstrong

Transcription

1 SKILL FOCUS: Administering a nebulizer DISCIPLINE: Medical Assistant LEVEL: 4 PEDIATRIC ASTHMA Estimated Time: 15 minutes Debriefing Time: 15 minutes Scan t Begin Patient Name: Patrick Armstrng SCENARIO OVERVIEW Patrick Armstrng is a 16-year-ld patient wh presents t the clinic experiencing a severe exacerbatin f his asthma. The prvider has just stepped ut fr lunch and is nt answering the phne. Students shuld utilize the Asthma Prtcl, recgnize that respiratry arrest is imminent, and call 911. State 1 requires cllectin f patient data. In state 2, students may attempt t perfrm a peak flw reading but realize he is t shrt f breath t d s. In state 3, students administer a nebulizer treatment per prtcl while waiting fr the ambulance t arrive. When paramedics arrive, students prvide an SBAR reprt t the paramedics. PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

2 LEARNING OBJECTIVES 1) Demnstrate prfessinalism in a healthcare setting 2) Practice standard precautins 3) Obtain vital signs 4) Obtain patient histry 5) Emply elements f therapeutic cmmunicatin based upn theries f psychlgy 6) Assist physician with patient care: specialty examinatins in pediatrics 7) Perfrm pulmnary functin testing 8) Cach patients related t health maintenance, disease preventin and treatment 9) Apply pharmaclgical principles t the preparatin and administratin f nnparenteral medicatins 10) Demnstrate safety and emergency practices in health care CURRICULUM MAPPING WTCS PROGRAM OUTCOMES Prvide patient care in accrdance with regulatins, plicies, laws, and patient rights Demnstrate prfessinalism in a healthcare setting Demnstrate safety and emergency practices in a healthcare setting PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

3 SIMULATION LEARNING ENVIRONMENT & SET UP PATIENT PROFILE Name: Patrick Armstrng DOB: 11/16/20xx Age: 16 MR#: 1116 Gender: Male Height: cm (5 ft 11 in) Weight: 109 kg (240 lbs) Allergies: NKDA Admitting Diagnsis: shrtness f breath (R06.02) Medical Histry: asthma, unspecified (493.90) Surgical Histry: nne Cde Status: Full cde Ethnicity: African American Spiritual Practice: unknwn Primary Language spken: English EQUIPMENT/SUPPLIES/SETTINGS Patient Street clthes, ball cap, phne, jewelry can be present Has his albuterl inhaler with him Mnitr Settings Vitals: HR 114, RR 38, BP 149/88, Temp 36.8, O2 sat 85% n RA, Pain 0/10 Supplies Equipment t btain vitals including xygen saturatin Peak flw meter Nebulizer equipment Duneb medicatin PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

4 QR CODES REPORT PATIENT DUONEB FACILITATOR PEAK FLOW D PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

5 TEACHING PLAN PREBRIEF The facilitatr shuld lead this prtin f the simulatin. The fllwing steps will guide yu thrugh Prebrief. Scan the QR cde: Scan t Begin while students are in Prebrief Meet Yur Patient (n ipad) and explain hw the ipad wrks in the simulated learning envirnment including: Explain hw t use the ipad scanner and QR cdes. Remind students that there are multiple QR cdes in the simulatin, but they shuld nly scan them if they think it will prvide data necessary fr their assessment and evaluatin f the patient. Fr sme scenaris, it may be helpful t tell students where the QR cde are lcated. Fr thers, yu may want students t find the QR cdes during their assessments. This is yur chice. As the facilitatr, yu shuld be aware that thrughut the simulatin sme QR cdes are necessary t the prgramming f the ipad cntent. Directins fr which QR cdes are required (t be scanned) in each state are listed under each state f the dcumentatin belw. The QR cdes are als in BOLD type. Discuss the simulatin Learning Objective(s) (n ipad) as well as any ther Prebrief materials Get Reprt n ipad Pssible Facilitatr Questins What are yur pririties when yu are rming a pediatric patient experiencing an acute asthma attack? Hw shuld peak flw readings be btained? What is the prper technique fr administering a nebulizer treatment? Play the Patient vide n ipad Pssible Facilitatr Questin What are yur pririties f data cllectin fr Patrick? PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

6 Review initial tabbed cntent Pssible facilitatr questins What is the asthma actin plan and hw is it used t help patients t selfmanage their asthma? Review the prtcl fr referring a patient experiencing an acute asthma attack. Based n the initial vide interactin with the patient, where d yu anticipate the patient may fall in the mildmderate-severe categries? PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

7 ASTHMA PROTOCOL PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

8 VITALS The ipad shws the enterable vitals screen. Checked against fllwing values: HR 134, RR 38, BP 149/88, Temp 36.8, O2 sat 85% n RA, Pain 0/10 PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

9 GROWTH CHART PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

10 PROBLEM LIST Patient Name DOB MR# Patrick A. Armstrng 11/16/20XX 1116 Allergies Height (cm) Admissin Weight (kg) NKDA Prblem List Currently Knwn Medical Prblem(s) 1. Asthma CURRENT MEDICATION LIST Patient Name DOB MR# Patrick A. Armstrng 11/16/20XX 1116 Allergies Height (cm) Admissin Weight (kg) NKDA Current Medicatin List Medicatin Albuterl Inhaler Descriptin 2 puffs q4 hurs PRN fr shrtness f breath ASTHMA ACTION PLAN See Appendix A PATIENT EDUCATION See Appendix B fr Patient Educatin handuts EMERGENCY CONTACT INFORMATION Patient Name DOB MR# Patrick A. Armstrng 11/16/20XX 1116 PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

11 Allergies Height (cm) Admissin Weight (kg) NKDA Emergency Cntact Infrmatin Cntact Cntact Infrmatin Father: Martin Armstrng Phne: Address: 202 Suth Main Street Anytwn, WI LEVEL 1 When the Level 1 tab is tapped, the ipad reads, The ipad is at Level 1. SCANNER Use this t scan available QR Cdes. EXIT The ipad reads, Are yu sure yu want t exit? All data will be lst. If N is selected, the ipad will return t the tabbed cntent. If Yes is selected, the ipad will let the student(s) exit and prmpt them t cmplete an embedded 3-5 minute survey. PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

12 STATE 1 MEASURE AND RECORD PATIENT INFORMATION Patient Overview Patient is experiencing an acute asthma attack. He is in the red zne and is becming agitated, drwsy, and cnfused. Expected Student Behavirs Intrduce themselves t the patient Verify patient identity with name and date f birth Immediately btain vital signs Obtain a brief patient histry t establish respiratry status Establish current respiratry status by referring t asthma prtcl May attempt t ntify the prvider, but the prvider has stepped ut fr lunch and is nt answering the phne. Recgnize severity f attack; may elect t call 911 immediately r perfrm peak flw If students elect t perfrm a peak flw they shuld scan QR Cde: Peak Flw D and recgnize patient is t shrt f breath t perfrm the prcedure. Technician Prmpts Patient speaking in tw wrd sentences, breathing faster than nce every tw secnds, lts f accessry muscle use. Agitated, but becming drwsy and cnfused. The prvider has stepped ut fr lunch and is nt answering the phne. Initial patient respnses can include: Can t catch... my breath (Pause fr a few secnds while breaths heavily) S tired frm breathing (breathes heaving and quickly) Where s my mm? (drwsily, whiny) PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

13 Facilitatr Questins Where s my dg? I brught my dg where is he?! (r similar statements shwing he is cnfused and becming unaware where he is.) Using the vital signs yu btained and the Asthma prtcl, what is Patrick s current asthma status in terms f mild, mderate r severe? What shuld yu d when yu cannt cntact the prvider and yu are cncerned abut a patient s status? Tabbed ipad Prmpts & Cntent Changes The scenari autmatically advances t Level 2 after the student(s) scans QR Cde: Facilitatr indicating they have successfully cmpleted the Expected Student Behavirs. The ipad will read, Yu have been apprved t prceed. LEVEL 1/2 When the Level 1 tab is tapped, the ipad reads, The ipad is at Level 1. After the student(s) scans QR Cde: Facilitatr, the Level 1 tab will autmatically change t a Level 2 tab (students are nt prmpted abut this). When the Level 2 tab is tapped, the ipad reads, The ipad is at Level 2. PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

14 STATE 2 ATTEMPT PEAK FLOW READING AND NEBULIZER Patient Overview Students quickly instruct the patient n hw t perfrm a Peak Flw reading. Students bserve a vide f the patient attempting the prcedure but is s shrt f breath he can t breathe ut. The reading is negligible. At this pint the student shuld call 911 if has nt dne s already. Expected Student Behavirs Accurately but rapidly instruct the patient n hw t use a peak flw meter. (A handut n hw t use a Peak Flw Meter is included under the Patient Educatin tab.) Students shuld scan QR Cde: Peak Flw D and recgnize that the patient is t shrt f breath t perfrm the peak flw reading. Determine the patient is in the red zne accrding t the Asthma Actin Plan. Apply xygen if it is available. Call 911 and prvide accurate infrmatin t the dispatcher. Administer a Duneb while waiting fr the ambulance. Scan QR Cde: Duneb t view the label and indicate the Duneb was administered. (Nte: this will set a 3-minute timer fr ambulance arrival. See details belw.) Attempt t call Patrick s parents. When they get vic , utilize patient cnfidentiality when leaving a prfessinal message. Technician Prmpts Overview: Patient is extremely shrt f breath but tiring quickly frm the wrk f breathing. He cannt frcibly breathe ut r use peak flw meter crrectly. Initial patient respnses can include: I can t breathe. (tired, drwsy) What? PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

15 Wh are yu? Where am I? Students will be scanning a QR cde t view a vide f the patient unable t use the Peak Flw meter. When students call 911 and yu play the rle f the dispatcher ask the fllwing questins if the students dn t prvide the infrmatin: What is the patient s name? What is the patient s date f birth? Have yu cntacted the parents? When students attempt t call Patrick s parents, play a vic message. When EMS arrives, rle play the part f the paramedic. Ask the fllwing questins if the student des nt prvide these details in their handff reprt: What is the patient s name? What is the patient s date f birth? Have yu cntacted the parents? What is the emergency cntact infrmatin? Did yu btain a peak flw reading? Did yu administer a nebulizer treatment? What is the prvider s name? What is the patient s medical histry? Is he n any medicatins? Des he use drugs r alchl? Pssible Facilitatr Questins What are yur cncerns? Des Patrick fall in the green, yellw, r red zne right nw? Hw will yu respnd? Hw will yu administer the nebulizer? PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

16 Describe hw t utilize patient cnfidentiality while leaving a vic fr the emergency cntact persn. What infrmatin shuld be included in the handff reprt t the paramedics? Tabbed ipad Prmpts & Cntent Changes After the student(s) scans QR Cde: Duneb, a three-minute timer begins. After three minutes elapse, a message will display n the ipad that EMS has arrived. Prepare t prvide a handff reprt t the paramedics. After the students prvide a handut reprt t smene rleplaying the part f an EMT, they may exit the scenari. PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

17 DEBRIEF QUESTIONS 1. Reactin: Hw d yu feel this scenari went? (Allw students t vent their emtinal reactins befre delving int learning bjectives.) 2. Review understanding f learning bjectives: Demnstrate prfessinalism in a healthcare setting a. If yu culd d ver while cmmunicating prfessinally with Patrick, the dispatcher, the emergency cntact persn, r the paramedics, is there anything yu wuld d differently? 3. Review understanding f learning bjectives: Assist physician with patient care: specialty examinatins in pediatrics a. When assisting with patient care f a pediatric patient experiencing an asthma attack, what data shuld be cllected? 4. Review understanding f learning bjectives: Perfrm pulmnary functin testing a. Hw did yu cach Patrick t use the peak flw meter? b. Was his attempt at using the peak flw meter successful? Why r why nt? c. Hw are the peak flw readings used in the Asthma Actin Plan? d. Using the Asthma Actin Plan, what zne was Patrick s status? 5. Review understanding f learning bjectives: Apply pharmaclgical principles t the preparatin and administratin f nn-parenteral medicatins a. Hw des a Duneb help a patient experiencing an asthma attack? b. Was xygen required at this time? Why r why nt? 6. Review understanding f learning bjectives: Demnstrate safety and emergency practices in healthcare. a. Describe what emergency measures yu initiated t keep Patrick safe. b. If yu culd d ver, is there anything different yu wuld have dne fr Patrick? 12) Summarize/Take Away Pints: In this scenari yu assisted in caring fr a pediatric patient experiencing a severe asthma attack. What is ne thing yu learned frm participating in this scenari that yu PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

18 will take int yur nursing practice? (Ask each student t share smething unique frm what the ther students share.) NOTE: Debriefing technique is based n INASCL Standard fr Debriefing and NLN Thery- Based Debriefing by Dreifuerst. PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

19 SURVEY Print this page and prvide t students. Students, please cmplete a brief (2-3 minute) survey regarding yur experience with this ARISE simulatin. There are tw ptins: 1) Use QR cde: Survey a) Nte: Yu will need t dwnlad a QR cde reader/scanner nt yur wn device (smartphne r tablet). There are multiple free scanner apps available fr bth Andrid and Apple devices frm the app stre. b) This QR cde will nt wrk in the ARIS app. SURVEY 2) Cpy and paste the fllwing survey link int yur brwser: a) PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

20 SIMULATION APPENDIX A: ASTHMA ACTION PLAN PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

21 APPENDIX B: PATIENT EDUCATION HANDOUTS PEAK FLOW RATE Peak flw rate (r peak expiratry flw rate) is the measurement f hw much air yu can blw ut f yur lungs in ne breath. It is useful fr yu t measure and track this because it will help yu knw when yur asthma is flaring up and/r when yu shuld seek medical attentin. STEPS FOR PERFORMING THE PEAK FLOW RATE PROCEDURE: 1. Ensure the muthpiece is clean and free f bstructins. 2. Ensure the marker is set t zer. 3. Stand up r sit upright. PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

22 4. Take as deep a breath in as yu can and hld it. 5. Place the muthpiece in yur muth and frm as tight a seal as pssible arund it with yur lips. 6. Breathe ut as hard as yu can thrugh yur muth. Plug yur nse if yu have t. 7. Observe and recrd the reading. 8. Repeat the prcess at least 2 mre times and recrd the highest reading. PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

23 9. Take yur readings every day. If pssible, yur readings shuld be taken abut the same time every day. 10. Keep a daily jurnal f yur peak flw rates as well as any ther asthma-like symptms yu experience (such as cughing r wheezing). 11. Bring yur jurnal t dctrs appintments. This will help him/her make sure yu are taking the prper asthma medicatins. 12. Find yur nrmal peak flw rate and track yur peak flw zne. Related patient educatin handuts: NORMAL PEAK FLOW RATE, ASTHMA ACTION PLAN Cntent adapted frm: and PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

24 USING AN MDI WITH A SPACER If yu have been diagnsed with a lung disease such as asthma r COPD, the use f an MDI (metered dse inhaler), like Albuterl r Flvent, may be indicated. These instructins will ensure yu are using the MDI and Spacer crrectly. STEPS FOR USING AN MDI WITH A SPACER: 1. Take ff the MDI cap. The cap is a small cvering lcated ver the muthpiece t prevent freign bjects frm getting in the MDI. Ensure the muthpiece and spray hle are clean. 2. Shake the MDI. Hld the inhaler in a vertical psitin with ne hand and shake it 10 t 15 times. 3. Prime the MDI. If this is the first time yu ve used the MDI r if yu have nt used it in mre than a week, yu need t prime it. This ensures the inhaler delivers the crrect amunt f medicine when used. Yu prime the MDI by squeezing the canister dwn int the plastic muthpiece, emitting a single spray. IMPORTANT: After yu prime the MDI, yu need t repeat Step 2 Shake the MDI. PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

25 4. Cnnect the MDI and the spacer. Cnnect the MDI muthpiece t the back end f the spacer. Depending n the spacer and muthpiece yu have, they may click tgether neatly, r the muth piece might simply slide in thrugh a narrw rubber slit. 5. Breathe ut as much as yu can. Ideally, yu want t empty yur lungs as much as pssible. 6. Place the spacer s muthpiece in yur muth. It shuld sit just abve yur tngue. Keep yur lips clsed arund it. Lift yur chin up slightly. Hld the inhaler between yur pinter finger and thumb. 7. Squeeze the inhaler nce then breathe in the medicatin slwly and deeply. Pull air int yur lungs thrugh yur muth until yu reach yur peak capacity. Sme spacers have a whistle n them. Listen fr the whistle. If yu hear it, yu are breathing in t rapidly. If yu dn t hear it, yu are breathing in at an acceptable rate. PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

26 8. Remve the spacer muthpiece frm yur muth. Hld yur breath fr abut 10 secnds. Then, exhale slwly and deeply thrugh yur muth. 9. Shake the MDI. If yu are prescribed a secnd puff f the MDI, yu must shake the MDI again (like in Step 2) befre repeating Steps 4-8. Cntent adapted frm: PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

27 NORMAL PEAK FLOW RATE T create yur asthma actin plan, yu need t find yur nrmal peak flw rate. This is dne by recrding yur peak flw rate fr tw weeks at abut the same time f day when yur asthma is under cntrl. Then, yu and yur dctr will determine what a nrmal peak flw rate is fr yu. Once yu knw yur nrmal peak flw rate, fllw the zne system n yur Asthma Actin Plan. This system helps yu and yur dctr decide hw t treat yur asthma. The zne system can be cmpared t the clrs f a traffic light. Green Zne 80% t 100% f yur nrmal peak flw rate signals g. Yur asthma is under gd cntrl. Cntinue t fllw the green zne f yur asthma actin plan. Yellw Zne 50% t 80% percent f yur nrmal peak flw rate signals cautin. Yur symptms culd get better r wrse. Fllw the yellw zne f yur asthma actin plan. Red Zne Less than 50% f yur nrmal peak flw rate signals stp. This a Medical Alert! Cntact yur healthcare prvider nw and fllw the red zne f yur asthma actin plan. Related patient educatin handuts: PEAK FLOW METER, ASTHMA ACTION PLAN Cntent adapted frm: and PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

28 SIMULATION APPENDIX C: NEW ASTHMA ACTION PLAN PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

29 CREDITS Asthma Severity prtcl frm: Natinal Heart, Lung, Bld Institute (2007) The Expert Panel Reprt 3 (EPR 3) Guidelines fr the Diagnsis and Management f Asthma. Dwnladed frm: Asthma Actin Plan frm Natinal Heart, Lung, Bld Institute (2007). Dwnladed frm: Medicatin infrmatin frm Natinal Library f Medicine: Daily Med at REFERENCES Glbal Initiative fr Asthma (2016). Pcket Guide fr Asthma Management and Preventin. Dwnladed frm: Natinal Heart, Lung, Bld Institute (2007) The Expert Panel Reprt 3 (EPR 3) Guidelines fr the Diagnsis and Management f Asthma. Dwnladed frm: Jint Cmmissin (2016). Children s Asthma Care. Dwnladed frm Peak Expiratry Flw Predictin. Medscape Calculatrs. Dwnladed frm: Sawicki, G. and Haver, K. (2016). Acute asthma exacerbatins in children: Hme/ffice management and severity assessment. In: UptDate, Pst TW (Ed), UptDate, Waltham, MA. (Accessed n August 1, 2016) PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,

30 This wrk by the Wiscnsin Technical Cllege System TAACCCT IV Cnsrtium is licensed under a Creative Cmmns Attributin 4.0 Internatinal license. Third party marks and brands are the prperty f their respective hlders. Please respect the cpyright and terms f use n any webpage links that may be included in this dcument. This wrkfrce prduct was funded by a grant awarded by the U.S. Department f Labr s Emplyment and Training Administratin. The prduct was created by the grantee and des nt necessarily reflect the fficial psitin f the U.S. Department f Labr. The U.S. Department f Labr makes n guarantees, warranties, r assurances f any kind, express r implied, with respect t such infrmatin, including any infrmatin n linked sites and including, but nt limited t, accuracy f the infrmatin r its cmpleteness, timeliness, usefulness, adequacy, cntinued availability, r wnership. This is an equal pprtunity prgram. Assistive technlgies are available upn request and include Vice/TTY (771 r ). PEDIATRIC ASTHMA SIMULATION UPDATED: JANUARY 27,