SIMULATION. SKILL FOCUS: Complete Pulmonary Exam & O2 Titration DISCIPLINE: Respiratory Therapy LEVEL: 1 HEART FAILURE. Patient Name: Hector Fernandez

Transcription

1 SKILL FOCUS: Cmplete Pulmnary Exam & O2 Titratin DISCIPLINE: Respiratry Therapy LEVEL: 1 HEART FAILURE Estimated Time: 30 minutes Debriefing Time: 30 minutes Scan t Begin Patient Name: Hectr Fernandez SCENARIO OVERVIEW This patient was admitted t the medical telemetry flr fr an exacerbatin f his knwn endstage cngestive heart failure as well as cellulitis in his right lwer extremity. He als has bstructive sleep apnea, a histry f COPD, and multiple ther cmrbidities. He arrives t the unit n a nn-rebreather mask. Student receive a phne call frm the RN asking fr the patient s O2 t be weaned t a high-flw nasal cannula, if pssible. The nurse als mentins that the MD wrte rders fr a respiratry therapy cnsult and t call with recmmendatins. Students shuld perfrm a cmplete pulmnary exam and take a cmplete patient histry. During histry taking, students learn that Hectr uses Spiriva and Albuterl inhalers at hme and he wears a CPAP at night fr OSA. Student must recmmend the inhalers and CPAP t the prvider using SBAR frmat. HEART FAILURE SIMULATION UPDATED: JUNE 12,

2 LEARNING OBJECTIVES SIMULATION 1. Demnstrate prper infectin cntrl 2. Obtain accurate vital signs 3. Evaluate xygenatin status and adjust xygen as necessary 4. Perfrm a cmplete pulmnary exam 5. Obtain a fcused health histry 6. Evaluate patient data 7. Recmmend apprpriate treatment(s) t prvider 8. Effectively cmmunicate with the patient and interprfessinal team 9. Dcument accurately CURRICULUM MAPPING WTCS RESPIRATORY THERAPY PROGRAM OUTCOMES Apply respiratry therapy cncepts t patient care situatins Demnstrate technical prficiency required t fulfill the rle f a respiratry therapist Practice respiratry therapy accrding t established prfessinal and ethical standards RESPIRATORY SURVEY Perfrm pulse ximetry Review the medical recrd utilizing medical recrd keeping and charting methds cnsistent with hspital plicy and prcedures Utilize infectin cntrl principles Obtain a fcused health histry Evaluate patient data Perfrm a basic cardivascular assessment HEART FAILURE SIMULATION UPDATED: JUNE 12,

3 Perfrm a respiratry assessment Obtain vital signs RESPIRATORY THERAPEUTICS II Perfrm prcedures t assess xygenatin Evaluate xygenatin Demnstrate the use f medical gas equipment Assess the need fr medical gas therapy RESPIRATORY DISEASE Analyze signs, symptms, etilgy, pathgenesis and treatment fr cardivascular diseases/disrders CLINICAL PRACTICE Apply standard precautins Assess vital signs Perfrm pulse ximetry Perfrm chart review Perfrm a pulmnary exam Administer xygen therapy HEART FAILURE SIMULATION UPDATED: JUNE 12,

4 SIMULATION LEARNING ENVIRONMENT & SET-UP ENVIRONMENT Inside rm: Patient in bed, as clse t fwlers psitin as pssible Inside r utside rm: Hand sanitizer and/r sink Outside rm: Cmputer r frm(s) fr dcumentatin PATIENT PROFILE Name: Hectr Fernandez DOB: 09/06/19XX Age: 62 MR#: Gender: Male Height: 175 cm (5 10 ) Weight: 86.4 kg (195#) Allergies: penicillin (hives) Admitting Diagnsis: Right lwer extremity cellulitis and CHF Medical Histry: cngestive heart failure, crnary artery disease, anterir MI with stenting 4 years ag, chrnic atrial fibrillatin, hypertensin, chrnic renal insufficiency, COPD, OSA, restless leg syndrme, hypthyridism, diabetes mellitus 2, chrnic cnstipatin Surgical Histry: R TKR 15 years ag Cde Status: Full Ethnicity: Hispanic Spiritual Practice: Christian, Cathlic Primary Language: Spanish Secndary Language: English EQUIPMENT/SUPPLIES/SETTINGS Patient Hspital gwn N mulage ID band present with QR cde Mnitr Settings N mnitr HEART FAILURE SIMULATION UPDATED: JUNE 12,

5 Simulatr vitals: HR 78, RR 24, BP 128/84, Temp 37.1, Sat = 100 % n lpm NRB mask Supplies General Respiratry Equipment Pulse ximeter Medicatins High-flw nasal cannula and/r ther devices t facilitate O2 titratin Nne needed HEART FAILURE SIMULATION UPDATED: JUNE 12,

6 QR CODES SIMULATION START PATIENT REPORT PATIENT ID SBAR RIGHT LEG LEFT LEG RIGHT IV LEFT IV HEART FAILURE SIMULATION UPDATED: JUNE 12,

7 CHEST QR CODES SIMULATION Cut alng the dtted lines. Fld alng the slid line t create a bi-fld f the diagram and QR cde. ANTERIOR 2 ANTERIOR 3 ANTERIOR 6 ANTERIOR 7 POSTERIOR 0 POSTERIOR 1 POSTERIOR 4 POSTERIOR 5 HEART FAILURE SIMULATION UPDATED: JUNE 12,

8 RIGHT AXILLARY 1 LEFT AXILLARY 1 HEART FAILURE SIMULATION UPDATED: JUNE 12,

9 PREBRIEF SIMULATION TEACHING PLAN 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. Describe hw a QR cde sund will wrk in the scenari. Fr the mst authentic sund experience, student shuld use ear buds r the ARISE stethscpe fr all QR cdes with the fllwing symbl:. Example: QR Cde: Chest Anterir 1 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. Level Up tab This tab tells the cntent in the ipad t change t what is needed fr the next state f a simulatin. It is used a few times in this scenari after the prvider is ntified t display new rders (thse just given ver the phne) and lab results, etc. Medicatin QR Cdes The student(s) must scan QR Cde: Patient ID prir t scanning any medicatin. That scan is valid fr 2 minutes and then it times ut. The student(s) will need t scan QR Cde: Patient ID again t give mre medicatins. MAR Hyperlinks On the MAR all medicatins are underlined and hyperlinked t DailyMed, which is a medicatin reference hused by the HEART FAILURE SIMULATION UPDATED: JUNE 12,

10 Natinal Library f Medicine. Students can click n these links during the simulatin fr up-t-date medicatin cntent, labels, and package insert infrmatin. 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 fr this patient? View Patient vide n ipad Pssible Facilitatr Questins What cmmunicatin strategies culd yu emply when yu assess and evaluate Hectr? Advance t the Patient Prfile screen (n ipad). This will act as a simulated patient chart. Students can view the tabbed cntent n the ipad (see belw) prir t entering the patient s rm and thrughut the simulatin as needed. Yu shuld give student sme time (5 minutes) t review this cntent nw, prir t entering the patient s rm. Facilitatr Nte: There are a lt f medicatins in the MAR and all are linked t Dailymed. This may be a gd pprtunity t review general pharmaclgy. H&P N reprts available. ORDERS Patient Name DOB MR# Hectr Fernandez 09/06/19XX Allergies Height (cm) Admissin Weight (kg) Penicillin (hives) HEART FAILURE SIMULATION UPDATED: JUNE 12,

11 Prvider Orders SIMULATION Date Time Order Tday 10 minutes Admit t Virtual Medical Telemetry Unit ag Diagnsis: X lwer leg cellulitis, mild exacerbatin CHF Cnditin: Fair Cde Status: Full Cde Cardiac mnitring with vitals every 4 hurs x 24 hurs, then every 8 hurs Call if BP <90/60 r > 170/90, HR <50 r > 120, RR <8 r >24, T > 38.5 C, SaO2 < 92% n 4 lpm r > O2 Activity: Ambulate TID and as tlerated Diet: 2 g sdium, Carbhydrate cntrlled Dietary Cnsult 2000 ml/24 hur fluid restrictin Weight n admissin and every AM Insert Fley catheter fr strict I &O O2 t keep SaO2 > 90% If smker within the last 12 mnths, prvide smking cessatin Respiratry Therapy Cnsult. Call with recmmendatins. Cntinue these medicatins frm the skilled nursing facility: 1. Lisinpril 2.5 mg PO daily 2. Metprll ER 100 mg PO daily 3. Spirnlactne 25 mg PO daily 4. Cumadin 3 mg PO daily n M, W, F 5. Atrvastatin 20 mg PO daily 6. Diltiazem ER 120 mg PO mg daily 7. Levthyrxine 100 mcg PO daily 8. Glipizide and Metfrmin 2.5 mg/250 mg PO with breakfast 9. Carbidpa and Levdpa ER 50 mg/200 mg PO at HS 10. Aspirin enteric cated 81 mg PO daily 11. Acetaminphen 500 mg PO 2 tabs every 4-6 hurs fr pain r fever PRN HEART FAILURE SIMULATION UPDATED: JUNE 12,

12 12. Nitrglycerin 0.4 mg SL every 5 minutes times 3 dses PRN fr angina, if angina pain persists call Prvider 13. Milk f Magnesia 30 ml PO daily PRN fr cnstipatin, may repeat nce per day if n relief 14. Dcusate sdium 100 mg PO 2 times per day PRN fr cnstipatin, hld if diarrhea r abdminal pain Medicatins: Cefazlin 2 g IV every 8 hurs Clindamycin 900 mg IV every 8 hurs Fursemide 40 mg PO every 12 hurs K+ replacement per prtcl Labs: (If nt dne in the ED) CBC with differential, Chem 7, Magnesium, BNP, Liver Enzymes, TSH, HbA1c, CK & Trpnin, INR (If nt dne in ED) Bld cultures x 2, wund culture, urinalysis AM Labs: Chem 7, BNP, fasting lipid prfile (If nt dne in ED) Chest x-ray n admissin and in the AM (If nt dne in ED) ECG n admissin and in the AM Obtain ECG fr new nset chest pain STAT PRN Echcardigram nw Prvide and dcument heart failure instructins: diet and fluid restrictins, activity, medicatins, daily weight recrding, wrsening symptms, fllw-up appintment after discharge Cnsult scial wrker fr advanced directives Cnsult with cardilgist Cnsult fr cardiac rehabilitatin dr. Jacbsn, MD MAR Patient Name DOB MR# Hectr Fernandez 09/06/19XX Allergies Height (cm) Admissin Weight (kg) Penicillin (hives) HEART FAILURE SIMULATION UPDATED: JUNE 12,

13 Medicatin Administratin Recrd Scheduled Lisinpril 2.5 mg PO daily Due Tday nne 0800 Metprll ER 100 mg PO daily Due Tday nne 0800 Spirnlactne 25 mg PO daily Atrvastatin 20 mg PO daily Diltiazem ER 120 mg PO mg daily Levthyrxine 100 mcg PO daily Glipizide and Metfrmin 2.5 mg/250 mg PO with breakfast Aspirin enteric cated 81 mg PO daily Due Tday nne 0800 Due Tday nne 0800 Due Tday nne 0800 Due Tday nne 0800 Due Tday nne 0800 Due Tday nne 0800 Cumadin 3 mg PO daily n M, W, F Fursemide 40 mg PO every 12 hurs Due Tday nne Due Tday Yesterday 2230 Tday 1.5 hurs ag Cefazlin 2 g IV every 8 hurs Clindamycin 900 mg IV every 8 hurs Due Tday Due Tday Tday 1.5 hurs ag Tday 1.5 hurs ag Cntinuus Infusin PRN HEART FAILURE SIMULATION UPDATED: JUNE 12,

14 Acetaminphen 500 mg PO 2 tabs every 4-6 hurs fr pain r fever PRN Nitrglycerin 0.4 mg SL every 5 minutes times 3 dses PRN fr angina, if angina pain persists call Prvider Milk f Magnesia 30 ml PO daily PRN fr cnstipatin, may repeat nce per day if n relief Dcusate sdium 100 mg PO 2 times per day PRN fr cnstipatin, hld if diarrhea r abdminal pain Tday 2 hurs ag Discntinued DAILY RECORD Patient Name DOB MR# Hectr Fernandez 09/06/19XX Allergies Height (cm) Admissin Weight (kg) Penicillin (hives) Daily Recrd Vitals Tday 2 hurs ag Pulse Resp. Rate BP Systlic BP Diastlic Temp ( C) O2 Saturatin (%) Tday 30 minutes ag Applied Oxygen 2 lpm 15 lpm Pain HR I & O (ml) Input Output Ttal HEART FAILURE SIMULATION UPDATED: JUNE 12,

15 Daily Weight (kg) VITALS Tday 30 minutes ag 86.4 SIMULATION The ipad shws the enterable vitals screen. PROGRESS NOTES N reprts available. LABS-DIAGNOSTICS Patient Name DOB MR# Hectr Fernandez 09/06/19XX Allergies Height (cm) Admissin Weight (kg) Penicillin (hives) Labratry Results CBC with Differential Tday 2 hurs ag [time] [time] Units Reference Range WBC 11.8 x10 3 ul F: /M: RBC 3.6 x10 6 ul F: /M: Hgb 9.9 g/dl F: /M: HCT 30.2 % F: /M: MCV 76.7 fl F: /M: MCH 25 pg MCHC 30 g/dl RDW 12.3 % F: /M: Platelet 182 x10 9 ul F: /M: MPV HEART FAILURE SIMULATION UPDATED: JUNE 12,

16 Neutr Lymph Mn Es Bas Chem 7 with Magnesium Tday 2 hurs ag [time] [time] Units Reference Range Glucse 162 mg/dl Fasting BUN 32 mg/dl Creatinine 3.2 mg/dl F: /M: Sdium 134 meq/l Ptassium 3.8 meq/l Chlride 108 meq/l Carbn Dixide 28 meq/l Magnesium 1.7 meq/l Liver Enzymes Tday 2 hurs ag [time] [time] Units Reference Range ALT 53 U/L 7-55 AST 36 U/L 8-48 ALP 102 U/L Albumin 4.8 g/dl Ttal Prtein 6.9 g/dl Bilirubin 0.9 mg/dl HEART FAILURE SIMULATION UPDATED: JUNE 12,

17 BNP Tday 2 hurs ag SIMULATION [time] [time] Units Reference Range BNP 2450 pg/ml < 75 years ld = <125 > 75 years ld = <450 TSH Tday 2 hurs ag [time] [time] Units Reference Range TSH 0.7 mlu/l CK & Trpnin Tday 2 hurs ag [time] [time] Units Reference Range CK 330 U/L M: /F: Trpnin 0 ng/ml <0.1 INR Tday 2 hurs ag [time] [time] Units Reference Range INR 2.4 secnds < 1.1 HbA1c Tday 2 hurs ag [time] [time] Units Reference Range HbA1c 10.3 % < 5.7 HEART FAILURE SIMULATION UPDATED: JUNE 12,

18 IMAGING SIMULATION Patient Name DOB MR# Hectr Fernandez 09/06/19XX Allergies Height (cm) Admissin Weight (kg) Penicillin (hives) Imaging Reprt DESCRIPTION: Prtable x-ray fr shrtness f breath EXAM: Prtable AP chest REASON FOR EXAM: Shrtness f breath COMPARISON EXAM: Nne available TECHNIQUE: kvp DISCUSSION: Dictatin pending IMPRESSION: Dictatin pending LEVEL UP 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. HEART FAILURE SIMULATION UPDATED: JUNE 12,

19 STATE 1 PATIENT ASSESSMENT Patient Overview Patient is n a NRB when students enter the rm. Hectr is tired and very irritated with his health. He is sick f being sick and will answer questins, but is nt that thrilled abut it. He is als wanting the NRB mask ff. Students will perfrm a cmplete pulmnary exam, btain a fcused health histry and wean O2. Expected Student Behavirs Perfrm apprpriate hand hygiene and infectin cntrl Intrduce themselves and verify the patient (can scan QR Cde: Patient ID) Accurately btain vital signs and interpret fr an adult patient Students must enter crrect vitals in the ipad t advance. The fllwing vitals are used: HR = 78 (within 4 either way), RR = 24 (within 3 either way), BP 128/84 (within 5 either way), Temp = 37.1 (n limit), Sat = 100 % (n limit) There is a place fr students t dcument whether n RA r O2 applied as well as the device, FiO2 and/r liter flw being used. This is nt tied t any prgramming. Perfrm a cmplete pulmnary exam Inspectin Students will nt find any abnrmalities in the chest exam. When the extremities are evaluated, pitting edema and Right-lwer extremity cellulitis is fund. (Scan QR Cde: Right Leg & QR Cde: Left Leg) Palpatin Students will nt find any abnrmalities in the chest exam. Percussin Students will nt find any abnrmalities in the chest exam. Auscultatin Scan QR Cde: Chest There are ten QR cdes t apply t the chest see abve Chest QR Cde chart fr lcatins HEART FAILURE SIMULATION UPDATED: JUNE 12,

20 SIMULATION Students will hear the fllwing breath sunds: Anterir 2, Anterir 3, Psterir 0, & Psterir 1 = nrmal/clear Perfrm a fcused health histry Anterir 6, Anterir 7, Psterir 4, Psterir 5, Right Axillary, & Left Axillary = fine crackles As students perfrm the pulmnary exam, they shuld simultaneusly cllect the patient s histry Questining may cntinue int State 2 f the scenari Questins can include: Hw are yu feeling/hw is yur breathing right nw? Have yu ever been a smker? D yu have any lung diseases like asthma r emphysema? D yu take any medicatins fr yur breathing? D yu use any machines t help yu breathe while yu sleep? Yur legs lk pretty puffy, hw lng have they been this way? Recgnize and respnd t abnrmal findings Demnstrate apprpriate cmmunicatin with the patient Technician Prmpts Patient is tired and very irritated with his health. He is almst defeated. He is sick f being sick and will answer questins, but is nt that thrilled abut it. He is cnstantly pulling at the NRB mask and wants it ff. Patient respnse can include: D I really need this mask? Can t yu take it ff nw? I m s sick f being in the hspital. I m never ging t get better When asked patient histry questins, respnses can include: HEART FAILURE SIMULATION UPDATED: JUNE 12,

21 Hw are yu feeling/hw is yur breathing right nw? Answer: Better than befre. Have yu ever been a smker? Answer: Of curse! Wh wasn t? Students shuld prbe further: If asked, he states he started smking when he was abut 14 years ld and quit when he was 56 years ld althugh, he still likes t have an ccasinal cigar. He smked 1-2 packs per day. D yu have any lung diseases like asthma r emphysema? Answer: They tell me I have that COPD thing. D yu take any medicatins fr yur breathing? Answer: Yeah. I take a cuple puffer things. Students shuld prbe further: If asked, he takes: 2 puffs Albuterl as needed He states he takes it a few times every day when he is shrt f breath. 1 puff Spiriva in the mrning D yu use any machines t help yu breathe while yu sleep? Answer: I have ne f thse CPAK things at night. Student shuld prbe further: If asked, he uses ARISE Hmecare and his settings are +8 cwp. He des nt have anyne that can bring his machine t the hspital. He is OK with using the hspitals machine. Yur legs lk pretty puffy, hw lng have they been this way? Answer: It seems like they ve been this way fr years. The right ne is always infected. When students wean the O2, gradually change SpO2 t 95%. Facilitatr Questins HEART FAILURE SIMULATION UPDATED: JUNE 12,

22 SIMULATION Analyze the vital signs: are they within nrmal limits? Analyze the findings frm the pulmnary exam: d yu have any cncerns? Analyze the patient histry: d yu have any cncerns? Based n yur finding frm bth the pulmnary exam and fcused health histry, what wuld yu like t d nw and why? Tabbed ipad Prmpts and Cntent LEVEL 1/2 When the Level 1 tab is tapped, the ipad reads, The ipad is at Level 1. The Level 1 tab will autmatically change t a Level 2 tab (students are nt prmpted abut this) when: Student(s) enters vital signs crrectly AND Student(s) scans ANY QR Cde: Chest When the Level 2 tab is tapped, the ipad reads, The ipad is at Level 2. HEART FAILURE SIMULATION UPDATED: JUNE 12,

23 STATE 2 REASSESSMENT & PROVIDER NOTIFICATION Patient Overview The patient is much happier with a nasal cannula device. Hwever, he is dne talking and just wants t rest. Students need t reassess SaO2 t ensure adequate xygenatin. Then, they shuld call the prvider t recmmend Spiriva and Albuterl inhalers as well as a CPAP at night fr OSA using SBAR frmat. This can be dne as a phne call r face-t-face with the technician, facilitatr, r designee playing the prvider rle. Students shuld als dcument per facility guidelines. Expected Student Behavirs Reassess patient after weaning/changing O2 device When vitals are rechecked, all are essentially the same except the Sat = 95%. Vitals may be entered n the ipad again at this time, but they are nt tied t ipad prgramming. If students listen t breath sunds again, nthing has changed frm State 1. Demnstrate apprpriate cmmunicatin with the prvider Students may scan QR Cde: SBAR Dcument accurately Technician Prmpts Nthing is needed frm the patient anymre. If playing the rle f the Prvider, ask apprpriate questins related t the infrmatin being relayed by the student. Facilitatr Questins Students shuld update the prvider using SBAR frmat. Why is it necessary t reassess the patient? HEART FAILURE SIMULATION UPDATED: JUNE 12,

24 LEVEL 2/EXIT SIMULATION Describe hw SBAR cmmunicatin imprves the interprfessinal cmmunicatin prcess. When the Level 2 tab is tapped, the ipad displays a plaque the reads, Have yu updated the prvider? If N, the ipad reads, "Yu must update the prvider befre exiting." If Yes, the ipad reads, Scenari bjectives have been met. Are yu sure yu want t exit the game? 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. HEART FAILURE SIMULATION UPDATED: JUNE 12,

25 DEBRIEF Nthing needed frm the ipad. QUESTIONS 1. Hw did yu feel this scenari went? SIMULATION 2. What were the main issues yu had t deal with when caring fr Hectr? 3. Review understanding f learning bjective: Demnstrate prper infectin cntrl. a. What infectin cntrl issues did yu encunter with Hectr? b. What abut Hectr increases his risk fr infectins? 4. Review understanding f learning bjective: Obtain accurate vital signs. a. What, if any, challenges did yu encunter in btaining Hectr s vitals? 5. Review understanding f learning bjective: Evaluate xygenatin status and adjust xygen as necessary. a. Is Hectr s xygenatin status nrmal r abnrmal and why? b. Is this what yu wuld expect in a patient with cngestive heart failure? Why r why nt? 6. Review understanding f learning bjective: Perfrm a cmplete pulmnary exam. a. What cncerns did yu find during yur physical assessment and evaluatin? b. Is this what yu wuld expect in a patient with cngestive heart failure? Why r why nt? 7. Review understanding f learning bjective: Obtain a fcused health histry. a. What pieces f data were significant in Hectr s health histry? b. If yu culd d ver any part f getting Hectr s histry, what wuld it be and why? 8. Review understanding f learning bjective: Evaluate patient data. a. What abnrmal findings did yu find in the vital signs and/r physical assessment? Hw did yu respnd t these findings? 9. Review understanding f learning bjective: Recmmend apprpriate treatment(s) t prvider. HEART FAILURE SIMULATION UPDATED: JUNE 12,

26 10. Review understanding f learning bjective: Effectively cmmunicate with the patient and interprfessinal team. a. Were the cmmunicatin techniques yu used with Hectr effective? Why r Why nt? b. If Hectr was unable t speak English, hw wuld yu have adapted yu cmmunicatin techniques? c. If yu culd d ver, hw wuld yu change yur cmmunicatin with Hectr? 11. Review understanding f learning bjective: Dcument accurately. a. What is imprtant t dcument in yur assessments and interventins? 12. Summary/Take Away Pints a. Tday yu cared fr a Hispanic patient wh was experiencing an exacerbatin f his knwn cngestive heart failure. What is ne thing yu learned frm participating in this scenari that yu will take with yu int yur respiratry therapy practice? (Each student must share smething different frm what the thers share.) Nte: Debriefing technique is based n INASCL Standard fr Debriefing and NLN Thery Based Debriefing by Dreifuerst. HEART FAILURE SIMULATION UPDATED: JUNE 12,

27 SURVEY Print this page and prvide t students. SIMULATION 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. HEART FAILURE SIMULATION UPDATED: JUNE 12,

28 CREDITS SIMULATION BiPAP Prtc0l adapted frm RES Nn-Invasive Psitive Pressure Ventilatin Guideline frm and BiPAP/CPAP Prtcl frm tcls.htm CXR image frm: Lung sunds used with permissin frm Thinklabs Medical, LLC, Centennial, CO at Medicatin infrmatin frm Natinal Library f Medicine: Daily Med at Pitting Edema picture frm Pitting Edema picture with cellulitis frm HEART FAILURE SIMULATION UPDATED: JUNE 12,

29 REFERENCES SIMULATION American Heart Assciatin (2016). Get with the Guidelines: Heart Failure. Retrieved frm With-The-Guidelines---HFStrke_UCM_001099_SubHmePage.jsp Cleveland Clinic. (2017). B-type Natriuretic Peptide (BNP) Bld Test. Retrieved frm Clucci, MD, W. (April 2017). Treatment f Acute Decmpensated Heart Failure: Cmpnents f Therapy. Retrieved frm Fnarw, MD, G. C. & Weber, DO, J.E. (2004). Rapid Clinical Assessment f Hemdynamic Prfiles and Targeted Treatment f Patients with Acutely Decmpensated Heart Failure. Clinical Cardilgy, 27 (Supplement V). Retrieved frm f?sequence=1 Hyzy, MD, R. (April 2017). Nninvasive Ventilatin in Acute Respiratry Failure in Adults. Retrieved frm n&selectedtitle=1~150 Jint Cmmissin (2016). Specificatins Manual fr Jint Cmmissin Natinal Quality Measures. Dwnladed frm: ailure.html HEART FAILURE SIMULATION UPDATED: JUNE 12,

30 May Fundatin fr Medical Educatin and Research. ( ). Test ID: CK. Retrieved frm Nhria, A., Lewis, E., & Stevensn, L. (2002). Medical Management f Advanced Heart Failure. Jurnal f the American Medical Assciatin, 287 (5), Retrieved frm Stella, L. (2013). Understanding Measures fr Heart Failure Treatment, American Nurse Tday, 8(2). Retrieved frm Tleyjeh, MD, I., Burdetter, MD, S., & Baddur, MD, L. Cellulitis. Anitmicrbe. Retrieved frm WebMD, Inc. (2017). Hemglbin A1c (HbA1c). Retrieved frm rmal_levels_f_hba1c_hemglbin_a1c_chart Yancy CW, Jessup M, Bzkurt B, Butler J, Casey DE Jr, Drazner MH, Fnarw GC, Geraci SA, Hrwich T, Januzzi JL, Jhnsn MR, Kasper EK, Levy WC, Masudi FA, McBride PE, McMurray JJV, Mitchell JE, PetersnPN, Riegel B, Sam F, Stevensn LW, Tang WHW, Tsai EJ, Wilkff BL. (2013) ACCF/AHA guideline fr the management f heart failure: a reprt f the American Cllege f Cardilgy Fundatin/American Heart Assciatin Task Frce n Practice Guidelines. Circulatin. 2013;128:e240 e327. DOI: /CIR.0b013e31829e8776 HEART FAILURE SIMULATION UPDATED: JUNE 12,

31 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 ). HEART FAILURE SIMULATION UPDATED: JUNE 12,