Transcription

Adult Type I Diabetic KetoacidosisPre-simulation PreparationStudent Learner PackageFall 2017

1TABLE OF CONTENTSiiTable of ContentsSECTION 1INSTRUCTIONSSECTION 2SCENARIO OVERVIEWA.B.C.SECTION 3TitleSummaryEvidence BaseCURRICULUM INTEGRATIONA.B.Learning Objectives1. Primary2. Secondary3. Critical ElementsLearning Outcome Assessment / Rubric to be completed by student pre and postC.Pre-scenario learner activitiesSECTION 4 PATIENT PROFILEA.B.Case SummaryPatient/Client ProfileALL DATA IN THIS SCENARIO IS FICTICIOUS

2SECTION I: INSTRUCTIONSThe following document is meant to help you prepare for your upcoming simulation learning activity.It is important that you follow the following instructions to have the best possible learning outcomesfrom your simulation activity.Please read and follows these instructions as they are mandatory for this simulation.Instructions:1) Please read through this document as it will help you prepare for your upcoming simulation onDKA.2) Complete the assigned suggested readings3) Complete the presimulation preparation virtual simulation game (Instructor will provide link)4) Once you have completed reading this document and prepared for your simulation, please:a. Please print TWO copies of the rubric and bring them to your lab:i. Write your name on each copy.ii. Copy #1: Please complete copy #1 at home after you have finished your presimulation preparation (example, readings). Bring your completed rubric with you tothe simulation laboratory. Please identify that it is COPY #1.iii. Copy#2: Please complete copy #2 on site right after finishing your debriefingactivity. Please identify that it is COPY #2.b. Hand in all of your completed rubrics to your simulation facilitator.Most importantly, enjoy your learning experience!!ALL DATA IN THIS SCENARIO IS FICTICIOUS

3SECTION 2: SCENARIO OVERVIEWScenario Title: Type 1 Diabetes (Adult)Estimated Scenario Time: 25minDebriefing time: 30min Target group: 3 year BScN studentsCore case: Type 1 diabetic patient (Adult)CNO:Professional responsibility and accountability: (2) Recognizes individual competence withinLegislated scope of practice and seeks support and assistance as necessary. (11) Promotes current evidence-informed practices.Knowledge based practice: (26) Demonstrates a body of knowledge in the health sciences, includinganatomy, physiology, pathophysiology, psychopathology, pharmacology,microbiology, epidemiology, genetics, immunology and nutrition.Providing Registered Nursing care: (55) Provides nursing care that is based on critical inquiry and evidence-informeddecision- making. (56) Coordinates and provides timely nursing care for clients with various comorbidities, complexity and rapidly changing health statuses (58) Applies nursing knowledge when providing care to clients with acute, chronic,and/or persistent health challenges (e.g., stroke, cardiovascular conditions, mentalhealth and addiction, dementia, arthritis, diabetes). (62) Implements safe and evidence-informed medication practices.Ongoing Evaluation of client care: (70) Utilizes a critical inquiry process to continuously monitor the effectiveness ofclient care.CPSI:Domain 1: Contribute to a Culture of Patient Safety A commitment to applying core patient safety knowledge, skills, and attitudes toeveryday work.Domain 4: Manage Safety Risks Anticipating, recognizing, and managing situations that place patients at risk.ALL DATA IN THIS SCENARIO IS FICTICIOUS

4Domain 6: Recognize, Respond to, and Disclose Adverse Events Recognizing the occurrence of an adverse event or close call and responding effectively tomitigate harm to the patient, ensure disclosure, and prevent recurrence.CIHC:Domain: Team Functioning develop a set of principles for working together that respects the ethical values of membersrespect team ethics, including confidentiality, resource allocation, and professionalismDomain: Collaborative Leadership work with others to enable effective patient/ client outcomesBest Practice Guidelines Canadian Diabetes Association - Best and promising practices in diabetes educationCanadian Diabetes Association – CPG : Managing diabetes in hospitalBrief Summary of Case: 49 year old male admitted to a medical unit from the ER with a glucose of28.EVIDENCE BASE / REFERENCES (APA Format)Lewis, et al., (2014). Chapter 50. Nursing Assessment: Endocrine SystemLewis et al., (2014). Chapter 52. Nursing Management: Diabetes MellitusThomas, C.M., Bertram, E., & Johnson, D. (2009). The SBAR communication technique: Teachingnursing students professional communication skills. Nurse Educator, 34(4), 176-180.ALL DATA IN THIS SCENARIO IS FICTICIOUS

5SECTION 3: CURRICULUM INTEGRATIONDo WhatDemonstratePrioritizeA. SCENARIO LEARNING OBJECTIVESWith WhatFor WhatAn accurate assessment onTo determine etiology ofthe client suffering frompresenting symptoms andcomplications of type Idecide on approach fordiabetescare.Interventions usingassessment dataThreats to patient safetyIdentifyTo prevent a further declinein the health status of theclient suffering fromcomplications of type Idiabetes.To prevent undesirableeffectsDemonstratePrinciples of medicationadministrationTo help promote patientstabilization and recovery.CommunicateWith the patient and familyin an emergency situationTo reduce the anxiety of thepatient and his family.CommunicateData essential to thephysician or NP in adeterioratingsituation using theSBAR.To assist in thediagnosis and treatmentof the patient

6B. Learning Outcome Assessment(circle the response that applies & comment when necessary)Competency(based on “WhatFor”)Demonstrate an accurateassessment on the clientsuffering from complicationsof type I diabetes todetermine etiology ofpresenting symptoms anddecide on approach for care.Demonstrated attributes alignwith required competency Comments:Assessment yields anaccurate picture of theclient’s current conditionAssessment is conducted in away that appropriately alignswith the patient’sphysiological conditionEffectively incorporates athorough understanding oflab values when determiningpatient statusAssessment results inan accurate diagnosisAssessment involves use ofappropriate tools for datacollectionDemonstrated attributes needsome improvement to alignwith required competency Assessment yields a somewhataccurate picture of the client’scurrent conditionAssessment is conducted in away that somewhatappropriately aligns with thepatient’s physiologicalconditionIncorporates someunderstanding of lab valueswhen determining patientstatusAssessment results in asomewhat accurate diagnosisAssessment involves use ofsome appropriate tools fordata collectionDemonstrated attributes needmajor improvement to align withrequired competency Assessment does not yield anaccurate picture of the client’scurrent conditionAssessment is conducted in away that does notappropriately align with thepatient’s physiological conditionFails to incorporate anunderstanding of lab valueswhen determining patientstatusAssessment does not result inan accurate diagnosisAssessment does not involve useof appropriate tools for datacollection

7B. Learning Outcome Assessment(circle the response that applies & comment when necessary)Competency(based on “WhatFor”)Prioritize interventions usingassessment data to prevent afurther decline in the healthstatus of the client sufferingfrom complications of type Idiabetes.Demonstrated attributes alignwith required competency CommentsInterventions are organizedin a way that promotes thepatient’s recoveryAll interventions meet thepatient’s needsAppropriate interventionsare implemented in relationto abnormal findingsInterventions are carried outin a timely mannerIndependently recognizesand seeks help whenrequired patient care isbeyond scope of practiceEffectively defersinformation to appropriatecare providerDemonstrates regard forpatient safetyDemonstrated attributes needsome improvement to alignwith required competency Interventions are organized ina way that somewhatpromotes the patient’srecoverySome interventions meet thepatient’s needsSome appropriateinterventions areimplemented in relation toabnormal findingsInterventions are carried outin a somewhat timely mannerRequires some prompting torecognize and seek help whenrequired patient care isbeyond scope of practiceSomewhat effectively defersinformation to appropriatecare providerDemonstrates regard forpatient safetyDemonstrated attributes needmajor improvement to align withrequired competency Interventions are organized in away that does not promote thepatient’s recoveryInterventions do not meet anyof the patient’s needsFails to implement interventionsthat directly relate to abnormalfindingsInterventions are not carriedout in a timely mannerDespite prompting fails torecognize and seek help whenrequired patient care is beyondscope of practiceFails to defer information toappropriate care providerDemonstrates a lack of regardfor patient safety

8B. Learning Outcome Assessment(circle the response that applies & comment when necessary)Competency(based on “WhatFor”)Identify threats to patientsafety to prevent undesirableeffectsDemonstrated attributes alignwith required competency CommentsEffectively carries outsafety checksCare demonstrates aregard for y forminimizing harmDemonstrated attributes needsome improvement to alignwith required competency Carries out some safety checksCare demonstrates someregard for infection controlpracticesDemonstrates someaccountability for minimizingharmDemonstrated attributes needmajor improvement to align withrequired competency Fails to carry out safety checksCare demonstrates little tono regard for infectioncontrolpracticesDemonstrates little to noaccountability for minimizingharm

9B. Learning Outcome Assessment(circle the response that applies & comment when necessary)Competency(based on “WhatFor”)Demonstrate principles ofmedication administration tohelp promote patientstabilization and recovery.Demonstrated attributes alignwith required competency CommentsDelivers medication inaccordance with all the“rights” of administrationPrepares medications in asafe mannerPrepares and deliversmedication in a waythat supports thepatient’s recoveryAble to accurately identifypotential complicationsassociated with medicationsDemonstrated attributes needsome improvement to alignwith required competency Delivers medication inaccordance with some “rights”of administrationPrepares medications in asomewhat safe mannerPrepares and deliversmedication in a waythat somewhat supportsthe patient’s recoverySomewhat able to accuratelyidentify potentialcomplications associated withmedicationsDemonstrated attributes needmajor improvement to align withrequired competency The “rights” of administrationare not followed whendelivering medicationFails to prepare medications in asafe mannerPrepares and deliversmedication in a way that doesnot support the patient’srecoveryUnable to accurately identifypotential complicationsassociated with medications

10B. Learning Outcome Assessment(circle the response that applies & comment when necessary)Competency(based on “WhatFor”)Communicate usingtherapeutic principles todecrease anxiety in thepatient during an emergencysituation.Demonstrated attributes alignwith required competency CommentsUses a caring demeanour,resulting in compliancewith careInteracts with the patientin a way that facilitatesopen communicationDemonstrates a regardfor respecting the patientand their family’s right tobe informedConveys information topatient and family in a waythat promotes understandingDemonstrated attributes needsome improvement to alignwith required competency Uses a somewhat caringdemeanour, resulting in somecompliance with careInteracts with the patient in away that facilitates some opencommunicationDemonstrates some regardfor respecting the patient andtheir family’s right to beinformedConveys information topatient and family in a waythat promotes someunderstandingDemonstrated attributes needmajor improvement to align withrequired competency Does not use a caringdemeanour, resulting in little tono compliance with careInteracts with the patient ina way that does not facilitateopen communicationDemonstrates little to no regardfor respecting the patient andtheir family’s right to beinformedConveys information topatient and family in a waythat does not promoteunderstanding

11B. Learning Outcome Assessment(circle the response that applies & comment when necessary)Competency(based on “WhatFor”)Communicate data essentialto the physician or NP in adeteriorating situation usingthe SBAR to assist in thediagnosis and treatment ofthe patientDemonstrated attributes alignwith required competency CommentsDelivered data accuratelyportrays the criticalnature of the patient’sconditionReport is effective andresults in immediate buyinSecured collaboration isappropriate for theneeds of the patientDemonstrated attributes needsome improvement to alignwith required competency Delivered data somewhataccurately portrays the criticalnature of the patient’sconditionReport is somewhat effectiveand results in some buy-inSecured collaboration issomewhat appropriate for theneeds of the patientDemonstrated attributes needmajor improvement to align withrequired competency Delivered data does notaccurately portray the criticalnature of the patient’sconditionReport is not effective andresults in little-to-no buy-inSecured collaboration isinappropriate for the needs ofthe patient

7C. PRE-SCENARIO LEARNER ACTIVITIESPrerequisiteCompetenciesKnowledgeSkills/ Attitudes Lab values related to diabetic Pathophysiology and Etiology, risk factors,clinical manifestations ofketoacidosis/infection control/handdiabetic ketoacidosishygiene Obtain accurate glucose reading/ understand Diagnostic samplingindications for random sample versus fastingsample/ urine analysis