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o 4 o 4 o 3 o 5 o 2 o 3 o 4 o 4

o 2 o 4 o 2 o 4 o 2 o 2 o 4 o 4

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Dyspnea

Initial Assessment1. Check ABC, vital sign, SaO22. History taking : cardiac or pulmonary disease3. P/Ex : mental status, accessary muscle use, cyanosis, breath sound

Immediate Emergency Care1. Place in semi-fowler's position2. Administer O2 2-3L/min via nasal prong3. Maintain IV access4. Check ABGA, laboratory test5. Monitor EKG, NBP, SaO26. Check CXR, EKG

Start CPR

Prepare for intubation & positive ventilationSuction as neededAdminister medicationsPrepare for mechanical ventilator

AggravatedSaO2 90%≤RR 25, RR 8≥ ≤

Administer high O2(10L/min via reservior mask)Monitor respiratory failure1. SaO2 < 90% or2. RR > 35/min or3. PaO2 < 50mmHg or4. Cyanosis or5. Altered mental status or6. Exhaustion(weakness of respiration muscle)

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Initial Assessment1. Check ABC, vital sign, SaO22. History taking : cardiac or pulmonary disease3. P/Ex : mental status, accessary muscle use, cyanosis, breath sound

Immediate Emergency Care1. Place in semi-fowler's position2. Administer O2 2-3L/min via nasal prong3. Maintain IV access4. Check ABGA, laboratory test5. Monitor EKG, NBP, SaO26. Check CXR, EKG

Dyspnea

Improved90%<SaO2 <100%8<RR<25

Additional Assessment1. Further history taking2. Further physical examination3. Check laboratory test4. Check image study

Cardiac Origin1. ABR2. MonitorEKG, BP, SaO2

3. Administer O24. Considerdiuretics,antihypertensive drug,nitroglycerin

5. Check I/O

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Pulmonary Origin1. ABR2. MonitorEKG, BP,SaO2

3. Administer O24. Considerbonchodilator,antibiotics

5. Blow therapy,Suction

Initial Assessment1. Check ABC, vital sign, SaO22. History taking : cardiac or pulmonary disease3. P/Ex : mental status, accessary muscle use, cyanosis, breath sound

Immediate Emergency Care1. Place in semi-fowler's position2. Administer O2 2-3L/min via nasal prong3. Maintain IV access4. Check ABGA, laboratory test5. Monitor EKG, NBP, SaO26. Check CXR, EKG

Dyspnea

Improved90%<SaO2 <100%8<RR<25

Additional Assessment1. Further history taking2. Further physical examination3. Check laboratory test4. Check image study

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Initial Assessment1. Check ABC, vital sign, SaO22. History taking : cardiac or pulmonary disease3. P/Ex : mental status, accessary muscle use, cyanosis, breath sound

Immediate Emergency Care1. Place in semi-fowler's position2. Administer O2 2-3L/min via nasal prong3. Maintain IV access4. Check ABGA, laboratory test5. Monitor EKG, NBP, SaO26. Check CXR, EKG

Dyspnea

Improved90%<SaO2 <100%8<RR<25

Additional Assessment1. Further history taking2. Further physical examination3. Check laboratory test4. Check image study

Other Cause1. ABR2. MonitorEKG, BP, SaO2

3. Administer O24. Others(Hypervaric,Transfusion,Hemodylisis)

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*

Pulseless

Start CPRPrepare for intubation & positive ventilationSuction as neededAdminister medicationsPrepare for mechanical ventilator

yes

yes no

*

AggravatedSaO2 90%≤RR 25, RR 8≥ ≤

Improved90%<SaO2 <100%8<RR<25

Administer high O2(10L/min via reservior mask)Monitor respiratory failure1. SaO2 < 90% or2. RR > 35/min or3. PaO2 < 50mmHg or4. Cyanosis or5. Altered mental status or6. Exhaustion(weakness of respiration muscle)

Additional Assessment1. Further history taking2. Further physical examination3. Check laboratory test4. Check image study

Cardiac Origin1. ABR2. MonitorEKG, BP, SaO2

3. Administer O24. Considerdiuretics,antihypertensivedrug,nitroglycerin

5. Check I/O

Pulmonary Origin1. ABR2. MonitorEKG, BP, SaO2

3. Administer O24. Considerbonchodilator,antibiotics

5. Blow therapy,Suction

Other Cause *1. ABR2. MonitorEKG, BP, SaO2

3. Administer O24. Others(Hypervaric,Transfusion,Hemodylisis)

Dyspnea

Initial Assessment1. Check ABC, vital sign, SaO22. History taking : cardiac or pulmonary disease3. P/Ex : mental status, accessary muscle use, cyanosis, breath sound

Immediate Emergency Care1. Place in semi-fowler's position2. Administer O2 2-3L/min via nasal prong3. Maintain IV access4. Check ABGA, laboratory test5. Monitor EKG, NBP, SaO26. Check CXR, EKG7. Consider bronchodilator if bronchospasm(audible wheezing) *

no

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Additional Assessment Guideline1. History takingOnset, duration, intensity of dyspneaAggravating factor, relieving factorAssociated symptom : cough, sputum, hemoptysis, PND, DOEPast history : preexisting medical condition, medication

psychiatric condition

2. Physical examination

Vital sign : tachypnea, hypopnea, tachycardia,hypotension, fever

Skin/nails : clubbing, pale skin/conjunctiva, rash,subcutaneous emphysema

Neck : JVDChest : barrel chestLung : wheeze, rale, rhonchi, diminshed breath soundHeart : gallop, murmur, muffles heart soundsExtremity : peripheral edema3. Laboratory findingBNP, cardiac biomarker, D-dimer

4. Image finding

CXR, EKG, CT, echocardiogram, bedside U/S

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Introduction:

The Bay Area Simulation Collaborative (BASC) is comprised of representatives

from schools of nursing and hospitals in the ten Bay Area counties. The CINHC

provides leadership for the BASC. This project, which is the third component of the

Bay Area Nursing Resource Center, involves faculty development for nursing faculty

and hospital educators in the Bay Area.

Scenario development is the second component of the BASC project. The

BASC team is spearheading this new approach to education through developing

simulation scenarios

and curriculum. The BASC will facilitate training educators to write scenarios

in the BASC developed template; validate, test and ultimately, make scenarios

available to the BASC community.

Utilization of simulation in schools, hospitals and regional centers will

ultimately increase the quality of nursing education and practice. The overall goal is

the enhancement of patient safety.

The scenarios are the property of the BASC. The writers have agreed to release authorship

and waive any and all of their individual intellectual property rights surrounding all scenarios.

BAY AREA SIMULATION COLLABORATIVE

BASCSimulation Scenario Template

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TABLE OF CONTENTS

SECTION I SCENARIO OVERVIEW

A. Evidence Base

SECTION II CURRICULUM INTEGRATION

A.

Learning Objectives

1. Primary

2. Secondary

3. Critical Elements

B. Pre-scenario learner activities

SECTION III SCENARIO SCRIPT

A. Case Summary

B. Key Contextual Details

C. Scenario Cast

D. Patient/Client Profile

E. Baseline patient/client simulator state

F. Environment / equipment / essential props

G. Case flow /triggers / scenario development

SECTION IV APPENDICES

A. PHYSICIAN ORDERS

SECTION V ADDENDUM

A. Addendum 1: Pre-scenario Learner checklist

BASC REV template (12/15/08 5/09)

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SECTION I: SCENARIO OVERVIEW

Scenario title:

Original Scenario

Developer(s):

Date - original scenario

Validation date: Draft Pilot Approved

Revision Dates:

Estimated Scenario Time: (i.e. 15 minutes)

Debriefing time: (i.e. 30 minutes)

Target group:

Core case

Brief Summary of Case:

EVIDENCE BASE / REFERENCES

(List all references include complete citation, following APA guidelines)

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SECTION II: CURRICULUM INTEGRATION

A. SCENARIO LEARNING OBJECTIVES

1. Learning Outcomes (Global)

1.

2.

3.

2. Specific Learning Objectives

1.

2.

3.

4.

5.

6.

7.

8.

3. Critical Elements

(Key points to observe to determine if scenario objectives are met)

1.

2.

3.

4.

5.

B. PRE-SCENARIO LEARNER ACTITIVIES

Prerequisite Knowledge

Required prior to participating in the scenario

Psychomotor Competencies Cognitive competencies:

q q

q q

q q

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SECTION III: SCENARIO SCRIPT

A. Case summary

B. Key contextual details

C. Scenario Cast

Patient/ Client

q Human Patient Simulator(SimMan®, SimBaby®, ECS®, HPS®)

q Standardized Patient

q Low-mid fidelity manikin

q Hybrid (Blended simulator)

RoleBrief Descriptor

(Optional)

Confederate (C) or Learner

(L)

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D. Patient/Client Profile

Last name: First name:

Gender: Age: Ht: Wt: BMI:

Ethnicity: Religion:

1. History of present illness

Primary Medical Diagnosis

Medication

allergies:Reaction:

Food/other

allergies:Reaction:

2. Review of Systems

CNS

Cardiovascular

Pulmonary

Renal/Hepatic

Endocrine

Heme/Coag

Musculoskeletal

Integument

Developmental

Hx

Psych History

Social History

Alternative/ Complementary

Medicine History

3. Current

medication

Drug Dosase Route Frequency

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4. Laboratory, Diagnostic Study Results

Highlighted labs added at the suggestion of Maternal Child faculty template reviewer

Na: K: Cl: HCO3: BUN:

Cr: BS: HgA1C:

Hgb: Hct: Plt: WBC:

PT PTT INR

ABG-pH: paO2: paCO2: HCO3/BE: SaO2:

Ca: Mg: ABO Blood Type:

LFTs: Albumin: SGOT: SGPT: AlkPhos:

VDRL: GBS: Herpes: HIV: Herpes:

CXR: ECG:

CT: MRI:

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E. Baseline Patient/Client Simulator State

This may vary from the baseline data provided to learners

1. Manikin physical appearance - Mark X next to item and/or describe

Gender:

Attire:

ID band present,

accurate information

ID band present,

inaccurate information

ID band absent or not

applicable

Allergy band present,

accurate information

Allergy band present,

inaccurate information

Allergy band absent or

not applicable

Alterations in appearance (moulage):

2. Initial Vital Signs Monitor display in simulation action room:

(Should be appropriate for the scenario setting)

No monitor

display

Monitor on, but no

data displayed

Monitor on,

standard display

BP: HR: RR: T: SpO2:

CVP: PAS: PAD: PCWP: CO:

AIRWAY:

FHR:

Lungs:

Sounds/mechanicsLeft: Right:

Heart:

Sounds:

ECG rhythm:

Other:

Bowel sounds: Other:

3. Intravenous lines - INITIAL manikin set up

Saline

lock #1

Site

:

IV patent

(Y/N)

IV #1 Site

:

Fluid

type:

Initial

rate:

IV patent

(Y/N)Main

Piggyback

IV #2Site

:

Fluid

type:

Initial

rate:

IV patent

(Y/N)Main

Piggyback

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4. Non-invasive monitors INITIAL manikin set up–

NIBPECG

First lead:

ECG

Second lead:

Pulse oximeter Temp monitor/type

5. Hemodynamic monitors- INITIAL manikin set up

A-line

Site:

Catheter/tubing

Patency (Y/N)

CVP

Site:

PAC

Site:

6. Other monitors/devices

Foley catheter

Amount in

drainage

bag:

Appearance

of urine:

Epidural catheterInfusion pump

Pump settings:

Fetal Heart rate

monitor/tocometerInternal External

7. Digital images of initial manikin appearance

Insert digital photo of initial

manikin appearance here

Insert digital photo of initial

manikin appearance here

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F. Environment, Equipment, Essential props

Standardized set ups for equipment/supplies for each commonly simulated environment is recommended

1. Scenario setting

Medical-Surgical Unit Patient Room

Pediatric Unit Patient Room

Perinatal Unit Room

ICU Patient Room

PICU Patient Room

NICU Patient Room

ED Bay

Trauma Bay (ED)

Labor & Delivery Room

Labor & Delivery Operating Room

Operating Room

Home Health

Out-patient clinic

Pre-Hospital

Other:

2. Confederate placement - INITIAL scenario set up

RoleGeneral instructions (Initial placement and disposition)

Key actions to implement triggers for learner

3. Equipment, supplies, monitors

(In simulation action room or available in adjacent core storage rooms)

Bedpan/

Urinal

Foley catheter

insertion kit

Straight

catheter kit

Incentive

spirometer

IV Infusion

pumpFeeding pump Pressure bag

Wall suction

apparatus

Nasogastric

tube

ETT suction

catheters

Oral suction

catheters

Chest tube

insertion kit

DefibrillatorCode Cart 12-lead ECG

machine

Chest tube

drainage equip

PCA infusion

pump

Epidural

infusion pump

Central line

Insertion Kit

Dressing change

equipment

IV fluid

Type:

IV fluid

Type:

Tubes/drains

Type:

Blood product

ABO Type:

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4. Respiratory therapy equipment/devices

Nasal cannula Face tentSimple Face

MaskNon rebreather mask

BVM/Ambu bagNebulizer

treatment kit

Flowmeters

(extra supply)

5. Essential props/special effects

6. Documentation and Order Forms

H & P Consult reports Nurses notes

Admit Orders Vital Sign

recordTriage forms

Physician

ordersICU flowsheet Code Record

Progress notes

Medication

Administration

Record

Anesthesia/

PACU record

Laboratory

resultsGraphic record

Standing

(protocol)

orders

Medication

reconciliationActivity forms

Transfer

ordersShift assessment

Prenatal record

Actual medical record binder,

constructed per institutional

guidelines

Other

Describe:

7. Medications (to be available in sim action room)

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G. Case Flow / Triggers/ Scenario Development StatesInitiation of Scenario :

State Patient Status Desired learner actions & triggers to move to next state

1. Baseline Learner Actions:Operator:

Triggers:

Teaching Points:

State Patient Status Desired actions & triggers to move to next state

2.

Learner Actions:

Operator:

Triggers:Teaching Points:

3. Learner Actions:

Operator:

Triggers:Teaching Points:

- 69 -

State Patient Status Desired Actions & Triggers to move to next state

4. Learner Actions:

Operator:

Triggers

Teaching Points

Scenario End Point:

Suggestions to increase or decrease scenario complexity:

- 70 -

Section . PHYSICIAN ORDERSⅤ

Patient Name:

DOB:

Age:

MR#:

Diagnosis:

No Known Allergies llergies & Sensitivities

Date Time PHYSICIAN ORDER AND SIGNATURE

Signature

- 71 -

Addendum 1: Pre-scenario LEARNER checklist

Last name: First name:

SIMULATION SCENARIO INFORMATION

Date: Time: Location:

Course

Number

Course

title:

Educational Activity

IMMEDIATE PRE-BRIEFING LEARNER CHECKLIST

q Simulator/equipment/environment orientation completed

q Simulation participation consent signed

q Understands guidelines and expectations for scenario

q Has accomplished all pre-scenario requirements

q All participants understand assigned roles

q Has been given timeframe expectations

q Other

Signature

(Faculty/Facilitator)Print last name Date

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