Vsim - Edited Clinical Worksheets

CONCEPT MAP WORKSHEET
DESCRIBE DISEASE PROCESS AFFECTING PATIENT

(INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS)
Most common fall-related injury resulting in being hosptilizied which is a leading cause of disability among
older adults. Bone fracture, the periosteum an blood vessels in the marrow, cortex, and surrounding soft
tissues are disrupted resulting in bleeding from the damaged ends of the bone and the neighboring tissue.
Clot formation occurs and bone tissue immediately adjacent to the fracture dies causing an inflammatory
response where the vascular tissue increases blood flow to the entire bone. Bone-forming cells in the
periosteum, endosteum, and marrow are activated to produce subperiosteal procallus along the outer surface
of the shaft and over the broken ends of the bone. Collagen and matrix, which become mineralized to form
callus, are synthesized by osteoblasts within the procallus. During the repair process, remodeling occurs;
unnecessary callus is resorbed, and trabeculae form along stress lines. -XNew bone, not scar tissue, forms
over the healed fracture
DIAGNOSTIC TESTS PATIENT INFORMATION ANTICIPATED PHYSICAL FINDINGS
(REASON FOR TEST AND
RESULTS) Name: Edith Jacobson
Gender: F
X-ray shows location of fracture and Age: 85
is used to determine if surgical DOB: 09/20/1934 -Displacement of the extremity
intervention is necessary. WT: 47.6 kg - Limited or abnormal (ROM)
HT: 152 cm -Edema and discoloration
CT and MRI used to show Allergies: None -Inability to move or bear weight
abnormalities of complex fractures Adm On: 02/02/2021 on the affected leg
Bone scan can be used to reveal an

occult fracture.
ANTICIPATED NURSING INTERVENTIONS

Impaired physical mobility r/t right hip fracture AEB bed rest
Asculate bowel sound and monitor elimination habits
Passive range of motion exercises
Antiembolism stocking application, knee-length Antiembolism stocking application, knee-length
Fall management Fall management
Fall prevention Fall prevention
Body mechanics Body mechanics
vSim ISBAR ACTIVITY STUDENT WORKSHEET
INTRODUCTION My name is Tedra Floyd and I am a RN working on the Orthopedic

Your name, position (RN), unit you are unti 1555.
working on
SITUATION
My patients name is EJ and she is 85-years-old. She is being
Patient’s name, age, speciﬁc reason for visit admitted because of fall fracturing her hip.
BACKGROUND EJ has a 10-year history of osteoporosis.

Patient’s primary diagnosis, date of
admission, current orders for patient
ASSESSMENT EJ vital signs are stable

Current pertinent assessment data using head
to toe approach, pertinent diagnostics, vital
signs
RECOMMENDATION
You will need to reposition Mrs. Jacobson as she needs to be
Any orders or recommendations you may have turned every 2 hours. You should perform a focused
for this patient musculoskeletal assessment, reinforce safety, and provide
patient education on fall risk. Assess her pain level and medicate
for pain if needed.
PATIENT EDUCATION WORKSHEET
NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE
MEDICATION: raloxifene hydrochloride
CLASSIFICATION:
selective estrogen receptor modulators-SERMs.
PROTOTYPE:
Tamoxifen
SAFE DOSE OR DOSE RANGE, SAFE ROUTE

60 mg PO once daily
PURPOSE FOR TAKING THIS MEDICATION

To prevent or treat osteoporosis; to reduce risk of invasive breast cancer in postmenopausal women with
osteoporosis and postmenopausal women at high risk for invasive breast cancer
PATIENT EDUCATION WHILE TAKING THIS MEDICATION

Contact physician immediately if unexplained calf pain or tenderness occurs.
Avoid prolonged restriction of movement during travel.
Drug does not prevent and may induce hot flashes.
Do not take drug with other estrogen-containing drugs.
Tell prescriber if you are taking drugs to lower your cholesterol.
Do not breast feed while taking this drug.
MEDICATION: morphine sulfate-naltrexone hydrochloride
CLASSIFICATION:
narcotic analgesic
PROTOTYPE:
Embeda or Roxanol

10 to 30 mg every 4 hours or as directed by physician by mouth

Used to treat moderate to severe pain when around-the-clock pain relief is needed for a long time period.
Naltrexone is included in this medication to prevent the misuse of the narcotic ingredient.

DoRecognize the signs and symptoms of a possible opioid overdose. These include slowed, shallow, or difficult
breathing, severe sleepiness, or not being able to respond or wake up. If you know or think someone is
overdosing, give the person naloxone if you have access to it, and always call 911 or go to an emergency room
right away. Naloxone is a temporary treatment, so repeat doses may be required. Even if you give naloxone, you
still need to get emergency medical help right away.
MEDICATION: Docusate sodium
CLASSIFICATION:
- Legal: pharmacy, Functional: laxative, Chemical: anionic surfactant.
PROTOTYPE:
Dioctyl, Docusol, Flectcher’s enemette

- Increases water penetration to soften stools for easier passage.

- Onset of action generally 1-2 days after oral administration, 5-20 minutes after enema.
- Swallow tablets whole, do not chew them.
- Health education: other possible means of avoiding constipation.
- Inform that normal bowel movements do not always occur daily.
- Do not use in the presence of abdominal pain, nausea, vomiting.
-Notify clinician if constipation is unrelieved or symptoms of electrolyte imbalance occur (muscle cramps, pain,
weakness, dizziness).
- If diarrhoea occurs, discontinue use.
MEDICATION:
CLASSIFICATION:
PROTOTYPE:

Clinical Worksheet
Date: 02/02/2021 Student Name: Tedra Floyd Assigned vSim: Edith Jacobson
Initials: Diagnosis: HCP: Isolation: IV Type: Critical Labs: Other Services:
EF Location:
Hip fracture n/a n/a Complete blood
Age:
85 RIGHT HAND count/Chemistry
Fall Risk:
M/F: Length of Stay: Consults: Fluid/Rate: panel/Coagulation Consults Needed:
F Yes
screening/Blood
TBA n/a Lactated ringer’s No consult/orthpedic
Code Status: Transfer: type and screening
solution at 84 might be needed in
Allergies: n/a
Full code mL/hr IV the future
N/S
Why is your patient in the hospital (Answer in your own words and include the History of present Illness)?:
EJ is admitted to the hospital due to falling and fracturing her hip. She has a 10 year history of osteoporosis which causes brittle bones.
Health History/Comorbities (that relate to this hospitalization):

-Osteoporosis
-Dizziness
Shift Goals/ Patient Education Needs:

1. Pain management/ educate patient on pain precautions
2. Skin assessments/ educate patient on why we do skin assessments and the importance
3. Repostion client every 2 hours/ educate patient on positioning to avoid ulcers
4. Check patient vitals every 2 hours/ educate patient on why it is important to know vitals to be alert for any changes in body
Path to Discharge:
Path to Death or Injury:

Alerts:
What are you on alert for with this patient? (Signs & Symptoms) Management of Care: What needs to be done for this Patient Today?
1. Falling 1. Skin assessment
2. Skin issues 2. Neurological assessment
3. 3. Respiratory assessment
pain
4. Pain managment
What Assessments will focus on for this patient?
(How will I identify the above signs &Symptoms?) 5. Vital signs
Keep call light within reach 6. Repostion

1.
2. Check patient every 2 hours/repostion Priorities for Managing the Patient’s Care Today
1.
Vital signs
3.
Ask questions about pain level on scale 1-10 2. Skin assessments
3. Pain managment
List Complications may occur related to dx, procedure, comorbidities:
4. Repostion every 2 hours
Broken bones/fall
1.
2. Pressure Ulcers
What aspects of the patient care can be Delegated and who can do it?
3.
Death Thing such as ADL can be delegated to the UAP/CNA
What nursing or medical interventions may prevent the above Alert or complications?
Repostion client every 2 hours

1.
Cheking vitals
2.
3. Give pain medication when needed
4. Call light is within reach

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What is causing the patient's hip fracture?

What is causing the patient's hip fracture?

What are the anticipated physical findings for this patient?

What are the anticipated physical findings for this patient?

CONCEPT MAP WORKSHEET

DESCRIBE DISEASE PROCESS AFFECTING PATIENT

Bone scan can be used to reveal an

ANTICIPATED NURSING INTERVENTIONS

INTRODUCTION My name is Tedra Floyd and I am a RN working on the Orthopedic

BACKGROUND EJ has a 10-year history of osteoporosis.

ASSESSMENT EJ vital signs are stable

MEDICATION: raloxifene hydrochloride

SAFE DOSE OR DOSE RANGE, SAFE ROUTE

PURPOSE FOR TAKING THIS MEDICATION

PATIENT EDUCATION WHILE TAKING THIS MEDICATION

MEDICATION: morphine sulfate-naltrexone hydrochloride

SAFE DOSE OR DOSE RANGE, SAFE ROUTE

PURPOSE FOR TAKING THIS MEDICATION

PATIENT EDUCATION WHILE TAKING THIS MEDICATION

MEDICATION: Docusate sodium

SAFE DOSE OR DOSE RANGE, SAFE ROUTE

PURPOSE FOR TAKING THIS MEDICATION

PATIENT EDUCATION WHILE TAKING THIS MEDICATION

SAFE DOSE OR DOSE RANGE, SAFE ROUTE

PURPOSE FOR TAKING THIS MEDICATION

PATIENT EDUCATION WHILE TAKING THIS MEDICATION

Health History/Comorbities (that relate to this hospitalization):

Shift Goals/ Patient Education Needs:

3. Repostion client every 2 hours/ educate patient on positioning to avoid ulcers

Path to Death or Injury:

1. Falling 1. Skin assessment

2. Skin issues 2. Neurological assessment

Keep call light within reach 6. Repostion

Repostion client every 2 hours

3. Give pain medication when needed

4. Call light is within reach

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