SIM Lab

SIM Lab ( NT 3 ) Location: Medical-Surgical Ward History/Information: The patient is a 68-year-old male who was admitted the previous night with reported history of syncopal episodes. He had two syncopal episodes the day of his admission (unwitnessed by medical personnel but reported by patient’s wife). Upon admission to the Emergency Department he was found to be in a normal sinus rhythm with HR 80 and asymptomatic. His 12 lead ECG was normal as well as his cardiac enzymes. He is also a known Type II diabetic controlled with an oral hypoglycaemic agent. His blood sugar (BS) upon admission was 11 and his wife reports she checked his BS with each syncopal episode and it was greater than 9. He has hypertension controlled with ace inhibitor, hypercholesterolaemia (diet controlled, recently started atorvastatin), and gastroesophageal refl ux disease (GERD). He has no known allergies. The patient has been married for 45 years and his wife was present upon admission. She went home for the night and planned to return in the AM to take him home. She is anxious about his symptoms and admission. They have three sons who all live away, although they call regularly and frequently come home to visit. The patient is a devout Catholic. He plays golf for exercise and likes to have two martinis every evening to relax. He was admitted for observation. He was placed on telemetry and had an IV cannula inserted into his right hand. During his admission he did have two episodes of controlled atrial fi brillation with no symptoms or syncope. These were self-limiting, lasting only two to three minutes each. The night was otherwise uneventful. You are the day shift nurse and just received handover from the night shift staff. You go into the patient’s room to meet him and perform your assessment. Healthcare Provider’s Orders: Admit to Medical-Surgical Ward for 24-hour observation Telemetry Up as required Vital signs every four hours Diabetic, low cholesterol diet IV cannula, fl ush every shift Medications as at home: Metformin 500mg PO twice per day Omeprazole 40mg PO every AM Atorvastatin 10mg PO every day Enalapril 20mg PO once a day Start enteric coated aspirin 300mg PO every day Atenolol 25mg PO every day Labs: FBC, Electrolytes, Urea, Creatinine, Glucose, Troponin, Haemoglobin A1C, AST/SGOT, LDH, Cholesterol, Triglycerides, LDL, HDL, PTT CPK with isoenzymes every 8 hours x3 12 lead ECG for chest pain and notify healthcare provider Chest x-ray posterior and anterior/lateral Plan for discharge in AM and follow-up with primary healthcare provider in 2 weeks Learning Objectives: Defines brain attack pathology (KNOWLEDGE). Analyses the event history and assessment findings in a patient with brain attack symptoms (ANALYSIS). Performs a focused neurological assessment on a patient with brain attack symptoms (APPLICATION). Anticipates diagnostic orders and therapies, including medications, for the patient with an acute brain attack (COMPREHENSION). Prioritizes the implementation and approach to caring for a patient with an acute brain attack (ANALYSIS). Safely administers thrombolytic therapy (APPLICATION). Evaluates the patient’s response to nursing interventions for the brain attack and acutely hypertensive patient (EVALUATION). Analyses situation and determines appropriate delegation duties (ANALYSIS). Differentiate between the following terms. 1 What does each term mean and what are the differences between them? When are each used? Brain attack Cerebral vascular accident (CVA) Stroke 2. Identify the various lobes of the brain and their function. 3. Discuss the risk factors for brain attack (stroke) and related measures for stroke prevention. 4. What cardiac rhythm predisposes the patient to stroke and why? 5. Discuss the following labs: Urea and Electrolytes, Liver functions, Cardiac enzymes, Full blood count, Coagulation labs (PTT, INR), Lipid profi le (Cholesterol, LDL, HDL and Triglycerides) and their indications for the person having a brain attack. 6. Describe the pathophysiology of ischaemic and haemorrhagic brain attack (stroke). 7. What are the various causes of ischaemic and haemorrhagic brain attacks (strokes)? 8. Practice performing and documenting a neurological exam. This should include assessment of level of consciousness, cranial nerves, motor, sensory, coordination, gait and refl exes(babinski). 9. Review the National Institute of Health Stroke Scale (NIHSS) www.strokecenter.org/trials/scales/nihss.html and discuss when its use is indicated. 10. What role does blood pressure play in the stroke victim? 11. Describe dysphagia and the potential complications that can occur in the stroke patient. 12. What symptoms will a stroke patient exhibit who has “neglect”? 13. Discuss the administration of thrombolytic therapy with the drug alteplase recombinant. Address the following questions: What is this drug? Who is a candidate for this and who is not? What is the time frame for receiving this drug? How is it given? What is the nursing management of the patient receiving thrombolytics? What potential side effects can occur with use of thrombolytics?