Section VI: Scenario Progression Scenario States, Modifiers and Triggers Patient State Patient Status Learner Actions, Modifiers & Triggers to Move to Next State 1. Baseline State Patient Learner Actions Modifiers Patient initially confused and - Patient reassurance Changes to patient condition based on learner action refusing vital signs slightly - Check vitals - Patient allows vitals to be taken to be taken but will agitated. - Cap sugar (6.4mmol/L) when reassurance provided allow if - Attempt history targeted to - Confederate nurse to offer appropriately presenting complaint reassurance and take vitals if not approached. - Request family done by sim participants Rhythm: sinus member/collateral history rhythm Triggers HR: 86/min For progression to next state BP: 150/70 - All actions completed or after 5 RR: 14/min mins 2. Worsening Confusion O2SAT: 95 % T: 37.3 oC 2. Worsening Patient Learner Actions Modifiers Confusion answers a - Collateral history - Patient allows IV access when No change in vital couple of - Verbal de-escalation distracted signs. questions then - Environmental management - Confederate nurse to prompt stops - Offer oral sedative for IV access if not volunteered interacting. - IV access with broad panel of Seems blood work drawn Triggers distracted. - IV/IM sedative - Outstanding de-escalation by team or sedative given 3. 3. De-escalation Patient asking Learner Actions Modifiers No change in vital about her - Make plans for further -Confederate nurse to prompt by signs mother and investigations – asking about patients disposition wants to go ECG/CXR/urine/CT head home, but more - Make plans for admission END CASE PRN settled and - Possible IV fluid. cooperative. Section VII: Supporting Documents, Laboratory Results, & Multimedia Laboratory Results
Scenario States, Modifiers and Triggers Patient State Patient Status Learner Actions, Modifiers & Triggers to Move to Next State 1. Baseline State Patient initially refusing vital signs to be taken but will allow if appropriately approached. Rhythm: sinus rhythm HR: 86/min BP: 150/70 RR: 14/min O2SAT: 95 % T: 37.3 oC Patient confused and slightly agitated. Learner Actions - Patient reassurance - Check vitals - Cap sugar (6.4mmol/L) - Attempt history targeted to presenting complaint - Request family member/collateral history Modifiers Changes to patient condition based on learner action - Patient allows vitals to be taken when reassurance provided - Confederate nurse to offer reassurance and take vitals if not done by sim participants Triggers For progression to next state - All actions completed or after 5 mins 2. Worsening Confusion 2. Worsening Confusion No change in vital signs. Patient answers a couple of questions then stops interacting. Seems distracted. Learner Actions - Collateral history - Verbal de-escalation - Environmental management - Offer oral sedative - IV access with broad panel of blood work drawn - IV/IM sedative Modifiers - Patient allows IV access when distracted - Confederate nurse to prompt for IV access if not volunteered Triggers - Outstanding de-escalation by team or sedative given 3. 3. De-escalation No change in vital signs Patient asking about her mother and wants to go home, but more settled and cooperative. Learner Actions - Make plans for further investigations – ECG/CXR/urine/CT head - Make plans for admission - Possible IV fluid. Modifiers -Confederate nurse to prompt by asking about patients disposition END CASE PRN Section VI: Scenario Progression Section VII: Supporting Documents, Laboratory Results, & Multimedia Laboratory Results
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