PURPOSE:

The following information is to be used in guiding your preparation and participation in the virtual simulation scenario for this course. This document will provide applicable course outcomes in preparation for your simulation.

SCENARIO OVERVIEW:

Mateo Sanchez (he/him/his) is a client who has been brought to the emergency room at Chamberlain Pediatric Hospital.  The mother reports fever, a loss of appetite, and is less playful over the past 48 hours. 

LEARNER OBJECTIVES:

1. Utilize clinical reasoning skills to perform a health history and physical assessment on a pediatric client. (COs 1, 2, 3,4,6, and 7)
2. Construct a plan of care based by prioritizing assessment findings and nursing diagnoses (COs 1,2,3,4,6, and 7)
3. Evaluate patient outcomes to determine the effectiveness of nursing interventions and need for ongoing care (Cos 1,2,4, and 7,)
4. Communicate and collaborate with the pediatric client, family, and interdisciplinary healthcare team members (Cos 2 and 3) 

STUDENT ROLES DURING SIMULATION:

You are the staff nurse at the hospital who will be conducting a comprehensive physical assessment, interpreting labs, and applying clinical judgment in your nursing plan of care. After completing your assessment, you are expected to document your findings as a Nurse’s Note in SBAR format.

KEY FEATURES OF i-HUMAN PATIENTS®:

• As the nurse, you are expected to complete the case scenario using the following tabs: EHR, History, Physical, Analyze, Actions, Nursing Notes, Summary
• There are required questions and/or additional information provided related to this case. The questions, information, and videos must be completed/reviewed prior to progressing to the next tab.
• Nursing Notes: At the end of the simulation, you will document your assessment findings using ISBAR.

CONFIDENTIALITY:

To preserve the educational value, integrity, and safety of the learning environment, you agree to maintain strict confidentiality about the proceedings of the simulation session, details of the training scenarios, and the performance of all participants. You acknowledge that this expectation aligns with the guidelines related to the Health Insurance Portability and Accountability Act (HIPAA) as well as laws governing Protected Health Information (PHI) in client care environments.  You will not view, discuss, share, record, or disclose any confidential information pertaining to the session. You understand that lapses in confidentiality are considered academic misconduct and could result in dismissal from the academic program.

 FICTION AGREEMENT:

You will suspend judgment of realism for any given simulation in exchange for the promise of learning new knowledge and skills. This process will require you to treat the simulated patient as a real patient with a genuine desire to learn, even when it may be difficult to do so.

DUE DATE:

The virtual simulation must be completed during Week 6.

SIMULATION TIMING:

• Pre-brief: 30 minutes
• Run Time: 2.5 hours
• Debriefing: 60 minutes

ASSESSMENT & EVALUATION

Faculty will utilize your participation measurements in the i-Human Patients® case, and debriefing discussions to identify areas of opportunity for enhancement of your clinical growth. Your experiences in i-Human Patients® will contribute to your overall completion of clinical requirements for the course as documented on the Clinical Learning Evaluation tool.

i-Human Patients® Evaluation – What does my total score mean?

  REVIEW AND COMPLETE PRIOR TO THE START OF THE VIRTUAL SIMULATION:

In order to prepare for the simulation, you are required to complete the pre-simulation questions below and submit this prework to the faculty via uploading your responses in Canvas prior to the start of the virtual simulation. If you do not complete the pre-simulation questions and upload them, you will not be able to access or participate in the simulation.

1. Describe the expected assessment findings in a pediatric client with meningitis.
2. Describe the key nursing interventions for a patient experiencing an active seizure.
3. Discuss the actions, side effects, contraindications, and nursing considerations of the following medications:

• Ceftriaxone
• Vancomycin hydrochloride
• Diazepam

4. Discuss informed consent and the best method for obtaining informed consent from parents who do not speak English as their primary language.

1. Compare and contrast the adult Glasgow coma scale and the pediatric Glasgow coma scale.

COMPLETE AFTER THE VIRTUAL SIMULATION:

To finalize your clinical learning experience, you will need to complete the following steps:

• Immediately following the completion of the virtual simulation, you will complete the evaluation of the simulation using the survey link provided.
• After completing the i-Human Patients® case, you will need to download the i-Human Patients® PDF Performance Evaluation and upload it to the Weekly Clinical Learning Assignment in the week the case is assigned.
• Document your clinical learning experience after completion, you are required to document on a Clinical Learning Evaluation (CLE), your performance rating and the specific simulation performed within the formative comments.

Pre-Simulation Questions:

1. Expected assessment findings in a pediatric client with meningitis include:
   • Fever
   • Headache
   • Stiff neck (nuchal rigidity)
   • Photophobia
   • Altered mental status
   • Irritability
   • Poor feeding or decreased appetite
   • Vomiting
   • Seizures
   • Bulging fontanelle (in infants)
2. Key nursing interventions for a patient experiencing an active seizure include:
   • Ensuring patient safety by removing harmful objects from the vicinity
   • Protecting the patient’s head from injury, such as by placing a soft object under their head
   • Positioning the patient on their side to prevent aspiration of secretions
   • Maintaining a patent airway
   • Administering antiepileptic medications as prescribed
   • Monitoring vital signs
   • Documenting the onset, duration, and characteristics of the seizure activity
3. Actions, side effects, contraindications, and nursing considerations of the following medications:
   • Ceftriaxone:
     • Actions: It is a broad-spectrum antibiotic effective against many gram-positive and gram-negative bacteria.
     • Side effects: Diarrhea, nausea, vomiting, rash, and allergic reactions.
     • Contraindications: Hypersensitivity to cephalosporins or penicillins.
     • Nursing considerations: Monitor for signs of allergic reactions. Assess renal and hepatic function regularly.
   • Vancomycin hydrochloride:
     • Actions: It is a glycopeptide antibiotic effective against gram-positive bacteria, particularly methicillin-resistant Staphylococcus aureus (MRSA).
     • Side effects: Nephrotoxicity, ototoxicity, red man syndrome, and thrombophlebitis.
     • Contraindications: Hypersensitivity to vancomycin.
     • Nursing considerations: Monitor renal function and hearing status. Administer slowly to reduce the risk of red man syndrome. Rotate injection sites to minimize the risk of thrombophlebitis.
   • Diazepam:
     • Actions: It is a benzodiazepine used as an anticonvulsant and anxiolytic.
     • Side effects: Drowsiness, dizziness, respiratory depression, hypotension, and paradoxical reactions.
     • Contraindications: Hypersensitivity to benzodiazepines, respiratory depression, and acute narrow-angle glaucoma.
     • Nursing considerations: Monitor respiratory status and blood pressure. Administer with caution in patients with impaired hepatic or renal function. Avoid abrupt discontinuation to prevent withdrawal symptoms.
4. Informed consent and the best method for obtaining informed consent from parents who do not speak English as their primary language:
   • Informed consent involves ensuring that the patient or their legal guardian understands the risks, benefits, and alternatives to a proposed treatment or procedure before giving consent.
   • The best method for obtaining informed consent from parents who do not speak English as their primary language is to use a qualified medical interpreter proficient in both English and the parents’ native language. This ensures accurate communication and comprehension of medical information. Written materials in the parents’ language should also be provided whenever possible.
5. Comparison of the adult Glasgow Coma Scale (GCS) and the pediatric Glasgow Coma Scale (PGCS):
   • The adult GCS assesses eye opening, verbal response, and motor response, with scores ranging from 3 to 15.
   • The PGCS is modified for use in pediatric patients and includes eye opening, verbal response, and motor response, with scores ranging from 3 to 15.
   • However, the components and scoring criteria are adjusted to be age-appropriate for pediatric patients. For example, verbal response is modified based on developmental milestones, and motor response may include different age-appropriate movements.
   • Both scales are used to assess level of consciousness and neurological status in patients with traumatic brain injury, stroke, or altered mental status.