learner skill validation

Skill ValidationPNCI® - Learner

1Program for Nursing Curriculum Integration (PNCI®)© 2012 CAE Healthcare, Sarasota, FL v.5

BackgroundPatient History

Past Medical History: Although the patient is Hispanic, she can speak English and provides her history to the nurse. She reports that one week ago she was in the hospital for a femoral-popliteal bypass graft that was performed on her right leg. She noted some drainage coming from her incision and thought she would have it checked out. She has a history of diabetes, for which she takes insulin. She took her insulin this morning at home just before she ate breakfast. On the way to the hospital, she tripped on a curb and hurt her left ankle. She is asking if she can soak her foot in hot water to make it feel better. She is also very anxious and concerned about not being able to care for herself when she returns home.

Allergies: No known drug allergies

Medications: NPH insulin 30 units SUBCUT every AM

Code Status: Full code

Social/Family History: Daughter lives near patient and can assist with care

Handoff Report

Situation:The patient is an 86-year-old Hispanic female who was admitted to the Medical-Surgical Unit with a non-healing wound on her upper right leg where a femoral-popliteal bypass graft was performed four days ago.

Background:Patient has a history of diabetes for which she takes insulin. The patient also suffered an injury to her left ankle when she tripped on a curb on the way to the hospital today.

Eliana RuizAge: 86

Weight: 55 kg

Location: Medical-Surgical Unit



Handoff Report Continued

Assessment:Vital signs: HR 88, BP 145/80, RR 28, SpO2 95% on room air and temperature 38.6CGeneral appearance: Anxious and concerned about not being able to care for herself when she returns homeCardiovascular: Sinus rhythm. Pedal pulses 2+ bilaterallyRespiratory: Breath sounds with crackles bilaterally. Non-productive coughGI: Normoactive bowel sounds. Had a bowel movement last eveningGU: Incontinent of urineExtremities: Swelling and bruising noted on left ankle. Draining wound on right upper leg at femoral-popliteal bypass graft site Skin: Pink and slightly moistNeurological: Alert and oriented to person, place and time. Pupils equal, round and reactive to light and accommodation. No neurological deficitsIVs: NoneLabs: Blood glucose to be checked before meals and at bedtimeFall Risk: High risk for fallsPain: Complaining of pain to right leg graft site and of tenderness over left ankle

Recommendations:Implement admission orders and monitor for instability. Notify healthcare provider of abnormal assessment findings.

Orders

Initial Healthcare Provider’s OrdersAdmit to Medical-Surgical UnitDiagnosis: Non-healing right femoral-popliteal bypass graftFull codeDiet 1200 calorie ADAUp with assist three times a dayVital signs every 4 hoursNotify healthcare provider if BP greater than 180/100, HR greater than 100, RR greater than 30 or temp greater than 38.3CPulse oximetry every shiftRespiratory therapy to induce sputum collection for culture and sensitivityCheck blood glucose AC and at bedtimeNPH insulin 30 units SUBCUT every AMSliding scale insulin AC and at bedtime: Less than 50 – Administer 1 amp of Dextrose 50% and notify healthcare provider 50 – 70 - Administer 15 g of simple carbohydrates (6 ounces of orange juice or skim milk) and repeat the blood glucose in 15 minutes. Notify the healthcare provider. 151-200 – 2 units Regular SUBCUT 201-250 – 4 units Regular SUBCUT



Orders Continued

251-300 – 6 units Regular SUBCUT 301-350 – 8 units Regular SUBCUT 351-399 – 10 units Regular SUBCUT 400 or Greater – Notify healthcare providerCefTRIAXone 750 mg IM every 24 hours, first dose after sputum culture has been completedAcetaminophen 650 mg PR every 4 hours prn mild pain or fever above 38CMorphine 4 mg PO or IM every three hours prn prior to dressing change and prn every four hours for severe painSTAT Chest x-rayChange dressing every 24 hours to right leg bypass graft site using sterile wet-to-moist technique with normal salineInsert urinary catheter for incontinenceIncentive spirometry every hour while awake



PreparationLearning Objectives

Relates the significance of the patient’s symptoms and assessment findings (APPLYING)•Utilizes appropriate techniques to reconstitute an antibiotic, mix insulin and administer •intramuscular and subcutaneous medications (APPLYING)Demonstrates insertion, care and removal of a urinary catheter (APPLYING)•Demonstrates a sterile wet-to-moist dressing change (APPLYING)•Assesses and interprets pain appropriately and administers medication correctly •(UNDERSTANDING)Records assessment findings, procedures and patient outcomes accurately (REMEMBERING)•Utilizes appropriate teaching strategies regarding diabetic foot care to an elderly, Hispanic, lower •socioeconomic patient (APPLYING)Communicates appropriate patient information to the healthcare provider (APPLYING)•Utilizes therapeutic communication techniques when communicating with the patient (APPLYING)•Analyzes treatment modalities and evaluates patient outcomes to those treatments (ANALYZING)•

Recommended eDose modules for learners to complete before the SCE:Medication Dosage Calculation Skills

X Medication Orders & S. I. Units Tablets & Capsules Liquid MedicinesX Injections I.V. Infusions

Injectable Medicines Therapy Slow I.V. Injections Intermittent Infusions Continuous Infusions

Pediatrics

This SCE addresses the following QSEN Competencies: X Patient-Centered CareX Teamwork and CollaborationX Evidence-Based PracticeX Quality ImprovementX Safety Informatics



Preparation Questions

What is a femoral-popliteal bypass? Describe possible postoperative complications.•What is the correct technique for the insertion, care and removal of a urinary catheter?•What is the correct technique for administering a reconstituted intramuscular medication?•What is the correct technique for mixing and administering insulin?•What are the signs and symptoms of hyperglycemia and hypoglycemia? How would each be •treated?What are the principles of sterile technique?•What is the procedure for performing a wet-to-moist sterile dressing change?•What would be appropriate teaching strategies for an elderly, Hispanic patient regarding diabetic •foot care?What therapeutic communication techniques would be appropriate for a patient who is anxious?•What is an incentive spirometer and how is it used?•

References

Ackley, B.J., & Ladwig, G.B. (2010). Nursing diagnosis handbook: An evidence-based guide to planning care (9th ed.). St. Louis, MO: Elsevier Mosby.

Berman, A., Snyder, S.J., & McKinney, D.S. (2011). Nursing basics for clinical practice. Upper Saddle River, NJ: Pearson.

Carstens, J. (2010). Injection (subcutaneous): Clinician information. Evidence summaries – Joanna Briggs Institute, (1 pp.). Retrieved May 26, 2011, from Evidence-Based Resources from the Joanna Briggs Institute. (Document ID: 2002789181).

Carstens, J. (2010). Injection (intramuscular): Clinician information. Evidence Summaries – Joanna Briggs Institute, (1 pp.). Retrieved May 26, 2011, from Evidence-Based Resources from the Joanna Briggs Institute. (Document ID: 2002789171).

Cocoman, A., & Murray, J. (2010). Recognizing the evidence and changing practice on injection sites. British Journal of Nursing, 19(18), 1170-1174.

Forehand, M. (2010). Bloom’s taxonomy. Emerging perspectives on learning, teaching, and technology. Department of Educational Psychology and Instructional Technology, University of Georgia. Retrieved from http://projects.coe.uga.edu/epltt/index.php?title=Bloom%27s_Taxonomy

Giger, J.N., & Davidhizar, R.E. (2007). Transcultural nursing: Assessment and intervention (5th ed.). St. Louis, MO: Mosby.

Jayasekara, R. (2009). Medication (oral): Administration & storage. Evidence Summaries – Joanna Briggs Institute (1 pp.). Retrieved June 6, 2011, from Evidence-Based Resources from the Joanna Briggs Institute. (Document IDF: 1737369641).



References Continued

Johnson-Russell, J. (2010). Facilitated debriefing. In W.M. Nehring & F.R. Lashely (Eds.), High fidelity patient simulation in nursing education, 369-385. Sudbury, MA: Jones and Bartlett.

Kesten, K. (2011). Role-play using SBAR technique to improve observed communication skills in senior nursing students. Journal of Nursing Education, 50(2), 79-87. Retrieved June 6, 2011, from ProQuest Nursing & Allied Health Source. (Document ID: 2246889791).

Lockwood, C., Conroy-Hiller, T., & Page, T. (2004). Vital signs. International Journal of Evidence Based Healthcare, 2(6), 207-230. doi:10.1111/j.1479-6988.2004.00012.x

Lynn, P. (2011). Taylor’s clinical nursing skills: A nursing process approach (3rd ed.). Philadelphia, PA: Kluwer/Lippincott.

Melnyk, B.M., & Fineout-Overholt, E. (2010). Evidence-based practice in nursing & healthcare: A guide to best practice (2nd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

National Council of State Boards of Nursing. (2010). 2010 NCLEX-RN test plan. Retrieved from https://www.ncsbn.org/2010_NCLEX_RN_Testplan.pdf

Quality and Safety Education for Nurses. (2011). Quality and safety competencies. Retrieved from http://www.qsen.org/competencies.php

Rathnayake, T. (2009). Ankle sprain (acute): Treatment. Evidence Summaries – Joanna Briggs Institute, (1 pp.). Retrieved, from Evidence-Based Resources from the Joanna Briggs Institute.

Smeltzer, S.C., Bare, B.G., Hinkle, J.L., & Cheever, K.H. (2009). Brunner and Suddarth’s Textbook of Medical Surgical Nursing (12th ed.). Philadelphia, PA: Kluwer/Lippincott.

Stomski, N. (2009). Urethral catheterization. Evidence Summaries – Joanna Briggs Institute, (1 pp). Retrieved May 20, 2011, from Evidence-Based Resources from the Joanna Briggs Institute. (Document ID: 1939267051).

Stomski, N. (2009). Urinary tract infection (catheter-related): Prevention. Evidence Summaries – Joanna Briggs Institute, (1 pp.). Retrieved May 20, 2011, from Evidence-Based Resources from the Joanna Briggs Institute. (Document ID: 1939267071).

Stomski, N. (2009). Urinary catheter: Removal. Evidence Summaries – Joanna Briggs Institute, (1 pp.). Retrieved May 20, 2011, from Evidence-Based Resources from the Joanna Briggs Institute. (Document ID: 1939267031).

Taylor, C., Lillis, C., LeMone, P., & Lynn, P. (2011). Fundamentals of nursing: The art and science of nursing care (7th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.



References Continued

The Joint Commission. (2011). National patient safety goals. Retrieved from http://www.jointcommission.org/ standards_information/npsgs.aspx

Weber, J., & Kelley, J. (2007). Health assessment in nursing (3rd ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Wynaden, D., Landsborough, I., McGowan, S., Baigmohamad, Z., Finn, M., & Pennebaker, D. (2006). Best practice guidelines for the administration of intramuscular injections in the mental health setting. International Journal of Mental Health Nursing, 15, 195-200. doi:10.1111/j.1447-0349.2006.00423.x

Authors

Nancy McMenamy and Judy Johnson-Russell, Texas Woman’s University - Dallas, TX. Reviewed by Nancy McMenamy, Texas Woman’s University - Dallas, TX and Christie Schrotberger, Diane Mathe, Lynde Rabine, Gwen Leigh and Donna Walls, CAE Healthcare - Sarasota, FL, 2012

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