Deanne Ross is a 62 year old female admitted to the progressive care unit today at 6 am with increased fatigue, lethargy, new confusion, and ESRD (CRF). Deanne has a long history of anemia, non-insulin dependent diabetes mellitus, HTN and chronic pyelonephritis resulting in permanent damage to her kidneys. She has a history of noncompliance with dialysis and with medications. She missed her last two appointments with her nephrologist. She currently has an AV fistula in her left forearm and has been receiving hemodialysis 3 days/week for the last year. Diagnostic test ordered for Deanne this admission include renal scan and ultrasound, CBC, BUN, serum creatinine, serum electrolytes, urinalysis, ABG, and glucose. Glucometer checks AC and HS, and a 12 lead ECG. Deanne’s weight has increased by 5lbs over the last couple of days. She has 4+ pitting edema noted in her lower extremities, fine crackles are present bilaterally in both lung field bases, and Deanne has a +JVD. Deanne lives with her 36-year-old daughter, Lynn. Her diet is No Concentrated Sweets and 1500 mL fluid restriction. She has NKA. Student nurses are expected to prioritize care for this complex patient. Students should recognize abnormal findings through assessment and intervene appropriately. Patient is pleasantly confused and can appear to understand her disease process and medication administration. Students are expected to use soft skills, communicate with the patient and direct questions to the daughter. If critical actions are not completed, the patient has worsening mental status with complete organ failure.
1. Explain the pathophysiology of multi-system failure processes through pre-simulation assignments.
2. Demonstrate critical thinking abilities through psychomotor skills for care of the complex patient.
3. Participate in assessment of the complex patient and correctly identify abnormalities noted.
4. Evaluate effectiveness of nursing interventions applied through simulation experience.
5. Reflects on simulation experience through discussion with peers and faculty after simulation concludes.
Internal medicine, Nephrology