The document provides information for a simulation scenario involving a patient presenting with acute upper GI bleeding. A 60-year-old Chinese male accompanied by his wife presents to a free community clinic complaining of nausea, abdominal discomfort, and dark stools for several days. Initial assessment reveals elevated vital signs and abdominal tenderness. The patient then vomits bright red blood twice, becoming pale and weak with declining vital signs. Learners are expected to recognize signs of acute GI bleeding, provide supportive care, and arrange emergency transport. Debriefing questions assess learners' critical thinking and nursing care for this type of scenario.
Triage is the term derived from the French verb trier meaning to sort or to choose
It’s the process by which patients classified according to the type and urgency of their conditions to get the Right patient to the Right place at the
Right time with the
Right care provider
Triage is the term derived from the French verb trier meaning to sort or to choose
It’s the process by which patients classified according to the type and urgency of their conditions to get the Right patient to the Right place at the
Right time with the
Right care provider
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Perfecting the art of medical hypnosis as an alternative to traditional anesthesia, learnings from Sodexo's International Leaders' Survey, addressing the challenges and opportunities created by the multi-generational workforce in hospitals, improving transport services to increase efficiency, news around the world.
Approach to internship (mbbs in bangladesh perspective)Pritom Das
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
C H A P T E R 1
Clinical reasoning, evidencebased
practice, and symptom analysis
Basic health assessment involves the application of the practitioner’s knowledge and skills to identify and
distinguish normal from abnormal findings. Basic assessment often moves from a general survey of a body
system to specific observations or tests of function. Such an approach to assessment and clinical decision
making uses a deductive process of reasoning. For example, a specialist examining a patient with known
hyperthyroidism would conduct a physical examination to test for deep tendon reflexes. Brisk or hyperreflexic
reflexes would lead the practitioner to conclude that a hyperthyroid state is a likely cause of these findings. This
would greatly narrow the choices of diagnostic tests and treatment decisions.
Advanced assessment builds on basic health assessment yet is performed more often using an inductive or
inferential process, that is, moving from a specific physical finding or patient concern to a more general
diagnosis or possible diagnoses based on history, physical findings, and the results of laboratory and diagnostic
tests. The practitioner gathers further evidence and analyzes this evidence to arrive at a hypothesis that will lead
to a further narrowing of possibilities. This is known as the process of diagnostic reasoning.
Diagnostic reasoning
Diagnostic reasoning is a scientific process in which the practitioner suspects the cause of a patient’s symptoms
and signs based on previous knowledge. The practitioner gathers relevant information, selects necessary tests,
makes an accurate diagnosis, and recommends therapy. The difference between an average and an excellent
practitioner is the speed and focus used to arrive at the correct conclusion and initiate the best course of
evidencebased treatment with minimum harm, cost, inconvenience, and delay. This expertise of the
practitioner is acquired through knowledge and a skill set developed through experience in clinical practice.
Repeated practice with real cases helps to develop memory schemes for relating clinical problems and store
them in longterm memory.
By using diagnostic reasoning, the practitioner is able to accomplish the following:
• Determines and focuses on what needs to be asked, what data need to be obtained, and what needs to
be examined
• Performs examinations and diagnostic tests accurately
• Clusters all pertinent findings
• Analyzes and interprets the findings
• Develops a list of likely or differential diagnoses
The diagnostic process
The primary care context
The process of assessment in the primary care setting begins with the patient or caregiver stating a reason for
the visit or a chief concern. Most visits to primary care providers involve concerns or symptoms presented by
the patient, such as an earache, vomiting, or fatigue. The initial evidence is collected through a patient history.
Demographic information, such as gend ...
A health assessment is a plan of care that identifies the specific needs of a person and how those needs will be addressed by the healthcare system or skilled nursing facility. Health assessment is the evaluation of the health status by performing a physical exam after taking a health history.
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Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
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Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
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1.4 modern child centered education - mahatma gandhi-2.pptx
Integrated simulation
1. CORE CASE 1
Introduction:
In Simulation Laboratory, we are attempting to set the stage and integrate technology in
your learning experience Much time and effort is being spent on creating an environment
as real as possible, with electronic charts, equipment, and experiences as close to a true
clinical environment as possible, and have a simulator, we called ALEX (Adult Learning
Educational Experience), to respond like a true patient.
Our ALEX, patient simulator, can talk, breathe, have a heartbeat, bowel sounds, and can
have all physiologic functions vary depending on the patient’s age and condition.
Your roles are generally to follow the nursing process of assessment, diagnosis, planning,
intervening, and evaluation of care for a patient in a short time frame. Each scenario has a
patient introduction, contact with the patient, and then time to debrief about the care.
Core Case Scenario: Acute upper GI Bleed part 1
Estimated scenario time: 25 minutes
Debriefing time: 20 minutes
Lesson Overview:
The scenario takes place at a free community clinic. A team of 4 learners will be given a
patient presenting acute upper GI bleed symptoms. Learners will be expected to obtain
health information, perform relevant assessment, provide standard of care related to
patient safety and infection control, and communicate effectively.
Target learners:
Nursing students who have learned how to obtain health information, vital signs, and
perform basic physical examination.
Learning objectives:
1. Implements therapeutic communication
2. Implements patient safety measures
3. Identifies the primary nursing diagnosis
4. Demonstrates focus physical examination
5. Applies shared logical methods – making observations, inferences, and
predictions
Scenario learning objectives:
1. Demonstrates how to communicate and obtain health information from an ESL
patient.
2. Develops critical thinking to obtain relevant assessment information including
vital signs and patient medical history.
3. Demonstrates focus physical examination.
4. Recognizes signs and symptoms and predisposing factors of acute upper GI bleed.
5. Develops nursing diagnosis.
Complexity – Core Case to Complex Case:
This scenario will adapt to different levels of learners. The Core Case allows learners to
build confidence and practice basic nursing skills and identify signs/symptoms of an
acute upper GI bleed.
2. CORE CASE 2
The Complex Case is for learners who have learned to insert large-bore IV, nasogastric
drainage, and urinary catheter, obtain blood sample, and administer fluid bolus.
Suggestion for role assignment:
Mr. Wong (high-fidelity patient simulator), Mrs. Wong (student), RN (the primary
learner), and triage nurse (student), and a patient care assistant (student).
Required equipment:
Universal precaution equipment
Stethoscope
BP cuff
Thermometer
Pulse oxymetry
Trash can
Emesis basin
Tissues
Telephone
Signs for patient simulator describing facial expression during different phase of the
scenario
Technology resources:
High-fidelity patient simulator
Electronic medical record software
Accommodations
A student with disabilities may present validation of his/her disability and request
services by contacting the Student ADA Coordinator at (xxx) xxx-xxxx. It is the
student’s responsibility to request accommodations each semester/term. To request
academic accommodations, students are required to complete the application process
before or at the beginning of each term. Please refer to the university’s ADA
accommodations policy and procedure in your student handbook.
To accommodate students with disabilities, the role play assignment may be adjusted
subject to reasonable accommodation and/or assistive technology/devices such as
headphones/speaker and installing Dragon speech recognition software and/or MAGic ®
Screen Magnification software
Procedure:
1. Introduce Who is Who in the Simulation?
You will be assigned to a role during your experience at SON free clinic. The
following are the most common roles in the scenarios.
1. Charge Nurse
You are responsible for overall organization of safe, quality patient care delivery on
your unit. You are a resource to all staff members and are responsible for appropriate
staff assignments and delegation of duties. You are knowledgeable about all patients
on your unit including condition status, scheduled procedures, treatments and required
facility policy and procedure that may impact your decisions. You may serve as the
gate-keeper to facilitate communication and delivery of safe, efficient, and appropriate
3. CORE CASE 3
care. You provide leadership and guidance for the health care team members working
with you and you take care of your staff as well as your patients.
2. Primary and Collaborative Nurses
You are responsible for planning and overseeing implementation of safe, quality,
patient care for those patients assigned to you and the staff assigned to assist you in
that implementation. You communicate significant patient events and any related
issues to your charge nurse. You provide guidance and leadership to the health care
team members working with you in your assigned area.
3. Recorder/Observer
You are a primary care giver to an assigned group of patients, however you provide
assistance to other nurses when the situation arises. For the purpose of this sim lab,
you will primarily be responsible for recording patient event activities. You will chart
assessments, interventions, and outcomes on the appropriate documentation tool. You
will perform other duties as requested by the charge nurse or primary nurse.
4. Support Members
This is a versatile role, governed by the individual scenario. You may be a physician,
radiology technologist, respiratory therapist, nursing assistant, spouse, friend, lab
technician, nursing student, volunteer, EMT, whatever! Be prepared to “walk” in that
person’s shoes as you depict this role.
5. Special Guests
Although the preparation materials will script out the scenario, be prepared for
anything! You never know when a faculty member may make a special guest
appearance in a role you were not anticipating.
2. Introduce phase in simulation
Phase Activities
Framing NOS elements introduction: Shared methods – difference
among observation, inference, and prediction
Scenario introduction
Activating Shift report/patient report
Scenario progression (cues are provided if needed)
4. CORE CASE 4
Debriefing Guided reflection questions:
What were your primary nursing diagnoses in the scenario?
What nursing interventions did you use?
What outcomes did you measure?
Where is your patient in terms of these outcomes now?
What did you do well in the scenario?
If you were able to do this again, what would you do
differently?
Socratic questioning approach
1. What information including patient interview and physical
examination would you consider as subjective and objective
data?
2. How would you use the information you have gathered?
3. What do you use to make inferences and predictions?
4. How do inferences and predictions help in a clinical
situation?
3. Assign student roles
4. Discuss assessment method Lassater Clinical Judgment Rubric
5. Present the case scenario
Core Case Scenario
Initial presentation:
A middle aged male comes to a free community clinic accompanied by his wife.
He appears anxious and does not feel well. He says to the triage nurse that he’s been
nauseous for the past day or so, has an upset stomach, and darker colored stools for these
past few days.
Anticipated actions: Learners will obtain recent health history, vital signs, and perform
basic physical assessment pertaining to abdominal discomfort.
Patient’s information:
Mr. Wong, 60 years old, Chinese male, married, has been out of job for 6 months, and no
insurance. Previous occupation is a cook at Chinese restaurant. Primary language is
Mandarin. He reads, writes, and speaks simple English. His highest education is 3rd
grade. He has no siblings and no children. His weigh is 60 kg and is 165 cm tall.
He smokes 1 pack per day, is a social drinker, and is active but no regular exercise.
Patient’s recent health history:
Mr. Wong claims overall in good health with no significant health problems and fairly
active. He has not had travel history recently and has not eaten at any place unusual. He
confirmed feeling nauseated for couple days with occasional heartburn with spicy foods.
He slipped on some ice when shoveling snow recently and twisted his right knee, but he
feels a little bit better now. He can walk around fine.
He has no known allergy except for lactose intolerance.
Patient’s past medical history:
5. CORE CASE 5
No surgeries, his wife adds that he had chest pain a few months ago and the doctor placed
a stent in LCA. He also thinks he had an ulcer a couple years ago from stress.
He denies having hypertension, diabetes, and COPD.
He was diagnosed with hyperlipidemia a few years ago, but he has never taken any
medication for it.
Patient’s family history:
Father: CAD
Mother: DM type 2
Patient’s vital sign:
BP: 140/90 mmHg
HR: 90 bpm
RR: 24 rpm
Basic physical assessment:
Heart sound: regular clear no murmur
Lungs sound: clear no wheezes, no crackles
Abdomen: bowel sounds hyperactive in all 4 quadrants,
slightly tender to palpation in all quadrants
The rest of exam is normal
Progression 1:
Five minutes after the physical examination, Mr. Wong vomits a large amount of bright
red blood emesis, feels worse and is weak. He becomes pale and clammy. Both Mr. and
Mrs. Wong are very anxious.
Anticipated actions: Learners will have patient lie supine, recheck vital signs, and request
further staff assistance (call a physician). Learners will address patient and spouse
worries and demonstrate therapeutic communication.
Patient’s vital sign:
BP: 120/80 mmHg
HR: 120 bpm
RR: 24 rpm
Progression 2:
After five minutes, Mr. Wong still feels lightheaded, woozy and vomits another large
amount of bright red blood emesis. His vital signs are BP 100/60 mmHg, HR 130 bpm,
and RR 26 rpm.
Anticipated actions: Learners will arrange for ER transport and give a report to ER staff.
Scenario progression outline:
Approx.
Time
Monitor
Settings
Patient/Mannequin
Actions
Expected
Interventions
Cue/Prompt
5 min none looks anxious, introduce self, start Role member
6. CORE CASE 6
alert & oriented;
speech clear, soft
voice, & slow to
respond
interview, identify
a ESL patient &
low education
level; speak clear,
simple English at
slower pace
providing cue:
spouse
Cue: if the learner
fails to adjust
patient’s language
needs, the spouse
will request the
learner to repeat
the question
10 min Baseline:
BP 140/90, HR
90, RR 24,
T 37.5 Celsius
reg,clear,○m
clear,no
wheezes, no crackles
hyperactive,
tender
shows compliance
states tender to
abdomen palpation
wash hands, obtain
a set of VS,
perform focus
physical exam
Role member
providing cue:
spouse
Cue: if the learner
fails to perform
focus physical
exam, the spouse
will ask about the
sound of his
husband stomach
5 min After
vomiting:
BP 120/80, HR 120,
RR 24, T 38 Celsius
Vocal sound:
Vomiting
pale & clammy
lie patient supine,
recheck VS, call
for help, address
patient & spouse
worries
Role member
providing cue:
spouse
Cue: if the learner
fails to recheck
VS, the spouse
will ask how’s the
patient’s HR, BP,
RR
5 min After
vomiting:
BP100/60, HR
130, RR 26,
T 39.5 Celsius
Vocal sound:
Vomiting
woozy &
lightheaded
arrange ER
transport & call
ER staff to give
report
Role member
providing cue:
other clinic staff
Cue: if the learner
fails to transfer
patient to ER, the
other staff will ask
whether or not the
situation is under
control or need to
call an ambulance
Debriefing questions:
Assessing learners’ perception:
What are the patient’s vitals?
What is the patient’s presenting history?
Assessing learners’ comprehension:
What is the most likely patient’s medical diagnosis?
7. CORE CASE 7
What is the nursing diagnosis for this patient?
What is most concerning to learners about this patient’s situation?
Assessing learners’ projection:
What factors place the patient at higher risk for adverse outcomes?
What is likely to happen in the next few minutes?
What is the anticipated nursing intervention on the patient’s arrival at ER?
Assessing learner’s critical thinking skills:
What information including patient interview and physical examination would you
consider as subjective and objective data?
How would you use the information you have gathered?
What do you use to make inferences and predictions?
How do inferences and predictions help in a clinical situation?
Note: If the clinic has IV starting kits, learners should be able to initiate starting at least
1x large-bore IV access before sending the patient to ER.
Wrap-up evaluation:
What do you feel went well?
What could have been done better?
How could we make this scenario a better learning experience in the future?
Proposed correct nursing procedure:
Wash hands
Introduce self
Identify the patient
Obtain BP, pulse, RR, temperature including orthostatic vital signs
Position/comfort patient
Auscultate heart, lungs, & bowel sounds
Support patient/family
Call for help
Signs & Symptoms of upper GI bleed:
Bright red blood or coffee ground emesis
Melena (black, tarry stools)
Decreased B/P
Vertigo
Drop in Hct, Hgb
Confusion
Syncope
Orthostatic VS.
Predisposing factors of upper GI bleed:
Medication e.g. NSAIDs
Prior history of GI disease
Esophageal varicies
Esophagitis
8. CORE CASE 8
PUD
Gastritis
Carcinoma
Suggested nursing diagnosis:
Fluid volume deficit related to acute loss of blood, as well as gastric secretions
Ineffective tissue perfusion related to loss of circulatory volume
Anxiety related to upper GI bleeding, uncertain outcome, and source of bleeding
Risk for aspiration related to active bleeding and altered level of consciousness
9. CORE CASE 9
References
Cayley, W. (n.d.) HPS acute GI bleed. Retrieved from
www.fmdrl.org/index.cfm?event=c.getAttachment&riid=1177
Health Canada. (2005). Chapter 5: Gastrointestinal system. In Clinical practice guidelines
for nurses in primary care. Retrieved from http://www.hc-sc.gc.ca/fniah-
spnia/pubs/services/_nursing-infirm/2000_clin-guide/chap_05d-eng.php
Krumberger, J. (2005). How to manage an acute upper GI bleed. RN, 68(3). Retrieved
from CINAHL with Full Text database (AN 2005072688).
Lasater, K. (2007). Clinical judgment development: Using simulation to create an
assessment rubric. Journal of Nursing Education, 46(11), 496-503.
Lewis, S.L., Heitkemper, M. M., Dirksen, S. R., O’Brien, P.G., & Bucher, L. (2007).
Medical-surgical nursing: Assessment and management of clinical problems. St.
Louis, Missouri: Mosby Elsevier.