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Simulated Clinical Experience (SCE) Overview

Location: Emergency Department

Learning Objectives

History/Information: A 75-year-old male is brought into the Emergency Department from home by the paramedics complaining that breathing got worse the past few days. He has a long-standing history of emphysema and a previous acute myocardial infarction 12 years ago and states he had an upper respiratory infection about two weeks ago. Despite his long-standing chronic obstructive pulmonary disease (COPD), he continues to smoke two packs of nonfi ltered cigarettes per day at a minimum. He uses oxygen at home, and the paramedics report he was sitting in his lazy-boy recliner with the oxygen in place at a fl ow rate of 2 liters per minute by nasal cannula and smoking when they arrived. He reports he also takes some heart medications but does not know the names, nor can he describe the pills due to his severe shortness of breath. He is allergic to penicillin. His wife did not arrive with him as she is waiting for one of their children to pick her up and bring her to the hospital. The paramedics started a saline lock in the right forearm. Healthcare Providers Orders: O2 at 2LPM nasal cannula ECG and O2 saturation monitoring IV of 0.9% NS at 150mL/hour CBC, Electrolytes, BUN, Creatinine, Glucose, ABG STAT Chest x-ray STAT 12 lead EKG STAT 1. .States the precautions needed for oxygen therapy and fl uid administration for a person with long-term COPD (KNOWLEDGE 2. 3. 4. 5. 6.

.Uses patient history and assessment data to plan and provides care for a person with COPD who develops respiratory fai

.Anticipates diagnostic orders and therapies, including medications, for the person with an acute exacerbation of COPD (CO .Discusses the cardiac consequences of long-term emphysema (COMPREHENSION). .States the appropriate rationale for endotracheal intubation for the person in respiratory failure (KNOWLEDGE).

.Analyzes the event history, assessment fi ndings and arterial blood gas results to anticipate, prepare for and assist with end

Program for Nursing Curriculum Integration (PNCI )

Learner 1

structive lung disorder?

he nurse consider when giving oxygen to the patient with an obstructive lung disorder and why?

Questions related to obstructive disorders? ing management issuesto Prepare for the Simulated Clinical Experience

References
Global Initiative for Chronic Obstructive Lung Disease (GOLD), World Health Organization (WHO), and National Heart, Lung, and Blood Institute (NHLBI). (2005). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Retrieved October 22, 2005 from http://www. guideline.gov/ summary/ summary.aspx?view id=i&doc id=8128 Joanna Briggs Institute for Evidence Based Nursing and Midwifery. (2007). Best practice: Vital signs. Retrieved March 25, 2008 from http://www.joannabriggs.edu.au/ best practice/bp8.php?win=NN Jarvis, H. (2006). Exploring the evidence base of the use of non-invasive ventilation. British Journal of Nursing (BJN) 15(14), 756-759. Kunisaki, K.M., Rice, K.L. and Niewoehner, D.E. (2007). Management of acute exacerbations of chronic obstructive pulmonary disease in the elderly: An appraisal of published evidence. Drugs and Aging 24(4), 303-324. MacNee, W. (2003). Acute exacerbations of COPD. Swiss Medical Weekly 133, 247257. McGee, S. (2007). Evidence-based physical diagnosis (2nd ed.). Philadelphia: Saunders. Pastaka, C., Kostikas, K., Karetsi, E., Tsolaki, V., Antoniadou, I. and Gourgoulianis, K.I. (2007). Non-invasive ventilation in chronic hypercapnic COPD patients with exacerbation and a pH of 7.35 or higher. European Journal of Internal Medicine 18(7), 524-530. Pierson, D.J. (2004). Indications for mechanical ventilation in adults with acute respiratory failure. Respiratory Care 47, 262-265.

ment fi ndings would the nurse identify in a patient experiencing respiratory failure?

mean to be in acute respiratory failure?

cardiac consequences of long-term COPD?

opriate interventions for a person with COPD who is showing signs of respiratory failure?

O2 represent?
2

do nurses intervene with an altered SpO ?

parameters that indicate the need for intubation?

o be done to prepare for intubation?

s assess for correct placement of an endotracheal tube immediately after the intubation?

nursing care issues for a person with an endotracheal tube?

ollowing terms related to a mechanical ventilator a.


b.

.Mode
.Rate .Tital Volume

d. FIO e. PEEP
2

c.

f. Pressure Support

Roefaro, J. and Daryanani, A.A. (2004). Treatment options for the management of chronic obstructive pulmonary disease. Formulary Retrieved October 22, 2005 from http://www.a and management of chronic heart failure in the adult. American College of Cardiology Foundation and the American Heart Association, Inc.39, 542- 555. Journal 97, 120-126. Skrepnek, G.H. and Skrepnek, S.V. (2004) An assessment of therapeutic regimens in the treatment of acute exacerbations in chronic obstructive pulmonary disease and asthma. The American Journal of Managed Care 10, S139-S152. Sinuff, T. and Keenan, S.P. (2004). Clinical practice guideline for the use of noninvasive positive pressure ventilation in COPD patients with acute respiratory failure. Journal of Critical Care 19(2), 82-91. Learner Soto, F.J. and Varkey, B. (2003). Evidence-based approach to acute exacerbations of COPD. Current Option in Pulmonary Medicine, 9 117-124. Wouters, E.F.M. (2005). COPD managementa hospital physicians view. Respiratory Medicine: COPD Update 1(1), 3-17.

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