Virtual Clinical Replacement Simulation-based Education Lesson Plan
Virtual Clinical Replacement Simulation-based Education Lesson Plan
Darrell Johnson V2
Learning Objectives:
After completion of the lesson, the student will be able to:
- Discuss possible causes/risk factors related to the health condition.
- Discuss clinical manifestations of Parkinson’s disease and key physical assessment.
- Discuss medical management including medications.
- Develop a nursing plan of care using current evidence-based practice.
- Apply QSEN competencies in the management of a patient with Parkinson’s Disease.
Instructional Component/Pre- work:
Review Parkinson Disease Overview and Professional level information : Up To Date: Parkinson’s Disease Management
- Review Unfolding Case Study: Applying the QSEN Competencies to the care of Patients with Parkinson’s Disease (found on Beachboard site).
- Answer the 8 questions in the PPT and submit into the appropriate Dropbox.
- Upon completion review the analytics and evaluate where you could have improved.
Reflection (post simulation & debriefing):
Once you have completed the case study, reflect on the following questions:
- What did I do well?
- What can I improve on? (Use some of the information from the analytics in your I-Human case study)
Describe three to five important concepts you learned from the activity, then describe how you will apply your knowledge of each concept to future patient situations.
Unfolding Case Study:
Applying the QSEN Competencies to the care of Patients with Parkinson’s Disease
Gerry Altmiller, EdD, APRN, ACNS-BC
You are assigned to care for Mr. Conley, age 70, who was admitted to your unit post-operative yesterday for excision of a strangulated inguinal hernia. His VS are stable, IVF infusing D5.45 NS at 100ml/hr, bowel sounds have returned, and his surgical site is clean, dry, and intact. He is ordered percocet for pain PO PRN and and is currently pain free. He is beginning a clear liquid diet this am.
His past medical history includes mild hypertension, benign prostatic hypertrophy, degenerative joint disease, and Parkinson’s Disease.
- QSEN Competency: Teamwork and Collaboration
Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
During team huddle with the surgeon and medical resident, you report concerns from the AM assessment which include that Mr. Conley’s speech is slurred, soft, and slow and his face is expressionless with some drooling. He has a noticeable tremor of the right hand. His appearance is thin and frail.
- Theory Burst
- Parkinson’s Disease is a chronic, progressive, neurodegenerative disorder characterized by:
–Tremor at rest
- Pill-rolling, tremor resembles rotary motion; often first sign
- Handwriting begins large and trails off
–Slowness in initiation of movement (bradykinesia)
- arm swing with walking, swallowing saliva, blinking, blank facial expression, stooped posture
–Increased muscle tone (rigidity)
- Cog-wheel rigidity; jerking quality to purposeful movements
- Generalized slowness-loss of dopamine, a neurotransmitter in brain needed to initiate movement
- More common in men
- Affects 160 per/100,000; Diagnosis increases with age
- No specific test; diagnosis based on H & P and positive response to antiparkinson’s medications
- QSEN Competency: Teamwork and Collaboration
Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
The team determines the plan of care for the day is:
- Resume PO medications
- Sinemet 25mg/100mg CR PO three times daily
- Hytrin 2 mg PO at bedtime
- Celebrex 100mg PO twice daily
- Lexapro 10 mg PO daily
- OOB x 3
- Ambulate as tolerated
- Progress diet as tolerated; assess swallowing function
- Consult Physical Therapy and Speech Therapy
- QSEN Competency: Safety
Minimize risk of harm to patients and providers through both system effectiveness and individual performance.
What immediate safety priorities for the day do you identify and why?
Refer to slides 2 and 3 for details.
(Submit your answer to the assigned DropBox).
- QSEN Competency: Evidence-based Practice
Integrate the best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
Theory Burst
- Staff education regarding Parkinson’s Disease medication therapy
–Aimed at correcting imbalance of neurotransmitters in brain-dopamine
–Must be on time due to end of dose wear-off
- When medications work, the patient is “on” and able to initiate movements; Once levels drop, patient experiences “off” time and unable to initiate movements
–Medications can cause dyskinesia
- Uncontrolled movements of face, eyelids, mouth, tongue, arms, hands, legs, squirming movements
- Medication Reconciliation
What concerns do you have regarding Mr. Conley’s medications?
(Submit your answers to the assigned Dropbox).
- Theory Burst
Medication aimed at Parkinson’s Disease symptom relief:
- Sinemet: levodopa with carbidopa crosses the blood-brain barrier & converts to dopamine. Carbidopa inhibits an enzyme that would breakdown the levodopa
- MAO-B Inhibitors: (Eldepryl, Azilect) inhibit the breakdown of dopamine
- COMT inhibitors: slow the breakdown of levodopa, thus prolonging its action
- Amantadine: promotes effects of dopamine
Mrs. Conley arrives to assist with Mr. Conley’s hygiene needs. While speaking with you, she states “He hasn’t gotten his pills yet and he didn’t get them yesterday! I am so upset! When he doesn’t get his pills, this is what happens. He didn’t look like this at home.”
How should you respond to Mrs. Conley?
What actions can you take as his nurse?
(Submit your answered to the assigned DropBox).
- QSEN Competency: Teamwork and Collaboration
Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
Mr. Conley’s Sinemet CR (sustained release) arrives on the unit.
What important nursing considerations are associated with this medication administration?
(Submit your answered to the
assigned DropBox).
- QSEN Competency: Teamwork and Collaboration
Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
The speech therapist arrives and evaluates Mr. Conley with you. She determines that Mr. Conley’s swallowing allows for safe feeding. As she asks him questions, he is slow to answer and Mrs. Conley frequently answers questions for him.
What interventions can you suggest to help improve Mr. Conley’s communication?
(Submit your answer to the assigned DropBox).
A regular house diet is delivered for Mr. Conley for lunch. Mr. Conley attempts to eat with assistance from his wife but complains that it is too much work and he is not hungry.
- QSEN Competency: Informatics
Use information and technology to communicate, manage knowledge, mitigate error, and support decision making.
You document the poor intake for lunch in the electronic health record and decide to search for diet information regarding Parkinson’s Disease patients.
What dietary accommodations would be most appropriate for Mr. Conley?
(Submit your answer to the assigned DropBox).
After a few days, Mr. Conley is ready for discharge to home. What important teaching should be included in his discharge instructions?
(Submit your answer to the assigned DropBox).
- QSEN Competency: Quality Improvement
Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.
After caring for Mr. Conley, what improvements can you suggest for the care of hospitalized Parkinson’s Disease patients?
(Submit your answer to the
assigned DropBox).
- The QSEN Competencies
- QSEN Competency: Patient Centered Care
Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient preferences, values, and needs. - QSEN Competency: Teamwork and Collaboration
Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care. - QSEN Competency: Evidence-based Practice
Integrate the best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care. - QSEN Competency: Quality Improvement
Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems. - QSEN Competency: Safety
Minimize risk of harm to patients and providers through both system effectiveness and individual performance. - QSEN Competency: Informatics
Use information and technology to communicate, manage knowledge, mitigate error, and support decision making.
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