A patient comes in and complains of cold-like symptoms. Her past medical history includes an open reduction internal fixation of the right hip — in this case, a hip replacement. Her CO2 levels and her white blood cell count are both elevated, and her hemoglobin and platelet counts are normal.
Two Nursing students are asked to volunteer to come and assess the patient, who is laying on a hospital bed.
They clean their hands, check the patients’ ABCs — airway, breathing and circulation — and see if she is responsive.
“How are you feeling?” a female Nursing student asks.
“I’m feeling a little short of breath, ” Justine Pamiloza, the coordinator of the nursing simulation lab responds, providing the voice of the patient, in this case a mannequin.
This is a typical scenario given to Penn students in simulation labs, a class that composes a core part of the School of Nursing’s curriculum. Students are given the opportunity to practice procedures and assessments on realistic mannequins — ones that breath, cough and have their very own vital signs — so that students are prepared for a real hospital environment.
“Do you know who the president is?” a male student asks to gauge the patient’s responsiveness.
“I think it’s Obama.”
The students then ask the patient about her allergies, check her breathing using a stethoscope and assess her status based on vital signs given by the instructor: blood pressure, heart rate, respiratory rate and temperature.
“She has a fever, she’s tachycardic , she has low oxygen saturation, her lung sounds are diminished,” the student states.
The simulation is long but moves so rapidly that I oftentimes don’t pick up on the intricacies of what the students say.
Based on this assessment and feedback from the patient, students are expected to respond appropriately whether it be by starting an IV, administering drugs or antibiotics or “calling” the doctor or nurse practitioner.
“Take a couple of deep breaths for me and try to cough,” the female student says to the patient.
Based on a fake chest x-ray “ordered” by the instructor, the patient is ordered to be given ANSEF, an antibiotic used to treat pneumonia in response to patient symptoms of respiratory distress or generally having trouble breathing.
The students debrief after the patient is fully assessed. Two additional students are asked to volunteer for the second part of the simulation.
The patient has started sweating a bit. Her pain has gotten more uncomfortable and she can’t catch her breath. Since the medicine was administered, her throat has been itchy and tight.
“We’re concerned about anaphylaxis,” the female Nursing student says. “She’s wheezing and there is redness on her skin.”
I am amazed at how life-like these mannequins are. When I arrived at the simulation lab, it was just me and the inanimate mannequins, which were now sim men and women, breathing and making human-like noises.
The students determine that the patient needs a nebulizer to help with her breathing, as well as an IV and Benadryl .
“I’m going to get you some medicine to clear up your lungs a bit, it’s called Albuterol — it might make you a little jittery but it’s meant to open up your lungs,” the male student says.
The students constantly check to make sure it’s the right time, right patient and right dosage in addition to doing bed checks where they ask the patient’s name and date of birth.
This simulation was intended to teach students how to properly assess a patient who presented with pneumonia and developed an allergic reaction to the medicine prescribed to her, calling for further treatment to reverse the reaction.
The positive feedback from classmates includes “good therapeutic communication” and “explaining everything in a clear, professional manner.”
The instructor explains that the simulation is important to understand what a real emergency room or operating room would be like. She stresses that keeping the patient calm is essential.
“What do you do when you walk into a room and the patient is mentating fine but they feel a little funny?” Pamiloza asks. “You want them to stay calm, talk them through it, tell them you think they’re going through something and that you’re going to call the doctor or nurse practitioner.”
“In real life nursing you’re doing everything and a top priority is notifying the physician, but it’s important to get the nursing assessment done prior to doing that,” she said.
Correction: A previous version of this article said ANSEF is an antibiotic used for patients experiencing respiratory distress. It is used to treat pneumonia in patients exhibiting those symptoms.
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