Concept Map Worksheet

Describe Disease Process Affecting Patient (include pathophysiology of disease process)

Most common fall-related injury resulting in hospitalization and leading cause of disability among older adults. With bone
fracture, the periosteum and blood vessels in the marrow, cortex, and surrounding soft tissues are disrupted resulting in
bleeding from the damaged ends of the bone and the neighboring tissue. Clot formation occurs and bone tissue
immediately adjacent to the fracture dies causing an inflammatory response where the vascular tissue increases blood
flow to the entire bone for 48 hours. Bone-forming cells in the periosteum, endosteum, and marrow are activated to
produce subperiosteal procallus along the outer surface of the shaft and over the broken ends of the bone. During the
repair process, remodeling occurs, and new bone is formed over the healed fracture.

Diagnostic Tests Patient Information Anticipated Physical

(Reason for test and results) Findings
- X-ray shows location of fracture and is Name: Edith Jacobson  Displacement of the
used to determine if surgical Gender: Female extremity
intervention is necessary. Age: 85 years old o Significant
DOB:09/20/1934 shortening of
- CT and MRI used to show
Weight: 47.6 Kg extremity and
abnormalities of complex fractures.
Hight: 152 cm significant
Allergies: No known external rotation
- Bone scan can be used to reveal an
Adm On:09/05/2020 (intertrochanteric
occult fracture.
fracture)
 Limited or abnormal
range of motion (ROM)
 Edema and discoloration
of the surrounding tissue
 Inability to move or bear
weight on the affected leg

Anticipated Nursing Interventions

- Impaired physical mobility r/t Right hip fracture AEB bed rest.
- First, we will assess the degree of immobility from the fracture and note the patient’s perception of immobility. The
patient may self-restrict, requiring education and information about the need to regain mobility of the affected joint
or bone.
- We will auscultate bowel sounds, monitor elimination habits and assist the patient to void on a fracture pan and
provide privacy when able. It is important to maintain a bowel movement routine since bed rest and narcotics can
slow peristalsis down causing more complications.
- And we will stress safety to the patient as healing fractures may require the patient to need more assistance so we will
make sure the patient has a call bell and adequate help to ambulate or to take care of other needs.
- Impaired skin integrity r/t physical immobilization.
- We will examine skin for open wounds, foreign bodies, rashes, bleeding, discoloration and blanching. This provides
information regarding circulation and problems that may be caused the immobilization that we can address before
worsening occurs.
- We will cleanse the skin with warm, soapy water to reduce contaminants.
vSim ISBAR Activity STUDENT
WORKSHEET
Introduction I'm the Nurse(RN) Livan from the Emergency
Your name, position (RN), unit you are working Department.
on
Situation Mrs. Jacobson is an 85-year-old white female who was
admitted last evening after falling and fracturing her hip.
Patient’s name, age, specific reason for visit X-rays have been taken and show left intertrochanteric hip
fracture. Mrs. Jacobson is scheduled for surgery
tomorrow.
Background Mrs. Jacobson has a 10-year history of osteoporosis, and
her daughter reports that recently Mrs. Jacobson has been
Patient’s primary diagnosis, date of admission, having dizzy spells.
current orders for patient

Assessment
Current pertinent assessment data using head to
toe approach, pertinent diagnostics, vital signs
Mrs. Jacobson's vital signs are stable. Her pain is under
control with morphine every 4 hours, and I medicated her
at 1400. Her pain level was 2 after the morphine. The skin
is intact; color and sensation around the hip area are
within normal limits. A Morse Fall Scale assessment was
completed on admission, and her score was 45. Fall
precautions were implemented.

Recommendation You will need to reposition Mrs. Jacobson as she needs to

be turned every 2 hours. You should perform a focused
Any orders or recommendations you may have musculoskeletal assessment, reinforce safety, and provide
for this patient patient education on fall risk. Assess her pain level and
medicate for pain if needed.

2
Adapted from vSim for Nursing Wolters Klewur
PATIENT EDUCATION WORKSHEET
Name of Medication, Classification, and Include in Prototype
MEDICATION:

-Morphine sulfate–naltrexone hydrochloride

- Raloxifene

CLASSIFICATION:

-Morphine sulfate–naltrexone hydrochloride

Therapeutic class: Opioid analgesic
Pharmacologic class: Opioid agonist-antagonist.

- Raloxifene
Therapeutic class: antiosteoporosis
Pharmacologic class: selective estrogen modulator

PROTOTYPE:

- Embeda
- Evista
Safe Dose or Dose Range, Safe Route
Morfphine: 2.5-5 mg q3-4hr PRN, infused over 4-5 minutes; dose range, 4-10 mg
Raloxifene: 60 mg PO qDay

Purpose for Taking this Medication

Morphine acts as a mu receptor agonist. It binds to produce a sedative/ analgesic effect.
Raloxifene prevents and treats osteoporosis by mimicking the effects of estrogen increasing the density
(thickness) of the bone.

Patient Education While Taking this Medication

Morphine: Instruct patient how and when to ask for pain medication. Do not stop taking without
discussing with health care professional; may cause withdrawal symptoms if discontinued abruptly after
prolonged use. May cause drowsiness or dizziness. Advise patient to change positions slowly to minimize
orthostatic hypotension. Encourage patients who are immobilized or on prolonged bedrest to turn, cough,
and breathe deeply every 2 hr to prevent atelectasis.

Raloxifene: Instruct patient should eat and drink plenty of foods and drinks that are rich in calcium and
vitamin D while you are taking raloxifene. Advise patient to avoid long periods of restricted movement
(such travelling) because of increased risk of venous thromboembolism. Inform patient that flashes may
occur.

3
Adapted from vSim for Nursing Wolters Klewur
 Clinical Worksheet
Date: 09/16/2020 Student Name: Livan Martell Iglesias Assigned vSim: Edith Jacobson

Initials: EJ Diagnosis: left HCP: Dr. Diaz Isolation: N/A IV Type: N/A Critical Labs: Other Services:
intertrochanteric hip HTC: 42% X-Ray, MRI
Age: 85 years old fracture WBC: 18
Location: Left Plateles:195
Length of Stay: 09/05/2020 Fall Risk: Yes
M/F:M Hip Consults Needed:
Consults: Orthopedic Surgery
Code Status: Full Fluid/Rate: N/A
Code Allergies: NKA Transfer: N/A

Why is your patient in the hospital? (Answer in your own words and include History of present illness)

My patient is in the hospital because she fell and fractured her left intertrochanteric hip.

Health History/ Comorbidities (that relate to this hospitalization):

Patient has 10 years of history of osteoporosis

Shift Goals/ Patient Education Needs:

1- Reposition Mrs. Jacobson as she needs to be turned every 2 hours.
2- Performed a focused musculoskeletal assessment.
3- Reinforce safety and provide patient education on fall risk.
4- Assess her pain level and medicate for pain if needed.

Path to Discharge: The patient is scheduled for surgery tomorrow. Reposition the patient every 2 hours to avoid pressure injuries. Reinforce safety
and provide education on fall risk. Provide patient education on needing assistance for reposition. Asses pain level and medicate for pain if
needed.

Path to Death or Injury: N/A

 Clinical Worksheet

Alerts:

What are you on alert for with this patient? (Signs & Symptoms) Management of Care: What needs to be done for this patient today?
1- Pain
1- Administer 4 mg of morphine IV for pain
What assessments will focus on for this patient? (How will I identify 2- Administer Raloxifene PO daily
the above signs and symptoms?) 3- Perform focused musculoskeletal assessment
1- Assess pain level every 4 hours. 4- Reposition patient every 2 hours
5- Educate patient on fall risk
List complications that may occur related to dx, procedure, 6- Passive ROM exercises
comorbidities:
1- Pressure injuries
2- High pain level Priorities for managing the patient’s care today

What nursing or medical interventions may prevent the above Alert or 1- Asses pain level
complications? 2- Educate patient on fall risk
1- Reposition of the patient every 2 hours 3- Focused musculoskeletal assessment
2- Medicate as needed 4- Reposition every 2 hours

What aspects of the patient care can be delegated and who can do
it?
Patient care can be delegated to the LPN. The LPN can assess patient’s
vital signs only after the baseline had been obtained by the RN, transfer
the patient to get the X-Ray. Passive ROM exercises can be delegate to
the CNA.

5
Adapted from vSim for Nursing Wolters Klewur
 vSim Worksheets Grading Rubric (Not used for Clinical Worksheet)
Criteria 5 Points 4 Points 3 Points 2 Points 1 Point Total Points
Content Knowledge Follows all requirements Follows all requirements Knowledge of topic is Knowledge of topic is Knowledge of topic is
for the assignment. for the assignment. partially covered. general in more than general throughout entire
three areas of the worksheet, and/or does
Key information is worksheet. not cover all the required
Conveys well-rounded Major points of topic are
missing from 2 or more assignment areas.
knowledge of the topic. mostly covered in the
assignment areas. 1 or more areas of
Content well organized, required assignment
worksheet left blank.
logical. areas. Two or more areas left
Content unorganized
Worksheet difficult to blank on worksheet.
throughout worksheet.
Easy to read and Content organized, follow in two or more
understand throughout logical flow. Easy to areas. Unable to follow flow of
Difficult to understand
all of worksheet. read and understand worksheet.
content of paper.
through most of Information is
worksheet. incomplete in two or
more areas.
Critical Thinking Concisely explains each Explains each content Few aspects of the Information is basic. No
content area. area. content areas presented. aspects of the content
Presents information present in the worksheet.
about the topic. Few insights presented,
Analyzes information,
Some analysis, insight lacking analysis. Lacks insight, analysis,
connects data points to
present, some data points Data points not and conclusions.
provide accurate, concise
threaded together. connected to information
information.
provided.
No understanding from
Scholarly work.
Scholarly work. the content presented.
Little understanding
gained from information
presented.
Writing Composition An occasional spelling Some minor errors (1-3 Frequent errors (4-5 Numerous errors (5-6 Excessive errors (>6
(Spelling, Grammar, error present. errors) with spelling, errors) with spelling, errors) with spelling, errors) occur with
Sentence Structure) grammar and/or sentence grammar and/or sentence grammar, and/or spelling, grammar and/or
structure, not consistent structure. sentence structure sentence structure,
Grammar, readability,
throughout worksheet. throughout the throughout worksheet.
and sentence structure is
Errors effect ability to worksheet
error free.
Errors do not interfere comprehend information Unable to understand
with the readability or present on worksheet and Difficult to understand information presented in
comprehension of readability. information presented the worksheet.
information. due to numerous errors

Total Points: __________________

6
Adapted from vSim for Nursing Wolters Klewur

Patient Information:
Demographics, Diagnosis, Allergies,
Provider, Consults, Isolation, Fall
Risk, Intravenous Therapy, Critical
Labs, Services and Needed Consults
Medical History:
Why patient is in the hospital,
History of present Illness, Past
Medical/Surgical History,
Comorbidity Factors
Patient Education/Goals:
Shift Goals, Patient Education
Needs
Disease Progression:
Pathway to Death or Injury Pathway
to Health
AACIP:
Alerts, Assessments, Complications,
Interventions and Prevention
Nursing Care Plan:
Management of Care, Priorities for
Patient Care, Delegation
7
Adapted from vSim for Nursing Wolters Klewur
Rubric for Grading vSim Clinical Worksheet
5 3
All documented areas 100%
complete and provide thorough
information.
100% of HPI, Past Medical/Surgical
History and Comorbidity Factors
completed with thorough, relevant
information.
Thorough and detailed patient
education. Patient shift. goals are
SMART, relevant, and detailed
goals. 100% of worksheet area is
complete.
Pathway to death and health is
identified with detail. Information is
concise, relevant, accurate and
portraits appropriate timeframe for
occurrence. 100% of the information
needed for worksheet present.
Alerts, Assessments, Complications
and Interventions/Preventions
identified thoroughly. Answers
relevant to scenario. 100% of the
information needed is present.
Management of Care relevant to
case scenario and detailed. Priorities
for scenario identified. Identifies all
aspects of care that can be delegated
and identifies appropriate personnel
to delegate activities to. Answers
detailed; Critical thinking evident.
1 0
Three listed areas completed OR
documented areas 75% complete.
75% of HPI, Past Medical/Surgical
History and Comorbidity Factors
completed. Information relevant to
scenario.
Provides patient education but lacks
thoroughness or details. Patient shift
goals missing 1-2 components of
SMART goals. 75% of information
needed for worksheet area present.
Pathway to death and health is
identified. Information is relevant
and accurate. Missing timeframe for
occurrence. 75% of information
needed for worksheet area present.
Alerts, Assessments, Complications
and Interventions/Preventions
identified. Most answers relevant to
scenario. 75% of the information
needed for worksheet area present.
Management of Care, Priorities or
delegation sections relevant to
scenario. Answers generic to
situation. Some evidence of critical
thinking present.
Less than three listed areas
completed OR documented areas
less than 50% completed.
50% of HPI, Past Medical/Surgical
History and Comorbidity Factors
completed. Information basic and
lacks relevancy.
Patient education lacks thoroughness
and details. Patient shift goals
missing 3 – 4 components of
SMART goals. 50% of the
information needed for worksheet
area present.
Missing over 50% of needed
information for worksheet area
present. Pathway to death and health
identified but content either not
relevant or accurate for situation
present in scenario.
Missing 2 – 3 areas on worksheet.
Answers not relevant to scenario.
50% of the information needed is
present.
Missing relevant data in one or more
categories (management of care,
prioritization, delegation). Answers
basic without detail. Little to no
evidence of critical thinking present.
Total Points:
Patient information area blank.
25% of HPI, Past Medical/Surgical
History and Comorbidity Factors
completed. Information not relevant,
or content areas left blank,
Missing patient education and/or
patient shift goals. Patient shift goals
lack all components of SMART
goals. 25% of the information
needed for worksheet area present.
Pathway to death and health
contains information not relevant or
accurate to the scenario or section
left blank.
Missing 4 or more areas on
worksheet. Answers not relevant to
scenario. 25% of the information
needed for worksheet area is present.
Information provided not relevant to
scenario. Answers are basic without
detail. No evidence of critical
thinking. Missing answers in one or
more area.