Student Nurse Exercise Book

Begin your shift ....................................................................................................................................................... 2

Get report ........................................................................................................................................................... 2
Document vitals and assessments .......................................................................................................................... 3
Document vitals .................................................................................................................................................. 3
Document Assessments ...................................................................................................................................... 4
Document Daily Cares ......................................................................................................................................... 5
Administer Medications .......................................................................................................................................... 6
Administer Simple Meds ..................................................................................................................................... 6
Send a Message to the Pharmacy ....................................................................................................................... 7
Administer IV meds – HHL – Non-integrated pump areas ..................................................................................... 7
Start an IV med ................................................................................................................................................... 7
Stop an IV Med.................................................................................................................................................... 8
Edit an Administration ........................................................................................................................................ 8
End your Shift .......................................................................................................................................................... 9
Document Patient Education .............................................................................................................................. 9
Document Shift I/O ............................................................................................................................................. 9
Sign Out ............................................................................................................................................................. 10
Take over patient assignments ......................................................................................................................... 10
Additional exercises .............................................................................................................................................. 10
Document Vitals and Assessments ................................................................................................................... 11
Collect a Lab ...................................................................................................................................................... 11
Assess, remove, and add a line ......................................................................................................................... 12
Document Patient Education ............................................................................................................................ 12
Answer Key............................................................................................................................................................ 13
Answers - Begin your shift ................................................................................................................................ 13
Answers - Document Vitals and Assessments .................................................................................................. 14
Answers - End your Shift ................................................................................................................................... 14
Answers - Arrive a transfer patient................................................................................................................... 14
Answers - Blood administration........................................................................................................................ 14
Answers - Additional exercises ......................................................................................................................... 14

1
Begin your shift
Patient: Kingsley (Sepsis)

Get report
In this exercise, you and a partner will each play the role of a nurse. One of you will be the current nurse
(Maurice Foley), who is just finishing up. The other will be the new nurse coming on shift (Nurse). Only the
new nurse should log in and follow the instructions in this exercise. The current nurse (Maurice) won't log in,
but will serve as a guide for the new nurse.

SCENARIO:

Nurse Maurice Foley is just finishing his night shift. He's giving report to the nurse who is coming on shift
about a patient, Kingsley.

TRY IT OUT:

 Nurse: "How'd things go on your shift? What do I need to know?"

 Maurice Foley: "There are a few things. Let's take a look at the chart."

▪ Confirm chart is open to the Overview report.

 Nurse: "I see the principal problem is: _________________."

 Maurice Foley: "Yes. The other hospital problems are:"

▪ List the other problems being addressed during admission:

 Nurse: "I notice the patient has a wound located on their ________________."

▪ Hint: Find the Lines, Drains, and Airways section of the Overview report.

 Nurse: "I can see the patient's lines here too"

▪ How many lines are currently active?

 Nurse: "What are the current medications?"

 Nurse: "When are the next meds due?"

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 ▪ Hint: Use the Report link in the Medications section. Click the Legend link to view the Legend
and determine Due medications.

▪ Return to the Overview report.

 Nurse: "Good to know. What's the current diet order?"

 Nurse: "Where can I review all of the patient's current orders?"

 Maurice Foley: "There's a separate report for that."

▪ Hint: Click Active Orders.

 Nurse: "All right. Anything else?"

 Maurice Foley: "We're good to go.

Document vitals and assessments

Patient: Kingsley

Document vitals
SCENARIO:

You just visited Kingsley for the first time. You collected his vitals and now you'd like to document them.

TRY IT OUT:

 In the Flowsheets activity, which button should you click to document at the current time: Add Col or
Insert Col?

 If you haven't already, add a time column for the current time in the Vitals Flowsheet.

 Document the following values:

▪ Heart rate is 90 beats per minute, taken from the monitor.

▪ Respirations are 18.

▪ Blood pressure is 105/66.

▪ Remember: You can use a space instead of a slash when you document blood pressure.

▪ You collected BP manually from the patient's right arm. Keep the Patient Position cell blank for
now.

▪ SpO2 is 99%.

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  You ask Kingsley to rate his pain on a scale of 0-10. He tells you his pain is at a 4. When you ask him
where the pain is he points to his right knee, where his infection started. Document that information.

 Click the Last Filed button to view the most recent documentation.

 Kingsley's height and weight are unchanged since they were last filed, but you still document the
values.

 The data you just entered in Kingsley's chart currently appears with blue lines in the flowsheet cell,
which indicates the information is pending and isn't yet filed.

 The easiest way to save data in Flowsheets is to move away from the flowsheet you're currently
looking at.

▪ You can open another tab in Flowsheets.

▪ You can open another activity in the chart.

▪ You can close the chart.

 Open the Summary activity, then return to the Vitals flowsheet.

 The documentation you recorded is still there, but the blue lines are gone so the documentation is now
filed.

 You can also save your documentation without leaving your flowsheet by clicking File.

 In the Patient Position row, enter Lying.

 Click File.

 You just realized you entered the wrong data for respirations. The patient is actually breathing at 20
respirations, not 18. Fix the data in the chart and click File to save the data.

 You notice the black corner that appears in the edited cell. What do you think this means?

▪ Hint: Use the Legend

 Check the audit trail for respirations:

▪ Select the respirations cell that contains the data you changed.

▪ In the Details report, find the Show Audit section and review the audit trail of documented
values.

Document Assessments
SCENARIO:

In this exercise, you'll document an assessment for Kingsley.

TRY IT OUT:

 Open the Assessment Flowsheet.

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  You performed the assessment 20 minutes ago. Use the Insert Col button to add a time column for 20
minutes ago.

▪ Tip: Enter n-20 as a shortcut.

 Kingsley is within defined limits (WDL) for Neuro.

▪ Hint: Use the Details report to review the defined limits. If you don't see the report, use the
small blue arrow to the right of your flowsheet to expand it.

▪ Select WDL for the assessment.

 Kingsley meets WDL criteria for HEENT and you didn't perform any HEENT interventions.

 The previous nurse documented an abnormal respiratory assessment so you want to document an up-
to-date assessment.

▪ His respiratory depth is regular and his effort is unlabored. There is accessory muscle use and
his chest expansion is symmetrical. His right and left breath sounds are clear.

 Document an abnormal peripheral vascular assessment. Document edema on Kingsley's right lower
extremity. Use the last filed details to guide your other choices for the other assessment rows.

▪ Use the paper icon to add a comment to specify the edema is on Kingsley's right knee.

 Document an abnormal integumentary assessment for Kingsley. Choose your own values.

 Document a Braden Scale assessment. Choose your own values.

 Document WDL for the remaining assessments.

Document Daily Cares

SCENARIO:

Your patient is doing well and is starting to move around. You're ready to document daily cares.

TRY IT OUT:

 Open the Daily Cares/Safety Flowsheet.

▪ Note: If you don’t see this flowsheet face – up, use the search bar to locate it and pull it into the
activity.

 Using your own clinical knowledge, document an assessment for Safe Environment. Choose your own
values.

 While assessing mobility, you determine that your patient is up and moving around the room with little
assistance. Document their activity.

▪ Hint: Remember the mnemonic "left-click to pick, right-click to stick" when you're documenting
from the Details sidebar report.

 Take a few minutes to explore and document the remaining groups on your own.

5
 ▪ Hint: If you're uncertain what content should be documented in a row, use the description in
the Details report for guidance.

 If you have time, go back to the Assessment to further explore and document.

 Challenge: Document an assessment group without using your mouse:

▪ Use the Arrow Keys and the Spacebar.

▪ Press Enter to move to next row.

▪ Press F5 to view your choices.

▪ Press F6 to add a comment.

Administer Medications
Patient: Kingsley

Administer Simple Meds

SCENARIO:

Your patient is due for an application of ointment that will help with the wound on their right knee.

TRY IT OUT:

 Scan your patient's wristband (the barcode next to your patient's name on the classroom information
sheet). (If you already scanned your patient it will have "Scanned" with a green check mark, so you will
not have to scan again)

 On the MAR click Show All Details to see details for all the medications at the same time.

 Find the row for the bacitracin ointment.

▪ Review the medication details.

 Scan the medication barcode. In the med admin window, enter the following details:

▪ Action: Given

▪ Date: today

▪ Time: due time

▪ Dose: 1 application

▪ Site: other

▪ Comment: right knee

▪ Click Accept.

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  Notice the Given action that now appears on the MAR.

 Note – If necessary, provide an off-schedule reason if giving the medication off schedule.

Send a Message to the Pharmacy

SCENARIO:

You rescheduled the next dose of your patient's antibiotic, but you'd like the pharmacy to adjust the ongoing
schedule forward by one hour.

You also noticed that the stock of the antibiotic is running low and you'd like the pharmacy to dispense more.

TRY IT OUT:

 Create a message to the pharmacy about your patient's dose:

▪ On the right side of the MAR, click the Rx button for the antibiotic order for which you already
adjusted the next Due time.

▪ The Send Message to Pharmacy window opens. Note that it already includes the patient's name
and the relevant medication.

▪ In the Reason field, enter Adjust Times and press Tab.

▪ Write a note to the pharmacy in the Message field.

▪ Click Send.

 You also want to request more antibiotic. Scroll to the order's row on the MAR.

▪ Click the Rx button.

▪ Enter your message.

▪ Click Send.

 To review the messages you just sent to pharmacy, click Rx Messages at the top of the MAR. Notice
your 2 messages under the Recent message history header.

Administer IV meds – HHL – Non-integrated

pump areas
Patient: Search for patient GeorgeOne-IPRN

Start an IV med
SCENARIO:

7
We need to document giving the patient an IV fluid.

TRY IT OUT:

 Scan the patient wristband.

 Scan the sodium chloride infusion med barcode.

 Link to the Left PIV – if the medication is not already linked to a line.

 Confirm the following details are entered:

▪ Action: New Bag

▪ Date: today

▪ Time: enter the time the bolus ended

▪ Dose: 150 mL/hr

▪ Rate: 150 mL/hr

 Click Accept to document the start of the IV med.

Stop an IV Med
SCENARIO:

For the sake of training, let's stop the infusion so you learn how to document stopping an IV med on the MAR.

TRY IT OUT:

 Open the MAR and find the row for the sodium chloride infusion you recently administered.

 The infusion was running for 30 minutes and then you stopped it.

 Click in the time cell to the right of the New Bag action.

 In the med admin window, enter the following details:

▪ Action: Stopped

▪ Date: today

▪ Time: 30 minutes after it started

 Click Accept and see the Stopped action listed on the MAR.

Edit an Administration
SCENARIO:

The time you recorded for the Stopped action is incorrect. Edit the administration details to reflect accurate
timing.

TRY IT OUT:
8
  Find the row for the pantoprazole infusion you just stopped.

 Edit the stopped action to be 10 minutes later than you originally entered.

▪ Hint: Click the Stopped action and select the Edit administration check box.

End your Shift

Patient: GeorgeOne

Document Patient Education

SCENARIO:

Before you leave for the day you'll document the education you covered with your patient.

TRY IT OUT:

 Open the Education activity.

 Select the Pain Management and Self Care titles.

 Click Document and indicate the following details:

▪ The patient is the learner and the learner demonstrated acceptance.

▪ You explained and demonstrated the content.

▪ The patient verbalized understanding of the material and demonstrated understanding.

 Click File.

 Notice the green check marks that now appear in the education tree structure for the teaching points
you've documented on.

 Use your clinical judgement to document on another section of education content.

Document Shift I/O

SCENARIO:

Now you'll document your patient's intake and output to complete your shift documentation.

TRY IT OUT:

 Open Flowsheets to the tab you'll use to document intake and output.

 For areas using integrated IV pumps - Use Pump Rate Verify to document infusions from the infusion
pump.

 Use your clinical judgement to document the following additional intake and output values:
9
 ▪ P.O intake (mL)

▪ Voided urine (mL)

▪ Unmeasured stool occurrence

Sign Out
SCENARIO:

You're done with your shift and ready to go home. The last thing you need to do is sign out.

TRY IT OUT:

 From what workspace did you Sign In at the beginning of your shift?

 Go to that activity and click Sign Out.

▪ This takes you off the treatment team of your patients.

▪ Notice your My Patients list is now blank.

 Always make sure you sign out before you leave. If you forget, the system will automatically sign you
out an hour after your shift's end time.

Take over patient assignments

SCENARIO:

Patient: Mandy

You'll be the nurse for the patient that just arrived so you'll add yourself to the treatment team.

TRY IT OUT:

 Open Patient Lists and find the list of patients in your unit LALK Nephrology 5.

▪ Hint: Use the My Unit list or find your unit under Available Lists.

 Assign yourself as the nurse for the patient.

▪ Hint: Right-click and select Assign Me.

 Confirm the assignment is complete by opening your My Patients list.

Additional exercises

10
Document Vitals and Assessments
SCENARIO:

Patient: Mandy
You visit your patient, take vitals, and perform some assessments. Now you'll document your findings on the
chart.

TRY IT OUT:

 Open your patient's chart to Flowsheets.

 Enter a set of vitals.

▪ Challenge: Use only your keyboard to document faster.

▪ Completion match on options. Ex: for temperature source, enter "or" to find "oral".
▪ For selecting multiple values use the semicolon. Ex: for heart rate source, enter "right;
radial"
▪ Press Enter to move to the next row.

 Use your clinical judgement to enter a 0-10 pain assessment.

▪ Add a comment to one of your values by selecting the paper icon within the cell.

 Your patient has an incision from surgery. What Flowsheets tab includes a section for you to document
an assessment of the incision?

 Use your clinical judgment to document an assessment of the incision.

 Use your clinical judgment to document an additional assessment of your choice.

Collect a Lab
PATIENT: Kingsley

SCENARIO:

The physician ordered a wound culture to be collected and sent to the lab. You'll collect the specimen, print
the label, and send it to the lab.

TRY IT OUT:

 Where in Epic can you print the specimen label and document the specimen collection?

 Because you used the Work List in class, use the Brain to document the collection this time. The steps
are the same.

 From the Brain, find the 0700 wound culture collection task for your patient.

 Start by clicking the Print Label button to launch the specimen collection window.
11
 ▪ Note: You won't actually print the label in training.

 Next, you'd scan the labels you just printed. But remember in training we don't have specimen labels.

▪ Click the scan label link to bypass the scan and choose "Scanner not available" for the override
reason.

 Confirm the information is correct and complete the collection task.

 What icon on the Brain indicates that your collection task is complete?

Assess, remove, and add a line

PATIENT: Kingsley

SCENARIO:

Your patient is due for some IV meds but first you'll assess and manage his active lines.

TRY IT OUT:

 Open the LDA Avatar.

 Find the left PIV and document an assessment using your clinical judgement.

▪ Hint: Hover over the Left PIV and click the Assess button to open the assessment window.

 After your assessment, you decide to remove the existing left PIV and add a new line.

 Remove the left PIV. Document the current date and time for removal.

 Add a new peripheral IV to patient's left arm. Use your clinical judgement for the location/orientation.

▪ Hint: Click the Add button and search for "PIV".

Document Patient Education

PATIENT: Kingsley

SCENARIO:

The patient's sister has been at the hospital and she wants to know how things are progressing. You'll update
the Learning Assessment to include the patient's sister and you'll also document the education you provided
them today.

TRY IT OUT:

 Open the Education activity.

 First, update the Learning Assessment to include the patient's sister.

▪ On the Assessment tab, find the existing assessment and click Copy to New.

▪ Add the patient's sister as Co-Learner #1.

12
 ▪ When it's updated click File.

▪ Notice the new assessment is now listed with updated information.

 Now, open the Education tab and document the education you provided to the patient and his sister.

 Using your clinical judgement, perform the following tasks:

▪ Document learner progress on several education points of your choice.

▪ Hint: Select several points, click the Document button, select the progress details, and
click File.

Answer Key
Answers - Begin your shift
 I see the principal problem is _____________.

▪ Sepsis

 List the other problems being addressed during admission:

▪ Asthma

▪ Bursitis

 How many lines are currently active?

▪ Three

 What are the current medications?

▪ <bacitracin>

▪ <clindamycin>

▪ <sodium chloride bolus>

▪ <vancomycin>

▪ <sodium chloride infusion>

▪ <acetaminophen>

13
  What's the current diet order?

▪ Adult regular

Answers - Document Vitals and Assessments

 In the Flowsheets activity, which button should you click to document at the current time: Add Col or
Insert Col?

▪ Add Col

Answers - End your Shift

 From what workspace did you Sign In at the beginning of your shift?

▪ Patient Lists

Answers - Arrive a transfer patient

How do you know that your patient has signed and held orders?

 Banner at the top of the Summary activity

Answers - Blood administration

 What should you do when a patient has a reaction to blood?

▪ Stop the transfusion. <Follow your organization's policy for documenting a reaction.>

Answers - Additional exercises

 Your patient has an incision from surgery. What Flowsheets tab includes a section for you to document
an assessment of the incision?

▪ Assessment

 You're ready to scan the patient's wristband. From what screens in Epic can you scan the patient's
wristband to open their MAR?

▪ The Brain

▪ Patient Lists

▪ The MAR

 Based on the patient's blood sugar from the scenario, how many units of insulin will you administer?

▪ <4 units>

 How do you know the override pull is linked to the order?

▪ The link icon in the medication details section of the MAR.

14
  Where in Epic can you print the specimen label and document the specimen collection?

▪ The Brain

▪ The Work List

 What icon on the Brain indicates that your collection task is complete?

▪ Green checkmark

© 2018 Epic Systems Corporation. All rights reserved. PROPRIETARY INFORMATION - This item and its contents may not be accessed, used, modified, reproduced, performed, displayed, distributed or disclosed unless and
only to the extent expressly authorized by an agreement with Epic. This item is a Commercial Item, as that term is defined at 48 C.F.R. Sec. 2.101. It contains trade secrets and commercial information that are confidential,
privileged and exempt from disclosure under the Freedom of Information Act and prohibited from disclosure under the Trade Secrets Act. After Visit Summary, Analyst, App Orchard, ASAP, Beaker, BedTime, Bones, Break-
the-Glass, Caboodle, Cadence, Canto, Care Everywhere, Charge Router, Chronicles, Clarity, Cogito ergo sum, Cohort, Colleague, Community Connect, Cupid, Epic, EpicCare, EpicCare Link, Epicenter, Epic Earth, EpicLink,
EpicWeb, Good Better Best, Grand Central, Haiku, Happy Together, Healthy Planet, Hyperspace, Kaleidoscope, Kit, Limerick, Lucy, MyChart, OpTime, OutReach, Patients Like Mine, Phoenix, Powered by Epic, Prelude, Radar,
Resolute, Revenue Guardian, Rover, Share Everywhere, SmartForms, Sonnet, Stork, Tapestry, Trove, Welcome, Willow, Wisdom, and With the Patient at Heart are registered trademarks, trademarks or service marks of
Epic Systems Corporation in the United States of America and/or other countries. Other company, product and service names referenced herein may be trademarks or service marks of their respective owners. U.S. and
international patents issued and pending.

This guide is based on Epic 2018.

© 2018 Epic Systems Corporation. All rights reserved. PROPRIETARY INFORMATION - This item and its contents may not be accessed, used, modified, reproduced, performed, displayed,
distributed or disclosed unless and only to the extent expressly authorized by an agreement with Epic. This item is a Commercial Item, as that term is defined at 48 C.F.R. Sec. 2.101. It contains
trade secrets and commercial information that are confidential, privileged and exempt from disclosure under the Freedom of Information Act and prohibited from disclosure under the Trade
Secrets Act. After Visit Summary, Analyst, App Orchard, ASAP, Beaker, BedTime, Bones, Break-the-Glass, Caboodle, Cadence, Canto, Care Everywhere, Charge Router, Chronicles, Clarity, Cogito
ergo sum, Cohort, Colleague, Community Connect, Cupid, Epic, EpicCare, EpicCare Link, Epicenter, Epic Earth, EpicLink, EpicWeb, Good Better Best, Grand Central, Haiku, Happy Together,
Healthy Planet, Hyperspace, Kaleidoscope, Kit, Limerick, Lucy, MyChart, OpTime, OutReach, Patients Like Mine, Phoenix, Powered by Epic, Prelude, Radar, Resolute, Revenue Guardian, Rover,
Share Everywhere, SmartForms, Sonnet, Stork, Tapestry, Trove, Welcome, Willow, Wisdom, and With the Patient at Heart are registered trademarks, trademarks or service marks of Epic
Systems Corporation in the United States of America and/or other countries. Other company, product and service names referenced herein may be trademarks or service marks of their
respective owners. U.S. and international patents issued and pending.

This guide is based on Epic 2018.