Geriatric Fluid Volume Deficiency

Background

Background

Minni Frost is an 87-year old adult who is being transferred to the Emergency Department (ED) for assessment. She currently lives in a retirement centre with her spouse. She has experienced nausea and vomiting x 24 hours with associated decreased oral intake. Minni is increasingly lethargic today and her spouse states she has been slightly confused for the past 12 hours.

Target Audience: Nursing students and New Graduate Nurses.

Level: Intermediate to Advanced

Keywords: Fluid and Electrolytes, Geriatric Nursing, Medical-Surgical, Heart Failure, PPE, COVID-19
Learning Outcomes


Learning Outcomes

  1. Communicate relevant priority information to the healthcare team to identify threats to patient status.

  2. Performs a comprehensive assessment of the older adult to identify threats to patient status.

  3. Recognizes early signs and symptoms and related complications of fluid volume imbalance to prioritize and implement interventions.

  4. Selects and dons/doffs PPE appropriately as per public health measures in an acute care setting to protect self and others.

  5. Communicates using therapeutic principles with the patient and within the patient’s circle of care to decrease anxiety and promote collaboration of care.
Self Assessment Rubric


Self-Assessment Rubric

The use of this customized learning outcomes rubric, based on self-regulated learning (SRL) theory, allows student self-assessment of the game content and targeted learning outcomes.  Each rubric also describes competency indicators which levelled from the novice to competent learner. Below each learning outcome, users can provide additional comments/reflections/rationale to support scoring. The self-assessments rubric can be used to:
  1. Assess success on preparation for the simulation
  2. Assess performance during the simulation
  3. Guide the post-simulation debriefing in order to identification remedial learning requirements.
Further, the rubric can be used by the simulation facilitator for evaluation purposes or by examining the difference between instructor assessment scores and students’ self-assessment of the understanding of course criteria.
For the Geriatric Fluid Volume Deficit: Assessment and Prioritized Interventions (word document) – click here

For the Geriatric Fluid Volume Deficit: Assessment and Prioritized Interventions (pdf) – click here
Game Link


  English Game LinkClick here
  1. The game works best using Google Chrome or Firefox.  The game does not have full functionality when using your cell phone.
  2. You will be shown a video of an interaction between a nurse and a patient, their family and/or other medical staff.
  3. Following each video, you will be asked to select the most appropriate response.
  4. Please note that sound is required to fully understand the interactions within the video.
  5. It is preferred you use Google Chrome or Firefox to maintain optimal audio/visual output.
  6. The game will take approximately 20-30 minutes to complete.
  7. You may complete the virtual simulation game as many times as you like.
 
Virtual Debrief


The Can-Sim Virtual Simulation Games are an online resource that can be used as either presimulation preparation, stand-alone games, or as a teaching resource in or outside of the classroom. According to The International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Simulation Practice (2016), debriefing is a critical aspect of the simulation experience. Debriefing after simulation provides the opportunity for self-assessment and peer evaluation by giving feedback to others. Therefore, it is important that after any simulation, a debriefing should take place. Options for debriefing a virtual simulation game debriefing include:

  1. Embedded feedback debrief: CAN-Sim Virtual Simulation Games (VSG) are designed to provide the player with immediate feedback to selected responses in the form of an Embedded Debrief. Aligned with the game’s learning outcomes, the player is required to answer a series of multiple-choice clinical decisions key points during the game. Upon selecting a response, the player will be shown a video clip portraying the outcome of their chosen response with a written rationale on why their decision was either correct or incorrect. Correct responses will advance the game to the next video and corresponding decision point.

  2. Self-debrief: Use the provided game-specific Learning Outcomes Assessment Rubric to reflect on perceived self-competence specific to game learning outcomes. It is recommended that completion of the Learning Outcomes Assessment Rubric should be done before and after playing the virtual simulation game. Using the Learning Outcomes Assessment Rubric, reflect on areas of perceived competence and areas needing further improvement. We have provided suggested reading resources to support further learning.

  3. In-person debrief: This form of debriefing involves a traditional face-to-face debrief with a facilitator. This debrief can be performed in the classroom or lab setting.

  4. Synchronous online debrief: This involves an online debrief immediately following gameplay guided by a simulation facilitator using a video-conference software (ie. Zoom, Adobe Connect). Similar to an In-person Debrief, the synchronous online debrief uses an online platform.

  5. Asynchronous online debrief – This asynchronous involves a debrief using a discussion board platform where participants post responses to reflective debriefing questions. Other participants and facilitators then respond to reflective postings.
Reflective Questions

Reflective Questions

 
  1. The patient has Advanced Directives includes a Do Not Resuscitate Order (DNR). What interventions directly related to the DNR order?

  2. The patient’s daughter calls for information about the status of her mother (Minnie Frost). What should the nurse consider before responding?

  3. The patient is becoming increasingly confused and agitated. They are trying to pull out their intravenous (IV) and climb out of bed. When should restraints be considered?

  4. The patient suddenly deteriorates and the patient’s elderly husband is demanding to come in and stay at her bedside. He is elderly, has a chronic respiratory condition and thus is at high risk due to COVID-19. How would you handle this situation?

  5. As the patient has a change in cognitive status, how should the nurse best differentiate between delirium, dementia, and depression?

 

Resources

Resources

CASN/ACESI Entry to Practice Gerontological Care Competencies for Baccalaureate Programs In Nursing
Click here to access the document

Hshieh, T. T., Inouye, S. K., & Oh, E. S. (2018). Delirium in the elderly. Psychiatr Clin North Am41(1), 1-17.

Im, J. H., Je, Y. S., Baek, J., Chung, M. H., Kwon, H. Y., & Lee, J. S. (2020). Nutritional status of patients with COVID-19. International Journal of Infectious Diseases100, 390-393.

Uchmanowicz, I., Jankowska-Polańska, B., Mazur, G., & Froelicher, E. S. (2017). Cognitive deficits and self-care behaviors in elderly adults with heart failure. Clinical Interventions In Aging12, 1565.

Wang, X., Sun, C., Hu, H. X., Wang, Z. X., Wang, H., Peng, H., … & Cai, M. (2020). Expert consensus on the nursing management of critically ill elderly patients with coronavirus disease 2019. Aging Medicine.

Wilson, J. E., Mart, M. F., Cunningham, C., Shehabi, Y., Girard, T. D., MacLullich, A. M., … & Ely, E. W. (2020). Delirium. Nature Reviews Disease Primers6(1), 1-26.  

 

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