Simulation Scenarios

Full access to scenarios – contact Marian Luctkar-Flude mfl1@queensu.ca

Acute Care Nursing


Brain Attack (Durham/UOIT)
Description: The patient (64 year old male) was admitted to the medical unit yesterday with Stroke, CT scan reveals left sided ischemic brain attack. After treatment, the patient is transferred to a neurological stroke unit where the student provides care.  The student will be required to assess and provide interventions in response to post-treatment complications.  For scenario – Click here

Care of the Client with Unmanaged Pain (York University)
Description:  The client underwent surgery yesterday for an insertion of an intramedullary nailing of the right femur fracture. The learners are to assess a post-operative client, manage an aggressive client, recognize inadequate pain management, understand the difference between narcotic dependency, tolerance and addiction and consult with other health care providers to advocate for a need to change a client’s plan of care. For scenario – click here

Hypovolemic Shock (Laurentian University)
Description: In this scenario, learners are to assess the postoperative patient, recognize the signs and symptoms of hypovolemic shock; and intervene appropriately to minimize adverse patient outcomes and support recovery.  Interventions should include:  assessment and interpretation of vital signs (including pain); focused neurological and abdominal assessments, assessment of postoperative equipment (Jackson Pratt, dressing, intravenous, foley catheter), effective communication with physician; therapeutic communication and teaching with the patient and family and subsequent safe administration of blood product.  For scenario – Click here

Motor Vehicle Crash with Burn (University of Windsor Ontario)
Description: Patient arrives in the Emergency Department via ambulance post motor vehicle crash (MVC). He was a restrained driver and was T-boned by another car on the driver’s side, the vehicle’s airbags were not deployed.  During extraction from the vehicle by the firefighters, there was a spontaneous combustion of the vehicle and the patient sustained partial thickness burns to the lower extremities. Patient arrives in the ED in respiratory distress with severe pain to the upper chest and a pneumothorax.  The year 4 students must prioritize the patient’s care which entails, prepping for chest tube insertion, pain medication, fluid resuscitation, dressing the burns, and setting up for intubation.  For scenario – click here

Multiple Patient Trauma – University of Ottawa
Description: This is a multiple patient scenario involving 3 patients in the Observation Unit following an MVC.

Patient A: R/O fetal distress/injury
Patient B: R/O Head Injury
Patient C: Splenic Laceration
For scenario – Click here

Multiple Patient Scenario (University of Windsor Ontario)
Description:  The scenario will involve four nursing students in total.  Based on the report, the nursing students will be required to decide which of their three assigned patients (CHF, Diabetes mellitus, Renal) need to be seen first. The nursing students will need to decide on a plan of care based on the patient’s condition and status. All three patients will have needs that will require nursing intervention. For scenario – click here

Severe Asthma Exacerbation (Laurentian University)
Description: In this scenario, learners are to assess and recognize signs and symptoms related to a severe asthma attack.  In addition, the learner needs to be able to intervene effectively and in a timely fashion; which should include: assessment, vital signs, oxygen therapy, medication administration communication skills for pediatric patient and their families/caregivers and identification of triggers.  For scenario – Click here

 

Cardiology


Chest Pain Assessment and Management (Laurentian University)
Description:  In this scenario, learners are expected to collect data in order to further evaluate the origin of her heartburn.  Data collection should culminate in a call to the patients’ physician.  Orders for Nitro spray will be received. Learners are expected to safely administer the medication and include all necessary assessments.   Chest pain remains unrelieved with Nitro administration and learners will recognize need to transport patient to local hospital via ambulance for further evaluation and management. For scenario – click here

 

 

Community Care Nursing


Working as street nurse (Durham/UOIT)
Description:  A street nurse works full-time in a downtown urban setting. Her position encompasses developing supportive relationships and identifying social, mental and physical health needs with clients and linking clients with community resources. A client living on the street requests socks and money from the nurse. As the client is changing her socks, the nurse observes an open wound on the heel of her right foot.  The nurse recognizes signs of substance use and the client reports recently being sexually assaulted by her boyfriend. The nurse establishes a connection with the client and collaboratively discusses a plan of care that results in the client consenting to accept care and go to the emergency department/urgent care/walk in clinic with the nurse.  For scenario – click here

Community care of patient with diabetes (Brock University)
Description: Older adult with newly diagnosed diabetes  being cared for in his home environment.  Designed to challenge the year 4 students with completing a home assessment and health teaching about medications, diet, smoking, and exercise.  Communication is needed with the physician, patient, family, and other healthcare providers.  The students are also faced with a patient who is undergoing a significant life change with the recent admission of his spouse to long-term care.   For Scenario – Click here

Maternal Child


Normal labour and delivery (Brock University)
Description: This is a multi option scenario representing the four stages of delivery. Scenarios can be run separately or as an entire labour and delivery process.

For scenario – Click here


Shoulder dystocia vaginal delivery – healthy neonate (Nipissing University)
Description: Noelle is a 24 year old gravida 3 para 1 who enters the birthing unit at 41 weeks gestation who experienced a previous vaginal delivery of a macrosomic infant after a 16-hour labor period. She was diagnosed with gestational diabetes in both pregnancies and that she has been taking her own capillary blood glucose (CBG) levels 3 times a day. For scenario – click here

Hypertensive disorder of pregnancy (Ryerson University)|
Description:  Care of a 41 year old pregnant client. She is currently 26 weeks pregnant (G1 – T0 – P0 – A0 – L0).  She is considered overweight with a pre-pregnancy BMI of 27.5 (5’4”/160lbs or 163cm/73kg).   She was found to be newly hypertensive with a weight gain of 8 lbs over the last two weeks and mild edema.  The client is admitted for observation and evaluation. For scenario – click here

 

Medical


Management and discharge planning – Diabetic patient – (Lakehead University)
Description: The patient is admitted to your unit with open sores on the first three toes of her right foot and anorexia x 3 days. She was diagnosed with Type 2 Diabetes 25 years ago and has a history of hypertension, peripheral vascular disease, and experiences intermittent claudication. She lives alone in a small house and has a son and daughter who both live out of town. For scenario – click here

Care of the patient experiencing diabetic ketoacidosis – adult dka (Trent University)  *Presimulation serious game available
Description: 49 year old male enters the ER with a glucose of 28 mmol/L.  The learner will need to complete a full assessment, identify abnormal assessment findings and provide appropriate care for a patient experiencing DKA.  Focus is on medication administration, communication, and assessment.  For scenario – click here

Care of the patient experiencing congestive heart failure (Trent University)
Description:  This is a standalone scenario for managing congestive heart failure.  Pt.  is an elderly women in hospital with progressive respiratory distress. In this scenario the students/learners are expected to recognize the patients increased level of anxiety and increased respiratory distress.  Students are to conduct a focused cardiopulmonary assessment and apply appropriate interventions such as repositioning, apply O2, call for assistance using SBAR, and administer correct dosage of ordered medication.     Patient improves with appropriate and timely interventions.   For scenario – click here

Care of the patient experiencing hypoglycemia (University of Western Ontario)
Description: The client is a 66 year-old male admitted two days ago with an anterior myocardial infarction.  He has numerous risk factors for heart disease, including diabetes.  It is now 1130 hours.  The nurse has been called by the client.  The client complains of palpitations, nausea and is diaphoretic.  For scenario – click here

DVT to PE respiratory distress (Queen’s University)   *Presimulation serious game available
Description: A 67 year old male patient on an orthopedic unit, post-op day 2 with a DVT in R calf. Heparin protocol was initiated. Patient has a history of a previous anterior myocardial infarction (MI) 12 months ago with placement of 2 stents. V/S have been stable over the night shift with no complaints. Patient is mildly short of breath and complaining of mild chest pain. 02 saturation (sat) is 90% on room air.  Heparin has been infusing at sub-therapeutic rate. Patient is diagnosed with PE and condition worsens to respiratory failure requiring placement of advanced airway and mechanical ventilation. For scenario – click here

Mental health


Mental health scenario (Lakehead University)
Description: Student(s) are at the bedside of client who expresses thoughts of self-harm. Need to establish a therapeutic relationship, conduct assessments, and collaborate with client on priorities for care. For scenario – click here

De-escalation of the angry patient (McMaster University)   *Presimulation serious game available
Description: A young man becomes increasingly upset and agitated during what he feels is a lengthy wait time in the emergency department of a community hospital despite his frequent and anxious requests to be seen to “get straightened out”.  His verbal and non-verbal cues appear to go unnoticed by emergency department nursing staff. For example, no one has approached him to inform him of the duration of the additional wait time nor to inquire further about his urgent concerns. For scenario – click here 

Suicide risk assessment  (University of Western Ontario)
Description: The client is a 19 year-old university student who presents to the Student Health Services Clinic accompanied by his roommate.  His friend is concerned about the client’s extreme fatigue and withdrawal from his usual social activities.  The nurse determines a suicide risk assessment should be performed.  Results of the assessment are to be reported to the health care team.  For scenario – click here

Palliative


End of life (Lakehead University)
Description: In this scenario, learners are to assess the patient’s needs from a holistic perspective and apply a palliative approach to care. Learners are to respond with effective nursing interventions that may include physical (i.e. positioning, need for supplemental oxygen, mouth care, medications), emotional/affective (i.e. acknowledging grief and loss, responding to anger, appropriate use of humour), mental/cognitive social, spiritual/religious, cultural aspects of care for the client and family. For scenario – click here

End of life: Breaking bad news (University of Ottawa)
Description: This is the part B of a two part unfolding scenario that can be used as a single, stand-alone scenario.  Case A: Palliative patient – admitted to the oncology unit from the ER with end stage lung cancer. For scenario Part A – click here

Case B: 55 year old male client is imminently dying of lung cancer with a Palliative Performance Scale (PPS). of 10%. DNR assigned. Client chose to die at home.  He is married and spouse is at the bedside. Client has 2 adult children and 3 grand-children who live out of town. One of which arrives at the home just after her/his father passes away. Nurses must provide comfort measures to the dying client and support the spouse during final breaths of life, in addition to breaking bad news to the child who arrives too late to say goodbye. For scenario Part B – click here

End of life (University of Windsor)
Description: Patient with stage four mesothelioma lung cancer that is being cared for in the home environment.  Designed to challenge the year 4 student with doing an assessment and critically thinking next steps when caring for a patient who becomes hemodynamically unstable.  Communication is paramount, with physician, EMS, and family.  The patient is sent to the hospital and arrives obtunded.  He goes into cardiac arrest, resuscitation is attempted but unsuccessful. The year 4 students are faced with a grieving family and preparing the body after death. For scenario – click here

 

Pediatric


Post op surgical site infection (Laurentian University)
Description: A 7 year old male patient previously healthy, 2 days post-op (# L femur-ORIF) with increased c/o pain and presence of localized swelling to left leg. In this scenario, learners are to assess and recognize signs and symptoms related to surgical site infection and pain management following an open reduction internal fixation (ORIF) procedure 2 days ago. In addition, the learner needs to be able to intervene effectively; which should include: pain assessment, vs assessment, infection control, wound care, PCA pump management and appropriate communication skills for pediatric patient and their families/caregivers. For scenario – click here

Tracheostomy care – (Mcmaster University)
Description: Learners are to perform a physical assessment of a pediatric patient, with a focus on the respiratory system. Routine suctioning and tracheostomy care should be performed. Learners should anticipate risks to patient safety and have appropriate safety and emergency equipment for patients with an artificial airway/respiratory distress (suction, oxygen, Ambubag with tracheostomy connection & face mask, extra tracheostomy x2 at bedside), and appropriately respond and intervene when the tracheostomy is accidentally removed (rapid assessment of patient ABCs, call for assistance, cover tracheostomy and provide ventilation via Ambubag with face mask, attempt tracheostomy reinsertion by RN if institutional policy allows -OR- call RT/MD for reinsertion).  For scenario – click here

 

Pediatric diabetic ketoacidosis (DKA) (Trent University)
Description:  10 year old male, admitted to the pediatric floor with a diagnosis of pneumonia. He has a past history of Type 1 diabetes that is well controlled.  Overnight, patient develops fever, nausea and vomiting.  His blood sugar at home was 22 mmol/L. In this scenario, learners are to assess and recognize diabetic ketoacidosis and intervene effectively to include: physical assessment, O2 administration, glucometer testing, mixing and administration of an IV insulin infusion. For scenario – click here

Étude de cas : acidocétose diabétique pédiatrique
Garçon de 10 ans admis au service pédiatrique après avoir reçu un diagnostic de pneumonie. Il souffre de diabète de type 1 qui est bien géré. Pendant la nuit, le patient est devenu fiévreux, a eu des nausées et des vomissements. Son taux de glycémie était de 22 mmol/L à la maison.  Lors de la simulation, les apprenants devront identifier et évaluer l’acidocétose diabétique, intervenir de manière efficace, effectuer une évaluation physique, adminstrer de l’oxygène, faire une analyse avec un glucomètre, préparer et administrer une solution d’insuline par IV.

 

Pediatric pneumonia (McMaster University)
Description: Patient is a 2 year old, admitted with pneumonia.  Mom has left to go home and attend to younger sibling. Grandmother is at bedside and upset and concerned about grand-daughter’s condition. Nursing students (2-3) will need to manage care of child who begins to cough and describe shortness of breath, as well as grandmother whose emotional state escalates to one of anger as she observes her grand-daughter’s condition. For scenario – click here

Pediatric meningitis and medication calculation (Ryerson University)
Description: A 12 year old who presented to the Emergency Department (ED) approximately 5 hours ago.  The patient has a 48 hr history of flu like symptoms (low grade temp (38.1OC), mild headache, generalized aches/pains). 2 hours before being brought to the ED, the patient voiced complaints of neck pain, increasing headache, photophobia, and had a temperature of 40.1OC.  The patient’s Aunt reported that he may have had tremors in the left arm but lasted less than a minute and happened only once. The patient has been admitted with a diagnosis of bacterial meningitis to the Pediatric GIM Unit for further follow-up and treatment. For scenario – click here

Death and dying (York University)
Description: 7 year old client diagnosed 11 months ago with a glioblastoma multiforme brain tumor.  Her initial symptoms were headaches sometimes associated with early morning vomiting or ataxia. She was rushed to the local children’s hospital a week later experiencing a seizure. Several diagnostic tests concluded a brain tumor and a partial resection of the tumor and histology examine confirmed the diagnosis of glioblastoma multiforme. The child underwent daily radiation treatments for 6 weeks with minimal reduction of the tumor. Four weeks ago, Aaliyah experienced a prolonged seizure requiring hospitalization. The family has decided to provide end-of-life care at home with the support of the palliative care team from the oncology unit. For scenario – click here

Disclosure of no harm patient safety incident (Pediatric) (Durham/UOIT)
Description: Once student conducts safe dosage range, recognizes that error has been made; completes patient assessment and then notifies preceptor; clinical leader (unit manager) and attending physician are informed. Preceptor and student discuss patient safety incident and now begin discussion about what needs to be done. For scenario – click here

 

Surgical


Post-op complication TKA – pulmonary embolism (Nipissing University)
Description – A 58 year old female patient admitted from recovery room postoperatively for a Left Total Knee Arthroplasty (TKA). She arrived on the floor 72 hours ago. She is now complaining of chest pain and severe shortness of breath. Pain is worse on inspiration and in her substernal chest.  For scenario – click here

Elderly patient with urosepsis (Queen’s University)   *Presimulation serious game available
Description: 82 year old male encountered in the ER department upon transfer from a long-term care (LTC) facility, with foley catheter in situ, and wrist restraints tied to bed/stretcher rails. PSW accompanying patient describes a 2 day onset of increasing confusion & agitation. Family member arrives as patient’s condition is deteriorating with worsening vital signs and decreased level of consciousness until patient unresponsive. Patient requires treatment for septic shock and transfer to ICU.  For scenario – click here  

GI bleed (Ryerson University)
Description: A. Jones is a 76 year old widow who slipped and fell outside their home and fractured their left hip.  A. Jones was admitted three days ago and had an internal fixation of her hip 2 days ago. The surgery was uneventful, recovery has been slow.  A. Jones has a history of Hypertension, osteoarthritis, and “stomach problems”.  A. Jones has a history of heavy drinking but states she has recently “cut back to 1-2 drinks per day” and currently smokes ½ to1 PPD.  For scenario – click here

Blood transfusion (University of Western Ontario)
Description: The client is a 52 year-old male admitted to hospital for a bowel resection due to adenocarcinoma of the colon.  He is one-day post-op.  His hemoglobin is 74 g/L and the physician has ordered 2 units of packed red blood cells to be administered, each over two hours.  He is very anxious about the transfusion. Once the transfusion commences, he develops hives on his chest.  This causes his anxiety to increase.  An order for IV Benadryl is obtained and the client’s condition stabilizes. For scenario – click here