VSIM STUDY GUIDE: SHERMAN "RED" YODER (AGE 80) PARTS 1 & 2 | NURSING
CLINICAL SIMULATION | GERONTOLOGY & ACUTE CARE COMPLETE SOLUTION
GUIDE | LATEST VERSION 2026/2027
SECTION 1: PATIENT OVERVIEW
Full Name Sherman "Red" Yoder
Age 80 years old
Gender Male
Setting Medical-Surgical / Acute Care Unit
Primary Diagnosis Heart Failure (HF) with Acute Exacerbation
Secondary Chronic Obstructive Pulmonary Disease (COPD),
Diagnosis Hypertension, Type 2 Diabetes Mellitus
Code Status Full Code
Allergies No Known Drug Allergies (NKDA)
Attending Dr. Price
Simulation Focus Assessment, medication administration, patient
education, care coordination
SECTION 2: CHIEF COMPLAINT & HISTORY OF PRESENT
ILLNESS
Chief Complaint
,Mr. Yoder presents with progressive shortness of breath, bilateral lower extremity
edema, and a weight gain of 8 lbs over the past 3 days. He reports increasing
fatigue and orthopnea, requiring 3 pillows to sleep.
History of Present Illness
Sherman "Red" Yoder is an 80-year-old male with a known history of heart failure
(EF 35%), COPD, hypertension, and type 2 diabetes. He was brought to the
emergency department by his daughter due to worsening dyspnea and bilateral
leg swelling. He reports compliance with his medications but admits to dietary
indiscretion over the past week (high sodium intake at family gatherings). He
denies chest pain, fever, or chills.
Past Medical History (PMH)
• Congestive Heart Failure (CHF) — EF 35% (systolic dysfunction)
• Chronic Obstructive Pulmonary Disease (COPD)
• Hypertension (HTN) — controlled
• Type 2 Diabetes Mellitus (T2DM)
• Myocardial Infarction (MI) — 5 years ago
• Atrial Fibrillation (A-Fib) — on anticoagulation
Social History
• Lives with daughter
• Former smoker: 40 pack-year history, quit 10 years ago
• Denies current alcohol use
• Retired farmer
SECTION 3: BASELINE VITAL SIGNS & PHYSICAL ASSESSMENT
Initial Vital Signs on Admission
Parameter Value Normal Range
Blood Pressure 168/94 mmHg < 120/80 mmHg
Heart Rate 98 bpm (irregular) 60–100 bpm
Respiratory Rate 24 breaths/min 12–20 breaths/min
SpO2 88% on Room Air 95–100%
Temperature 98.4°F (36.9°C) 97.8–99.1°F
Weight 198 lbs (up 8 lbs) Baseline 190 lbs
, Pain 3/10 (mild chest 0/10
tightness)
Head-to-Toe Assessment Findings
RESPIRATORY: RR 24, labored breathing; SpO2 88% on RA; crackles (rales)
bilateral lung bases — worse at right base; use of accessory muscles noted;
orthopnea present.
CARDIOVASCULAR: HR 98, irregular rhythm (A-Fib); BP 168/94; S3 gallop
present (classic HF sign); JVD (jugular venous distension) visible at 45 degrees;
3+ pitting edema bilateral lower extremities up to knees.
NEUROLOGICAL: Alert and oriented x3; slightly anxious; PERRL 3mm; no focal
neurological deficits.
SKIN: Pale, cool extremities; mottling noted on lower legs; skin turgid with
edema.
ABDOMEN: Soft, mildly distended; hepatomegaly noted on palpation
(hepatojugular reflux positive); bowel sounds present x4.
RENAL/OUTPUT: Urine output decreased (oliguria); urine concentrated (dark
amber).
SECTION 4: DIAGNOSTIC TEST RESULTS & INTERPRETATION
Laboratory Values
Lab Test Patient Value Normal Range Clinical
Significance
BNP (B-type 1,200 pg/mL < 100 pg/mL CRITICAL —
natriuretic peptide) confirms acute
HF exacerbation
Sodium (Na+) 132 mEq/L 136–145 LOW —
mEq/L dilutional
hyponatremia
from fluid
overload
Potassium (K+) 3.2 mEq/L 3.5–5.0 mEq/L LOW — monitor;
risk for
arrhythmia with
diuresis
CLINICAL SIMULATION | GERONTOLOGY & ACUTE CARE COMPLETE SOLUTION
GUIDE | LATEST VERSION 2026/2027
SECTION 1: PATIENT OVERVIEW
Full Name Sherman "Red" Yoder
Age 80 years old
Gender Male
Setting Medical-Surgical / Acute Care Unit
Primary Diagnosis Heart Failure (HF) with Acute Exacerbation
Secondary Chronic Obstructive Pulmonary Disease (COPD),
Diagnosis Hypertension, Type 2 Diabetes Mellitus
Code Status Full Code
Allergies No Known Drug Allergies (NKDA)
Attending Dr. Price
Simulation Focus Assessment, medication administration, patient
education, care coordination
SECTION 2: CHIEF COMPLAINT & HISTORY OF PRESENT
ILLNESS
Chief Complaint
,Mr. Yoder presents with progressive shortness of breath, bilateral lower extremity
edema, and a weight gain of 8 lbs over the past 3 days. He reports increasing
fatigue and orthopnea, requiring 3 pillows to sleep.
History of Present Illness
Sherman "Red" Yoder is an 80-year-old male with a known history of heart failure
(EF 35%), COPD, hypertension, and type 2 diabetes. He was brought to the
emergency department by his daughter due to worsening dyspnea and bilateral
leg swelling. He reports compliance with his medications but admits to dietary
indiscretion over the past week (high sodium intake at family gatherings). He
denies chest pain, fever, or chills.
Past Medical History (PMH)
• Congestive Heart Failure (CHF) — EF 35% (systolic dysfunction)
• Chronic Obstructive Pulmonary Disease (COPD)
• Hypertension (HTN) — controlled
• Type 2 Diabetes Mellitus (T2DM)
• Myocardial Infarction (MI) — 5 years ago
• Atrial Fibrillation (A-Fib) — on anticoagulation
Social History
• Lives with daughter
• Former smoker: 40 pack-year history, quit 10 years ago
• Denies current alcohol use
• Retired farmer
SECTION 3: BASELINE VITAL SIGNS & PHYSICAL ASSESSMENT
Initial Vital Signs on Admission
Parameter Value Normal Range
Blood Pressure 168/94 mmHg < 120/80 mmHg
Heart Rate 98 bpm (irregular) 60–100 bpm
Respiratory Rate 24 breaths/min 12–20 breaths/min
SpO2 88% on Room Air 95–100%
Temperature 98.4°F (36.9°C) 97.8–99.1°F
Weight 198 lbs (up 8 lbs) Baseline 190 lbs
, Pain 3/10 (mild chest 0/10
tightness)
Head-to-Toe Assessment Findings
RESPIRATORY: RR 24, labored breathing; SpO2 88% on RA; crackles (rales)
bilateral lung bases — worse at right base; use of accessory muscles noted;
orthopnea present.
CARDIOVASCULAR: HR 98, irregular rhythm (A-Fib); BP 168/94; S3 gallop
present (classic HF sign); JVD (jugular venous distension) visible at 45 degrees;
3+ pitting edema bilateral lower extremities up to knees.
NEUROLOGICAL: Alert and oriented x3; slightly anxious; PERRL 3mm; no focal
neurological deficits.
SKIN: Pale, cool extremities; mottling noted on lower legs; skin turgid with
edema.
ABDOMEN: Soft, mildly distended; hepatomegaly noted on palpation
(hepatojugular reflux positive); bowel sounds present x4.
RENAL/OUTPUT: Urine output decreased (oliguria); urine concentrated (dark
amber).
SECTION 4: DIAGNOSTIC TEST RESULTS & INTERPRETATION
Laboratory Values
Lab Test Patient Value Normal Range Clinical
Significance
BNP (B-type 1,200 pg/mL < 100 pg/mL CRITICAL —
natriuretic peptide) confirms acute
HF exacerbation
Sodium (Na+) 132 mEq/L 136–145 LOW —
mEq/L dilutional
hyponatremia
from fluid
overload
Potassium (K+) 3.2 mEq/L 3.5–5.0 mEq/L LOW — monitor;
risk for
arrhythmia with
diuresis
