Fall 2021
SIM LAB ADMISSION TICKET
Patient name: Malcolm Little
Visit # 2
Scenario: CHF
SLS: Health Assessment 8.1
Allergies: PENICILLIN
Course Objectives: By the end of the course, the student should be able to:
1. Identify competent nursing care for clients with chronic conditions utilizing evidence-based
practice guidelines (SLO 1, 2, 5).
2. Differentiate care needs of the elderly adult experiencing alterations in health (SLO 2, 3,
5).
3. Acknowledge legal and ethical issues in healthcare (SLO 3).
4. Prioritize nursing care for patients with chronic alterations in health (SLO 1, 2, 4, 5).
5. Develop an individualized teaching plan for the client with the goal of improving and
maintaining personal health (SLO 1, 2, 3, 4).
6. Correctly calculate medication doses appropriate for the population (SLO 1, 5).
THOROUGHLY ANSWER THE FOLLOWING COMPREHENSIVELY and submit 24 hours BEFORE
SIMULATION TIME (48 hours preferable). Incomplete tickets will be returned for redo, and must
be in before the simulation.
**ANSWERS MUST BE paraphrased AND CITE PROFESSIONAL source (Author, year, page).
1. Paraphrase (with reference) the mechanism that occurs when LCHF causes pulmonary
edema. A) How does it move from the vessels? B) Where exactly is the fluid is within the
lungs?
LCHF causes pulmonary edema because it means that the left ventricle is not contracting
so it causes the fluid to back up into the left atrium and the pulmonary veins. The fluid is
in the pulmonary veins in the lungs because the blood does not flow out of the heart
instead it flows backwards from where it came in the heart (Woosley, HF Chart).
2. You receive STAT orders for Furosemide and a Foley for a patient in fulminant pulmonary
edema. A) Based on research, how does each relieve pulmonary edema? B) In your
opinion, which intervention would you do first? C) Why?
Furosemide is a diuretic, so it is going to cause the patient to pee out the excess fluid in
the body. The folly is going to help the patient eliminate urine easier and at a quicker
rate to reduce the pulmonary edema. I would complete the folly catheter first because
the furosemide is going to cause the patient to pee but if the patient has urinary
retention or difficulty urinating the folly is going to reduce the pulmonary edema at a
faster rate making it easier for the patient to breathe quicker. (Harding, 2020)
, Fall 2020
SIM LAB ADMISSION TICKET
3. Your patient asks how Furosemide will take the water out of his lungs and feet. In your
own words, explain this to the patient in lay terms.
Furosemide is a drug that works to eliminate excess water from the body. This drug
works in the kidneys by eliminating sodium and water following. It is going to make you
pee a lot since it works in the kidneys.
4. List six labs used to diagnose/assess CHF with the normal values for each
Sodium: 135-145 mEq/L Potassium: 3.5-5 mEq/L BUN: 10-20 mg/dL Creatinine: 0.16-1.2
mg/dL ANP: <100 pg/mL BNP: <900 pg/mL
5. Based on research, paraphrase the relationship between potassium and digoxin. Both
impact the other. A) How does hypokalemia affect digoxin levels? B) How does Digoxin
toxicity affect potassium?
Digoxin is an antidysrhythmic and if the patient has hypokalemia it is going to increase
the digoxin levels. This is dangerous because digoxin has a small therapeutic index and
can become toxic. If digoxin levels are toxic then it can cause an increase in potassium
resulting in hyperkalemia (Vallerand, 2021).
6. Opinion: Which IV fluid would be contraindicated in CHF. Why?
The IV fluid that would be contraindicated is 0.9% Normal Saline because the patient is
already having fluid volume overload. Water follows sodium so if there is more sodium
in the body there is going to be more fluid. To help the CHF patient, the nurse wants to
decrease their fluid volume overload.
7. Your patient has ascites secondary to R CHF. Using paraphrase, explain how and why the
fluid moved into the abdomen.
Right sided congestive heart failure means that the right ventricle is not working and
fluid gets backed up into the right atrium. The right atrium will then back up into the
inferior and superior vena cava. This is going to cause the fluid to be in the abdomen
resulting in ascites (Woosley, HF Chart).
8. Opinion: Why are troponins ordered for this patient? What do troponin levels tell about
his CHF??
Troponins are normally low but will increase in the case of injury, much like CHF patients
experience. I think they were ordered to see how extensive the damage to the patient’s
heart muscle is, how much atrophy has occurred (Harding, 2020).
SIM LAB ADMISSION TICKET
Patient name: Malcolm Little
Visit # 2
Scenario: CHF
SLS: Health Assessment 8.1
Allergies: PENICILLIN
Course Objectives: By the end of the course, the student should be able to:
1. Identify competent nursing care for clients with chronic conditions utilizing evidence-based
practice guidelines (SLO 1, 2, 5).
2. Differentiate care needs of the elderly adult experiencing alterations in health (SLO 2, 3,
5).
3. Acknowledge legal and ethical issues in healthcare (SLO 3).
4. Prioritize nursing care for patients with chronic alterations in health (SLO 1, 2, 4, 5).
5. Develop an individualized teaching plan for the client with the goal of improving and
maintaining personal health (SLO 1, 2, 3, 4).
6. Correctly calculate medication doses appropriate for the population (SLO 1, 5).
THOROUGHLY ANSWER THE FOLLOWING COMPREHENSIVELY and submit 24 hours BEFORE
SIMULATION TIME (48 hours preferable). Incomplete tickets will be returned for redo, and must
be in before the simulation.
**ANSWERS MUST BE paraphrased AND CITE PROFESSIONAL source (Author, year, page).
1. Paraphrase (with reference) the mechanism that occurs when LCHF causes pulmonary
edema. A) How does it move from the vessels? B) Where exactly is the fluid is within the
lungs?
LCHF causes pulmonary edema because it means that the left ventricle is not contracting
so it causes the fluid to back up into the left atrium and the pulmonary veins. The fluid is
in the pulmonary veins in the lungs because the blood does not flow out of the heart
instead it flows backwards from where it came in the heart (Woosley, HF Chart).
2. You receive STAT orders for Furosemide and a Foley for a patient in fulminant pulmonary
edema. A) Based on research, how does each relieve pulmonary edema? B) In your
opinion, which intervention would you do first? C) Why?
Furosemide is a diuretic, so it is going to cause the patient to pee out the excess fluid in
the body. The folly is going to help the patient eliminate urine easier and at a quicker
rate to reduce the pulmonary edema. I would complete the folly catheter first because
the furosemide is going to cause the patient to pee but if the patient has urinary
retention or difficulty urinating the folly is going to reduce the pulmonary edema at a
faster rate making it easier for the patient to breathe quicker. (Harding, 2020)
, Fall 2020
SIM LAB ADMISSION TICKET
3. Your patient asks how Furosemide will take the water out of his lungs and feet. In your
own words, explain this to the patient in lay terms.
Furosemide is a drug that works to eliminate excess water from the body. This drug
works in the kidneys by eliminating sodium and water following. It is going to make you
pee a lot since it works in the kidneys.
4. List six labs used to diagnose/assess CHF with the normal values for each
Sodium: 135-145 mEq/L Potassium: 3.5-5 mEq/L BUN: 10-20 mg/dL Creatinine: 0.16-1.2
mg/dL ANP: <100 pg/mL BNP: <900 pg/mL
5. Based on research, paraphrase the relationship between potassium and digoxin. Both
impact the other. A) How does hypokalemia affect digoxin levels? B) How does Digoxin
toxicity affect potassium?
Digoxin is an antidysrhythmic and if the patient has hypokalemia it is going to increase
the digoxin levels. This is dangerous because digoxin has a small therapeutic index and
can become toxic. If digoxin levels are toxic then it can cause an increase in potassium
resulting in hyperkalemia (Vallerand, 2021).
6. Opinion: Which IV fluid would be contraindicated in CHF. Why?
The IV fluid that would be contraindicated is 0.9% Normal Saline because the patient is
already having fluid volume overload. Water follows sodium so if there is more sodium
in the body there is going to be more fluid. To help the CHF patient, the nurse wants to
decrease their fluid volume overload.
7. Your patient has ascites secondary to R CHF. Using paraphrase, explain how and why the
fluid moved into the abdomen.
Right sided congestive heart failure means that the right ventricle is not working and
fluid gets backed up into the right atrium. The right atrium will then back up into the
inferior and superior vena cava. This is going to cause the fluid to be in the abdomen
resulting in ascites (Woosley, HF Chart).
8. Opinion: Why are troponins ordered for this patient? What do troponin levels tell about
his CHF??
Troponins are normally low but will increase in the case of injury, much like CHF patients
experience. I think they were ordered to see how extensive the damage to the patient’s
heart muscle is, how much atrophy has occurred (Harding, 2020).
