NURS 617
SIMULATION DEVELOPMENT PLAN TEMPLATE
Date: File Name:
Discipline: Nursing Student Level: Registered Nurses
Expected Simulation Run Time: 20 minutes Guided Reflection Time: 15 minutes
Location: Life Support Education Department Location for Reflection: Classroom 5
Admission Date: after receiving 2 nitroglycerin sprays in-route to
the
Today’s Date:
Brief Description of Client
Name: John Smith
Gender: M Age: 54 Race: White
Weight: 95kg Height: 182.8 cm
Religion: Christian Major Support: Family
Phone: (336) 987-6543
Allergies: PCN, ACE inhibitors, bee venom,
mushrooms, and pineapple
Immunizations: Tdap up to date, No recent
influenza or pneumonia vaccination
Attending Physician/Team: Emergency Medicine
Past Medical History: Hypertension,
hyperlipidemia, type II diabetes mellitus,
osteoarthritis
History of Present illness: Patient has had
increasing pain for the last two hours. He believed
it to be indigestion and took tums without relief
about 90 minutes ago. His wife called EMS when
he broke into a sweat and turned pale about one
hour ago.
The patient is currently complaining of pain at 7/10
Page 1 of 12
Downloaded from http://sirc.nln.org with the permission of the National League for Nursing and Laerdal Medical. This
document may be reproduced as long as it retains the following copyright statement:
© Copyright, 2010. Simulation in nursing education: From conceptualization to evaluation. New York: National League for
Nursing. Reprinted with permission.
If you find this Simulation Design Template useful, we would appreciate hearing from you. Please send an email message
with your comments to .
, NURS 617
Psychomotor Skills Required Prior to
Simulation
Basic life support
Advance cardiac life support IV
insertion
Medication administration
Rhythm interpretation
Vital sign interpretation including
capnography
Cognitive Activities Required prior to
Simulation [i.e. independent reading (R), video
review (V), computer simulations (CS), lecture (L)]
R – BLS and ACLS provider manual
V- BLS and ACLS videos or
CS- BLS and ACLS simulations or
L – BLS and ACLS lectures/skills stations
Page 2 of 12
Downloaded from http://sirc.nln.org with the permission of the National League for Nursing and Laerdal Medical. This
document may be reproduced as long as it retains the following copyright statement:
© Copyright, 2010. Simulation in nursing education: From conceptualization to evaluation. New York: National League for
Nursing. Reprinted with permission.
If you find this Simulation Design Template useful, we would appreciate hearing from you. Please send an email message
with your comments to .
, NURS 617
hospital with EMS. The patient refused aspirin
stating, “it makes his stomach hurt”.
Social History: Patient quit smoking 3 months ago
after smoking 1-2 ppd for 27 years. He drinks 12
beers per week and denies any illegal drug use.
Primary Medical Diagnosis: Chests pain likely due
to acute coronary syndrome.
Surgeries/Procedures & Dates:
Left knee surgery 2005
Appendectomy 1996
Hernia repair 2000
Nursing Diagnoses:
Acute pain related to myocardial ischemia as
evidenced by self-reports of chest pain discomfort
using a standardized pain scale.
Fear related to the unknown, threat of myocardial
infarction, and/or death as evidenced by
restlessness, increased heart rate, blood pressure,
and respiratory rate, and increased questions.
Risk for decreased cardiac output related to
myocardial ischemia affecting contractility.
Risk for dysrhythmias secondary to ischemia.
Page 3 of 12
Downloaded from http://sirc.nln.org with the permission of the National League for Nursing and Laerdal Medical. This
document may be reproduced as long as it retains the following copyright statement:
© Copyright, 2010. Simulation in nursing education: From conceptualization to evaluation. New York: National League for
Nursing. Reprinted with permission.
If you find this Simulation Design Template useful, we would appreciate hearing from you. Please send an email message
with your comments to .
SIMULATION DEVELOPMENT PLAN TEMPLATE
Date: File Name:
Discipline: Nursing Student Level: Registered Nurses
Expected Simulation Run Time: 20 minutes Guided Reflection Time: 15 minutes
Location: Life Support Education Department Location for Reflection: Classroom 5
Admission Date: after receiving 2 nitroglycerin sprays in-route to
the
Today’s Date:
Brief Description of Client
Name: John Smith
Gender: M Age: 54 Race: White
Weight: 95kg Height: 182.8 cm
Religion: Christian Major Support: Family
Phone: (336) 987-6543
Allergies: PCN, ACE inhibitors, bee venom,
mushrooms, and pineapple
Immunizations: Tdap up to date, No recent
influenza or pneumonia vaccination
Attending Physician/Team: Emergency Medicine
Past Medical History: Hypertension,
hyperlipidemia, type II diabetes mellitus,
osteoarthritis
History of Present illness: Patient has had
increasing pain for the last two hours. He believed
it to be indigestion and took tums without relief
about 90 minutes ago. His wife called EMS when
he broke into a sweat and turned pale about one
hour ago.
The patient is currently complaining of pain at 7/10
Page 1 of 12
Downloaded from http://sirc.nln.org with the permission of the National League for Nursing and Laerdal Medical. This
document may be reproduced as long as it retains the following copyright statement:
© Copyright, 2010. Simulation in nursing education: From conceptualization to evaluation. New York: National League for
Nursing. Reprinted with permission.
If you find this Simulation Design Template useful, we would appreciate hearing from you. Please send an email message
with your comments to .
, NURS 617
Psychomotor Skills Required Prior to
Simulation
Basic life support
Advance cardiac life support IV
insertion
Medication administration
Rhythm interpretation
Vital sign interpretation including
capnography
Cognitive Activities Required prior to
Simulation [i.e. independent reading (R), video
review (V), computer simulations (CS), lecture (L)]
R – BLS and ACLS provider manual
V- BLS and ACLS videos or
CS- BLS and ACLS simulations or
L – BLS and ACLS lectures/skills stations
Page 2 of 12
Downloaded from http://sirc.nln.org with the permission of the National League for Nursing and Laerdal Medical. This
document may be reproduced as long as it retains the following copyright statement:
© Copyright, 2010. Simulation in nursing education: From conceptualization to evaluation. New York: National League for
Nursing. Reprinted with permission.
If you find this Simulation Design Template useful, we would appreciate hearing from you. Please send an email message
with your comments to .
, NURS 617
hospital with EMS. The patient refused aspirin
stating, “it makes his stomach hurt”.
Social History: Patient quit smoking 3 months ago
after smoking 1-2 ppd for 27 years. He drinks 12
beers per week and denies any illegal drug use.
Primary Medical Diagnosis: Chests pain likely due
to acute coronary syndrome.
Surgeries/Procedures & Dates:
Left knee surgery 2005
Appendectomy 1996
Hernia repair 2000
Nursing Diagnoses:
Acute pain related to myocardial ischemia as
evidenced by self-reports of chest pain discomfort
using a standardized pain scale.
Fear related to the unknown, threat of myocardial
infarction, and/or death as evidenced by
restlessness, increased heart rate, blood pressure,
and respiratory rate, and increased questions.
Risk for decreased cardiac output related to
myocardial ischemia affecting contractility.
Risk for dysrhythmias secondary to ischemia.
Page 3 of 12
Downloaded from http://sirc.nln.org with the permission of the National League for Nursing and Laerdal Medical. This
document may be reproduced as long as it retains the following copyright statement:
© Copyright, 2010. Simulation in nursing education: From conceptualization to evaluation. New York: National League for
Nursing. Reprinted with permission.
If you find this Simulation Design Template useful, we would appreciate hearing from you. Please send an email message
with your comments to .
