NUR 377 Advanced Medical Surgical Nursing

vSim Course Point Pharmacology: Juan Carlos

Please complete the below activities to receive credit for the virtual simulation assignment.
A rubric is available under the “assignments” tab in BlackBoard, so you can review the
entire point breakdown.
 Pre-simulation Quiz, vSim and post-simulation quiz for Juan Carlos in the Pharmacology
vSims.
o You do not need to complete the Documentation Assignment within vSim
o The Guided Reflection Questions within vSim are included within this Simulation
Worksheet
o Must achieve an 80% on the vSim with a maximum of 3 attempts
 The simulation worksheet (below)
 Submit the following to Blackboard by Wednesday June 3, 2020 at 9:00am EST
o Simulation Worksheet; information must be typed and submitted as a word doc
o Screenshot of pre-quiz score, post-quiz score, and vSim feedback
Simulation Worksheet
Describe the disease process affecting patient (include Pathophysiology of Disease
Process)
Foot Ulcer in the presence of Diabetes Type II:
Individuals with diabetes may have diminished nerve working due to peripheral diabetic
neuropathy. This implies that the nerves that more often than not carry torment sensation to the
brain from the feet don’t work as well and it is conceivable for harm to happen to your foot
without feeling it. Treading on something, wearing tight shoes, cuts, rankles and bruises can
all create into diabetes foot ulcers. Limited supply routes can too decrease blood stream to the
feet among a few individuals with diabetes and this could impede the foot’s capacity to mend
legitimately. When the foot can not mend, a foot ulcer can develop.

Explain the following Treatment:

Debridement: the removal of damaged and necrotic tissue or foreign objects from a wound to
promote wound healing
Different types of debridement:
Autolytic debridement Using body’s own enzymes and moisture with hydrocolloids, hydrogels and transp
films

Enzymatic Using chemical enzymes: collagenase, papain-urea

debridement
 Mechanical Hydrosurgery, ultrasonic debridement
debridement

Surgical debridement Using sharp surgical debridement/Hydrosurgery • In the operating room • Bedside
debridement

Biological debridement Maggot debridement therapy

Why debride?
Dead tissue acts as a medium for bacterial growth and increases the risk of infection.
Bacterial colonies that are commonly present in necrotic tissue may develop proteases that bre
ak down essential components of the extracellular matrix and have a negative impact on granul
ation tissue formation.

Explain the following lab values and what the listed result means for the patient (normal
values are noted in the parentheses):
Glucose (65-140mg/dl) 185mg/dL: Hyperglycemia. It means impaired regulation of Blood
glucose level, which may be due to deficiency of insulin or resistance to action of insulin

GHb A1c (<6%) 8.3 %: This test is a very important measure of how well your diabetes is
controlled. It measures the average of the blood sugar levels over the last three months. This
value it means that the patient’s blood glucose was poorly regulated and remained elevated for
most of the time during past 3 months.

Medications: List classification, why is it prescribed for the patient and nursing
considerations.
Insulin detemir SC 5 units 2x daily:
 Classification: antidiabetics
 Use: control of hyperglycemia in patients with type 1 or type 2 diabetes mellitus
 Nursing Considerations:
- Assess patient for signs and symptoms of hypoglycemia (anxiety; restlessness; tingling
in hands, feet, lips, or tongue; chills; cold sweats; confusion; cool, pale skin
- Monitor body weight periodically.
- Explain to patient that this medication controls hyperglycemia but does not cure
 diabetes

Insulin aspart SC sliding scale:

 Classification: antidiabetics
 Use: control of hyperglycemia in patients with type 1 or type 2 diabetes mellitus
 Nursing Considerations:
- Assess for symptoms of hypoglycemia (anxiety; restlessness; tingling in hands, feet,
lips, or tongue; chills; cold sweats; confusion; cool, pale skin; difficulty in
concentration; drowsiness
- Monitor body weight periodically

Glyburide 0.75 mg PO daily:

 Classification: antidiabetics
 Use: control of blood sugar in type 2 diabetes mellitus when diet therapy fails
 Nursing Considerations:
- Observe for signs and symptoms of hypoglycemic reactions (sweating, hunger,
weakness, dizziness, tremor, tachycardia, anxiety). Patients on concurrent betablocker
therapy may have very subtle signs and symptoms of hypoglycemia. ● Assess patient
for allergy to sulfonamides. ● Lab Test Considerations: Monitor serum
- Assess patient for allergy to sulfonamides
- Monitor CBC during therapy

Metformin XR 1000 mg PO 2x daily

 Classification: antidiabetics
 Use: management of type 2 diabetes mellitus: may be used with diet, insulin, or
sulfonylurea oral hypoglycemics
 Nursing Considerations:
- When combined with oral sulfonylureas, observe for signs and symptoms of
hypoglycemic reactions (abdominal pain, sweating, hunger, weakness, dizziness,
headache, tremor, tachycardia, anxiety)
- When combined with oral sulfonylureas, observe for signs and symptoms of
hypoglycemic reactions (abdominal pain, sweating, hunger, weakness, dizziness,
headache, tremor, tachycardia, anxiety)
- Metformin should be temporarily discontinued in patients requiring surgery involving
restricted intake of food and fluids. Resume metformin when oral intake has resumed
and renal function is normal.
- Explain to patient that metformin helps control hyperglycemia but does not cure
diabetes.

Scenario Analysis Questions:

1. What priority problem(s) did you identify for Juan Carlos? Did your priorities
change during the scenario? Why?
Initially, I believed that the wound to his great right toe would be the priority problem.
Instead, his blood glucose bottomed out and that became my priority.
 2. What data that was presented to you or that you gathered indicated a need for more
education for Juan Carlos in regard to diabetes management?
After checking his A1C, I realized that his diabetes has not been managed which is an indicator
of under education of a disease. I used this as a teaching point.

3. List and discuss the importance of patient education on proper diabetic control.

It is important for a diabetic to maintain a healthy lifestyle. To do so, it is essential for

he/she to maintain their blood glucose level. Maintaining blood glucose helps diabetics
heal wounds, maintain system function, and avoid more serious conditions.

4. Path to Death or Injury: (What is the worst thing that can happen to your patient
and how will you prevent it?)
The worst that can happen to this patient is an amputation of the leg. To prevent the end
result of foot ulcers for patients with diabetes type 2, they are advised to take good care
of their feet. One should be advised to avoid wearing tight shoes, regularly check their
feet for any injuries. One should also avoid walking around without shoes and keeping
their feet clean at all times.

5. What other interprofessional team members should be involved in Juan Carlos’s

care?
I would suggest involving a nutritionist and a wound care team for Juan Carlo’s care.
Because nutrition is such an important part of healing, a nutritionist would be my priority
concern.

Reflection Questions:
1. How did the simulated experience of Juan Carlos’s case make you feel?
I felt a little bit unprepared at first, but after reading the orders I realized I was really
familiar for the treatments of hypoglycemia. After a while, I felt relatively in control.

2. Discuss the actions you felt went well within this scenario?
In my opinion, most of the simulation went well. After checking the blood glucose level,
the rest seemed like second nature. I knew that insulin would need to be administered and
that a protein and carbohydrate combination would be necessary. After checking the
order, I realized that I was correct. Also, I knew that I needed to have another nurse
verify the insulin. After reading he was a diabetic, I immediately thought to assess the
legs and check the pedal pulses.
3. Reflecting on Juan Carlos’s case, were there any actions you would do differently if
you were to repeat this scenario?  If so, how would your patient care change?
Initially, I did not educate the patient on adverse effects of his medications. Although it
would not have necessarily changed the patients care much, it would have had to the
patient better understand why their blood glucose dropped if they were unaware. I was
just under the impression that a diabetic would have already been educated, but I have to
remember that education is extremely important: never assume a patient understands
what is going on.