Virtual Clinical Replacement Student Requirements

1. Students must wear uniform.

2. Students must have camera on during the entire session.
3. Student must be on camera during the session free of noise and distractions.
4. Clinical Replacement Packets must be submitted in its entirety by 11:59PM within 24
hours of the clinical via Blackboard. If packet is not turned in, student will not get credit
for clinical.
 CONCEPT MAP/ PLAN OF CARE

This activity creates an opportunity for you to organize the nursing care required for the patient
care presented in your assigned vSim.
Student Learning Outcome
At the end of this activity, student will be able to:
1. Describe pathological events associated with the patient’s disease process or condition.
2. Create a plan of care and priori zed nursing interventions based on patient care needs.
3. Identify anticipated diagnostic and physical assessment findings related to
the identified condition or disease process.

Assignment
1. Log into thePoint and Launch the assigned vSim, following the instructions posted on
your learning management system (LMS) or given by your clinical instructor.
2. Review the information contained in the patient information.
3. Review the smart sense links associated with the Nursing Care, Diagnostics,
Pharmacology found in the suggested reading area.
4. Create the follow concept map. List pathophysiology associated with the patient’s disease
process or condition, the anticipated physical assessment findings, vital signs,
diagnostics, specific nursing interventions and other patient information on associated
with the patient situation.
5. Utilize the smart sense links throughout the vSim to complete the worksheet.
6. Submit your concept map for review.

2
Adapted from vSim for Nursing Wolters Klewur
 Concept Map Worksheet

Describe Disease Process Affecting Patient (include pathophysiology of disease process)

Stroke occurs when the blood supply to part of your brain is interrupted or reduced, preventing brain tissue from getting
oxygen and nutrients. Brain cells begin to die in minutes. Two main causes of stroke are a blocked artery known as
ischemic stroke or leaking or bursting of a blood vessel known as hemorrhagic stroke. Some people may have only a
temporary disruption of blood flow to the brain, known as a transient ischemic attack (TIA), that doesn't cause lasting
symptoms

Diagnostic Tests Patient Information Anticipated Physical

(Reason for test and results) Findings
 Tomography scan Vernon Russel is a 55-year-old male  weakness in the left side
 Blood Glucose test to check blood admitted to the hospital 2 weeks ago of the body
sugar levels for a stroke with mild left hemiplegia.  some sensory losses in
 HgbA1c1 left side
 CBC  pupils are equal
 BMP  mobility is decreased, and
 PT strength is weakened
 INR

Anticipated Nursing Interventions

 Perform neuro assessment and vital signs per shift

 Bedside blood glucose checks twice daily before breakfast and at bedtime
 Medication as ordered by provider
 Labs: CBC, BMP, PT, and INR
 Patient will be educated on risk and prevention of falls.
 Educate on the importance of passive range of motion exercises to increase mobility and circulation.
 Physical therapy and Occupational therapy two times a day
 Patient will be educated on how to manage symptoms or complications after stroke

3
Adapted from vSim for Nursing Wolters Klewur
 ISBAR ACTIVITY

This SBAR activity assists you in building the skill of communicating pertinent information
when caring for a patient. Appropriate actions you should do to complete this activity include
finding appropriate data to provide a thorough SBAR report.
Student Learning Outcomes
At the end of this activity, student will be able to:
1. Identify pertinent data from the patient information area of the vSim suggested reading
section.
2. Communicate pertinent information for a patient using ISBAR.
Assignment
1. Log into thePoint and launch the assigned vSim, following all instructions posted on your
learning management system (LMS).
2. Review the information contained in the patient information area of the suggested reading
section.
3. Review the smart sense links found within the Nursing Care, Diagnostics and
Pharmacology areas of the suggested reading.
4. Navigate and fill out the data in the following document using the patient information
provided in the suggested reading area.
5. Submit for review.

4
Adapted from vSim for Nursing Wolters Klewur
vSim ISBAR Activity STUDENT WORKSHEET

Introduction Livan Martell primary nurse at the transitional care unit

Your name, position (RN), unit you are working on

Situation Vernon Russel is a 55-year-old male admitted to the hospital 2

weeks ago for a stroke with mild left hemiplegia.
Patient’s name, age, specific reason for visit

Background Admitted on 09/29/2020

Activity: up with walker
Patient’s primary diagnosis, date of admission, Vital signs and neuro-checks per shift
current orders for patient Bedside blood glucose checks twice daily before breakfast and
bedtime.
Diet as tolerated.
Labs: CBC, BMP, PT, and INR.
Medications: aspirin 81 mg orally daily, metformin 500 mg
orally twice daily, losartan 50 mg orally twice daily, nicotine
patch 1 mg once daily for 6 weeks, chlorthalidone 25 mg daily.

Assessment Patient has limited range of motion of the left shoulder to 160
degrees. Limited range of motion of the left elbow to 140 degrees.
Current pertinent assessment data using head to Full range of motion of the other joints in the arms. Normal sensation
toe approach, pertinent diagnostics, vital signs for touch and pain on patient’s arms and hands. Active range of
motion against gravity in the left arm. Active range of motion against
full resistance in the right arm. 3 out of 5 strength in the left arm and
hand grasp, and 5 out of 5 in the right arm and hand grasp. All skin
free of lesions or scars; regular color and odor. Nails were smooth,
clean, intact, with no signs of cyanosis or clubbing. Active motion
against gravity in the left leg and active motion against full resistance
Recommendation Perform neuro assessment and vital signs per shift
Bedside blood glucose checks twice daily before breakfast and
Any orders or recommendations you may have for
at bedtime
this patient
Medication as ordered by provider
Labs: CBC, BMP, PT, and INR
Patient will be educated on risk and prevention of falls.
Educate on the importance of passive range of motion
exercises to increase mobility and circulation.
Physical therapy and Occupational therapy two times a day
Patient will be educated on how to manage symptoms or
complications after stroke

5
Adapted from vSim for Nursing Wolters Klewur
 PHARM-4-FUN

This activity provides you with the opportunity to create pertinent patient education on the
pharmacological agents associated with the vSim activity. You will utilize this worksheet for
each drug listed under the pharmacology are of the suggested reading section.
Student Learning Outcomes
At the end of this activity, student will be able to:
1. Explain purpose for taking the identified pharmacological agents.
2. Discuss pertinent patient education related to all the listed pharmacological agent.
Assignment
1. Log into thePoint and launch the assigned vSim, following all instructions posted on your
learning management system (LMS).
2. Review the information contained in the patient information.
3. Review the smart sense links associated with the Pharmacological agents found in the
suggested
4. reading area.
5. Use the smart sense link to complete the following “patient education” worksheet for
each
6. pharmacological agent listed in the Pharmacology are of the suggested reading section.
7. Submit for review.

6
Adapted from vSim for Nursing Wolters Klewur
PATIENT EDUCATION WORKSHEET

Name of Medication, Classification, and Include in Prototype

MEDICATION:
Aspirin 81 mg

CLASSIFICATION:
NSAID

PROTOTYPE:
Salicylates

Safe Dose or Dose Range, Safe Route

Mild- moderate pain adult: 350 -650 mg every 4 hours or 500 mg every 6 hours child: 10-15 mg/kg every 4-6 hours

Purpose for Taking this Medication

Nonsteroidal anti-inflammatory used to reduce fever and relieve mild to moderate pain from conditions such as
muscle aches, common cold, and headaches. It can also be used to reduce pain and swelling from conditions like
arthritis.

Patient Education While Taking this Medication

 Take with food or milk to reduce GI symptoms
 Do not give aspirin to children or teenagers with chickenpox or influenza like illness
 Discontinue aspirin with onset of ringing or buzzing in the ears
 Avoid alcohol when taking large doses of aspirin
 Take as directed by provider
 Avoid other medications containing aspirin due to danger of overdoes unless directed by provider

7
Adapted from vSim for Nursing Wolters Klewur
PATIENT EDUCATION WORKSHEET

Name of Medication, Classification, and Include in Prototype

MEDICATION:
Metformin 500 mg

CLASSIFICATION:
Metformin is in a class of drugs called biguanides

PROTOTYPE:

Safe Dose or Dose Range, Safe Route

Adult: PO Start with 500 mg q.d. to t.i.d. or 850 mg q.d. to b.i.d. with meals, may increase by 500–850 mg/d every 1–
3 wk (max: 2550 mg/d); or start with 500 mg sustained-release with p.m. meal, may increase by 500 mg/d at p.m.
meal qwk (max: 2000 mg/d)

Purpose for Taking this Medication

Metformin is used with a proper diet and exercise program and possibly with other medications to control high
blood sugar. It is used in patients with type 2 diabetes. Controlling high blood sugar helps prevent kidney damage,
blindness, nerve problems, loss of limbs, and sexual function problems.

Patient Education While Taking this Medication

 Be aware that hypoglycemia is not a risk when drug is taken in recommended therapeutic doses unless
combined with other drugs which lower blood glucose.
 Report to physician immediately S&S of infection, which increase the risk of lactic acidosis (e.g., abdominal
pains, nausea, and vomiting, anorexia).
 Do not breast feed while taking this drug without consulting physician.

8
Adapted from vSim for Nursing Wolters Klewur
PATIENT EDUCATION WORKSHEET

Name of Medication, Classification, and Include in Prototype

MEDICATION:
Losartan 50 mg

CLASSIFICATION:
Losartan belongs to a class of drugs called angiotensin receptor blockers (ARBs). It works by relaxing blood vessels so
that blood can flow more easily.

PROTOTYPE:
Cozaar

Safe Dose or Dose Range, Safe Route

Adult: PO 25–50 mg in 1–2 divided doses (max: 100 mg/d); start with 25 mg/d if volume depleted (i.e., on diuretics)

Purpose for Taking this Medication

Use to treat hypertension. Selectively blocks the binding of angiotensin II to the AT 1 receptors found in many tissues
(e.g., vascular smooth muscle, adrenal glands). Antihypertensive effect results from blocking the vasoconstricting
and aldosterone-secreting effects of angiotensin II.

Patient Education While Taking this Medication

 Notify physician of symptoms of hypotension (e.g., dizziness, fainting).
 Notify physician immediately of pregnancy.
 Do not breast feed while taking this drug.

9
Adapted from vSim for Nursing Wolters Klewur
PATIENT EDUCATION WORKSHEET

Name of Medication, Classification, and Include in Prototype

MEDICATION:
Nicotine patch

CLASSIFICATION:

Nicotine patches are used for smoking cessation. Nicotine is released from the patches and absorbed through the
skin. Released nicotine binds to nicotine receptors in the body, reducing nicotine craving and withdrawal symptoms
associated with smoking cessation.

PROTOTYPE:

Nicoderm CQ

Safe Dose or Dose Range, Safe Route

Apply 1 transdermal patch 16 h/d by the following schedule: 15 mg/d x 4–12 week, 10 mg/d x 2–4 week, 5
mg/d x 2–4 week

Purpose for Taking this Medication

Nicotine patches are used to control nicotine withdrawal symptoms and cravings associated with smoking cessation.

Patient Education While Taking this Medication

 Review carefully specific written instructions packaged with the chewing gum.
 Chew a piece of gum for approximately 30 min to get the full dose of nicotine.
 Chew only one piece of gum at a time. Chewing gum too rapidly can cause excessive buccal absorption and
lead to adverse effects: nausea, hiccups, throat irritation.
 Gradually decrease number of pieces of gum chewed in 24 h. Usually, a period of 3 mo is allowed before
tapering use of gum.
 Promptly discontinue use of transdermal patch and notify physician if a severe or persistent local or
generalized skin reaction occurs.
 Be aware that smoking while using the transdermal nicotine patch increases the risk of adverse reactions.
 Do not breast feed while taking this drug without consulting physician.

10
Adapted from vSim for Nursing Wolters Klewur
PATIENT EDUCATION WORKSHEET

Name of Medication, Classification, and Include in Prototype

MEDICATION:
Chlorthadilone 25 mg

CLASSIFICATION:
Chlorthalidone, also known as hygroton or thalitone, belongs to the class of organic compounds known as
isoindolones.

PROTOTYPE:
Hydrochlorothiazide (HCTZ)

Safe Dose or Dose Range, Safe Route

Hypertension
Adult: PO 12.5–25 mg/d, may be increased to 100 mg/d if needed
Child: PO 2 mg/kg 3 times/wk
Edema
Adult: PO 50–100 mg/d, may be increased to 200 mg/d if needed

Purpose for Taking this Medication

Chlorthalidone is used in the treatment of high blood pressure, edema and congestive heart failure.

Patient Education While Taking this Medication

 Maintain adequate potassium intake, monitor weight, and make a daily estimate of I&O ratio.
 Do not breast feed while taking this drug.

11
Adapted from vSim for Nursing Wolters Klewur
CLINICAL WORKSHEET

This activity creates an opportunity for you to prepare for a virtual clinical experience. This
activity provides you with the opportunity to manage patient care, prioritize interventions, and
identify aspects of care that could be delegated.

Student Learning Outcomes

At the end of this activity, student will be able to:

1. Describe pathological events associated with the patient’s disease process or condition.
2. Create a plan of care that is prioritized and is based on the patient’s care needs.
3. Identifies path to healing or health and path to death or injury.
4. Describes aspects of care that can be delegated and appropriate personnel to complete
delegated tasks.

Assignment

1. Log into thePoint and launch the assigned vSim, following all instructions posted on your
learning management system (LMS).
2. Review the information contained in the patient information.
3. Review the smart sense links associated with the Nursing Care, Diagnostics, and
Pharmacology, found in the suggested reading area.
4. Complete all areas of the attached clinical worksheet.
5. Submit the completed worksheet.

12
Adapted from vSim for Nursing Wolters Klewur
 Clinical Worksheet
Date: Student Name: Assigned vSim:

Initials: V.R Diagnosis: Right-side HCP: N/A Isolation: N/A IV Type: N/A Critical Labs: Other Services:
stroke Physical therapist
Age: 55 Hgb AIC: 7.1 Occupational
Location: N/A
theraspist
Length of Stay: N/A Fall Risk: high fall CL: 96
M/F: M
risk Consults Needed:
Consults: Neurology Fluid/Rate: N/A Nutrionist
Code Status: N/A Transfer: stand by
Allergies: no known Fall risk
assist, patient can
use walker

Why is your patient in the hospital? (Answer in your own words and include History of present illness)

The patient was admitted to the hospital due to right sided stroke with a mild left hemiplegia.

Health History/ Comorbidities (that relate to this hospitalization):

Patient has a history of hypertension, coronary artery disease, and diabetes mellitus type 2. Patient reports smoking a pack of cigarettes every day and does not exercise.

Shift Goals/ Patient Education Needs:

1. Patient will be educated on the principles of range of motion and mobility, and discuss fall risk with him

2.Will perform vital sign and neurological assessment every shift

3.Will perform musculoskeletal assessment

4.Nurse will safely administer morning medications in a timely manner

Path to Discharge:

Patient shows no changes or declines in consciousness and mobility, patient was given education to prevent fall, nutrition and importance of exercise, patient was given education on
medications needed for discharge.

Path to Death or Injury:

Patient was not educated on preventative measures against fall ris, patient had incidences of falling, patient showed changes or decline in consciousness and mobility and vital signs or
neurological assessments were performed, patient had reoccurrence of stroke because no preventative measures or interventions taken
 Clinical Worksheet

Alerts:
What are you on alert for with this patient? (Signs & Symptoms) Management of Care: What needs to be done for this

1. Circulation problems Patient Today?

2. Risk for falling 1. Nurse will reinforce the principles of range of motion and

3. Risk for neurological decline (decline in level of consciousness or loss of motor mobility
functions or senses)
2. Nurse will educate patient on fall risks and preventions
What Assessments will focus on for this
patient? (How will I identify the above 3. Bedside blood glucose check twice a day before breakfast and at bedtime
signs &Symptoms?)
4. Lab: CBC, BMP, PT, INR
1. Musculoskeletal Assessment
5. Vital signs and neuro assessment every shift
2. Morse fall risk assessment
6. Will administer medications that are ordered for the patient
3. Neurological Assessment 7. Physical and Occupational therapy twice a day

Priorities for Managing the Patient’s Care Today

List Complications may occur related to dx, procedure, comorbidities:
1. Nurse will reinforce the principles of range of motion and mobility
1. Falling
2. Nurse will perform musculoskeletal Assessment
2. Urinary incontinence
3. Nurse will educate patient on fall risk and discuss Morse fall risk assessment
3. Dysphagia
4. Nurse will stay by patient’s bedside during mealtimes for any signs or symptoms
What nursing or medical interventions may prevent the above Alert or of aspiration after patient is cleared to eat
complications?

1. Nurse will reinforce the principles of range of motion and mobility

What aspects of the patient care can be Delegated and who can do it?
2. Nurse will keep call light near patient and instruct patient to call when needing
help to ambulate to the bathroom Nurse can delegate CNA to take patient’s vital signs
Nurse will educate and discuss fall risk
14
Adapted from vSim for Nursing Wolters Klewur
 vSim Worksheets Grading Rubric (Not used for Clinical Worksheet)
Criteria 5 Points 4 Points 3 Points 2 Points 1 Point Total Points
Content Knowledge Follows all requirements Follows all requirements Knowledge of topic is Knowledge of topic is Knowledge of topic is
for the assignment. for the assignment. partially covered. general in more than general throughout entire
three areas of the worksheet, and/or does
Key information is worksheet. not cover all the required
Conveys well-rounded Major points of topic are
missing from 2 or more assignment areas.
knowledge of the topic. mostly covered in the
assignment areas. 1 or more areas of
Content well organized, required assignment
worksheet left blank.
logical. areas. Two or more areas left
Content unorganized
Worksheet difficult to blank on worksheet.
throughout worksheet.
Easy to read and Content organized, follow in two or more
understand throughout logical flow. Easy to areas. Unable to follow flow of
Difficult to understand
all of worksheet. read and understand worksheet.
content of paper.
through most of Information is
worksheet. incomplete in two or
more areas.
Critical Thinking Concisely explains each Explains each content Few aspects of the Information is basic. No
content area. area. content areas presented. aspects of the content
Presents information present in the worksheet.
about the topic. Few insights presented,
Analyzes information,
Some analysis, insight lacking analysis. Lacks insight, analysis,
connects data points to
present, some data points Data points not and conclusions.
provide accurate, concise
threaded together. connected to information
information.
provided.
No understanding from
Scholarly work.
Scholarly work. the content presented.
Little understanding
gained from information
presented.
Writing Composition An occasional spelling Some minor errors (1-3 Frequent errors (4-5 Numerous errors (5-6 Excessive errors (>6
(Spelling, Grammar, error present. errors) with spelling, errors) with spelling, errors) with spelling, errors) occur with
Sentence Structure) grammar and/or sentence grammar and/or sentence grammar, and/or spelling, grammar and/or
structure, not consistent structure. sentence structure sentence structure,
Grammar, readability,
throughout worksheet. throughout the throughout worksheet.
and sentence structure is
Errors effect ability to worksheet
error free.
Errors do not interfere comprehend information Unable to understand
with the readability or present on worksheet and Difficult to understand information presented in
comprehension of readability. information presented the worksheet.
information. due to numerous errors

Total Points: __________________

15
Adapted from vSim for Nursing Wolters Klewur
 Rubric for Grading vSim Clinical Worksheet
5 3 1 0
Patient Information: All documented areas 100% Three listed areas completed OR Less than three listed areas Patient information area blank.
complete and provide thorough documented areas 75% complete. completed OR documented areas
Demographics, Diagnosis, Allergies, information. less than 50% completed.
Provider, Consults, Isolation, Fall
Risk, Intravenous Therapy, Critical
Labs, Services and Needed Consults
Medical History: 100% of HPI, Past Medical/Surgical 75% of HPI, Past Medical/Surgical 50% of HPI, Past Medical/Surgical 25% of HPI, Past Medical/Surgical
History and Comorbidity Factors History and Comorbidity Factors History and Comorbidity Factors History and Comorbidity Factors
completed with thorough, relevant completed. Information relevant to completed. Information basic and completed. Information not relevant,
Why patient is in the hospital,
information. scenario. lacks relevancy. or content areas left blank,
History of present Illness, Past
Medical/Surgical History,
Comorbidity Factors
Patient Education/Goals: Thorough and detailed patient Provides patient education but lacks Patient education lacks thoroughness Missing patient education and/or
education. Patient shift. goals are thoroughness or details. Patient shift and details. Patient shift goals patient shift goals. Patient shift goals
SMART, relevant, and detailed goals missing 1-2 components of missing 3 – 4 components of lack all components of SMART
Shift Goals, Patient Education
goals. 100% of worksheet area is SMART goals. 75% of information SMART goals. 50% of the goals. 25% of the information
Needs
complete. needed for worksheet area present. information needed for worksheet needed for worksheet area present.
area present.

Disease Progression: Pathway to death and health is Pathway to death and health is Missing over 50% of needed Pathway to death and health
identified with detail. Information is identified. Information is relevant information for worksheet area contains information not relevant or
concise, relevant, accurate and and accurate. Missing timeframe for present. Pathway to death and health accurate to the scenario or section
Pathway to Death or Injury Pathway
portraits appropriate timeframe for occurrence. 75% of information identified but content either not left blank.
to Health
occurrence. 100% of the information needed for worksheet area present. relevant or accurate for situation
needed for worksheet present. present in scenario.

AACIP: Alerts, Assessments, Complications Alerts, Assessments, Complications Missing 2 – 3 areas on worksheet. Missing 4 or more areas on
and Interventions/Preventions and Interventions/Preventions Answers not relevant to scenario. worksheet. Answers not relevant to
identified thoroughly. Answers identified. Most answers relevant to 50% of the information needed is scenario. 25% of the information
Alerts, Assessments, Complications,
relevant to scenario. 100% of the scenario. 75% of the information present. needed for worksheet area is present.
Interventions and Prevention
information needed is present. needed for worksheet area present.

Nursing Care Plan: Management of Care relevant to Management of Care, Priorities or Missing relevant data in one or more Information provided not relevant to
case scenario and detailed. Priorities delegation sections relevant to categories (management of care, scenario. Answers are basic without
for scenario identified. Identifies all scenario. Answers generic to prioritization, delegation). Answers detail. No evidence of critical
Management of Care, Priorities for
aspects of care that can be delegated situation. Some evidence of critical basic without detail. Little to no thinking. Missing answers in one or
Patient Care, Delegation
and identifies appropriate personnel thinking present. evidence of critical thinking present. more area.
to delegate activities to. Answers
detailed; Critical thinking evident.
Total Points:

16
Adapted from vSim for Nursing Wolters Klewur