Montgomery College Nursing Simulation Scenario Library

Scenario File: CODE BLUE

Discipline: Nursing Student Level: 3rd Semester
Expected Simulation Run Time: 20 minutes
Guided Reflection Time: 30 minutes
Admission Date: 4/14/xx Psychomotor Skills Required Prior to
Today’s Date: 4/15/xx Simulation
Brief Description: • Vital Signs
Name: John Goldman • Physical Assessment – cardiac
DOB: 4/1/19xx • BCLS
Gender: Male Age: 80 • Administer IV Push medication
Race: Caucasian • Communication
Weight: 76 kg Height: 178 cm • Interdisciplinary Team Work
Religion: Catholic Major Support: Wife
Phone: XXX-XXX-XXXX Cognitive Activities Required Prior to
Allergies: NKA Simulation [i.e. independent reading (R), video
Immunizations: Flu & Pneumovax last Sept. review (V), computerst simulations (CS), lecture (L)]
Attending Physician/Team: Hospitalist • Read Pelico 1 Ed. Ch. 15 pp. 437 – 438; ch 17
Past Medical History: CAD, HTN, and pp. 461 – 488
CHF. Medications: • th
Read Lewis, 8 Ed. Chapters 34, 36, and
Appendix A “Cardiopulmonary Resuscitation
• Lasix 20mgPO QD
and Basic Life Support for Health Care
• HCTZ 25mg QD Providers”
• Complete Cardiac Rhythm self-study packet
History of Present illness: Palpitations (Course Guide)
with anxiety since two days ago
• Study Montgomery College CPR guidelines for
Social History: 40 pack year smoker – none adults
in 20 years, drinks alcohol occasionally. He is • Watch video:
retired and lives with his wife in an apartment http://www.youtube.com/watch?v=YEjljHme
in a 65+ community. OZk&feature=share&list=PL_2IMx1vzUkDHF
Primary Medical Diagnosis: Palpitations Wjz_unmL1FNmtsESo9N
with Anxiety reaction and shortness of breath. • Receive orientation to Code Team roles
Surgeries/Procedures & Dates: None • Receive orientation to crash cart
• Receive orientation to LifePak
Scenario Overview:
An 80-year-old man with a history of coronary
Nursing Diagnosis: Decreased Cardiac Output
artery disease, hypertension, and CHF was
admitted to an inpatient Intermediate Care r/t cardiac rhythm disturbance
Unit (Telemetry Unit) for heart palpitation and
anxiety. On second hospital day, he had Collaborative Problems: Respond
sudden onset of confusion, bradycardia, and appropriately and carry out roles of Code Blue
hypotension. He lost consciousness, and a Team
"code blue" was called.

Simulation Learning Objectives

 1. Assemble an organized code blue team response.

2. Perform duties appropriate to the participants’ role on the interdisciplinary team.

3. Identify the heart rhythm (VF, VT, Asystole) on monitor.

4. Identify appropriate treatment for the heart rhythm.

5. Initiate proper BLS, as specific in Montgomery College CPR check list for adults.

6. Be able to state defibrillator may be applied as many as three times (200 joules, 200/300

joules, and 360 joules or equivalent) for VF or pulseless VT.

7. Exhibit competent role performance under stressful conditions.

8. Demonstrate therapeutic communication in care of the patient and family.

9. Document the assessment data, patient changes, and intervention completed.

Program / Curriculum Specific Objectives

Fidelity (choose all that apply to this simulation)
Setting/Environment Medications and Fluids
o ER
o Med Surg ○ Oral Meds
o Peds
o ICU
o OR / PACU ○ IV Fluids: NSS 1000mL
o Women’s Center
o Behavioral Health ○ IVPB
o Home Health
o Pre-Hospital ○ IV Push:
o Other ___Telemetry Unite
o Epinephrine
o
Simulator/Manikin/s Needed: o Vasopressin
• High Fidelity manniken
○ IM / Subcut / Intradermal
Props: Cardiac simulator; Vtach – Vfib –
Asystole; ACLS algorhythms ○ Other
Equipment Attached to Manikin: Diagnostics Available
°IV tubing with primary line NSS
fluids running at 50 cc/hr o X-rays (Images) result
o Secondary IV line __ running at _ cc/hr o Labs
o IV pump o 12-Lead EKG
o Foley catheter ________cc output o Other________
o PCA pump running
o IVPB with ___ running at ___ cc/hr
o 02 NC @ 2L/min Documentation Forms
o Monitor attached o Admit Orders
o ID band o Physician Orders
o Other: Crash cart with cardiac o Flow sheet
simulator and Lifepak, adult monitor o Medication Administration Record
pads, epinephrine, Vasopressin o Kardex
o Graphic Record
Equipment Available in Room o Shift Assessment
o Bedpan/Urinal o Triage Forms
o Foley kit o Code Record
o Straight Cath Kit o Anesthesia / PACU Record
o Incentive Spirometry o Standing (Protocol) Orders
o Fluids: NSS 1000mL o Transfer Orders
o IV start kit o Other: Two patient’s charts
o IV tubing o For 1st scenario, need chart with a
o IVPB Tubing DNR order on it.
o IV Pump o 2nd scenario Full Code order.
o Feeding Pump
o Pressure Bag Recommended Mode for Simulation
o 02 delivery device__Ambu Bag______ (i.e. manual, programmed, etc.)
o Crash cart with airway devices and
emergency medications • High Fidelity
o Defibrillator/Pacer
o Suction
o Other
Roles/Guidelines for Roles Student Information Needed Prior to
○ Primary Nurse Scenario
○ Secondary Nurse  Has been oriented to simulator
○ Clinical Instructor  Understands guidelines /expectations for
○ Family Member #1 (wife) scenario
○ Family Member #2  Has accomplished all pre-simulation
○ Observer requirements
○ Physician / Advanced Practice Nurse  All participants understand their assigned
(Runs the code) roles
○ Respiratory Therapy  Has been given time frame expectations
○ Anesthesia o Other ____________________________
○ Pharmacy
○ Lab
Report Students Will Receive Before
○ Imaging
○ Social Services Simulation:
○ Clergy
○ Unlicensed Assistive Personnel Scenario Overview:
(Patient Care Technician/Tech) John Goldman, an 80-year-old male, history of
○ Code Team coronary artery disease, hypertension, and
○ Other___Supervisor / Recorder congestive heart failure admitted to Intermediate
Care Unit last night for heart palpitations and
Important Information Related to Roles anxiety. This morning, he had sudden onset of
confusion, bradycardia, and hypotension. He lost
• The Instructor hands students role consciousness, and a "code blue" was called.
cards, Asks students to identify
the rhythm, calls for Defibrillation You are on the code team and are
- and in the first scenario calls off answering the call.
the code when the DNR order is
found. (Overhead “CODE BLUE, SIM LAB, ROOM
• During the second code, the XXX”
patient converts to sinus rhythm
As students enter the room – HAND CARDS in
and breaths spontaneously after this order:
the epi + 2nd defib. • Primary RN: CALL FOR HELP &
INITIATE CODE BLUE
Significant Lab Values:
Chest X-ray result: • TECH: BRING CRASH CART, APPLY
o Pulmonary Congestion + LEADS, APPLY CPR BOARD, &
radiographic Cardiomegaly ALTERNATE COMPRESSIONS
o K. 2.8
• Respiratory Therapist: OXYGENATE
THE PATIENT WITH BAG-MASK
Physician Orders VENTILATIONS
MD order on Admission:
IV NSS @ 50 mL/hr • SUPERVISOR: RECORD THE
NPO for possible CATH CODE & run the Lifepak / retrieve meds
Cardiac Monitor FROM CART
Bedrest with BRP
DNR (first patient scenario only) • IV NURSE: CHECK IV AND
Electrolytes ADMINISTER MEDICATIONS
Chest X-ray
Lasix 20mg IV push, BID • SECONDRY RN: BRING THE
HCTZ 25mg PO, daily with sip of H2O. PATIENT”S CHART & CHECK
ORDERS
Physician Order During Code:
1. Defibrillate with 200 joules • CLERGY: SUPPORT WIFE
2. Administer Epinephrine, 1mg IV.
• WIFE: ASKS QUESTIONS AS A
Push.
SPOUSE WHO IS WORRYING ABOUT
3. Defibrillate with 300 joules again. HUSBAND’S LIFE
4. Administer Vasopressin 40 Unit,
IV. Push as a single dose for • FACULTY/ADVANCED
maintaining blood pressure and PRACTICE NURSE: ORDER
heart rate and rhythm in second MEDS, DEFIBRILLATOR, & ALL
scenario. OTHER ORDERS
References, Evidence-Based Practice Guidelines, Protocols, or Algorithms Used For
This Scenario: (site source, author, year, and page)

Mad Scientists ACLS Algorhythms:

2007 NCLEX-RN© Test Plan Categories and Subcategories
Choose all areas included in the simulation

Safe and Effective Care Environment

Management of Care
● Advance Directives ● Establishing Priorities
● Advocacy ● Ethical Practice
● Case Management ● Informed Consent
● Client Rights ● Information Technology
● Collaboration with Interdisciplinary Team ● Legal Rights and Responsibilities
● Concepts of Management ● Performance Improvement (QI)
● Confidentiality / Information Security ● Referrals
● Consultation ● Resource Management
● Continuity of Care ● Staff Education
● Delegation ● Supervision

Safety and Infection Control

● Accident Prevention ● Medical and Surgical Asepsis
● Disaster Planning ● Reporting of Incident/Event/
● Emergency Response Plan Irregular Occurrence/Variance
● Ergonomic Response Plan ● Security Plan
● Error Prevention ● Standard /Transmission-Based /
● Handling Hazardous and Infectious Materials Other Precautions
● Home Safety ● Use of Restraints/Safety Devices
● Injury Prevention ● Safe Use of Equipment

Health Promotion and Maintenance

● Aging Process ● Health Promotion Programs
● Ante/Intra/Postpartum and Newborn Care ● Health Screening
● Developmental Stages and Transitions ● High Risk Behaviors
● Disease Prevention ● Human Sexuality
● Expected Body Image Changes ● Immunizations
● Family Planning ● Lifestyle Choices
● Family Systems ● Principles of Teaching/Learning
● Growth and Development ● Self-Care
● Health and Wellness ● Techniques of Physical Assessment

Psychosocial Integrity
● Abuse/Neglect ● Psychopathology
● Behavioral Interventions ● Religious and Spiritual Influences
● Chemical and Other Dependencies on Health
● Coping Mechanisms ● Sensory/Perceptual Alterations
● Crisis Intervention ● Situational Role Changes
● Cultural Diversity ● Stress Management
● End of Life Care ● Support Systems
● Family Dynamics ● Therapeutic Communications
● Grief and Loss ● Therapeutic Environment
● Mental Health Concepts ● Unexpected Body Image Changes
Physiologic Integrity

Basic Care and Comfort

● Assistive Devices ● Nutrition and Oral Hydration
● Complementary and Alternative Therapies ● Palliative/Comfort Care
● Elimination ● Personal Hygiene
● Mobility/Immobility ● Rest and Sleep
● Non-Pharmacological Comfort Interventions

Pharmacological and Parenteral Therapies

● Adverse Effects/Contraindications ● Parenteral/Intravenous Therapies
● Blood and Blood Products ● Pharmacological Agents/Actions
● Central Venous Access Devices ● Pharmacological Interactions
● Dosage Calculation ● Pharmacological Pain Management
● Expected Effects/Outcomes ● Total Parenteral Nutrition
● Medication Administration

Reduction of Risk Potential

● Diagnostic Tests ● Potential for Complications from
● Lab Values Surgical Procedures and Health
● Monitoring Conscious Sedation Alterations
● Potential for Alterations in Body Systems ● System Specific Assessments
● Potential for Complications of Diagnostic ● Therapeutic Procedures
Tests/Treatments/Procedures ● Vital Signs

Physiologic Adaptation
● Alterations in Body Systems ● Medical Emergencies
● Fluid and Electrolyte Imbalances ● Pathophysiology
● Hemodynamics ● Radiation Therapy
● Illness Management ● Unexpected Response to Therapies
● Infectious Diseases
 Scenario Progression Outline

Timing Manikin Actions Expected Interventions May Use the

(approxi Following Cues
mate)
First 5 Manniken is not • Students answer code Role member providing
minutes breathing; cardiac quickly, receive roles, initiate cue:
monitor shows V-Fib care Wife: my husband is not
• First student assesses for responding
pulse, finds none, calls for
help, initiates compressions Tech: Do you need crash
• Second student brings cart, cart?
applies monitor pads, places
patient on resuscitation Instructor (Resident)
board, clears the room of • What is the Rhythm?
visitors and extra equipment (VF)
& alternates compression • What is the treatment
• Third student begins bag- that is called for?
mask ventilations • Prepare for
• Fourth student begins Defibrillation
documentation, retrieves • I’m clear, You’re clear,
ordered medications, sets we’re all clear
LifePak for defibrillation • Continue CPR
• Fifth student checks IV and • What is the Rhythm?
administers Epinepherine • What is the treatment?
when ordered (Vasopressin
in second scenario)
Next • Manniken not • Sixth student takes wife Role member providing
5-10 breathing. aside and consoles her cue:
• Monitor shows V-fib • Seventh student brings chart Instructor:
minutes
• (First time scenario from desk & reviews orders • Cue:
is run, shows • Eighth student asks • Give Epinepherine 1
Asystole after defib) questions as patient’s wife mg IV Push
• (Second time • Repeat Defibrillation
scenario is run, • I’m clear, You’re clear,
shows sinus rhythm we’re all clear
after 2nd defib) • (First time scenario is
• Supervisor run: “STOP CPR –
defibrillates when Patient has DNR order
called for on chart”)
• First student: gets • (Second time: “Stop
set of vital signs CPR – patient has
• BP is low converted to NSR –
• IV nurse: Gives continue to monitor”)
Vasopressin IV push
as ordered
• First RN checks VS
and reports normal
values.
Debriefing / Guided Reflection Questions for this Simulation
(Remember to identify important concepts or curricular threads that are specific to your program)

1. How did you feel throughout the simulation experiences?

2. Describe the objectives you were able to achieve?

3. Which ones were you unable to achieve (if any)?

4. Did you have the knowledge and skills to meet objectives?

5. Were you satisfied with your ability to work through the simulation?

6. To Observer: Could any person on the Code Team have handled any aspects of the
simulation differently?

7. If you were able to do this again, how could you have handled the situation differently?

8. What did the group do well?

9. What did the team feel was the primary nursing diagnosis and/or collaborative problems?

10. What were the key assessments and interventions?

11. Is there anything else you would like to discuss?

Scenario Specific Questions:

1. How did you feel when the Resident told you to stop CPR in the first scenario?

2. Do you think there was effective use of Delegation? Why or Why not?

Program/Curricular Specific Questions:

Complexity – Simple to Complex

Suggestions for changing the complexity of this scenario to adapt to different levels
of learners: