Davao Doctors College, Inc.

Gen. Malvar St., Davao City

Nursing Program
PACUCOA, Level IV Accredited Status

Simulation Design

Date: February 17, 2021 File Name: Simulation guide CODE

Discipline: Nursing Student Level: 4th year undergraduate
Expected Simulation Run Time: 25-30 Guided Reflection Time: 40-60 minutes
minutes
Location: Nursing Skills Laboratory Location for Reflection: Simulation room
Brief Description of Client

Name: Mrs. Fernandez Social History:

Gender: Female Psychomotor Skills Required Prior to
Age: 31 Vital Signs
Race:Filipino Physical Assessment
Weight: 65kg Communication
Height: 165cm Interdisciplinary Teamwork
Support: Husband
Attending Physician/Team: Dr. Gonzales Simulation
Past Medical History: HTN DM Pre operative
History of Present illness: 31-yearold Intra operative
woman GRAVIDA 3 PARA 3 previous CS Post operative
Phone: N/A
Immunizations: Unrecalled Cognitive Activities Required prior to
Study CAESARIAN SECTION SURGERY 6 hours
Surgery scheduled at 7am
Simulation:
Review OR TECH 1 hour
https://www.youtube.com/watch?
v=xyN48VnRYUY&ab_channel=NucleusMedicalMedia

Receive orientation to PRE OPERATIVE CARE

15mins
Receive orientation to INTRA OPERATIVE CARE
15mins

Nursing Diagnosis:

Primary medical diagnosis:

 Davao Doctors College, Inc.
Gen. Malvar St., Davao City

Nursing Program
PACUCOA, Level IV Accredited Status

Simulation Learning Objectives:

1. Apply the OR TECHNIQUE to initiate care for the client requiring Cesarian surgery.
2. Explain the indication, purpose and/or rationale involved during Cesarian Surgery.
3. Demonstrate therapeutic communications in care of the patient and/or family.
4. Prepare the equipment needed for intra operative.
5. Demonstrate proper techniques for asepsis and OR procedures..
6. Relate findings with Cesarian surgery.

Fidelity
Setting/Environment Medications and Fluids
 ER IV Fluids:
 Med-Surg Oral Meds:
 Peds IM or SC:
 ICU IV Push:
 OR / PACU
 Women’s Center Diagnostics Available
 Behavioral Health Labs
 Home Health
 Pre-Hospital Documentation Forms
 Other: Physician Orders
Simulator Manikin/s Needed: Admit Orders
Props: Medical record, monitoring sheet, nurses’ Flow sheet
notes, hand soap/sanitizer, OR table, OR theater Medication Administration Record
, manikin with pillow, kidney basin, mayo table, OR Kardex
instruments Graphic Record
Anesthesia / PACU Record
Equipment attached to manikin: Transfer Orders
IV tubing with Other:
Primary line fluids running at_______mL/hr
Secondary IV line running at_______mL/hr Physicians order:
Foley catheter________mL output
Preoperative management
02
Guidelines recommend a minimum preoperative
Monitor attached fasting time of at least 2 hours from clear liquids, 6
ID band hours from a light meal, and 8 hours from a
Other: regular meal. [11] However, patients are usually
asked not to eat anything for 12 hours prior to the
Suction procedure. [12]
Baby’s crib The following are also included in preoperative
management:
Roles/Guidelines for Roles 
 Circulating nurse Placement of an intravenous (IV) line
 Scrub nurse Infusion of IV fluids (eg, lactated Ringer
 Clinical instructor solution or saline with 5% dextrose)
 Surgeon Placement of a Foley catheter (to drain the
 Assitant surgeon bladder and to monitor urine output)
 Anesthesiologist
 pediatrician Placement of an external fetal monitor and
monitors for the patient’s blood pressure,
Davao Doctors College, Inc.
Gen. Malvar St., Davao City

Nursing Program
PACUCOA, Level IV Accredited Status

pulse, and oxygen saturation

Preoperative antibiotic prophylaxis (decreases

risk of endometritis after elective cesarean
delivery by 76%, regardless of the type of
cesarean delivery [emergent or elective])

Evaluation by the surgeon and the

anesthesiologist

Significant Lab Values:

Complete blood count

Blood type and screen, cross-match

Screening tests for human immunodeficiency

virus, hepatitis B, syphilis

Coagulation studies (eg, prothrombin and

activated partial thromboplastin times,
fibrinogen level)

Student Information Needed Prior to Scenario:

 Has been oriented to simulator
 Understands guidelines /expectations for
scenario
 Has accomplished all pre-simulation
requirements
 All participants understand their assigned
roles
 Has been given time frame expectations
 Davao Doctors College, Inc.
Gen. Malvar St., Davao City

Nursing Program
PACUCOA, Level IV Accredited Status

Simulation learning objectives:

1. Assemble an organized preparations of instruments.

2. Perform duties appropriate to the participants’ role on the interdisciplinary team (circulating nurse,
scrub nurse).
3. Exhibit competent role performance under stressful conditions.
4. Demonstrate OR technique procedures
5. Perform serving ,handling and counting accountables.
6. Demonstrate therapeutic communication in care of the patient and family.
7. Document the assessment data, patient changes, and intervention completed.

Scenario Progression Outline

Timing Mannikin Circulating nurse Scrub nurse May Use
Actions the
Following
Pre op Cues
Guidelines recommend Handwasing Students
a minimum preoperative are
fasting time of at least 2 randomly
hours from clear liquids, Surgical assigned
6 hours from a light handwashing with roles
meal, and 8 hours from
a regular Drying of hand
meal. [11] However,
patients are usually
asked not to eat Gowning
anything for 12 hours
prior to the Closed gloving
procedure. [12]
The following are also
included in preoperative Preparing
management: instruments

Placement of an
intravenous (IV) Draping
line
Infusion of IV fluids
(eg, lactated Ringer Serving towel
solution or saline
with 5% dextrose)
Placement of a Serving gown
Foley catheter (to
drain the bladder
and to monitor Serving gloves
urine output)

Placement of an Serving
 Davao Doctors College, Inc.
Gen. Malvar St., Davao City

Nursing Program
PACUCOA, Level IV Accredited Status

instruments

external fetal
monitor and Reporting
monitors for the accountables
patient’s blood
pressure, pulse,
and oxygen  Laparotomy
saturation  Delivery of
Fetus
Preoperative
 Repair of
antibiotic
Uterus
prophylaxis
(decreases risk of
endometritis after Closure of the
elective cesarean abdomen
delivery by 76%,
regardless of the
type of cesarean Washing of
delivery [emergent instruments
or elective])

Evaluation by the Recording

surgeon and the
anesthesiologist
Postoperative
management
See the list below:

 Routine
postoperative
assessment

 Monitoring of
vital signs, urine
output, and
amount of
vaginal bleeding

 Palpation of the
fundus

 IV fluids;
advance to oral
diet as
appropriate,
early feeding has
been shown to
shorten hospital
stay [16]
Davao Doctors College, Inc.
Gen. Malvar St., Davao City

Nursing Program
PACUCOA, Level IV Accredited Status

 IV or
intramuscular
(IM) analgesia if
patient did not
receive a long-
acting analgesic
or had general
anesthesia;
analgesia is
usually not
needed if patient
received regional
anesthesia,
with/without a
long-acting
analgesic
 Ambulation on
postoperative
day 1; advance
as tolerated
 If patient plans to
breastfeed,
initiate within a
few hours after
delivery; if
patient plans to
bottle feed, she
may use a tight
bra or breast
binder in the
postoperative
period
 Discharge on
postoperative
day 2 to 4, if no
complications 
 Discuss
contraception as
well as refraining
from intercourse
for 4-6 weeks
postpartum,
unless the
patient had
LARC placed at
the time of the
procedure
 Davao Doctors College, Inc.
Gen. Malvar St., Davao City

Nursing Program
PACUCOA, Level IV Accredited Status

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. Do you think there was effective use of Delegation? Why or Why not?
12. Is there anything else you would like to discuss?
 Davao Doctors College, Inc.
Gen. Malvar St., Davao City

Nursing Program
PACUCOA, Level IV Accredited Status

OPERATIVE REVIEW
(Operative Procedure/s)

1. Should be individually submitted every week in Operating Room Exposure.

2. Must be place in a short folder.

FORMAT:
I. Introduction
II. Anatomy
III. Pathophysiology
IV. Medical Management
V. Diagnosis
VI. Procedure Proper (with Instrumentation)
VII. Roles of Circulating and Scrub Nurse
VIII. Nursing Management
a. Nursing Care Plan
i. Pre Operative
ii. Intra Operative
iii. Post Operative
IX. Pharmacology
i. Pre- Operative
ii. Intra –Operative
iii. Post Operative
X. Bibliography

Prepared by:

LEONARDO C. MATUNDING,RN,MN
RLE Supervisor
Davao Doctors College, Inc.
Gen. Malvar St., Davao City

Nursing Program
PACUCOA, Level IV Accredited Status