Scenarios

• Dorothy Chen, 68

  Pneumonia Assessment

  Flagged overnight: productive cough, three-day fever, dropping pulse ox. Your first admission. Start with the basics.

• Tyler Moore, 22

  Appendicitis Triage

  Pain started near the belly button and migrated right. The clock is ticking on this one.

• Ashley Rivera, 29

  Anaphylaxis Response

  Hives and throat tightening — you just gave her the antibiotic. Recognize it fast and move.

• Frank Kowalski, 71

  COPD Exacerbation

  He knows this feeling. This time the sputum is thicker, his sats are lower, and he is working harder than usual to breathe.

• Robert Hayes, 58

  Acute Myocardial Infarction

  Crushing chest pressure, diaphoresis, jaw pain. Started at rest 45 minutes ago. This is not anxiety.

• Linda Park, 44

  Post-Operative Wound Infection

  Eight days post-op and the incision looks wrong — red, warm, draining. Wound assessment is your job before the surgeon walks in.

• Walter Thompson, 74

  Acute Heart Failure Exacerbation

  Six pounds in five days. He cannot lie flat. Bilateral ankle swelling and he stopped his diuretic without telling anyone.

• Marcus Johnson, 19

  Traumatic Brain Injury Assessment

  Brief LOC at the scene, now confused, vomited twice in the ambulance. Systematic neuro assessment before imaging — find what you can now.

• Emma Patel, 24

  Bacterial Meningitis Assessment

  Severe headache, stiff neck, photophobia, 102°F, six hours in. Her roommate says she was confused this morning. Time matters.

• Carol Bennett, 52

  Post-Op DVT and Pulmonary Embolism

  Day three post-knee replacement. Left calf pain and swelling, now sudden shortness of breath. Connect the dots.

• Jerome Williams, 28

  Sickle Cell Vaso-Occlusive Crisis

  He knows his pain better than anyone. It is 10 out of 10, bilateral, and two days of home management have not touched it.

• David Kim, 35

  Burn Wound Assessment

  Kitchen fire. Burns across the right arm and anterior chest. Use the Rule of Nines to estimate TBSA before the burn team arrives.

• Marcus Lee, 59

  Acute Kidney Injury

  Creatinine climbing since the CT with contrast yesterday. Urine output dropping. Catch it early.

• Eduardo Reyes, 52

  GI Bleed — Hematemesis

  Two episodes of bright-red hematemesis. His pressure is dropping. Move fast.

• Patricia Osei, 44

  Thyroid Storm Recognition

  Two days post-thyroidectomy. Temp 104°F, HR 148, agitated and confused. Rare and life-threatening — name it.

• Ryan Callahan, 31

  Hypovolemic Shock

  Blunt abdominal trauma. BP falling. Altered mental status. Hemorrhagic shock does not wait.

• Darren Moore, 36

  Autonomic Dysreflexia

  T4 spinal cord injury. BP 218/110, pounding headache, diaphoresis above the lesion. Find the trigger and fix it.

• Edna Kowalski, 79

  Urosepsis in Older Adult

  She has a foley and now she is confused with a low-grade fever. In older adults, atypical presentation is the rule.

• Jasmine Carter, 27

  Tension Pneumothorax Recognition

  Twenty minutes after central line placement — acutely hypotensive, absent breath sounds on the left, tracheal deviation right. Do not wait for imaging.

• Anthony Russo, 47

  Acute Pancreatitis

  Severe epigastric pain boring through to the back, elevated lipase, a big weekend. Assess him and manage his pain.

• William Greene, 61

  Liver Failure with Encephalopathy

  End-stage liver disease and now he is confused, asterixis on exam, ammonia rising. Recognize hepatic encephalopathy and act.

• Deja Thompson, 22

  Rhabdomyolysis

  Found in the same position for hours after a seizure. Dark tea-colored urine, diffuse muscle pain. Catch this before the kidneys fail.

• James Carter, 62

  Hypertension Teaching — New Diagnosis

  He just got the diagnosis and looks scared. BP 158/96, no symptoms, no idea what lisinopril does. Patient education before he leaves.

• Marcus Allen, 45

  Post-Op Pain Assessment

  Post-op day one. He is rating his pain 7 out of 10 and asking for something. Assess before you medicate.

• Beverly Morris, 70

  Urinary Catheter Care — Post-Op

  She has a foley and she is embarrassed about it. Your job is catheter care, infection prevention education, and making her feel like a person.

• Patricia Nguyen, 55

  New Diagnosis — Type 2 Diabetes

  Her A1C is 8.4 and she is overwhelmed. She does not know what the glucometer does. Start where she is.

• Raymond Torres, 58

  Lower Extremity Edema — DVT Precautions

  Post-op day two, left calf is puffy and tender. He is asking if it is normal. It is not. Assess it.

• Dorothy Walsh, 72

  Medication Safety — Polypharmacy Review

  She is going home today with eight medications. She cannot name two of them. Do the reconciliation before she walks out.

• Robert Daniels, 54

  Post-Op Day One — Head-to-Toe Assessment

  First post-op morning. He is stable, sipping liquids, asking when he can go home. Do a full head-to-toe before you answer that.

• Gloria Chen, 48

  Blood Glucose Monitoring Teaching

  New insulin order, first time with a glucometer. She is nervous and keeps dropping the lancet. Slow down and teach her.

• Frank Harrison, 67

  Basic Wound Care — Dressing Change

  Clean surgical wound, simple dressing change due. He is watching every move you make. Explain it as you go.

• Raymond Peters, 83

  Geriatric Polypharmacy Assessment

  Confused and falling. Warfarin, digoxin, metoprolol, metformin — and probably more at home. Medication review before he falls again.

• Patricia Green, 58

  Chemotherapy-Induced Nausea

  Cycle three of adjuvant chemo and she cannot keep anything down. Antiemetic protocol and hydration — get her stable enough to continue treatment.

• James Porter, 45

  Febrile Neutropenia

  Day ten post-chemo. Fever 38.4°C, ANC 0.3. Oncology emergency. Cultures, broad-spectrum antibiotics, isolation — in that order.

• Maria Torres (for son Liam), 6

  Pediatric Dehydration

  Two days of vomiting and diarrhea and he will not drink anything. Assess a sick child through a worried parent.

• Sofia Nguyen (for baby), 0

  Neonatal Jaundice Assessment

  Three days old and yellowing. Mom is anxious and breastfeeding is not established yet. Assessment and education — she needs both.

• Aiden Reyes, 9

  Pediatric Asthma Attack

  Wheezing since PE class, rescue inhaler left at home. Now working hard to breathe with a dropping sat.

• Rachel Martinez (for Maya), 2

  Pediatric Febrile Seizure

  First seizure — 90 seconds, stopped on its own. Her father is in a panic. The child is post-ictal. Lead this room.

• Tyler Warren, 17

  Opioid Overdose Recognition

  Unresponsive teen, pinpoint pupils, found by his parent. Recognize it and respond.

• Amanda Lee, 29

  Gestational Diabetes Education

  She failed her glucose tolerance test at 26 weeks and has no idea what it means for her or the baby. All education. Get her to understand and act.

• Tanya Brooks, 26

  Preterm Labor Management

  Contractions every five minutes at 32 weeks. Every intervention here is about buying the baby more time.

• Parent of Tyler (age 4), 4

  Suspected Child Abuse

  The story does not match the injuries. Document it and report it. Protect this child.

• Sandra Kim (for son Noah), 0

  Pediatric Sepsis — Infant

  Three months old. Fever, lethargic, barely feeding for 12 hours. Infant sepsis moves fast. Activate the bundle.

• Luisa Flores (for Mia), 1

  RSV Bronchiolitis — Toddler

  RSV season. Eighteen-month-old with nasal flaring, wheezing, barely eating. Supportive care — and knowing when she needs more.

• Keanu Makoa, 13

  Pediatric Meningitis

  Sudden headache, neck stiffness, photophobia, 103°F. Adolescent, dorm exposure. Empiric antibiotics do not wait for the LP result.

• Oliver Pham, 8

  Anaphylaxis — Pediatric

  Peanut exposure at school. Hives, vomiting, throat tightness. Eight years old and scared. Epinephrine first.

• Isabella Reyes, 6

  Post-Tonsillectomy Hemorrhage

  Eight hours post-tonsillectomy, restless and swallowing repeatedly. She is swallowing blood. This is a surgical emergency.

• Baby of Maria Gonzalez, 0

  Newborn Resuscitation — NRP

  Term newborn — limp, apneic, and blue at one minute. NRP is running. Know your role and do not hesitate.

• Baby of Kara Walsh, 0

  Substance-Exposed Newborn

  High-pitched cry, tremors, poor feeding. Classic NAS. Score it, keep him comfortable, and check on his mother.

• Amara Okafor, 28

  Eclampsia — Acute Seizure

  38 weeks, known severe preeclampsia, now actively seizing on the antepartum unit. Protect her, protect the baby.

• Jennifer Park (for son Ethan), 2

  Toddler Fever — Parent Reassurance

  He has a 101.5°F fever and his mother is convinced it is going to cause brain damage. It is not. Reassure her and teach her.

• Priya Sharma (for son Dev), 1

  Vaccine Hesitancy — Immunization Education

  Twelve-month visit. Everything is fine until you mention vaccines. His mother has questions. Answer them.

• Angela Reyes (for Sofia), 5

  Childhood Asthma — Inhaler Technique

  Newly diagnosed asthma. Her mother can't get the spacer to work. Before she goes home, she needs to understand this.

• Emma Larson, 8

  School-Age Anxiety — Pre-Procedure

  Eight years old, crying in the pre-op bay, refusing to let anyone near her. She is scared. Not combative — scared.

• Baby of Anna Williams, 0

  Newborn Assessment — First Hours of Life

  Baby arrived two hours ago. Mom is exhausted, dad is taking photos. Walk through the head-to-toe newborn assessment.

• Jennifer Kim (for Ryan), 6

  Pediatric Medication Teaching — Parent

  Antibiotic prescribed and ready to go. His mother has the bottle and a skeptical look. Teach the dose, the schedule, and what to watch for.

• Jordan Taylor, 34

  Major Depressive Disorder Assessment

  Persistent sadness, no interest in anything, not sleeping. Run the PHQ-9. This is where mental health nursing starts.

• Alex Morgan, 22

  Suicide Risk Assessment

  Hopeless after a job loss and a breakup. He is in the ED and you need to know: is he safe? Use the Columbia Scale and ask the direct question.

• Brian O'Sullivan, 47

  Alcohol Withdrawal Assessment

  Admitted for pneumonia 18 hours ago. Now tremulous, diaphoretic, agitated. Apply CIWA-Ar before this becomes a seizure.

• Sam Okonkwo, 29

  Acute Psychosis — De-escalation

  Disorganized, paranoid, command hallucinations. She is escalating. Stay calm, stay structured, keep everyone safe.

• Claire Donnelly, 19

  Restrictive Eating Disorder

  Her roommate brought her in. Extreme food restriction, fainting, hair loss. Sensitive assessment with a low threshold for escalation.

• Thomas Huang, 51

  Lithium Toxicity Assessment

  Coarse tremor, nausea, diarrhea, confusion. He started ibuprofen for knee pain four days ago. Lithium level: 2.4. Recognize toxicity and act.

• Helen Walsh, 81

  Dementia with Behavioral Crisis

  Advanced dementia, now agitated and refusing care. Redirect and de-escalate without restraints — a routine reality in long-term settings.

• Marcus Reyes, 34

  PTSD — Trauma-Informed Care

  Combat veteran. The smell of antiseptic triggers flashbacks and he is refusing wound care. Trauma-informed nursing means meeting him where he is.

• Danielle Frost, 29

  Opioid Withdrawal — COWS Protocol

  Sweating, cramping, agitated for 24 hours since her last opioid. Apply COWS. Comfort care and no judgment.

• Nina Shapiro, 26

  Manic Episode — Bipolar I

  Three nights without sleep, grandiose, pressured speech, impulsive. Inpatient unit. Assess and keep her safe.

• Harold Briggs, 55

  Serotonin Syndrome Recognition

  Started tramadol two days ago while still on his SSRI. Hyperthermia, clonus, agitation. Rare enough to miss, dangerous enough that you cannot.

• Kyle Donovan, 31

  Psychiatric Emergency — Involuntary Hold

  Active plan, access to means, refuses voluntary admission, and wants to leave. Legal and ethical duty. Navigate the 5150 hold without losing his trust.

• Renata Polk, 43

  Aggressive Patient — Verbal De-escalation

  Shouting, refusing medications, pacing the unit. De-escalate before this becomes a restraint situation.

• Sandra Williams, 58

  Adjustment Disorder — Acute Grief

  Terminal diagnosis. Refusing meals, expressing hopelessness, asking to go home. Not every patient needs a medication. Some need to be heard.

• Dylan Park, 20

  First-Episode Psychosis — Young Adult

  Three weeks of withdrawal, paranoid beliefs, disorganized speech. First psychiatric contact. His family brought him in. Do it right.

• Sarah Mitchell, 38

  Pre-Op Anxiety — Non-Pharmacological Comfort

  Surgery is in 90 minutes and she is shaking. HR 112, BP elevated. She has not had a sedative. What you say right now matters.

• Harold Fischer, 80

  Loneliness and Isolation — Therapeutic Presence

  He has been on this unit for eleven days and has not had a visitor. He does not need a nurse right now. He needs a person.

• Kevin O'Brien, 44

  Substance Use Screening — AUDIT-C

  Admitted for hypertension. Routine intake includes asking about alcohol. He is quiet. Ask it correctly.

• Caitlin Ross, 26

  Self-Harm Screening — Safety Assessment

  She is being discharged from a surgical floor. During your teaching she says something that stops you. Stay in the conversation.

• Melissa Turner, 32

  Psychoeducation — Antidepressant Timeline

  New prescription, first day. She wants to know why she will not feel better by the weekend. Explain how antidepressants actually work.

• Family of Daniel Cooper, 29

  Family Education — Supporting Depression

  His parents are in the waiting room and they do not understand why he will not just try harder. Teach them what depression actually is.

• Margaret Sullivan, 78

  Goals of Care Conversation

  Third admission this month. Her oncologist says further chemo will not help. Have the conversation she needs — about what matters to her, not just what medicine can do.

• George Fletcher, 72

  End-Stage Heart Failure

  EF 15%, LVAD in place. He is asking about deactivation. Device ethics and comfort care. He has decided enough is enough.

• Mary Chen, 64

  Cancer Pain Management

  Metastatic colon cancer and her current opioid regimen is not touching the pain. Thorough pain assessment — before you can treat it, understand it.

• Victor Santos, 67

  Malignant Hypercalcemia

  Metastatic lung cancer. Now confused, constipated, polyuric, vomiting. Corrected calcium 13.8. Oncologic emergency — treat it.

• Frances Bell, 56

  Status Epilepticus

  Eight minutes and still seizing. Known epilepsy, arrived by ambulance. Benzodiazepines first, then airway. Get the team moving.

• Arthur Klein, 82

  Advance Directive Conflict — Family Override

  Clearly documented DNR. His son is demanding full resuscitation and threatening to sue. Advocate for your patient — and navigate the family.

• Rosa Jimenez, 71

  Transitioning to Hospice

  Advanced pancreatic cancer, stopping chemo. This family meeting is about what comfort looks like — not what more treatment could offer.

• Clarence Davis, 88

  Last Hours of Life — Active Dying Signs

  Cheyne-Stokes breathing, mottling, unresponsive. His family is at the bedside and terrified. Guide them through — not away from — the last hours.

• Family of Tyler Grant, 24

  Organ Donation Conversation

  Their 24-year-old son is brain dead after a trauma. The OPO coordinator asks you to join the approach. This conversation cannot be undone.

• Betty Nakamura, 77

  Comfort-Focused Pain Management

  Hospice patient with refractory cancer pain. Her oral regimen is not working. Titrate the infusion and keep her comfortable.

• Family of Robert Kwan, 84

  Comfort Care — Actively Dying Patient

  He is in his last hours. His family is here and they do not know what to do. Neither do you — but you show up anyway.

• Walter Simmons, 78

  Explaining DNR — Patient Has Questions

  He signed a DNR last admission and does not really know what it means. He is asking now. Explain it clearly and let him decide.

• Katherine Rhodes, 69

  Family Asks If Morphine Is Speeding Death

  Her daughter pulls you aside in the hall. She watched you give the comfort dose and now she is afraid you hurt her mother. She deserves a real answer.

• Family of Miriam Cohen, 82

  Anticipatory Grief — Family Teaching

  Her family keeps asking if she is eating. She is not, and that is expected. Teach them what is happening without taking away their hope.

• Evelyn Barnes, 77

  Hospice Intake — First Comfort Assessment

  First hospice visit. She is home, in her own bed, family around her. Your job is not to treat the disease. Learn what comfort means to her.

• Family of George Whitfield, 88

  Bereavement Support After Patient Death

  He died 20 minutes ago. His wife is still at the bedside holding his hand. You are the nurse in the room. Stay.

• Evelyn Brooks, 61

  Advocating with a Dismissive Team Member

  You called with a concern. The provider dismissed it and ordered nothing. Your patient is getting worse. Escalate.

• Family of Raymond, 75

  Delivering Difficult News

  The family thinks he is improving. He is not. Tell them — compassionately and without false hope.

• Howard Miller, 43

  Redirecting an Inappropriate Patient

  He is making inappropriate comments and it is affecting your ability to care for him. Set the boundary — professionally and firmly.

• Susan Walsh, 55

  Asking for Help When You Don't Know

  You do not know the answer. Practice saying so and coming back with the right one.

• Diana Torres, 48

  Recovering After Saying the Wrong Thing

  You said the wrong thing and you know it. Repair the trust before the shift ends.

• Noah Garcia, 7

  Calming an Agitated Pediatric Patient

  Seven-year-old, scared, combative, refusing the procedure. His parents are helpless. De-escalate a child.

• Kevin Walsh, 69

  Difficult Family at the Bedside

  His daughter has been here since 6am, questions every decision, and just asked to speak to your supervisor. Manage this without losing the room.

• Cheryl Nguyen, 52

  Scope of Practice Boundary

  The family wants something outside nursing scope. Decline, explain once, and redirect — without damaging the relationship.

• Carmen Diaz, 74

  Delegating to UAP

  Four patients, one UAP, morning care ahead. Delegate safely and stay accountable for everything.

• Dorothy Evans, 67

  SBAR Handoff — Overnight Team

  Last hour of your shift and her condition just changed. Hand off with SBAR. Be complete.

• Mark Huang, 50

  Near-Miss Medication Error — Disclosure

  10 units drawn up instead of 1. You caught it before administration. Disclose the near-miss and file the incident report.

• Unit 4C — Night Shift, 0

  Charge Nurse — Staffing Shortage

  One RN called out mid-shift. No replacement coming. You are charge and the unit still needs to run safely.

• Fatima Al-Rashid, 39

  Interpreter Services — Language Barrier

  She needs to sign informed consent and no family is available to interpret. Professional interpreter services — her right, not a courtesy.

• Gerald Walsh, 72

  Reporting Up — Ignored SBAR Call

  You called, you reported, they dismissed it. His condition is deteriorating. Use the chain of command — now.

• Harry Coleman, 71

  Patient Refuses Medication

  He is refusing his evening medications and will not say why. Find out why before you document refusal and walk away.

• Sandra Park, 58

  HIPAA — Family Calls for Information

  A woman calls saying she is the patient's daughter and asks for an update. You have never met her. Handle it.

• Louise Greer, 67

  Anxious Patient — Repeated Call Light

  This is her fifth call in two hours. All stable. She is not managing her fear and it is affecting the unit. Address it.

• Victor Chong, 62

  Patient Questions a Medication Order

  He is looking at the pill in the cup and has questions. He has every right to ask. Give him real answers.

• Brenda Holloway, 54

  Patient Asks What You Think

  She wants to know if you think she should do the surgery. She is looking at you like you have the answer. Navigate it.

• Daniel Wright, 66

  Sepsis Recognition

  Two days of fever, confusion, and chills. UTI treated last week but she is worse. Apply SIRS criteria and escalate early.

• Barbara Allen, 71

  Acute Stroke Assessment

  Sudden facial droop, arm weakness, slurred speech — 45 minutes ago. NIHSS assessment. Rule out hemorrhage. Get her to imaging.

• Jessica Collins, 31

  Postpartum Hemorrhage

  One hour post-delivery. Heavy bleeding, boggy uterus. Recognize it and start the protocol.

• Carlos Mendez, 23

  Diabetic Ketoacidosis

  Type 1, out of insulin two days, now vomiting and confused. Recognize DKA. Start the protocol.

• Denise Hammond, 54

  Hypertensive Emergency

  Occipital headache, BP 210/130, blurred vision. End-organ damage in progress. Emergency, not urgency — know the difference.

• Carolyn Reed, 48

  Pulmonary Embolism Recognition

  Day three post-total knee replacement. Sudden pleuritic chest pain and tachycardia. PE until proven otherwise.

• Louise Martin, 63

  Transfusion Reaction — Anaphylactic

  Hives, hypotension, dyspnea — ten minutes into a blood transfusion. Stop the bag. Now.

• Harold Beck, 69

  Atrial Fibrillation — RVR

  Palpitations, near-syncope, irregular rhythm at 148 bpm on telemetry. Recognize A-fib with RVR and get the provider.

• Phillip Grant, 55

  Chest Tube Management

  Chest tube on water seal after a pneumothorax. There is bubbling in the water-seal chamber. Is it expected — or a complication?

• Beverly Carr (primary), 64

  Prioritization — Four-Patient Assignment

  Four patients, start of day shift. Two stable, one changed overnight, one discharging. Who do you see first — and why?

• Rosario Vega, 58

  Critical Lab Value — Panic Potassium

  Potassium 2.9 in a patient on digoxin — called as a critical value. Call it in. Act on the protocol.

• Phillip Adams, 61

  SIADH vs. Diabetes Insipidus

  Post-pituitary surgery, sodium 122, concentrated urine. SIADH or DI? The lab values tell you — if you know how to read them.

• Hannah Brooks, 18

  Acetaminophen Overdose — N-Acetylcysteine

  Intentional Tylenol overdose four hours ago, currently asymptomatic. Apply the Rumack-Matthew nomogram and start NAC — the window is closing.

• Veronica Chao, 39

  Neutropenic Precautions — Oncology

  Day ten post-chemo. Fever 38.5°C, ANC 350. Febrile neutropenia protocol — cultures, protective isolation, antibiotics within the hour.

• Taylor Scott, 25

  Postpartum Preeclampsia

  Delivered 24 hours ago, uncomplicated. Now BP 162/112 with a new headache. Late-onset postpartum preeclampsia — initiate magnesium.

• Owen Larson, 4

  Pediatric Airway Obstruction

  Four-year-old choking at dinner. Coughing and crying in the ED. Partial or complete obstruction — the distinction determines everything.

• Sandra Ortega, 66

  Acute Respiratory Failure — NIV

  COPD, worsening hypoxia and hypercapnia, not responding to high-flow oxygen. Recognize when supplemental O2 is not enough and escalate to NIV.

• Irene Watson, 84

  Medication Reconciliation — Polypharmacy

  Admitted after a fall with 12 home medications. Systematic reconciliation before anything is ordered.

• Donald Brooks, 77

  Fall Risk Assessment and Intervention

  Morse Fall Scale 65 and he wants to get up alone. Implement the fall bundle before he does it himself.

• Evelyn Harris, 91

  Wound Assessment — Pressure Injury Staging

  Bedbound after a hip fracture, coccyx wound developing. Stage it correctly and start the prevention bundle.

• Fatima Al-Mansouri, 45

  Cultural Sensitivity — Religious Accommodation

  She has not eaten since admission because no one set up her prayer time. Person-centered care starts here.

• Louis Brennan, 60

  Informed Consent — Patient Rights

  He signed the consent form. Now he has questions he did not ask. The surgeon is scrubbed in. This one is yours.

• Arthur Nelson, 73

  Fluid Balance — I&O and Daily Weights

  His intake is documented. His output is not. He has not been weighed today. Get the full picture before the provider rounds.

• Diane Marsh, 61

  IV Therapy — Infiltration Recognition

  He says his IV site hurts. It has been running for six hours. Look at it.

• Tyler Brooks, 28

  Vital Signs — Tachycardia Assessment

  HR 112 on your routine check. He says he feels fine. That does not close the assessment — it opens it.

• Kayla Monroe, 26

  Early Labor Assessment

  38 weeks, first baby, contractions every 8 minutes for two hours. She is timing them on her phone. She wants to know if this is it.

• Diana Ortega, 30

  Postpartum Fundal Assessment

  Six hours post-delivery, sore, tired, fielding questions faster than you can answer. Start with the fundus.

• Amara Johnson, 23

  Breastfeeding — Latch Difficulty

  Eighteen hours postpartum and the baby will not latch. She is crying more than the baby is. She says she is already failing.

• Emily, 28

  Newborn Discharge Teaching

  First baby goes home in an hour. Dad is googling. Mom has not slept. Teach them what they need, not everything you know.

• Fatima Hassan, 32

  Antepartum Hypertension Education

  BP 148/94 at 34 weeks, admitted for monitoring. She stayed up last night reading about preeclampsia. She is not wrong to be worried, but she needs the real picture.

• Alicia Chen, 30

  Fetal Heart Rate — Late Decelerations

  Active labor, 39 weeks. The EFM just started showing repetitive late decelerations. The attending is not in the room. You are.

• Aisha Williams, 28

  Postpartum Hemorrhage

  Two hours post-delivery. Second pad soaked in 30 minutes. Uterus is boggy. BP dropping.

• Priya Patel, 34

  Preeclampsia — Mag Toxicity

  Severe-feature preeclampsia, 36 weeks, two hours into the mag infusion. DTRs dropped to 1+. RR went from 16 to 14 in an hour. That is a trend.

• Gerald Peterson, 68

  ICU Admission — Systematic Assessment

  Respiratory failure, intubated an hour ago, just transferred from the ED. His wife is at the bedside. She has not been told anything yet.

• Ruth Blackwell, 74

  Ventilated Patient — Comfort and Family Update

  Day two on the vent. She is writhing. Her daughter has not left the chair by the bed since yesterday. Pain assessment before anything else.

• Carlos Medina, 56

  Sepsis Reassessment — ICU Day One

  Eight hours in. Antibiotics running, 2L in. BP still 84/52. He got the fluids and the antibiotics. Something is still wrong.

• Margaret Cho, 71

  ICU Delirium — Sedation Wean

  Sedation off four hours ago. She is awake, pulling at her lines, asking where her cats are. This is ICU delirium and it is yours to manage.

• Thomas Gallagher, 65

  Post-Op Cardiac Surgery — Day One Assessment

  Twelve hours post-CABG, extubated, pain 7/10. He wants to know if it worked. His wife has been in the waiting room since 6 a.m.

• Linda Torres, 58

  Ventilator High-Pressure Alarm — DOPE

  High-pressure alarm, O2 sat dropping, patient fighting the vent. Run DOPE before you call anyone.

• Frank Nguyen, 62

  ABG — Acute Respiratory Acidosis

  COPD exacerbation, two hours on BiPAP, ABG back: pH 7.28, PaCO2 72, PaO2 58. Two hours of BiPAP and nothing has improved.

• George Thompson, 71

  Septic Shock — Vasopressor Titration

  MAP 58 on norepi 0.1 mcg/kg/min. Fluids finished an hour ago. He has not moved. The intensivist wants your read.

• Steven Park, 52

  ED Chest Pain — Triage Assessment

  52-year-old, substernal pressure, 45 minutes, drove himself in. Gray. Diaphoretic. He says it is probably indigestion. It is not indigestion.

• Sofia Martinez, 28

  Pediatric Fever — ED with Anxious Parent

  Temp 103.8, two days of URI symptoms. The toddler is eating a popsicle. The mother has not slept in two nights and wants you to rule out meningitis.

• Derek Wallace, 34

  ED Alcohol Intoxication — De-escalation

  Found unresponsive in a parking lot. BAL 0.28, now awake and threatening to sue. He wants out. De-escalate before it gets physical.

• Sandra Lee, 34

  Pediatric Asthma — ED Discharge Teaching

  Mild exacerbation, three nebs, back to baseline. Mom does not own a spacer. She does not know which inhaler is which. Discharge teaching starts here.

• Jasmine Reid, 19

  ED Abdominal Pain — Initial Assessment

  RLQ pain, 12 hours, started periumbilical and migrated. She has a midterm tomorrow. She came in hoping you would tell her it was nothing.

• Robert Hammond, 67

  Acute Stroke — Door to CT

  Left-sided weakness, slurred speech, last known well 45 minutes ago. He drove himself in. The clock started when you saw him.

• Marcus Bell, 29

  Opioid Overdose — Naloxone

  Found unresponsive in a restaurant bathroom. Pinpoint pupils. RR 6. EMS is handing off now.

• Olivia Park, 8

  Pediatric Anaphylaxis

  Eight-year-old, birthday party, 10 minutes ago. Hives, stridor, RR 34. No prior reactions. Epinephrine first. Not diphenhydramine.

• Herbert Williams, 72

  Home Visit — Uncontrolled Diabetes

  A1C 11.2, admitted three weeks ago for a glucose of 780. First home visit post-discharge. He says his diet is fine. Check his pill bottles.

• Jordan Taylor, 15

  School Nurse — Inhaler Technique

  Mild wheeze in gym, resolved after two puffs, wants to go back to class. He taught himself inhaler technique from YouTube. It is wrong.

• Rachel Novak, 31

  Immunization Clinic — Vaccine Hesitancy

  Four-year-old is due for MMR. Mom watched a documentary last week and has questions. Answer them without making it a debate.

• Marvin Brooks, 58

  Discharge Planning — Social Determinants Screening

  CHF exacerbation, four days, ready to go home. No car. Nearest pharmacy is 18 miles away. Did not fill his furosemide last month because it cost too much.

• Gloria Evans, 54

  Community BP Screening — New Hypertension

  She came for a flu shot. BP is 162/98. She feels fine. That is the problem with hypertension.

• Eleanor Davis, 82

  Home Visit — Elder Abuse

  Post-hip-repair follow-up. Her son is the caregiver. Three bruises in different stages, not where hip patients bruise. She will not answer questions when he is in the room.

• Danielle Foster, 42

  Home Visit — Suicidal Ideation

  Wound care visit. She said yes on the depression screen. Thinks about it every day. Has a plan. You are in her living room.

• Jennifer Walsh, 45

  Brief Intervention — Opioid Misuse

  HTN follow-up. She has been taking her mother's oxycodone for back pain. Three times in two weeks. She is not worried about it.

All scenarios are available in the app.