Chest Pain on the Ward - Nursing VEsim
Case Overview
Patient Name: Allan Jackson
Age: 75
Setting: Ward 1A, The Prince Charles Hospital
Scenario Type: Tabletop Visually Enhanced Simulation (VEsim)
Target Audience: New Graduate Nurses / Early-career RNs
Facilitator(s): 1-2 (CNCF, CN or Educator)
Duration: 30–40 min (Scenario 15 min + Debrief 15–20 min)
Case Prompt
You are the nurse looking after Allan Jackson, a 75-year-old man admitted for NSTEMI and awaiting angiogram in the morning. He uses the call bell and states:
“I’m having chest pain again… it feels the same as before, but worse.”
On assessment, he is pale, diaphoretic, and in respiratory distress.
History Details
Presenting Complaint: Sudden retrosternal chest pain, nausea, SOB, diaphoresis
PMHx: CAD, Hypertension
Medications: Aspirin, Altace, HCTZ
Allergies: Nil
Social Hx: Ex-smoker
Objectives
- Recognise signs and symptoms of acute coronary syndrome and heart failure
- Appropriately escalate care using MET and Q-ADDS
- Initiate evidence-based interventions within nursing scope (oxygen, meds, obs)
- Use ISBAR framework to communicate effectively with the medical team
Case Progression Chart
| Stage | Status | Actions | Modifiers & Triggers |
|---|---|---|---|
| 1. Nurse-Call from Patient | HR 98, BP 175/60, RR 28, O2SAT 91% RA | Ask PQRST chest pain assessment questions (Provocation, Quality, Radiation, Severity, Timing) Request vitals from buddy Initiate supplemental oxygen as per Q-ADDS escalation pathway Notify TL or Reg |
Facilitator prompt: “He doesn’t look well.” Trigger: Nurse attends bedside |
| 2. Initial Assessment | HR 101, BP 179/90, RR 30, O2 93% on 6L | Full set of Q-ADDS obs ECG 1 shows T-wave inversion Administer PRN GTN/ASA Prepare for escalation |
After GTN x2, patient states pain remains. Trigger: Reassess patient and ECG |
| 3. Deterioration | HR 98, BP 160/85, RR 40, O2SAT 88% | ECG 2 shows anterolateral STEMI MET call or notify Cardiology Reg Administer oxygen, PRN meds Prepare for CCU transfer |
Facilitator prompt: “This looks like a STEMI…“ Trigger: MET call made or Cardiology Registrar contacted. Escalated through TL |
| 4. Cath Lab Preparation | HR 96, BP 145/80, RR 24, O2SAT 95% on 6L | Cardiology Reg confirms need for urgent PCI Ensure 2 large-bore IVs in place Confirm pathology collected (e.g., troponin, FBC, UEC) Collate current obs, ECGs, and med chart Complete nursing documentation for transfer Notify family if required |
Facilitator prompt: “Cath lab is ready, can you prepare Allan for transfer?” Trigger: Transfer completed or simulation end |
ECG & Imaging
- ECG 1: Anterolateral T-wave inversion
- ECG 2: STEMI (Anterior leads)
- CXR: Congestive Heart Failure (available on request)
Props & Visual Aids
- ECG printouts (baseline, evolving STEMI)
- Q-ADDS form & MET flowchart
- Medication chart with ASA, GTN, Frusemide
- ISBAR template
- Observation chart with prompts
- Role badges (Primary Nurse, Support Nurse, Facilitator)
Slide Deck in Development
- Slide 1: Case Overview and Objectives
- Slide 2: Case Prompt (Patient Call Bell Script)
- Slide 3: Initial ECG (T-wave inversion)
- Slide 4: Evolving ECG (STEMI)
- Slide 5: Q-ADDS Example and Escalation
- Slide 6: Ward 1A Chest Pain Protocol Summary
- Slide 7: Coronary Artery Anatomy & STEMI Territories
- Slide 8: Debrief Questions and Reflections
Debrief Questions
- What were the red flags in this presentation?
- When and why did you decide to escalate?
- How did Q-ADDS scoring guide your actions?
- Were you confident interpreting the ECGs?
- How did the team work together under pressure?
Facilitator Notes
- Use the Ward 1A chest pain protocol for reference
- Reinforce clinical reasoning in cardiac deterioration
- Highlight early intervention in ACS saves myocardium
- Tie actions back to scope of practice and escalation policy
Optional Variations
- Add a family member (confederate) for communication challenge
- Simulate concurrent nursing tasks (e.g., other patients requiring assistance)
- Incorporate documentation and post-MET care planning task
Created by: [Your Name / Educator]
Adapted from original physician-targeted case by Kyla Caners (2015), McMaster University
Version: 1.0 (Ward 1A VEsim Adaptation)
Date: [Insert date of use]