Mobility Focused Nursing Simulation Notes: Robert Hall

Date: April 20, 2026 Setting: Hospital — Medical-Surgical Floor Simulation App: Shadow Health (Elsevier) Course: Basic Nursing Skills (D442)

Simulation Checklist

EHR Review
Phase 1 — Therapeutic Introduction
Phase 2 — Health History
Phase 3 — Physical Assessment
Phase 4 — Geriatric Syndromes (SPICES, 5Ms, Frailty, Elder Abuse)
Phase 5 — Medication Review (Beers Criteria®)
Phase 6 — Care Plan
Education & Empathy documented
SBAR Hand-Off

Patient Overview

Age / Sex / Ethnicity: 80-year-old White male — DOB 12/28/1945
MR#: 1207126
Attending: Dr. Benjamin General
Chief Concern: Dizziness, DVT, Fall
Admitting Diagnosis: DVT
Secondary Diagnoses: HTN, Dizziness, Fall
Condition: Stable | Code Status: Full Code
Cognitive Baseline: [ ]
Functional Status (ADLs/IADLs): [ ]
Assistive Device: [ ]
Living Situation / Support: [ ]
Advance Directives: [ ]

EHR Review

Active Orders

Category	Order
Diet	Regular diet
Activity	Up with assist
Vitals	Q4H — notify for BP <90/60 or >160/110; HR <60 or >110; Temp >38.3°C/101°F; UOP <35 mL/h x 2h; RR >30 or <12
I/Os	Strict I/Os
Assessment	Per facility protocol
Fall	Initiate fall alert protocol
IV	Normal saline 0.9% continuous at 100 mL/hr

Labs Ordered

Lab	Timing	Purpose
CBC	NOW	Baseline; rule out infection, anemia
CMP	NOW	Electrolytes, renal/hepatic function
INR	NOW	Anticoagulation monitoring (apixaban)
Urinalysis	NOW	Rule out UTI, assess renal status
Head CT	NOW	Rule out intracranial hemorrhage (fall → possible head trauma)

Medications

Drug	Dose	Frequency	Route	Category	Notes
Metoprolol	25 mg	Daily	PO	Beta-blocker	Continue home med — HTN
Finasteride (Proscar)	5 mg	Daily	PO	5-alpha reductase inhibitor	Continue home med — BPH
Normal saline 0.9%	100 mL/hr	Continuous	IV	Fluid	Inpatient
Tramadol	50 mg	BID PRN severe pain	PO	Opioid-like analgesic	⚠️ Beers Criteria® — see below
Acetaminophen	325 mg (1–2 tabs)	q6h PRN mild pain	PO	Analgesic	Step-down pain option
Apixaban	5 mg	BID	PO	Anticoagulant (DOAC)	For DVT — fall risk + bleeding risk

Case Management Referrals

Apixaban therapy education
Home safety and fall risk assessment
PT for functional assessment and home recommendations

EHR Coaching Notes

⚠️ Tramadol is on the Beers Criteria® for older adults — see Phase 5 for full analysis
✅ Head CT ordered — appropriate post-fall safety measure; rule out ICH before anticoagulation continued
✅ Fall alert protocol initiated — consistent with admitting diagnosis and fall history
✅ PT referral ordered early — appropriate for 80YO with DVT and fall
⚠️ Metoprolol (beta-blocker) + dizziness presentation → orthostatic hypotension must be assessed
⚠️ Apixaban 5mg BID is DVT maintenance dosing — confirm patient is past the initial 7-day 10mg BID treatment phase; also note significant bleeding risk if patient falls again
✅ Strict I/Os ordered — appropriate with IV fluids in an 80YO (monitor for fluid overload)
⚠️ Finasteride → indicates BPH history → urinary urgency/hesitancy → nocturia → fall risk contributor (rushing to bathroom at night)

Phase 1 — Therapeutic Introduction

Patient Presentation (Student Report)

Pain located in left calf
Pain is impairing mobility
Pain likely contributed to the fall this morning

Communication Approach

[ ]

Instructor Coaching

✅ Location identified — left calf is the classic DVT site (deep veins of the calf/popliteal)
⚠️ This is the beginning of your OLDCARTS — you have Location. You still need: Onset, Character, Alleviating/Aggravating, Radiation, Timing, Severity
⚠️ Pain → impaired mobility → fall: you’ve already identified the chain of causation. Hold onto that — it will drive your nursing diagnosis
Key cue: calf pain in a patient now diagnosed with DVT means the clot is likely in the calf/popliteal venous system. Pulmonary embolism risk is real if the clot propagates proximally.

CJMM: Recognize Cues

Left calf pain → DVT until proven otherwise (confirmed by admitting diagnosis)
Pain-limited mobility → mechanical fall contributor
Fall in anticoagulated patient → ICH risk (CT pending)

Phase 2 — Health History

History Collected

Domain	Findings Reported	Gaps / To Follow Up
Chief Complaint
Left Leg Pain (OLDCARTS)
Dizziness
Fall Mechanism
Past Medical History
Medications (full list)
Allergies
Family History
Social History
ADL / IADL Status
Assistive Device Use
Prior Falls (past 12 months)
Fear of Falling
Advance Directives
Elder Abuse Screen
Frailty Indicators
Continence
Nutrition / Appetite / Weight Loss
Sleep
Mood / Depression Screen

Dizziness Differential

Cause	Supporting Evidence	Ruled Out?
Orthostatic hypotension
Cardiac arrhythmia
BPPV
Medication side effect
CNS / neurological

Instructor Coaching

[ ]

CJMM: Recognize Cues / Analyze Cues

[ ]

Phase 3 — Problem-Focused Physical Assessment

Objective Findings

System	Findings	Clinical Significance
Vital Signs 1300	Temp 36.5°C / BP 110/76 / HR 70 / RR 18 / O2 97% / Pain 10/10	Normothermic; normotensive; HR WNL; pain severe on arrival
Vital Signs 1400	Temp 36.8°C / BP 115/78 / HR 68 / RR 17 / O2 97% / Pain 7/10	Stable trend; pain partially controlled
Vital Signs 1500	Temp 36.5°C / BP 120/80 / HR 66 / RR 18 / O2 98% / Pain 2/10	BP at upper normal; HR trending down; pain well controlled
Vital Signs (lying — 5 min)	BP 120/80	Baseline supine
Vital Signs (standing — 1 min)	BP 108/72	Systolic drop 12 mmHg
Vital Signs (standing — 3 min)	BP 100/60 — pt reports dizziness	Systolic drop 20 mmHg ✅ / Diastolic drop 20 mmHg ✅ — POSITIVE ORTHOSTATIC HYPOTENSION
Orthostatic Change	Systolic ↓20 / Diastolic ↓20 with symptomatic dizziness at 3 min	Confirmed orthostatic hypotension — direct contributor to fall

✅ Assessed Orthostatic Blood Pressure

Blood pressure at rest

✅ Normotensive (120/80)
⬜ Hypotensive
⬜ Hypertensive

Evidence of orthostatic hypotension

⬜ No significant orthostatic changes
✅ Systolic decrease of ≥20 mmHg (120 → 100 = ↓20 mmHg)
✅ Diastolic decrease of ≥10 mmHg (80 → 60 = ↓20 mmHg)
✅ Exhibits signs of presyncope (patient reports dizziness at 3 min standing) | Neurological | | | | Cognition Screen (tool / score) | | | | Delirium Screen | | | | Cardiovascular | | | | Respiratory | | | | Left Leg — Inspection | | | | Left Leg — Neurovascular (6 P’s) | | | | Bilateral Strength | | | | Range of Motion | | | | Gait / TUG | | | | Skin / Pressure Areas | | | | Abdomen | | | | GU / Continence | | | | IV Site | No visible abnormal signs; dressing dry and intact | IV patent and safe — NS 100 mL/hr infusing as ordered | | IV Pump | Infusing at ordered rate | NS 0.9% at 100 mL/hr — confirmed correct | | IV Bag | Normal saline ✅; name and dosage correct ✅; no visible abnormal appearance ✅ | Fluid confirmed safe — matches order; no cloudiness, discoloration, or crystallization | | Eyes | Eyelids, conjunctiva, lens — no abnormalities; PERRL; normal constriction and dilation | No neuro-ophthalmic deficits; no signs of raised ICP or focal CNS lesion | | Mouth | Oral mucosa and gums: moist and pink, no bleeding; Lips: dry, chapped; Tongue: dry appearance | ⚠️ Dry lips and tongue suggest dehydration despite IV fluids — relevant with DVT, fall, and orthostatic hypotension | | Respiratory | Breath sounds diminished at right lower base; no adventitious sounds | ⚠️ Diminished RLL — requires follow-up; see coaching note below |

Left Leg Neurovascular Check (6 P’s)

P	Finding
Pain
Pallor
Pulselessness
Paresthesia
Paralysis
Poikilothermia

Instructor Coaching

[ ]

CJMM: Analyze Cues

[ ]

Phase 4 — Geriatric Syndrome Screening

SPICES Summary

Domain	Findings	Risk Level
Sleep
Problems Eating / Nutrition
Incontinence
Confusion / Cognition
Evidence of Falls
Skin Breakdown

Geriatric 5Ms

M	Domain	Findings
Mind
Mobility
Medications
Multicomplexity
Matters Most

Frailty Screening (FRAIL Scale)

Criterion	Finding	Score
Fatigue
Resistance (stairs)
Ambulation (1 block)
Illnesses (≥5 chronic)
Loss of weight (>5%)
FRAIL Total		/5

Elder Abuse Screen

Domain	Patient Response	Concern?
Safety at home	Feels safe at home	No
Physical harm	Skin inspection pending	[ ]
Emotional harm	Not reported	[ ]
Financial exploitation	Denies financial misconduct	No
Medication control	Not yet asked	[ ]
Food/care withheld	Denies withholding of food or care	No
Abuse/neglect disclosure	Denies any abuse or neglect	No

Elder Abuse Screen: Negative per patient report. Complete objective component with skin inspection.

Instructor Coaching

✅ All four validated questions asked and documented — this is a scored sim objective
✅ Patient screen negative across all domains — no current concerns
⚠️ Skin inspection still needed to complete the objective component of the abuse screen — unexplained bruising, excoriation, or pressure injuries complete the picture
⚠️ Medication control question not yet directly asked — consider adding in follow-up

CJMM: Prioritize Hypotheses

[ ]

Phase 5 — Medication Review (Beers Criteria®)

Full Medication List

Drug	Dose	Frequency	Route	Indication

PIMs Identified

Drug	Beers Category	Clinical Concern	Fall Risk?	Suggested Action

Instructor Coaching

[ ]

CJMM: Generate Solutions

[ ]

Phase 6 — Nursing Care Plan

Priority Nursing Diagnosis (PES Format)

[ ]

Short-Term Goal

[ ]

Interventions & Rationale

Intervention	Rationale

Evaluation

[ ]

Instructor Coaching

[ ]

CJMM: Take Action / Evaluate Outcomes

[ ]

Nursing Admitting Note (Drafted)

[ ]

Education & Empathy Log

Topic Educated	Patient Response	Empathy Moments

SBAR Hand-Off to Preceptor Diana

Component	Content
Situation
Background
Assessment
Recommendation

Mobility Focused Nursing Simulation Notes: Robert Hall

Simulation Checklist

Patient Overview

EHR Review

Active Orders

Labs Ordered

Medications

Case Management Referrals

EHR Coaching Notes

Phase 1 — Therapeutic Introduction

Patient Presentation (Student Report)

Communication Approach

Instructor Coaching

CJMM: Recognize Cues

Phase 2 — Health History

History Collected

Dizziness Differential

Instructor Coaching

CJMM: Recognize Cues / Analyze Cues

Phase 3 — Problem-Focused Physical Assessment

Objective Findings

✅ Assessed Orthostatic Blood Pressure

Left Leg Neurovascular Check (6 P’s)

Instructor Coaching

CJMM: Analyze Cues

Phase 4 — Geriatric Syndrome Screening

SPICES Summary

Geriatric 5Ms

Frailty Screening (FRAIL Scale)

Elder Abuse Screen

Instructor Coaching

CJMM: Prioritize Hypotheses

Phase 5 — Medication Review (Beers Criteria®)

Full Medication List

PIMs Identified

Instructor Coaching

CJMM: Generate Solutions

Phase 6 — Nursing Care Plan

Priority Nursing Diagnosis (PES Format)

Short-Term Goal

Interventions & Rationale

Evaluation

Instructor Coaching

CJMM: Take Action / Evaluate Outcomes

Nursing Admitting Note (Drafted)

Education & Empathy Log

SBAR Hand-Off to Preceptor Diana

Key Teaching Points (Running Log)

Student Strengths Noted

Areas to Revisit