Comprehensive Simulation Scenario for Nurse Training: Stroke Case History and Vital Signs Assessment
Scenario Title: Structured Interview, Neurological Symptom Evaluation, and Immediate Diagnostic Preparation for Suspected Stroke
Setting: Emergency Department / Neurology Unit
Characters:
- Nurse (RN) – Responsible for patient assessment and coordination of emergency stroke care
- Ms. Jiyeon Park (Patient) – 66-year-old female presenting with acute neurological deficits
Phase 1: Patient Identification and Communication
Nurse: Good morning, Ms. Park. I’m the nurse assisting you today. Could you please confirm your full name and date of birth?
Patient: Good morning. My name is Jiyeon Park, and my date of birth is May 10, 1958.
Nurse: Thank you, Ms. Park. I will ask you some questions to better understand your condition. All information will be kept confidential. If you experience discomfort during our conversation or the examination, please let me know.
Phase 2: Chief Complaint (CC)
Nurse: What brings you to the hospital today?
Patient: I suddenly developed facial drooping and weakness on the left side of my body.
Phase 3: History of Present Illness (HPI)
Nurse: When did these symptoms begin?
Patient: About three hours ago.
Nurse: Did the weakness or facial droop appear suddenly?
Patient: Yes, it happened very suddenly.
Nurse: Have the symptoms been constant, or do they come and go?
Patient: They’ve been constant.
Nurse: Which parts of your body are affected?
Patient: The left side of my face, arm, and leg.
Nurse: Have you noticed any changes depending on your position or activity?
Patient: No, nothing seems to affect it.
Nurse: Are you experiencing slurred speech, dizziness, or nausea?
Patient: Yes, I’m having trouble speaking clearly and feel a bit dizzy.
Nurse: Do you have any difficulty swallowing, double vision, or loss of balance?
Patient: Swallowing seems a little more difficult than usual.
Phase 4: Past Medical History (PMH)
Nurse: Have you ever experienced anything similar before?
Patient: No, this is the first time.
Nurse: Do you have a history of hypertension, diabetes, or high cholesterol?
Patient: I’ve had high blood pressure for about five years.
Nurse: Have you had any recent surgeries, trauma, or infections?
Patient: No recent procedures or illnesses.
Nurse: Have you ever been treated for atrial fibrillation or irregular heartbeat?
Patient: Not that I know of.
Phase 5: Family History (FH)
Nurse: Is there a family history of stroke, heart attack, or cardiovascular disease?
Patient: Yes, my father had a stroke in his 70s, and my brother has heart problems.
Nurse: Were they hospitalized or treated with long-term medications?
Patient: My father was hospitalized during his stroke episode.
Phase 6: Social History (SH)
Nurse: Do you currently smoke or drink alcohol?
Patient: I don’t smoke, but I drink occasionally—maybe once a month.
Nurse: Are you retired, or do you currently work?
Patient: I’m retired now. My past job in finance was very stressful.
Nurse: Do you maintain a regular exercise routine?
Patient: I try to go for walks a few times a week.
Nurse: How would you describe your typical diet?
Patient: I try to eat healthy, but I sometimes eat salty food.
Phase 7: Medication History and Allergies
Nurse: Are you currently taking any medications or supplements?
Patient: I take medication for blood pressure every day.
Nurse: Do you take any medications related to blood thinning or heart health?
Patient: No, only my blood pressure pills.
Nurse: Any side effects or adverse reactions to medications in the past?
Patient: None.
Nurse: Any known allergies to food, medications, or environmental elements?
Patient: No allergies that I know of.
Phase 8: Vital Signs Assessment
Nurse: Ms. Park, I’ll now check your vital signs to assess your overall condition. Please let me know if anything feels uncomfortable.
8.1 Temperature
Nurse: I’ll begin with your temperature using an ear thermometer.
(Performs hand hygiene, applies probe cover, gently inserts thermometer.)
Nurse: Your temperature is 37.1°C, which is within the normal range.
8.2 Blood Pressure
Nurse: Let’s check your blood pressure.
(Positions cuff, inflates, auscultates over brachial artery.)
Nurse: It’s 165/90 mmHg—elevated, and this may relate to your current symptoms.
8.3 Pulse
Nurse: I’ll now check your pulse.
(Counts radial pulse for one full minute to check for irregular rhythms.)
Nurse: Your heart rate is 100 beats per minute—slightly elevated.
8.4 Respiratory Rate
Nurse: I’ll now observe your breathing.
(Observes chest movements discreetly for one minute.)
Nurse: Your respiratory rate is 22 breaths per minute—mildly elevated.
Phase 9: Clinical Summary and Initial Plan
Nurse: Based on the history and your vital signs:
- Normal temperature suggests no fever or infection.
- High blood pressure is common during acute stroke onset.
- Tachycardia and slightly elevated respiratory rate align with neurological and emotional stress.
To confirm the diagnosis and determine the type of stroke, we’ll initiate the following:
- Non-contrast brain CT scan: To rule out hemorrhage (10–15 minutes).
- MRI (if needed): Provides detailed imaging of brain tissue.
- Blood tests: Glucose, lipid profile, CBC, clotting factors.
- Electrocardiogram (ECG): To assess for arrhythmias.
- Carotid Doppler (later): To evaluate blood flow in neck arteries.
We may also establish IV access and administer oxygen, if required.
Phase 10: Patient Education and Support
Nurse: Most of the tests are non-invasive and will be done promptly. Please stay calm and avoid unnecessary movement.
Patient: Will I need medication or surgery?
Nurse: If a clot is detected and you're eligible, the doctor may consider thrombolytic therapy. Further treatment will depend on test results.
Patient: I’m nervous, but I understand.
Nurse: That’s completely natural. We’ll monitor you closely and keep you informed throughout. Let’s begin with the brain CT scan now. Please let me know if you feel dizzy, confused, or worse at any point.
Learning Objectives for Nurse Trainees
- Conduct structured stroke assessments using FAST criteria and patient-reported history
- Correlate vital signs and neurologic symptoms with acute stroke
- Prepare and educate patients for urgent diagnostic testing
- Prioritize interventions based on time-sensitive stroke protocols
- Provide empathetic communication and reassurance during high-stress situations
End of Scenario
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