Case: Randy Adams (Iraq veteran)
Overview: Randy Adams, age 28, is a former National Guardsman who was deployed to Iraq. He and his wife Joy have twin boys, Jeff and Jarod, aged 18 months. After returning home, Randy went back to complete his fourth year of college, but had difficulty with coursework. After being placed on academic probation, he withdrew from the university and found employment at a local computer repair shop. Joy graduated with an engineering degree while Randy was deployed and has worked part time since the babies were born. We meet Randy, disoriented to time and place, in the emergency department following a car accident. We learn about his experiences in Iraq with improvised explosive devices (IEDs) and his social isolation. In subsequent scenarios, the nurse will reassess his mental status and explore how medications and therapy are working to relieve his post-traumatic stress disorder.
Monologue: Randy is being seen in the emergency department (ED) following an automobile accident. He is disoriented to time and place and displays a variety of emotions. He describes some of his experiences in Iraq with improvised explosive devices and his history of recurrent headaches. When an ED staff member calls his wife Joy, she shares more information about Randy's behavior since he returned from Iraq, the struggles that led him to withdraw from college, and his social isolation.
Randy's Introductory Monologue
Simulation Scenario 1
Randy is being discharged after 24 hours observation following his motor vehicle accident. His wife, Joy, is with him. He has referrals to see a neurologist, an appointment for evaluation at a behavioral health clinical, and several new discharge medications. The nurse will do a neuro check and review his discharge instructions.
Simulation Scenario 2
Randy does not keep his follow-up appointments with either the neurologist or the behavioral health center. He shows up at his doctor's office on the day prior to his scheduled appointment. Joy is not with him. The physician agrees to see him shortly, but asks the nurse to determine how he is recovering from his concussion, find out about his concerns and questions, and conduct a mental status screening.
Simulation Scenario 3
It is two weeks later. Randy is back at his physician's office for follow-up. This time Joy is with him. He reports that he saw a neurologist and psychiatrist and they prescribed new medications. The nurse will repeat the same assessments she did on the previous visit and compare them to those from his last visit.
Finish the Story Assignment
Learners have now seen Randy at three snapshots in time. What do they think his life will be like three months from now?
Author Janet K. Willhaus, PhD, RN
Assistant Professor - Boise State University