NursingCase studyPathophysiology

vSim Stan Checketts: severe abdominal pain activity packet

A clinical replacement activity packet for a virtual patient: a 52-year-old man in the emergency department with severe abdominal pain, vomiting, distension and no urine output, worked through a clinical worksheet, a plan of care concept map, pharmacology sheets and an ISBAR handoff. This guide covers why the four assigned readings are a single chain, the acid-base answer that is conditional, and the finding his own explanation cannot cover.

Aug 6, 2026Updated Aug 10, 2026

Editorial process

Last reviewed · August 6, 2026

Written by

Aaron Bishop

MA, Education

assignment interpretation and research-methods coaching across disciplines

Reviewed by

Dr. Nathan Cole

PhD, Rhetoric & Composition

Argumentation and thesis development

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Interpret the task
Assignment instructions
Deliverables
Proposed outline
Research plan
Reference shortlist
Final review

Four readings, one patient, one chain

The packet lists four assigned readings, and they are not four topics. Fluid volume disturbances, acid-base disturbances, hypovolaemic shock and bowel obstruction are one causal chain, printed in the order it runs backwards. Reading them as a list is the difference between a concept map and a set of bullet points.

Run the chain forwards from the obstruction. Bowel content stops moving, so fluid is sequestered in the lumen and the bowel wall — third spacing — while vomiting removes more from outside the circulation entirely. That is the fluid volume disturbance, and the vignette's findings are its stages laid out in order: poor skin turgor and dry mucous membranes, then dizziness and weakness on standing, then no urine since yesterday. When intravascular volume falls far enough that perfusion is compromised, the fluid deficit has become hypovolaemic shock. The four readings describe one patient at four points on the same trajectory, and the concept map is the artefact that will show whether you saw that or not. Building the map from the origin outward also makes the plan of care fall out of it, since each arrow is a problem and each problem needs an intervention.

The acid-base reading is the one that rewards care, because the answer is conditional rather than fixed. Persistent vomiting removes gastric acid, so the expected disturbance is a metabolic alkalosis, and it usually arrives with low chloride and low potassium because those are lost alongside. That is the textbook answer and it is probably right here. But if the obstructed bowel becomes ischaemic, anaerobic metabolism and lactate production push in the opposite direction and the picture turns acidotic — which makes a shift from alkalosis toward acidosis an ominous change rather than an improvement. Given that his pain has been getting worse, saying which disturbance you expect and what would make you revise it is a better answer than naming one. Naming a condition under which your own prediction fails is also the habit the post-simulation debrief will be looking for, and it is cheap to demonstrate here.

His own explanation is the trap the case is built around. He thought it might be the flu, and flu is a reasonable enough story for nausea, vomiting and feeling weak. It does not account for a distended abdomen or for eighteen hours without urine, and the nurse who accepts the patient's framing will document a gastrointestinal illness rather than a surgical emergency. The distension is the finding that does not fit, and the anuria is the one that sets the urgency. Naming both explicitly in the clinical worksheet — as findings that contradict the presenting narrative — is what a clinical judgement rubric is looking for. Patients supply explanations constantly and most of them are reasonable; the skill is noticing the one finding that the explanation leaves over, and treating that as the thread to pull.

The packet's own structure tells you how the effort splits. Step one carries four artefacts and an estimate of four to six hours, and each artefact does a different job: the clinical worksheet gathers and organises, the concept map shows the relationships between the problems, the pharmacology sheets are one per medication so their number follows from the plan you build, and the ISBAR worksheet compresses everything into a handoff. The recommendation line of that handoff is where most students go vague, and it is the line that carries the most weight — for this patient it should name what you want done and by when, not that the provider should be aware of the situation. Working backwards from the handoff can help: if you know what you would ask the provider for, the worksheets in front of it have a target.

Finding in the case	What it belongs to	What it indicates
Severe abdominal pain, worsening over days	Bowel obstruction	The primary process, and worsening pain raises ischaemia
Abdominal distension	Bowel obstruction	The finding his flu explanation cannot account for
Nausea and vomiting for days	Fluid and acid-base	Volume loss plus loss of gastric acid, chloride and potassium
Poor skin turgor, dry mucous membranes	Fluid volume deficit	Established deficit, extracellular
Dizzy and weak all evening	Fluid volume deficit	Compensation failing on position change
No urine since yesterday	Hypovolaemic shock	Renal perfusion compromised — the urgency marker

Likely learning objectives

Inferred from the brief — check these against your own rubric.

01
Trace a causal chain from a primary process through its fluid, electrolyte and perfusion consequences.
02
Predict an acid-base disturbance from a mechanism, and name the condition that would reverse the prediction.
03
Identify the findings that contradict a patient's own explanation of their illness.
04
Order clinical findings by the stage of deterioration they represent.
05
Write a handoff recommendation that names an action and a timeframe.

Assignment instructionsQuoted verbatim

Read the full question

Review every instruction before using the planning guidance that follows.

A 52-year-old patient in the Emergency Department with complaints of severe abdominal pain nausea and vomiting over the last few days what might be the cause? A 52-year-old patient has just arrived in the Emergency Department with complaints of severe abdominal pain, nausea, and vomiting over the last few days. His abdomen is distended. He has poor skin turgor and dry mucous membranes. He has not urinated since yesterday. He has felt “dizzy” and “weak” all evening. He thought it might be the flu, but decided to come in because the stomach pains were getting worse. He has signed informed consent for treatment and labs have been drawn. his name is Stan Checketts This are his issues Fluid Volume Disturbances, Chapter 13, pp. 259-262 Acid-Base Disturbances, Chapter 13, pp. 283-288 Hypovolemic Shock, Chapter 14, pp. 308-310 Bowel Obstruction, Chapter 47, pp. 1327-1329 This activity packet is intended to be used with your assigned virtual patient found in vSim. The Six Step learn flow in vSim is to be followed as instructed below. Once you have completed the Six Steps, in additon to this Clinical Replacement Activity Packet, submit for grading as instructed in your syllabus. LEARN FLOW – STEP ONE  Finish the Suggested Readings, then complete the following four activities: o Clinical Worksheet o Plan of Care Concept Map o Pharm4Fun Worksheet (one per medication) o ISBAR Worksheet EST. TIME: 4 – 6 HOURS LEARN FLOW – STEP TWO  Take the Pre-Simulation Quiz o Student may take several times using the answer key to provide immediate remediation prior to the virtual simulation. Quiz is recorded as complete. LEARN FLOW – STEP THREE  Launch the virtual simulation o Suggest student complete the vSim Tutorial prior to launching Step Three. o Each clinical experience in the simulation lasts a maximum of 30 minutes. o Student is to complete the simulation as many times as it takes to meet an 80% benchmark. Discussion: Severe abdominal pain LEARN FLOW – STEP FOUR  Complete the Post-Quiz o The answer key is not visible to the student until after they have submitted the quiz. o The quiz grade is recorded as a percentage LEARN FLOW – STEP FIVE  Document o The student documents the clinical events that occurred during the simulation using the information contained in step five. o If using DocuCare, the instructor assigns the same vSim patient which can be found in DocuCare cases. LEARN FLOW – STEP SIX  Reflection Questions o Students are to complete the reflection questions and submit to instructor post clinical replacement (see syllabus for details). o The quiz grade is recorded as a percentage 2 1 3 4 5 6 STUDENT LEARNING OUTCOMES ASSIGNMENT This ac�vity creates an opportunity for you to organize the nursing care required for the pa�ent care presented in your assigned vSim. At the end of this ac�vity, student will be able to: 1. Describe pathological events associated with the pa�ent’s disease process or condi�on. 2. Create a plan of care and priori�zed nursing interven�ons based on pa�ent care needs. 3. Iden�fy an�cipated diagnos�c and physical assessment findings related to the iden�fied condition or disease process. 1. Log into thePoint and launch the assigned vSim, following all instruc�ons posted on your learning management system (LMS). 2. Review the informa�on contained in the pa�ent informa�on. 3. Review the smart sense links associated with Nursing Care, Diagnos�cs, and Pharmacology found in the suggested reading area. 4. Create the following “concept map”. List the pathophysiology associated with the pa�ent’s disease process or condi�on, the an�cipated physical assessment findings, vital signs, diagnos�cs, specific nursing interven�ons, and other pa�ent informa�on associated with the pa�ent situa�on. 5. U�lize the smart sense links throughout the vSim to complete the worksheet. 6. Submit your concept map for review. CONCEPT MAP/ PLAN OF CARE EST. TIME: 30 MINUTES DESCRIBE DISEASE PROCESS AFFECTING PATIENT (INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS) CONCEPT MAP WORKSHEET DIAGNOSTIC TESTS (REASON FOR TEST AND RESULTS) PATIENT INFORMATION ANTICIPATED PHYSICAL FINDINGS ANTICIPATED NURSING INTERVENTIONS IS AR EST TIME MIN This SBAR ac�vity assists you in building the skill of communica�ng per�nent informa�on when caring for a pa�ent. Appropriate ac�ons you should do to complete this ac�vity include finding appropriate data to provide a thorough SBAR report. Discussion: Severe abdominal pain STUDENT LEARNING OUTCOMES At the end of this ac�vity, student will be able to: 1. Iden�fy per�nent data from the pa�ent informa�on area of the vSim suggested reading sec�on. 2. Communicate per�nent informa�on for a pa�ent using ISBAR. ASSIGNMENT 1. Log into thePoint and launch the assigned vSim, following all instruc�ons posted on your learning management system (LMS). 2. Review the informa�on contained in the pa�ent informa�on area of the suggested reading sec�on. 3. Review the smart sense links found within the Nursing Care, Diagnos�cs and Pharmacology areas of the suggested reading. 4. Navigate and fill out the data in the following document using the pa�ent informa�on provided in the suggested reading area. 5. Submit for review. INTRODUCTION vSim ISBAR ACTIVITY Your name, posi�on (RN), unit you are working on SITUATION Pa�ent’s name, age, specific reason for visit BACKGROUND Pa�ent’s primary diagnosis, date of admission, current orders for pa�ent ASSESSMENT Current per�nent assessment data using head to toe approach, per�nent diagnos�cs, vital signs RECOMMENDATION Any orders or recommenda�ons you may have for this pa�ent STUDENT WORKSHEET PHARM-4-FUN EST. TIME: 30 MIN (PER MEDICATION) This ac�vity provides you with the opportunity to create per�nent pa�ent educa�on on the pharmacological agents associated with the vSim ac�vity. You will u�lize this worksheet for each drug listed under the pharmacology are of the suggested reading sec�on. STUDENT LEARNING OUTCOMES At the end of this ac�vity, student will be able to: Discussion: Severe abdominal pain 1. Explain purpose for taking the iden�fied pharmacological agents. 2. Discuss per�nent pa�ent educa�on related to all the listed pharmacological agent. ASSIGNMENT 1. Log into thePoint and launch the assigned vSim, following all instruc�ons posted on your learning management system (LMS). 2. Review the informa�on contained in the pa�ent informa�on. 3. Review the smart sense links associated with the Pharmacological agents found in the suggested reading area. 4. Use the smart sense link to complete the following “pa�ent educa�on” worksheet for each pharmacological agent listed in the Pharmacology are of the suggested reading sec�on. 5. Submit for review. PATIENT EDUCATION WORKSHEET NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE MEDICATION: CLASSIFICATION: PROTOTYPE: SAFE DOSE OR DOSE RANGE, SAFE ROUTE PURPOSE FOR TAKING THIS MEDICATION PATIENT EDUCATION WHILE TAKING THIS MEDICATION STUDENT LEARNING OUTCOMES ASSIGNMENT This activity creates an opportunity for you to prepare for a virtual clinical experience. This activity provides you with the opportunity to manage patient care, prioritize interventions, and identify aspects of care that could be delegated. At the end of this ac�vity, student will be able to: 1. Describe pathological events associated with the patient’s disease process or condition. 2. Create a plan of care that is prioritized and is based on the patient’s care needs. 3. Identifies path to healing or health and path to death or injury. 4. Describes aspects of care that can be delegated and appropriate personnel to complete delegated tasks. 1. Log into thePoint and launch the assigned vSim, following all instructions posted on your learning management system (LMS). 2. Review the information contained in the patient information. 3. Review the smart sense links associated with the Nursing Care, Diagnostics, and Pharmacology, found in the suggested reading area. 4. Complete all areas of the attached clinical worksheet. Discussion: Severe abdominal pain 5. Submit the completed worksheet. CLINICAL WORKSHEET vSim Worksheets Grading Rubric Criteria 5 Points 4 Points 3 Points 2 Points 1 point Total Points Content Knowledge -Follows all requirements for the assignment. -Conveys well-rounded knowledge of the topic. -Content well organized, logical. -Easy to read and understand throughout all of worksheet. -Follows all requirements for the assignment. -Major points of topic are mostly covered in the required assignment areas. -Content organized, logical flow. -Easy to read and understand through most of worksheet.

What the activity packet asks you to produce

01
The suggested readings completed before the activities.
02
A completed Clinical Worksheet.
03
A completed Plan of Care Concept Map.
04
A Pharm4Fun Worksheet for each medication.
05
A completed ISBAR Worksheet.
06
The pre-simulation quiz, the simulation itself and the remaining steps of the six-step learn flow.
07
Submission for grading as instructed in the syllabus.

Worksheet, concept map, pharmacology, handoff

Read the four chapters as one sequence

Work out how obstruction produces fluid loss, how fluid loss produces shock, and where the acid-base change fits.

Clinical Worksheet — sort the findings by stage

Group the data into the primary process, the fluid deficit, the perfusion consequences, and what is not yet known.

Concept map — draw the arrows

Place the obstruction at the origin and connect each consequence to what produced it.

Predict the acid-base disturbance, conditionally

State the expected disturbance from the vomiting, name the electrolytes lost with it, and say what ischaemia would change.

Pharmacology sheets, one per medication

Complete a sheet for each drug the plan involves, including fluids and any antiemetic or analgesic.

ISBAR — write a recommendation that asks for something

Compress the case into the handoff and close with a specific request and a timeframe.

Where the chain from obstruction to shock is documented

Recommended databases

The four assigned course text chapters
PubMed / NCBI Bookshelf
The simulation platform's own resources

Search sequence

1.
Read the obstruction chapter first, since it is the origin of everything else in this case.
2.
Check what fluid and electrolyte losses obstruction and vomiting produce, and in what direction they move pH.
3.
Look up the stages of hypovolaemic shock so the findings can be ordered by severity rather than listed.
4.
Confirm what changes when obstructed bowel becomes ischaemic, since that reverses the acid-base prediction.

Sources for obstruction, volume loss and electrolyte change

These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.

Nothing here is cleared for citation until you have read it.

01
Small Bowel Obstruction
StatPearls, NCBI Bookshelf, US National Library of Medicine · 2023
Fluid sequestration, vomiting losses, the resulting hypovolaemia and the alkalosis-versus-acidosis distinction that turns on ischaemia. This single source connects three of the four assigned readings and is the backbone of the concept map.
02
Hypovolemia and Hypovolemic Shock
StatPearls, NCBI Bookshelf, US National Library of Medicine · 2023
The stages of volume depletion and the point at which deficit becomes shock. Use it to order the findings — turgor, then dizziness, then absent urine output — rather than listing them.
03
Hypokalemia
StatPearls, NCBI Bookshelf, US National Library of Medicine · 2023
Why potassium is lost alongside chloride and hydrogen in protracted vomiting, and what that does to the patient. It is what makes the acid-base answer specific rather than a label.
04
Evaluation and Management of Mechanical Small Bowel Obstruction in Adults
Agency for Healthcare Research and Quality, NCBI Bookshelf · 2022
The management sequence — resuscitation, decompression, and the findings that indicate surgery rather than observation. This is the source for the ISBAR recommendation being an action rather than a notification.

Before the packet is submitted

Common mistakes

Treating the four assigned readings as four separate topics rather than as stages of one process.
Building a concept map that lists problems without showing what causes what.
Naming an acid-base disturbance without saying what would change it.
Missing that worsening pain in an obstruction raises the possibility of ischaemia, which reverses the expected acid-base picture.
Accepting the patient's own explanation and documenting a gastrointestinal illness rather than a surgical presentation.
Recording the absence of urine output without recognising it as the urgency marker.
Producing one pharmacology sheet when the instruction says one per medication.
Writing an ISBAR recommendation that asks the provider to be aware rather than to act.

Submission checklist

The concept map shows directional relationships, not just a list of problems.
The obstruction appears as the primary process with the other three as consequences.
The expected acid-base disturbance is named, with the condition that would reverse it.
Electrolyte losses accompanying vomiting are identified specifically.
The findings that contradict the flu explanation are named as such.
The absent urine output is treated as an urgency marker rather than a data point.
There is one pharmacology worksheet per medication.
The ISBAR recommendation names a specific action and a timeframe.
All six steps of the learn flow are completed before submission.

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