-Explain to Mr. Burgundy that space in the ED is allocated based off of patient need -Complete initial post-op assessment Tear, Ecchymosis, Contusions, Bruising Nathaniel Gonzalez Type of Line: Peripheral, location ______________ CVL, location _____________ PICC, location _______________ Don Personal Protective Equipment Scenario 1 Regardez le Salaire Mensuel de Ubah Kalimat Efektif Online en temps rel. Scenario 4 Sarah Getts Temperature spiked during the night to 102.4, BP now 146/94 which is slightly elevated, respirations at 30 bpm and slightly labored, heart rate 102 versus 84 from last night shift. 20 ga. Hep-Lock in right forearm, skin warm and dry, generalized weakness with recent weight loss. Scenario 5 Full assessment of patient. Inform his partner that everything is being done to keep him comfortable. Educational Needs Increased acuity Dr. Brown, Educational Needs Increased acuity Scenario 5 Decreased Cardiac/perfusion: False -Reinforce to the patient to not get out of bed Full assessment Fall Risk Increased acuity Scenario 3 -Continue to observe urine for hematuria and document findings Scenario 4 Safety- Administer new pain medz Dr. Altace, Educational Needs Increased acuity Present health assessment including B/P and LOC and dressing. Isolative, appears fearful, crying, and refusing to see her husband. Skin warm and dry, all vital signs in WNL Peripheral Neurovascular Dysfunction False Psychological Needs Normal acuity Rapid Response team arrived including anesthesia. -Ensure there is a full O2 tank on the gurney, place patient on Nasal Cannula Assume that the oxidation state of sulfur is 2-22 and that iron atoms exist in both +2+2+2 and +3+3+3 oxidation states. She has arrived in pre-op and about to have surgery this morning. Scenario 2 Deficient Knowledge True Mr. Richardson is now vomiting and shows no relief 45 minutes after receiving pain medication. The client is onDemerol 25mgSlow Intravenous Push (SIVP) for pain. -Explain that Radium-223 mimics calcium and is absorbed during new bone growth. Health Change Increased acuity 50% intake. Impaired Skin Integrity, False You observe Ms. Getts being assisted by another nurse who is being blatantly rude and disrespectful to her. Full assessment His wife tells the nurse that he seemed very distant and did not want to talk much. Kathy Gestalt, 33yr-old, Dx- second day post-op open right Tibia/Fibula fracture, plaster cast in place on right lower leg. The Swift River is one of the most unique and popular trout fishing destinations in Massachusetts, yet the dynamics of this exceptional fishery have not been well understood. No Known allergies (NKA). Scenario 2 Mr. Greer has returned from the radiology where a CT scan was done after his fall and while no injuries were noted there were some suspicious areas noted making concern that the cancer may have spread to the bone. Disturbed body False Check physician orders Connect telemetry He asks to speak to a clergy member. Vital signs -Temp 98.6, BP 114/62, P 100, RR 20, SaO2 94%. Scenario 1 Pain Level Increased acuity Vital assessment Family arrive one hour after event to his prior room and find Mr. Thomason's room is empty and have no idea of the events that have just occurred. It was diagnosed by a portable X-ray and quickly splinted by the ER staff. Impaired skin integrity: False, Anxiety: True Fall, risk for: True Several hours later, Mr. Duncan is now complaining of nausea. Verify call light/ bed safety precautions The surgeon has suggested Androgen-deprivation therapy (ADT) with surgical castration (orchiectomy). Self-Care Deficit False Failure to Thrive True. Electrolyte Imbalance True Mr. Greer has just returned from surgery. Mrs. Smith shares with you that even though she signed the operative consent she was not sure if this was the right surgical procedure for her. Remind the nursing staff that the patient is NPO. Wash and glove hands Impaired Skin Integrity, Risk for True Skin warm and dry, all vital signs in WNL except 115 pulse, which is normal for him. Strict I&O, regular diet, intake 50%. Notify doctor Scenario 1 Diet as tolerated. -Ensure patient privacy and call for help and assist patient to bed once help arrives Senario 3 Acute Pain True Ineffective self-health mgmt: False, Disturbed body: False Sensorium Normal acuity, Physiological -Obtain chest tube tray and set-up pleurovac She is also to receive radiation, chemotherapy, and hormone therapy post operatively. -Tell the patient to call immediately if the chest pain gets worse or they become short of breath Bladder distention Pelvic pain Low back/flank pain Fear True Increased fall risk. Senario 5 Scenario 4 Senario 3 Notify lead nurse/doctor Perform full assessment and provide anti-nausea medicine. -Notify HCP of neuro findings When a physician makes an incision into a body cavity just superior to the diaphragm and inferior to the neck, what body cavity will be exposed? Scenario 4 is a 57 y/o who has been admitted for a radical prostatectomy. Scenario 2 She receives the pre-op medication. Acquire daily weight and food intake Document results Radial: ____ + Bilateral Other: _____________ RLE: Non-pitting Pitting ___ + Excess Fluid Volume, Risk for False The patient got dizzy when he stood up from the commode. Aggravating Factors: Nausea False Assess food consumption and intake and output Nausea False Scenario 5 0800 1200 The patient states that the symptoms occurred in the middle of the night and woke him from his sleep. In reassessing Ms. Monson, her vital signs are: BP -106/82, Temp-98.2, P-106, RR-18, SaO2-88. Ms. Cumble states that she has not had a BM for three days. Hx of dementia, from nursing home, fall one day ago. Chronic Pain False Scenario 5 Place patient on PCA pump Disoriented, confused = 4 Vital Assessment Scenario 3 -If cardiac is suspected call the provider and the rapid response team. Monitor and evaluate fluid intake Mr. Thomason is anxious and is obviously worsened from the shift before in overall condition. Purposive Communication Module 2, Chapter 1 - Summary Give Me Liberty! Imbalanced Nutrition False 156 terms. Flexes & withdraws = 4 Scenario 5 Scenario 4 Your notice Mr. Thomason is lying supine, appears slightly cyanotic in his lips, is exhibiting more effort to breathe, and is increasingly restless. Evaluate patient understanding He is restless with slight confusion but is easily orientated with attempts from nurse. Scenario 5 -Notify charge nurse of patient's deteriorating condition When the nurse retunes to the room the patient tells the nurse that when he went to the bathroom he became very lightheaded. Temperature is now 102.8. Bleeding False -Assess patient's understanding of the teaching and discuss home support, os de la main et de la ceinture pelvienne, Julie S Snyder, Linda Lilley, Shelly Collins. Obtain urinary screen Administer antipyretic medication When you enter the room, the patient is having chest pain again, and they are pale and diaphoretic. Respiratory Effort: Relaxed, Regular, Non-labored Pursed lip breathing Labored Scenario 3 But that's changing. Scenario 4 You, his prior nurse, notice the family and respond to them. Imbalanced Nutrition True Wash and glove hands Multiple abrasions, bruising Head, chest, and inner thigh. At Risk, Impaired Comfort False Fall, risk for: True The patient describes this pain as a heavy pressure with intermittent stabbing. He was recently diagnosed with stage III prostate cancer. Senario 5 -Start an IV He does not want to return to the nursing home, and does not wish to burden or live with his children. Verbal command = 3 Respiratory Assessment Contact charge nurse. What is the ratio of Fe\mathrm{Fe}Fe (II) atoms to Fe(III) atoms in this compound? Constipation, Risk for True -Ask the patient if it is okay to discuss his care in front of his children. Document results The patient tells the nurse that yesterday he was, "concerned about having an erection, and now they want to cut off my testicels". Respiratory Rhythm: Regular Rhythmic Irregular Periods of Apnea Cheyne-Stokes Robert Sturgess Robert Sturgess 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. Swift River Reflection Questions day 7 Answer each question thoroughly in multiple sentences. Scenario 3 Chronic Pain True All our products can be personalised to the highest standards to carry your message or logo. Too bad the cruise area was a very unatractive part of the River Elbe. Mr. Dominec has a male partner and has been married for the past ten years and share their three children to the marriage. Course Hero is not sponsored or endorsed by any college or university. Mr. Sturgess is uncomfortable with experiencing urinary frequency that keeps him from resting. Esteem Impaired Skin Integrity, Risk for False Fall, Risk for True Administer pain medications Document results and findings Sensorium Increased acuity, Physiological Non-significant past medical history. Scenario 3 Document findings/results, Ann Rails, 38 years old, c/o back pain, non-significant past medical history. Evaluate understanding Deficient knowledge: True Scenario 4 Dr. Starks, Physiological Dr. Rondeau, Educational Needs Increased acuity No known allergies (NKA). ASA is held but morphine 4 mg was given after his GI cocktail. A GI cocktail was administered, and the patient stated that it decreased his pain to a 6/10. Scenario 4 Scenario 5 Odor: __________, No Contact Social Services She is having some difficulty breathing. What order are you providing the information to the receiving nurse? Notify doctor if condition is abnormal Oriented to: Person Place Time Amount: _______ Ineffective Coping False Scenario 5 He is experiencing new onset of shortness of breath and has a nasal cannula with 2L of Oxygen in place. Recent chest X-ray shows diffuse bilateral interstitial infiltrates in all lobes. You determine to apply the restraint now. The provider advises the Nurse to draw a stat CBC, give a liter bolus of NS, and repeat CBC. Acute Pain True Scenario 5 Notify lead nurse/doctor Obtain patient record and follow patient as he is transferred to ICU Imbalanced Nutrition: True Three hours later, Ms. Getts is unsteady when standing by her bedside. He is a local TV news reporter that was filming an event at the county fair when there was an explosion. Chronic Sorrow False Senario 2 Offer masks to visitors -Evaluate patient's understanding of teaching Vital assessment Scenario 1 Wash hands Sa fortune s lve 2 000,00 euros mensuels Educate patient The patient has a Foley catheter in place and is reporting 8/10 incisional pain and he is asking why his throat is sore. Impaired Mobility True -Discuss effectiveness of sitter Provide comfort measures Pain Level Normal acuity -Ask Mr. Burgundy to lower his tone as it can be disturbing to other patients Secondary: Assess vital signs, auscultate heart, lungs, and bowl sounds. Prior to changing shift, you enter the patient's room to complete a full assessment, and Ms. Monson is now crying asking to for someone to take her home! Esteem How does the Med-surg simulator work? Fall, risk for True Document results Scenario 3 Provide comfort and pain measures IV maintenance fluids with D5 1/2 NS with 20 KCL @ 125ml/hr in left forearm. Acute Pain True Ms. Monson has been in restraints for the past two hours with a nursing assistant remaining with her. Tunneled, site _______________ Implanted port, accessed _____________________ Mr. Sturgess is recently dx w/ metastatic cancer of colon and he and his family have chosen only Where is my camera man!! You question her while reviewing her operative consent and determine that everything is correct. Remind physician to wash his hands before examining the patient Scenario 1 -Explain that Docetaxel is a hormone therapy that suppresses the testosterone that your testicles produce producing similar results as surgical intervention. Neptune is an average distance of 4.5109km4.5 \times 10^{9} \mathrm{km}4.5109km from the Sun. Deficient knowledge: False Background Robert Sturgess the client was admitted with Metastatic cancer of Colon, with history of diabetes. His, Joyce Workman Room 303 Joyce Workman Joyce Workman, 42- year old female who presents to the Diabetes Clinic with a new diagnosis of type II diabetes. Neuro WNL alert and cooperative. Remain with patient He has been taking his HIV medication daily. The pain makes him short of breath. -Begin q15 minute neuro checks Risk for Infection True When the nurse enters the room later that day to inform him that the procedure is scheduled for 1430, they see Mr. Gonzalez is sitting in front of a lunch tray. Impaired Gas Exchange False Suprapubic Insertion site: WNL S/S Infection : ____________________ Vital re-assessment Safety- Cardiovascular has pacer with rate of 82bpm on demand. Fall, Risk for True Scenario 2 Validate NPO Status Fall Risk Increased acuity Scenario 4 Therapeutic communication. Notify doctor for Foley catheter He is pale, weak, diaphoretic, and appears anxious. Pain Level Increased acuity Love and Belonging Fall, Risk for False Evaluate understanding Safety Constipation False You take his vital signs which are: Temp 101.3, Pulse 88, Resp 24, B/P 116/84. Hep-Lock in place left AC. Scenario 5 You arrive in room to check on her, after washing hands. The Physician tells you to have everything ready including a 22 French chest tube, and he will be in shortly to position the chest tube. Scenario 3 Document results. Stools are decreasing but patient remains very weak. Respiratory Rate: WNL Tachypnea Bradypnea Apical Pulse Rate: Heart Sounds: Normal S 1 S 2 S 3 Senario 3 Inspect cast site You now arrive in the recovery unit one hour post-surgery and you are told that the surgery went well. Assess vital results Scenario 2 Scenario 3 Notify family as to when they may come and visit. Cardiovascular Assessment Decisional Conflict False Describe the physical changes from aging and the care required. Provide information for MD to call family at home and explain what has just happened Health Change Increased acuity Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. Inform and educate spouse of dietary orders Mr. Mancia is holding Catholic Rosary in hand and is crying as you enter the room. Reasses temp in 1 hour. Demerol 25mg SIVP for pain, patient reports 7/10 on pain scale. Regardez le Salaire Mensuel de Tthuchicago Org en temps rel. -Ensure there is suction in the room, and check Heterotrophs include (1) autotrophs, saprophytes, and herbivores (2) omnivores, carnivores, and autotrophs (3) saprophytes, herbivores, and carnivores (4) herbivores, autotrophs, and omnivores. Remind staff that Universal Precautions are practiced at this hospital for all patients regardless of known infectious diseases. The bed arrives tomorrow. The patient was placed on 2 L O2 NC, EKG monitoring to include a 12 lead, Pulse Oximeter. Full assessment Health Change Increased acuity Check input/output for possible dehydration Upon entering room, you find Mr. Sturgess is quiet, appears tense and rigid but states, "I am feeling fine." He has not had his BP medication today. Full assessment LOC Normal acuity Skin: Warm/dry Clammy/diaphoretic Skin Turgor: Brisk Tenting 2Provide comfort in pre-surgical room Mr. Dominec. Fall Risk Increased acuity Begin post op education for day one Filmotka filmu Najvyia ponuka (2013). Assist patient out of bed Nausea: False Knowledge Deficit True Wash and glove hands ADA diet, intake 25%. DSD (dry sterile dressing), forehead laceration clean and dry intact. Dysfunctional Gastrointestinal Motility False Full assessment -Explain to patient why his throat may be sore Deficient Fluid Volume False Sensorium Normal acuity, Physiological Acute Confusion True Her husband and two grown children are also with her as she is prepared with gown and head cap awaiting transport to the operating room. Administer antipyretic medication Assess Evaluate medication effectiveness Fall, Risk for True View Swift River Reflection Questions (1).docx from NRSG 4412 at South College. Ambulates with minimal assistance. Scenario 5 No response = 1, Range of Motion: Full, Limited Diet as tolerated. The nurse observes an elderly lady who is crying and has not been taken care of yet. The 'Strandperle' (lit. The patient has been scheduled for an EGD today and has an order for Omeprazole (Prilosec) and Carafate (sucralfate). Scenario 2 Dr. Sangerstien, Viola Cumble, 92yr-old, second day post-op hip repair, Allergic to Penicillin. Senario 5 He warns the patient that if he does not comply with the treatment and preventive measures, he will need other treatments that may include. If patient statement differs from the surgical consent she has signed, notify surgeon immediately Provide verbal report to team members who respond to rapid response Elevate Extremity Nausea False Failure to Thrive: True. Scenario 2 She has received a dose of Hydrocodone for PRN pain 20 minutes ago. Comfort/Pain Assessment Allow for non-compliance of request DSD (dry sterile dressing), forehead laceration clean and dry intact. -Ensure IV is patent, Lithia Monson It is now third day post-op, the order is for Ms. Cumble to stand by bedside on both legs for 5 minutes, three times a day. palliative care. Paul Greer Assess for bowel sounds Perform pain reassessment Impaired Urinary Elimination True It is now two weeks later; Mrs. Smith has returned. -Reassess patients' vital signs, and place on q5 minutes continuous monitoring Blood, Glucose 185, 4 units of insulin sliding scale for coverage. Scenario 4 The heartburn has become worse since he started treatment for his URI. Recently he manifested an unusual black lesion on his thigh and developed an opportunistic fungal mouth infection which was treated successfully. Demerol 25mg SIVP for pain, patient reports 7/10 on pain scale. Pain Scale: 0 to 10: _______________ Combien gagne t il d argent ? Offer bedpan Flexes abnormally = 3 His coughing, to clear his airway, appears ineffective. Renal diet. Safety Explain reason for assessment and procedure The cancer was more advanced than they previously had thought so inguinal lymph nodes were removed. -Discuss with sitter that patient needs continual observation Cross), Chemistry: The Central Science (Theodore E. Brown; H. Eugene H LeMay; Bruce E. Bursten; Catherine Murphy; Patrick Woodward), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Educational Research: Competencies for Analysis and Applications (Gay L. R.; Mills Geoffrey E.; Airasian Peter W.), Campbell Biology (Jane B. Reece; Lisa A. Urry; Michael L. Cain; Steven A. Wasserman; Peter V. Minorsky), Principles of Environmental Science (William P. 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Place pt on PCA pump Notify charge nurse that discharge will probably not occur today. -Reassess patient's physical status prior to leaving him in the hallway -Advise sitter to notify nurse when leaving the room Imbalanced Nutrition True The patient asks the nurse to explain about these medications and why they are in such a hurry. Place call light and check bed for safety Deficient Diversional Activity False Physiological- Notify housekeeping. Odor: __________, *Types: Abrasion, Burn, Laceration, Puncture, Surgical, Pressure Ulcer, Vascular Ulcer, Maceration, Excoriation, Skin In the interim, start an IV and start infusing Ringers Lactate. Obtain Clinical Hours 24/7/365 In-Class and Lab Learning Resource Improve Clinical Practice Scenario 5 Administer protocol antidiarrheal medication The patient will be discharged today, and he will be ordering new prescriptions. Head/Face: Symmetric Asymmetric Drooping 20ga. -Discuss with family sitter if there are any other family members who can help with monitoring Lithia Palliative care. Yes Productive Non-productive Describe Sputum: _______________________
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