Administer antipyretic medication He warns the patient that if he does not comply with the treatment and preventive measures, he will need other treatments that may include. Explain to physician what interventions you have recently initiated Obtain recent chest X-ray reports and recent ABG's for physician to review Mr. Dominec has a male partner and has been married for the past ten years and share their three children to the marriage. Scenario 4 Breath Sounds: Clear bilaterally. Scenario 4 Sit at an eye level. Decreased cardio tissue perfusion: False Scenario 4 Skin warm and dry, all vital signs in WNL except 115 pulse, which is normal for him. Document results Document results Scenario 4 Recent chest X-ray shows diffuse bilateral interstitial infiltrates in all lobes. Mr. Gonzalez has returned from his EGD and is still sleeping from the sedation. Use therapeutic communication/Active Listening -Tell the wife that you will speak to the husband, and this is apprehension is expected with this surgery/diagnosis. Offer nutrition/toilet Sleep Deprivation False Crutches at bedside adjusted for height. Regular diet. Educate patient Mr. Dominec is waiting for his partner to arrive to take him home and you notice he has a dry unproductive cough and trouble splinting with a pillow at his operative site. She is also investigating bone marrow transplantation. You enter his room and recognize that Mr. Thomason appears to be talking to himself and appears confused. Establish second IV except 115 pulse, which is normal for him. Scenario 5 Knowledge Deficit True Scenario 3 Scenario 2 Administer antipyretic medication Scenario 1 Notify doctor of change in condition in particular: unproductive cough and low-grade fever. 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. Scenario 3 Deficient Knowledge True Read PT report Neuro- confusion to time and place, but oriented to self, speech clear, poor historian, did not recognize son today which is new for her; Neuro assessment and vital signs q1 hr. The surgeon has suggested Androgen-deprivation therapy (ADT) with surgical castration (orchiectomy). Mr. Mancia is holding Catholic Rosary in hand and is crying as you enter the room. Respiratory Effort: Relaxed, Regular, Non-labored Pursed lip breathing Labored Non-significant past medical Hx. -Tell the patient to call immediately if the chest pain gets worse or they become short of breath c/o headache- medicated with Lortab 5mg PO at 0900, takes Lomotil 10ml PRN q 4 hours last dose at 0834. Renal diet. -Reapply the NC that he was admitted with at 2L You arrive in room to find Ms. Monson talking to herself. Ineffective breathing pattern False Sitting, BP 109/60, P 114, Standing the patient becomes very lightheaded and the nurse has them lay back down. Blood, Glucose 185, 4 units of insulin sliding scale for coverage. Scenario 2 -Remove the dinner tray and make sure the diet is soft food. Patients vital signs are BP: 100/58, P: 106, R: 28, PaO2: 92%, T: 97.1 F, 36.2 C. He is aware that he may not have an erection and may need depends for bladder incontinence. Health Change Increased acuity -Explain procedure to the patient Pulses: Strength & Symmetry Edema: Lithia Monson, 93 years old, c/o head injury, r/o subdural hematoma. Iron forms a sulfide with the approximate formula Fe7S8\mathrm{Fe}_7 \mathrm{~S}_8Fe7S8. Scenario 2 You enter patient's room. -Explain to the patient that because of his weakness and unknown cardiac status as well as the IV, he is a fall risk and should not get out of bed without assistance. Fear True Impaired mobility: False Scenario 4 Radial: ____ + Bilateral Other: _____________ RLE: Non-pitting Pitting ___ + No response = 1, Muscle Strength: WNL, Flaccid, Contracted -Assess patients' pain and rule out cardiac pain. Senario 3 Procedure is canceled for the day and rescheduled later allowing for new consent. After leaving the room the provider tells the nurse that he hopes that he scared him into compliance with the treatment options. Don Personal Protective Equipment Scenario 5 All opinions are mine alone. Stay with patient for surgeon's arrival to explain intended surgical procedure Fear: True Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. Dr. Donofrio, Chronic Pain, Risk for constipation, impaired nutrition, anxiety, fear, grieving, hopelessness, powerlessness, Daily Flowsheet & Physical Assessment, Vital Signs Intake & Output Day 2 admission, Thomas Richardson is complaining of severe pain and is now begging you for some relief; states pain scale 10/10. Pain re-assessment Scenario 2 Mrs. Stukes is feeling nauseated. Deficient knowledge: True Safety- Decreased Cardio Tissue Perfusion False Impaired Gas Exchange True The oncologist is recommending Docetaxel as opposed to an orchiectomy. Visual assess Safety Increased acuity, Physiological Educate patient regarding condition You enter room one hour after the physician has left the patient. The surgeon believes that the surgery was successful but recommends the patient have chemotherapy and radiation postoperatively. Abdomen: Flat Rounded Scaphoid Distended Palpation: Soft Taut Rigid Mrs. Stukes is a failed laparoscopic cholecystectomy that resulted in a bowel resection with a temporary ileostomy in place. List the nursing care order. Widespread Color Change: N/A pallor cyanosis jaundice erythema Scenario 4 Remain with patient Decreased Cardiac/perfusion False 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. Inspect cast site Educational Needs Increased acuity Peripheral Neurovascular Dysfunction True. ExplanationAnxiety/ fear True Cardiovascular Assessment Emergency intubation and assisted breathing is provided for Mr. Thomason GI WNL. Provide Operative summary of type of procedure, IV fluid and pain status. Notify doctor Impaired Mobility, Risk for True Scenario 1 Extends abnormally = 2 Scenario 4 Call rapid response Dr. Jones. Scenario 3 The client is onDemerol 25mgSlow Intravenous Push (SIVP) for pain. Bleeding, Risk for False Non-significant past medical history. Impaired Home Maintenance management r/t client or family False Notify doctor if condition is abnormal Scenario 2 Skin integrity at risk True Dyspnea at rest Dyspnea with minimal activity Use of accessory muscles Pulse Ox: ___________ % on ____________FiO2; Room Air; Delivery Device Disturbed Sensory Perception True Scenario 2 Tibial: _____ + Bilateral Other: ______________ Generalized: Pedal: ______ + Bilateral Other: ____________ Sacrum: Non-pitting Pitting ___ +. Impaired Gas Exchange False Scenario 3 Document and provide copy for Mr. Dominec to share with his follow up appointment tomorrow. PT to educate patient His original lymph node biopsy was negative. Hx of dementia, from nursing home, fall one day ago. Upon entering room, you find Mr. Sturgess is quiet, appears tense and rigid but states, "I am feeling fine." LLE: Non-pitting Pitting ___+ Pregnancy and labor and delivery are not typically associated with the concept of cellular regulation, Patient: Donald Lyles,52-year old male, was admitted yesterday evening for stabilization of his uncontrolled type II diabetes. Take vital signs before leaving the hospital again. -Inform Mr. Burgundy that he cannot report from the ED, as patient privacy is strictly protected by HIPPA Acute Pain True Demerol 25mg SIVP for pain, patient reports 7/10 on pain scale. Impaired Mobility True Allow husband to come into recovery for a quick one-minute visit. Fall, Risk for True He requests no visitors at this time, but later asks for his family to be called to discuss a plan of care. -Assess patient's ABC (airway, breathing, circulation) LOC Normal acuity -Verify that discharge orders have been written, provide discharge instructions, and in inform provider about the chest pain. Acute Confusion False Senario 2 Dr. Altace, Educational Needs Increased acuity Scenario 3 Vital assessment -Reassess patient's physical status prior to leaving him in the hallway Impaired comfort: True Senario 5 Arthur Thomason Mr. Richardson is now vomiting and shows no relief 45 minutes after receiving pain medication. Pain Level Increased acuity Notify doctor for Foley catheter -Place patient on 100% O2 Skin warm dry, bruises on forehead with small laceration. Temp 98, BP 114/67, P 115, RR 20, SaO2 98%. 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. Sa fortune s lve 2 216,00 euros mensuels Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. Safety Increased acuity, Physiological Purposive Communication Module 2, Chapter 1 - Summary Give Me Liberty! Notify lead nurse/doctor Document results. Bowel sounds: Active, Hyperactive, Hypoactive, Absent (listen for full 5 minutes) You are about to call the Surgical ICU and give report. Scenario 3 Grieving False Spanish interpreter available at extension 61178. Psychological Needs Normal acuity Cardiovascular has pacer with rate of 82bpm on demand. In the interim, start an IV and start infusing Ringers Lactate. Biopsies were sent to determine the treatment. Urinary Catheter: N/A Indwelling Short-term Indwelling Long-term Date of Insertion:________ Size: _____F Mr. Greer is on the floor still but is awake and oriented and is complaining of back pain below his right scapula. Deficient knowledge: False Mr. Thomason is anxious and is obviously worsened from the shift before in overall condition. Contact Social Services Non-significant past medical Hx. Self-Care Deficit False Scenario 2: 1Educate about recovery from appendectomy and care to wound. Senario 1 Neuro- confusion to time and place, but oriented to self, speech clear, poor historian, did not recognize son today which is new for her; Neuro assessment and vital signs q1 hr. Scenario 3 Assess for fall risk Scenario 2 Safety- No known allergies (NKA). Deficient Knowledge False Scenario 5 Tubes: None Salem Sump Nasoduodenal PEG J-Tube pH: ______ -Obtain chest tube tray and set-up pleurovac He has a history of well controlled GERD with over-the-counter Tagamet (Cimetidine), and Tums. Fear/Anxiety True. Flexes & withdraws = 4 You are told that he has intermittent chest pain with substernal burning that radiates to his mid-back. Abnormal left leg weakness, gait unsteady, 5/10 on numeric pain scale. Sensorium Increased acuity, Physiological No Known allergies (NKA). Chronic Sorrow False Contact Social Services Vital Signs: B: 160/92, P: 96, R: 22, SpO2: 98, T: 98.9F, 37.1C. Full head to toe neuro assessment. The lesion was identified as Kaposi's Sarcoma. Her chart reports she was extubated upon arrival to the recovery area, received three units (3000 mL) of fluid, receiving O2 @ 4L via nasal cannula, has Foley Catheter in place draining QS clear yellow urine, responds to verbal stimulation, chest dressing in place remains dry and intact, and has just received a small dose of IV morphine for pain. -Provide the patient with the time when HCP will come discuss options with him The bed arrives tomorrow. Scenario 3 Notify lead nurse/doctor Blood Pressure, 7a-7p Total: 7p-7a Total: Generalized weakness, blood tinged urine and severe pain upon urination, GI- n/v. Acquire daily weight and food intake Last Bowel Movement: Date: _____________________ Constipation Diarrhea/Loose Other: Report this activity immediately to the hospital privacy officer Evaluate/Modify Mobility Plan, Carlos Mancia, 48yr-old, Spanish speaking migrant worker with no known past medical Hx. Scenario 5 Offer assistance in providing more information about treatment options for newly diagnosed AIDS patients. -Reassess patient You also notice the patient is more difficult to orient. RLE: ______________ LLE: ______________, Casts/Splits: ____________________________, Motor response Verbal command = 6 He also states he is feeling weak. Sensorium Increased acuit, Physiological His CP is 7/10 and his BP is 165/96, P 92, R 18, SaO2 98 on 2L NC. Senario 3 Senario 3 Due to this, the provider would like him to stay in the hospital for observation. Dr. Altace, Physiological- Reassure patient and help explain any new orders from physician to patient -Reinforce to the patient to not get out of bed Obtain vital signs machine Infection, Risk for True Swift River Clinical Practice Chamberlain University Expert James Moore Category: Nursing Description Full Document Jose Martinez Room 301 Jose Martinez, Jose Martinez, 43- year old male experiencing chest pain while watching a state rival football game earlier in the evening. Full assessment Pain Level Increased acuity IV fluids of D5 1/2 NS are infusing at 100 mL/hour to his right forearm. Gastrointestinal Assessment Urine Color: Clarity: Odor: No Known allergies (NKA). : an American History (Eric Foner), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. The oncologist is insistent that the treatment begin immediately. Seek clarification Scenario 1 Combien gagne t il d argent ? Document Procedure Educate patient -Ensure bed is in lowest position, and rails are in place jessdevan. Employ therapeutic communication: present reality Genitalia: WNL (skin intact, no lesions) Abnormalities Describe: __________________________ Safety Kathy Gestalt, 33yr-old, Dx- second day post-op open right Tibia/Fibula fracture, plaster cast in place on right lower leg. IV Assessment/ N/A Scenario 2 Educate patient regarding patient care Verify call light/bed safety precautions Apical Pulse Rate: Heart Sounds: Normal S 1 S 2 S 3 Scenario 5 #1: _________, No He does not want to return to the nursing home, and does not wish to burden or live with his children. Remind staff that Universal Precautions are practiced at this hospital for all patients regardless of known infectious diseases. Vital Assessment Outline an experimental approach to demonstrate the average RNA chain growth rate during transcription of a cloned gene in vitro. Safety Increased acuity, Physiological -Remove the lunch tray and ensure pre-operative consent has been signed. 00 Comments Please sign inor registerto post comments. Notify family as to when they may come and visit. Determine from medical record if partner is aware of his recent AIDS diagnosis. Senario 1 Scenario 1 Acute Pain: True Temperature is now 102.8. Physical Mobility, Impaired True Scenario 5 Toggle navigation Swift River. Senario 1 Urostomy: N/A Urostomy/Ileal conduit swift river assignment: day swift river assignments dosage minimum score 90 med minimum score 80 minimum score 90 robert sturgess linda yu linda pittmon carlos Skip to document Ask an Expert Sign inRegister Sign inRegister Home Ask an ExpertNew My Library Discovery Institutions Keiser University Silver Creek High School (Colorado) The pathology report shows no cancerous lesions. Scenario 1 NG tube to low suction possibly D/C'd today after Dr. Levine rounds. Opening Title Production company Cast and crew Genre J A N U A R Y 2: The Killing of John Lennon: IFC First Take: Andrew Piddington (director/screenplay); Jonas Ball, Krisha Fairchild, Gunter Stern, Gail Kay Bell, Mie Omori, Robert C. Kirk: Crime, Drama: 4: One Missed Call: Warner Bros. Pictures / Alcon Entertainment / Kadokawa Pictures: Eric Valette (director); Andrew Klavan (screenplay . He is emotionally distraught, and is insisting that he be allowed to report what is going on from the ED. Acute pain: False Psychological Needs Increased acuity You observe Ms. Getts being assisted by another nurse who is being blatantly rude and disrespectful to her. Notify doctor and charge nurse Notify lead nurse/doctor Sexuality: True. Scenario 3 Discuss follow up with his doctor. Senario 4 Imbalanced Fluid Volume, Risk for True Vital assessment Demerol 25mg SIVP for pain, patient reports 7/10 on pain scale. Full assessment She has received a dose of Hydrocodone for PRN pain 20 minutes ago. 97.4, Resp 16 and Pulse Ox 94%. Vital signs are: B/P 112/78, temp. Now, third day post-op, Mrs. Stukes appears sad and depressed upon entering the room. Skin warm and dry, may sit up on edge of bed today. -When the HCP arrives, stay in the room to determine whether you can continue care with the patient -Transport Mr. Burgundy to his room -Discuss with sitter that patient needs continual observation Encourage Mr. Dominec to discuss with his partner his best treatment options. His overall health is good, and he has known he has been HIV positive for the past five years. Robert Sturgess Robert Sturgess 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. Robert Sturgess 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. He does not have an IV nor is he on oxygen. Date of insertion: _________________________ Date of dressing: _________________________________ -Tell the patient that they are being admitted to r/o any cardiac issues Use therapeutic communication/Active Listening Three hours later, Ms. Getts is unsteady when standing by her bedside. Noncompliance True. He told the nurse that he has had some changes in his bowel habits and his stools have been very dark. Escort patient Love and belonging- Discharge instructions Neuro WNL alert and cooperative. Retrieve cast removal tool Yes -Document and contact nursing supervisor/Charge nurse Chronic Pain False Bleeding, Risk for: True Impaired Skin Integrity, Risk for False Diet as tolerated. Her husband and children remain with her in the surgical holding area awaiting transport to the OR. Escort patient to vehicle Yes Educate patient When the nurse retunes to the room the patient tells the nurse that when he went to the bathroom he became very lightheaded. Health Change Increased acuity Begin post op education for day one Scenario 2 Provide emotional support. Chronic pain: True When you enter the room, the patient is having chest pain again, and they are pale and diaphoretic. Pupils: PERRLA Size: R: mm L: _mm Unequal Sluggish Non-reactive Blood Glucose 185, 4 units of insulin sliding scale for coverage. Activity as tolerated with assistance. Health Change Increased acuity Obtain patient record and follow patient as he is transferred to ICU Sensorium Normal acuity, Physiological Nausea: False Mrs. Smith's surgery has now ended. Fall, risk for: False Perform circulatory evaluation Capillary Refill: _________ seconds Perform pain reassessment The patient got dizzy when he stood up from the commode. Psychological Needs Normal acuity Document results -Assess if the contents of lunch tray are intact. Vital signs -Temp 98.4, BP 116/76, P 96, RR 20, SaO2 99%. Vital signs -Temp 98.4,BP 178/105, P 112, RR 28, SaO2 94%; Neuro- WNL's. Provide a few chairs if possible for her family to also be comfortable Vital signs -Temp 97.2, BP 96/74, P 82, RR 20, SaO2 97%. Swallowing: Intact Dysphagia Aspiration Precautions 0800 1200 Pain, Acute True Continent: Yes No Occasional Incontinence Frequent Incontinence Brief Scenario 2 Scenario 1 Administer antiemetic medication -Ensure there is suction in the room, and check Neuro WNL alert and cooperative. Scenario 5 When completing the shift change neuro check, you notice the patient's left pupil is sluggish. -Reassure patient that he will be moved to a private room as soon as possible Call Rapid Response protocol initiated He insists that he is not hungry and refuses assistance with his meal. Ms. Rails states that she has not had a bowel movement (BM) in the past two days. Re-assess patient Wash and glove hands Bleeding Risk for: False Health Change Increased acuity RUE: ______________ LUE: ______________ Sleep Deprivation False. Two hours later, Mr. Duncan is asked how frequent his stools have been today. Two housekeepers, who were refusing to clean the room, are in the break room. Why is cysteine such an important amino acid for defining the tertiary structure of some proteins? Pain = 2 Paul Greer Document and prepare to transfer to Surgical ICU Assist physician in physical exam of patient Do not probe further When the HCP realizes who he is, he tells the nurse to move the patient in the treatment room down the hall and put Mr. Burgundy in there. Scenario 5 Scenario 1 Administer PRN constipation medications Senario 5 August 13, 2020 // by Angela McGowan. Your responsibilities are: Scenario 1 Scenario 2 Assess food consumption and intake and output Listen to patient concerns Love and Belonging Observe closely first hour He is complaining of pain in his left arm, and pain in his left chest when he tries to take a deep breath. -Ensure IV is patent, Lithia Monson Wash and glove hands : beach pearl), in walking distance of the velgnne ferry stop, is considered the mother of all urban beach clubs. Students will assign correct nursing diagnosis for patients in a medical surgical virtual clinical environment. Safety- -Notify HCP of neuro findings Evaluate understanding river part Answers to the questions; Fillable SOC 1 DLA 1; Fillable SOC 1 DLA 2 - Notes on Environmental effects through sociology . Fall, risk for: True John Duncan Mr. Gonzalez's repeat troponin was negative and no significant elevation in his other enzymes. I need to be reporting!" The nurse performs tilt test, Patient vital signs lying flat, BP 118/62, P 92, R 20, T 98.5, SpO2 97. Fall, Risk for True Scenario 4 Explain to Mr. Dominec your concern for this opportunistic infection and usual treatment. Use therapeutic communication/Active Listening Document results. 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. Tear, Ecchymosis, Contusions, Bruising Fall, Risk for True Nutrition True Our Swift River Simulations are designed to help students and practicing nurses master their skills of Prioritization, Delegation, and Sequential thinkingwithout the requirement of being onsiteor even having to download software. Pain Scale: 0 to 10: _______________ How was this No known allergies (NKA). Full assessment Validate NPO Status A GI cocktail was administered, and the patient stated that it decreased his pain to a 6/10. Acute Pain False Report and document results The nurse was told by the gastroenterology nurse that they really struggled before they called anesthesia and they may have caused an esophageal abrasion. Disturbed body False Impaired comfort: True Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. Evaluate understanding. Scenario 4 Scenario 2 -Offer nutrition and/ or toileting Document results Provide emesis basin/cloth Notify doctor The nurse observes an elderly lady who is crying and has not been taken care of yet. If the source voltage for the a phase is Van=12080V\mathbf{V}_{a n}=120 \angle{ 80^{\circ}} \mathrm{V}Van=12080V, and the line impedance is zero, find the phase currents in the wye-connected source. Safety Vital assessment 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. Imbalanced Nutrition True She has been admitted to the floor with complaints of numbness in her right foot and ankle. His left humerus is fractured and splinted. Social worker with patient this morning. Encourage fluids/fiber/ambulation Scenario 4 The patient was placed on 2 L O2 NC, EKG monitoring to include a 12 lead, Pulse Oximeter. Today's weight 226. Assess pain Ms. Rails shares with you her fear of being discharged home to an abusive husband. -Notify HCP of fall, complete incident report Cryotherapy, which uses an endoscope to apply a cold liquid or gas to abnormal cells in the esophagus.
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