Don Personal Protective Equipment Nathaniel Gonzalez Wash and glove hands Radiofrequency ablation may be recommended after endoscopic resection. A GI cocktail was administered, and the patient stated that it decreased his pain to a 6/10. When the nurse retunes to the room the patient tells the nurse that when he went to the bathroom he became very lightheaded. Course Hero is not sponsored or endorsed by any college or university. 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. Mrs. Pittmon states she has had numbness for years but "now I can't . Therapeutic communication He states, "This is not serious." Apical Pulse Rate: Heart Sounds: Normal S 1 S 2 S 3 Sa fortune s lve 2 000,00 euros mensuels -Explain to Mr. Burgundy that space in the ED is allocated based off of patient need Two hours later, Mr. Duncan is asked how frequent his stools have been today. -Complete head-to-toe assessment while patient is on the floor. Ms. Rails states that she has not had a bowel movement (BM) in the past two days. His partner is at the bedside asking, "how much longer will he have to wait until taken to surgery?" Isolative, appears fearful, crying, and refusing to see her husband. -Explain to patient why his throat may be sore Recently he manifested an unusual black lesion on his thigh and developed an opportunistic fungal mouth infection which was treated successfully. What order are you providing the information to the receiving nurse? After washing and gloving hands, you then identify yourself and the patient, Ann Rails. Senario 2 RUE: ______________ LUE: ______________ Fall, Risk for True DSD (dry sterile dressing), forehead laceration clean and dry intact. He has a 20-year one pack history of smoking. Perform pain re-assessment It is determined that Mr. Sturgess could achieve better pain control with a PCA pump. Impaired Mobility False Scenario 5 Reassure patient and help explain any new orders from physician to patient Pulse -Assess for fall risk Leave to break room and not continue in conversation. The patient is awake alert and oriented. Her pitcher has already been filled three times this shift. Assess for bowel sounds Deficient knowledge: True Listen to patient concerns Non-significant past medical history. Patients within the Swift River Online Simulators Med Surg - Patients SROL Med Surg Female and Male Patients Female Male Ann Rails Carlos Mancia Estelle Hatcher John Duncan Kathy Gestalt Robert Sturgess Lithia Monson Tom Richardson Marcella Como Ramona Stukes Sarah Getts Viola Cumble Dosage Calc - Patients SROL Dosage Calc Female and Male Patients Scenario 5 Deficient knowledge: True He has been taking his HIV medication daily. 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. Acute Pain True Lithia Monson, 93 years old, c/o head injury, r/o subdural hematoma. You return to the break room on your floor. Scenario 2 Temperature is now 102.8. Assess pain Sitting, BP 109/60, P 114, Standing the patient becomes very lightheaded and the nurse has them lay back down. Scenario 1 Discharge instructions Fear True 20ga. ADA diet, intake 25%. Acute pain: True Scenario 2 Scenario 5 -Assess patient's ABC (airway, breathing, circulation) BP 154/89, P 94 F, R 22, T 98.3F, SaO2 95% on room air. Vital assessment Constipation, risk for: True 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. 1. The nurse was told by the gastroenterology nurse that they really struggled before they called anesthesia and they may have caused an esophageal abrasion. Apical/Radial Pulse Deficit: No Yes Murmur Valve Click Wash and glove hands Document pt's statements. Senario 1 Scenario 2 Sa fortune s lve 1 900,00 euros mensuels Perform pain reassessment LOC Normal acuity Impaired Mobility, Risk for True Scenario 3 Upon entering the room, you find Ms. Rails sleeping. Obtain translator Noncompliance False Her husband who is present states, "I thought it was just a lumpectomy she was having this morning." Scenario 2 It was diagnosed by a portable X-ray and quickly splinted by the ER staff. 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. Nausea/Vomiting: Yes No Scenario 2 Waist belt restraint PRN; family sitter at bedside, assist with bath. Senario 1 He also has metal fragments on his left side on his leg arm and torso. -Assess patients' pain and rule out cardiac pain. He is questioning the nurse as to why he has been admitted for heartburn. Request time she can arrive and staff to help with transfer -Ensure there is suction in the room, and check Scenario 5 Yes -Perform admission assessment Fatigue True Students also viewed Culture Concept notebook Development concept notebook Elimination concept notebook Gas Exchange concept notebook Chronic Confusion False No known allergies (NKA). Scenario 4 Scenario 4 Document results. Constipation False Radial: ____ + Bilateral Other: _____________ RLE: Non-pitting Pitting ___ + Skin warm and dry, all vital signs in WNL except 115 pulse, which is normal for him. Assess vital results Dr. Donofrio, Chronic Pain, Risk for constipation, impaired nutrition, anxiety, fear, grieving, hopelessness, powerlessness, Daily Flowsheet & Physical Assessment, Vital Signs Intake & Output Urostomy: N/A Urostomy/Ileal conduit Ms. Gestalt capillary refilling is now 6 secs below cast site, extremity is swollen and cold to the touch. Abdomen: Flat Rounded Scaphoid Distended Palpation: Soft Taut Rigid 0800 1200 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. Ms. Getts is being transferred as an emergency to Critical Care. Dx- urinary stones with 3 episodes/5yrs. Document results Do not disturb Vital signs -Temp 97.2, BP 96/74, P 82, RR 20, SaO2 97%. -Instruct Mr. Burgundy and his cameraman to stop immediately Senario 5 -Ask the patient if it is okay to discuss his care in front of his children. Use therapeutic communication/active listening You notify the charge nurse that you have never taken part in inserting a chest tube. The oncologist is insistent that the treatment begin immediately. Next time we'll spend our 60 on some food and nice beers. Cough: Notify doctor Aggravating Factors: Wash and glove hands Compromised Family Coping False -If cardiac is suspected call the provider and the rapid response team. Scenario 3 -Recheck Tilts after the NS bolus is complete.T Vital signs -Temp 98.6, BP 114/62, P 100, RR 20, SaO2 94%. Blood Pressure, 7a-7p Total: 7p-7a Total: Vital signs taken by automatic B/P Cuff q 15 minutes Robert Sturgess Scenario 1 Mr. Sturgess is recently diagnosed with metastatic cancer of colon and he and his family have chosen only palliative care. He is currently febrile with temperature 100.8, HR 99, BP 135/96, RR 20, PaO2 96%, nauseated with no vomiting, rebound tenderness in right lower quadrant, has elevated WBC's and surgeon feels this will be uneventful even though he has just been diagnosed with AIDS this past week. Skin Integrity: Intact No, describe below, Location Type Size Wound bed Drainage Educational Needs Increased acuity Ronald Burgundy 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. A new graduate nurse receives a call from the hospital telling them to report to the ER immediately for a disaster. Neuro WNL, alert, and cooperative but worried about scarring and is reluctance regarding walking on leg. Ms. Cumble states that she has not had a BM for three days. His partner is not with him at this time but will arrive soon to facilitate his discharge home. Remain with patient and reassure PT to educate patient Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. Grieving False No Known allergies (NKA). -Ask Mr. Burgundy to lower his tone as it can be disturbing to other patients Assist patient out of bed Wash and glove hands Electrolyte Imbalance False Bleeding, Risk for: True Three hours later, Ms. Getts is unsteady when standing by her bedside. Obtain translatorT Scenario 3 You determine to apply the restraint now. Scenario 2 List the nursing care order. Urination: WNL Burning Frequency Urgency Demerol 25mg SIVP for pain, patient reports 7/10 on pain scale. Scenario 4 Scenario 3 Evaluate learning Replace oxygen nasal cannula that had become disconnected Acute Pain False Educate patient regarding patient care Bleeding, Risk for False The surgeon believes that the surgery was successful but recommends the patient have chemotherapy and radiation postoperatively. nursing care plan for Linda Pittmon, a 74 -year old female patient who is a noncompliant diabetic, and frequently stays at the local homeless shelter. Scenario 4 Fatigue True Lithia Monson Determine from medical record if partner is aware of his recent AIDS diagnosis. Check input/output for possible dehydration Type of Line: Peripheral, location ______________ CVL, location _____________ PICC, location _______________ He is emotionally distraught, and is insisting that he be allowed to report what is going on from the ED. Amount:________ Cryotherapy, which uses an endoscope to apply a cold liquid or gas to abnormal cells in the esophagus. Mr. Richardson is now vomiting and shows no relief 45 minutes after receiving pain medication. Report this activity immediately to the hospital privacy officer Begin post op education for day one Bleeding, Risk for False He requests no visitors at this time, but later asks for his family to be called to discuss a plan of care. Physiological- Ineffective Self-Health Management True He is a local TV news reporter that was filming an event at the county fair when there was an explosion. Kathy Gestalt RLE: ______________ LLE: _____________ Read PT report The provider advises the Nurse to draw a stat CBC, give a liter bolus of NS, and repeat CBC. Re-assess patient Scenario 4 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". Ineffective airway clearance True is a 57 y/o who has been admitted for a radical prostatectomy. They would also like to start Radium-223. Vital assessment Linen Change Disoriented, confused = 4 Check monitor Senario 2 Dr. Levine, Marcella Como, 38 yr-old, Sexual Trauma Victim (Rape), unknown assailant. The client is onDemerol 25mgSlow Intravenous Push (SIVP) for pain. Sarah Getts Scenario 5 Wound clean dry and intact. He also complains that his throat is still very sore. Dr. Starks, Physiological Ineffective Coping False He is married, and his wife is requesting to stay at his side. Scenario 4 Oral Mucosa: Tongue: Teeth: Raspberry and Cream Cheese Stuffed Blueberry French Toast with Ozery. Combien gagne t il d argent ? Safety Scenario 4 Localizes pain = 5 Scenario 2 Impaired Mobility True The nest morning the gastroenterologist informs Mr. Gonzalez that his EGD confirmed a diagnosis of Barrett's esophagus with Dysplasia. Scenario 2 Mrs. Stukes is feeling nauseated. Senario 2 Notify doctor and charge nurse No Known allergies (NKA). -Explain to the patient that he is now considered stable, you are taking him to the hallway, and he will be admitted to an impatient room within a few hours Scenario 1 Multiple abrasions, bruising Head, chest, and inner thigh. -Transport Mr. Burgundy to his room Request sitter/family member to bedside Demerol 25mg SIVP for pain, patient reports 7/10 on pain scale. Ronald Burgundy Fall, Risk for True Document results The nurse performs tilt test, Patient vital signs lying flat, BP 118/62, P 92, R 20, T 98.5, SpO2 97. Provide emesis basin/cloth While assessing the patient, Mr. Greer tells you that he is very concerned about all the potential complications involved with this surgery. Assist patient Document results/findings All opinions are mine alone. -Reinforce to the patient to not get out of bed Report and document results Scenario 1 Wash and glove hands 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. Spiritual Distress False. No response = 1, Mobility: Social worker with patient this morning. -Ensure bed is in lowest position, and rails are in place Senario 4 Scenario 5 -Reapply the NC that he was admitted with at 2L Airborne Isolation. Perform full assessment and provide anti-nausea medicine. Evaluation patient after consult Swift River Medical-Surgical. Students will prioritize medical surgical . Cardiovascular Assessment Bed Bath: Assist or Total Impaired Skin Integrity, Risk for False Scenario 3 He insists that he is not hungry and refuses assistance with his meal. Peripheral Neurovascular Dysfunction False. Mr. Thomason is anxious and is obviously worsened from the shift before in overall condition. Scenario 2 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 . Mr. Greer is on the floor still but is awake and oriented and is complaining of back pain below his right scapula. 20ga. river part Answers to the questions; Fillable SOC 1 DLA 1; Fillable SOC 1 DLA 2 - Notes on Environmental effects through sociology . Background Robert Sturgess the client was admitted with Metastatic cancer of Colon, with history of diabetes. Enter the email address you signed up with and we'll email you a reset link. There is an order to apply a waist belt restraint if needed. Document teaching moment. Oral Care He is emotionally distraught and is insisting that he be allowed to report what is going on from the ER. The 'Strandperle' (lit. The patient has sustained an injury to her head, that is bandaged, and is bleeding from a wound to her right arm and chest area. Infection, Risk for True Educational Needs Increased acuity You discuss this cough with Mr. Dominec to determine how long he has had it. Check surgical consent for correct procedure and make sure operative site in marked. : an American History (Eric Foner), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. Mr. Duncan is now complaining of feeling "dizzy" when he stands. Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. Sensorium: Normal acuity, Bleeding, risk for: False Evaluate understanding Scenario 3 Neuro WNL alert and cooperative. Hep-Lock in place left AC. Retrieve cast removal tool Shock False Ineffective self-health mgmt: False, Disturbed body: False Hypothermia False -Evaluate patient's understanding of teaching 3Check surgical consent for correct procedure and make sure operative site is marked. Assess food consumption and intake and output Fear: True Safety Encourage fluids NURS 320 Med_Surg_Swift_River **New Patients from 2020, Post- Covid-19 Update:** **Charlie Raymond , John Duncan, Carlos Mancia, kenny barrett, Tim Jones, Julia Monroe, Donald Lyles, John Wiggins, Richard Dominec, Preston Wright, Tom Richardson, Joyce Workman, Karen Cole, Jose Martinez, Mary Barkley Charlie Raymond Nausea False Scenario 2 Assume role in response team of documenter His VS are BP 122/64, P 89, R 12, SpO2 93%. 2Provide comfort in pre-surgical room Mr. Dominec. Therapeutic communication. Safety Increased acuity, Physiological 45 terms. Grieving: False. Diet as tolerated. Administer protocol antidiarrheal medication Contact dietary consult -Explain to the patient that he has a procedure, and he cannot eat. Scenario 1 Sleep deprivation: False -Remind patient to call for help is he need to get up and provide patient with a urinal. The oncologist is recommending Docetaxel as opposed to an orchiectomy. Ms. Getts is now complaining of sudden sharp, substernal chest pain, very short of breath and is profusely diaphoretic. Scenario 3 Neuro WNL. 00 Comments Please sign inor registerto post comments. Safety Increased acuity, Physiological Love and Belonging Mr. Duncan's wife meets you in hall asking what she could bring her husband to eat from home. Full assessment Two housekeepers, who were refusing to clean the room, are in the break room. Fear/Anxiety True. Scenario 4 Check physician orders Upon assessment, you determined that she is confused to person, time, and place but is easily directable. In reassessing Ms. Monson, her vital signs are: BP -106/82, Temp-98.2, P-106, RR-18, SaO2-88. Senario 4 No known allergies (NKA). LUE: Non-pitting Pitting ___+ Neuro WNL's, alert and cooperative. -Start IV Acquire daily weight and food intake Impaired Gas Exchange False Evaluate/Modify Mobility Plan, Carlos Mancia, 48yr-old, Spanish speaking migrant worker with no known past medical Hx. Ms. Gestalt is second day post-op and has requested to get out of bed and to ambulate to bathroom. Scenario 4 Full assessment including both lying/standing Ask patient to explain to you what procedure she was expecting to have this morning. Deficient knowledge: True Psychological Needs Normal acuity Emergency intubation and assisted breathing is provided for Mr. Thomason You notice she is crying and is expressing fear that she "will always have this pain and numbness" and she doesn't think she can cope. She is also investigating bone marrow transplantation. Senario 2 Senario 1 He also states he is feeling weak. Scenario #2. Administer antiemetic medication Mr. Gonzales H/H is 12.7/38. The patient asks the nurse to explain about these medications and why they are in such a hurry. Discuss follow up with his doctor. Skin warm dry, bruises on forehead with small laceration. Pupils PERRLA, eyes clear. Peripheral Neurovascular Dysfunction False Mr. Sturgess is uncomfortable with experiencing urinary frequency that keeps him from resting. Vital signs -Temp 99.1, BP 124/62, P 77, RR 20, SaO2 91%. Perform circulatory evaluation The dinner tray is waiting for the patient in his room, and the nurse notices it is a regular diet. Call rapid response -Ensure patients is positioned in bed properly Spanish interpreter available at extension 61178. Scenario 4 No weight bearing today. Why is cysteine such an important amino acid for defining the tertiary structure of some proteins? No Known allergies (NKA). Impaired Comfort True Too bad the cruise area was a very unatractive part of the River Elbe. Full assessment Allergic to sulfa drugs. Verify call light/bed safety precautions Intermittent/Continuous Other: Readiness for Self-Care Enhancement True ASA is held but morphine 4 mg was given after his GI cocktail. LOC Normal acuity Perform circulatory evaluation Grieving False Stay with patient for surgeon's arrival to explain intended surgical procedure Scenario 5 Scenario 2 Home; Our Focus; Our Legacy; Our Partners; Our People; Our Fellows; Our Investments -Notify HCP of neuro findings Acute Pain True Provide Operative summary of type of procedure, IV fluid and pain status. Health Change: Increased acuity If patient statement differs from the surgical consent she has signed, notify surgeon immediately Sensorium Normal acuity, Physiological The charge nurse tells you she will send someone to assist you, and to get out 2mg of Versed to have ready to sedate the patient at time of procedure. Use therapeutic communication/active listening Fall, risk for: True Last Bowel Movement: Date: _____________________ Constipation Diarrhea/Loose Other: After two hours, Mr. Dominec is alert and cooperative, nauseated and concerned about impending surgery this evening. He tells the nurse he has called his wife and wants to be discharged now. Imbalanced Fluid Volume, Risk for True Impaired skin integrity: False, Anxiety: True Anxiety True Blood, Glucose 185, 4 units of insulin sliding scale for coverage. Scenario 2 Release restraints/full range of motion Vital assessment Stoma: N/A Colostomy Ileostomy Effluent Consistency: Perform circulatory evaluation student name date: nur 113 assessment swift river patient: robert sturgess handoff robert sturgess, 81 years old, metastatic ca of colon, hx of diabetes. The charge nurse tells you not to move the patient, because there is no special treatment according to social status. Check pedal capillary refill Refer call to contact health department Mr. Dominec leaves the room and you discharge him and escort him and his partner to the car. : an American History (Eric Foner), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham), Psychology (David G. Myers; C. Nathan DeWall), Biological Science (Freeman Scott; Quillin Kim; Allison Lizabeth), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. #1: _________, No Continue.Robert Sturgess Room 305 Robert Sturgess, 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. 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? She receives the pre-op medication. Scenario 3 NKDA Assessment The client vital signs are: Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%, Neuro WNL alert and cooperative. Mr. Greer has just been visited by his wife. The charge nurse tells the nurse to take Mr. Burgundy to the floor, because his room is now ready. Identify patient Nausea: False Mr. Gonzalez's repeat troponin was negative and no significant elevation in his other enzymes. Fall, Risk for True -Discuss with sitter that patient needs continual observation Bleeding False Self-Care Deficit False Diet as tolerated. -Call security for assistance and compliance officer She has been documented as being obese, new onset. Insertion site: Dry/Intact Redness Tenderness/Pain Warmth Coolness Swelling Drainage Notify doctor if condition is abnormal Imbalanced Nutrition True Scenario 5 Safety Scenario 1 Continent: Yes No Occasional Incontinence Frequent Incontinence Brief She has just been transported from recovery. Love and belonging Senario 4 Acute Pain True Use therapeutic communication/Active Listening He has been readmitted for a red spot on his sacrum of 1 cm and a 2 cm blister on his right heel. -Reassure patient that he will be moved to a private room as soon as possible Neuro WNL alert and cooperative. Mr. Richardson is now pain free and questioning why he is plagued with recurring urinary stones. Scenario 5 -Reassess patient q 5 minutes until awake, then 15 minutes until they are fully awake (not Drowsy). Scenario 1 Vital signs -Temp 97.2, BP 96/74, P 82, RR 20, SaO2 97%. Respiratory Rate: WNL Tachypnea Bradypnea Notify lead nurse/doctor Assess intake and output and possible reasoning

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