Scenario 4 Recently he manifested an unusual black lesion on his thigh and developed an opportunistic fungal mouth infection which was treated successfully. Assess vital results Check monitor Scenario 3 Nausea False He has been readmitted for a red spot on his sacrum of 1 cm and a 2 cm blister on his right heel. -Document and contact nursing supervisor/Charge nurse Mr. Sturgess does not have a living will or durable power of care completed. Need frequent reminder to stay in room and maintain mask precautions. Abnormal left leg weakness, gait unsteady, 5/10 on numeric pain scale. Elevate head of bed Notify lead nurse/doctor Remind staff that Universal Precautions are practiced at this hospital for all patients regardless of known infectious diseases. No Use therapeutic communication/Active Listening Impaired comfort: True Perform pain reassessment She is having some difficulty breathing. Pain Level Increased acuity Vital signs -Temp 99.1, BP 124/62, P 77, RR 20, SaO2 91%. -Explain to Mr. Burgundy that space in the ED is allocated based off of patient need Ms. Cumble states that she has not had a BM for three days. Waist belt restraint PRN; family sitter at bedside, assist with bath. Health Change Increased acuity He states, "This is not serious." They were also concerned about the next patient going into that room and the use of the lavatory. Psychological Needs Normal acuity Regardez le Salaire Mensuel de New King James Bible Download For Windows 7 en temps rel. Richard Dominec, A 47-year-old married father of three children has been admitted for an emergent appendectomy in the evening as soon as there is space available in the OR. Obtain translator Continent: Yes No Occasional Incontinence Frequent Incontinence Brief Esteem Secondary: Assess vital signs, auscultate heart, lungs, and bowl sounds. Remain with patient Color:__________ The patient will be discharged today, and he will be ordering new prescriptions. The sister of Mr. Mancia calls from home to speak with you. Glasgow Coma Scale 0-15 Musculoskeletal She is also to receive radiation, chemotherapy, and hormone therapy post operatively. Odor: __________, *Types: Abrasion, Burn, Laceration, Puncture, Surgical, Pressure Ulcer, Vascular Ulcer, Maceration, Excoriation, Skin Nausea False Impaired home maintenance mgmg r/t client or family: False 00 Comments Please sign inor registerto post comments. 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. Scenario 3 Document teaching moment. Sensorium Increased acuity, Physiological No Known allergies (NKA). Scenario 1 -Remind patient to call for help is he need to get up and provide patient with a urinal. 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. Document pt's statements. Mr. Sturgess is recently diagnosed with metastatic cancer of colon and he and his family have chosen only palliative care. Scenario 4 LOC Increased acuity Include patient condition change in shift report Roger Clinton, 57-year-old male construction worker arrives at 0600 to be prepared for a partial thyroidectomy to determine if he has cancer. Pain Level Normal acuity Scenario 5 Self-Care Deficit False Genitourinary Assessment After two hours, Mr. Dominec is alert and cooperative, nauseated and concerned about impending surgery this evening. The cancer was more advanced than they previously had thought so inguinal lymph nodes were removed. Skin warm and dry, all vital signs in WNL except 115 pulse, which is normal for him. Health Change Increased acuity "I am feeling fine." Educational Needs Increased acuity Use therapeutic communication/Active Listening Scenario 3 Health Change Increased acuity Clinical 2. 20ga. Remain with Patient, Sarah Getts, 77 yr-old, Dx- Chronic Renal Failure, admitted with hyperkalemia (5.9, Eq/L)/hyponatremia (128mEq/L). Compromised Family Coping False Scenario 3 Call rapid response Swallowing: Intact Dysphagia Aspiration Precautions -Recheck Tilts after the NS bolus is complete.T -Explain to Mr. Greer that it may take several days for healing, and he may have temporary incontinence, but it will resolve over time. Evaluate understanding Verify call Light/bed safety precautions Notify doctor if condition is abnormal Scenario 4 Physiological- Upon entering room, you wash/glove hands. Scenario 2 He has been taking his HIV medication daily. Senario 1 Hopelessness True Connect telemetry Ineffective Renal Perfusion, Risk for True Pain Level Normal acuity Fall, Risk for True Vital signs -Temp 98.4, BP 116/76, P 96, RR 20, SaO2 99%. -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 -Advise patient not to get up and walk on his own Arthur Thomason Pain Level Increased acuity He insists that he is not hungry and refuses assistance with his meal. -Transport Mr. Burgundy to his room High fall risk. Scenario 2 Mr. Greer has just returned from surgery. Scenario 5 , a 58-year-old male patient presents to the ER CO CP 10/10. Provide Operative summary of type of procedure, IV fluid and pain status. -Ensure the bed is in lowest position, the side rails are up, the call light is in reach, and ask the patient if they need anything before you leave the room Document results Full head to toe neuro assessment. Allow family to remain Robert Sturgess - Swift River Swift River University Nightingale College Course Concepts of Nursing I (BSN 246) Academic year2022/2023 Helpful? Severe pain (10/10) medicated q 30 minutes x4 with IV Morphine 2mg with little relief. Upon entering the room, the patient appears to be trying to get out of bed Perform neuro assess Scenario 5 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. Cryotherapy, which uses an endoscope to apply a cold liquid or gas to abnormal cells in the esophagus. 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. Comfort/Pain Assessment Scenario 2 Check input/output for possible dehydration 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 -Reassess patient's physical status prior to leaving him in the hallway Re-assess patient Don Personal Protective Equipment Senario 3 2021-22, Historia de la literatura (linea del tiempo), Respiratory Completed Shadow Health Tina Jones, CH 02 HW - Chapter 2 physics homework for Mastering, BI THO LUN LUT LAO NG LN TH NHT 1, Leadership class , week 3 executive summary, I am doing my essay on the Ted Talk titaled How One Photo Captured a Humanitie Crisis https, School-Plan - School Plan of San Juan Integrated School, SEC-502-RS-Dispositions Self-Assessment Survey T3 (1), Techniques DE Separation ET Analyse EN Biochimi 1. Scenario 5 Notify lead nurse Educate patient -Begin q15 minute neuro checks Obtain translator Fatigue True Pain: No Yes: Location: ______________________ Acute Chronic Constant Intermittent -Assess patient's ABC (airway, breathing, circulation) Ineffective airway clearance True His partner is not with him at this time but will arrive soon to facilitate his discharge home. Ineffective Peripheral Tissue Perfusion False Nutrition True Explain that he will probably not be going home at least until his doctor sees him. Teach Cameron. Ask patient to explain to you what procedure she was expecting to have this morning. Educational Needs Increased acuity Skin cool to touch and appears pale. Senario 3 Impaired Skin Integrity, Risk for False Combien gagne t il d argent ? Describe the physical changes from aging and the care required. Mr. Greer is on the floor still but is awake and oriented and is complaining of back pain below his right scapula. Scenario 4 Scenario 1 Notify doctor for Foley catheter Next time we'll spend our 60 on some food and nice beers. Yes Sexuality: True. Fall, Risk for True Full assessment Bed Bath: Assist or Total Wash and glove hands Surrounding skin: Moist/Intact Red/Erythema Irritation Scenario 1 Toggle navigation Swift River. You have them remain with you, seated in comfortable place, while you call ICU and attempt to locate physician for them. Bleeding, Risk for: True Acute Confusion True Apical Pulse Rate: Heart Sounds: Normal S 1 S 2 S 3 Linen Change -Discuss with sitter that patient needs continual observation Scenario 3 Diet as tolerated, up ad lib after gait training. He is emotionally distraught and is insisting that he be allowed to report what is going on from the ER. -Tell the patient to call immediately if the chest pain gets worse or they become short of breath Mr. Richardson is requesting assistance to ambulate to bathroom. Outline an experimental approach to demonstrate the average RNA chain growth rate during transcription of a cloned gene in vitro. This will treat any cancer that may have metastasized to the bone. Now, meeting the CDC definition, he has full blown AIDS but is asymptomatic at this time. Senario 2 Mr. Thomason is anxious and is obviously worsened from the shift before in overall condition. Assign nursing diagnosis and plan the appropriate intervention and evaluate outcomes while working through time pressure and distractions, including random call light requests. Respiratory Effort: Relaxed, Regular, Non-labored Pursed lip breathing Labored Hep-Lock in place left AC. Scenario 5 Nathaniel Gonzalez Mr. Gonzalez's repeat troponin was negative and no significant elevation in his other enzymes. Impaired mobility: False Heterotrophs include (1) autotrophs, saprophytes, and herbivores (2) omnivores, carnivores, and autotrophs (3) saprophytes, herbivores, and carnivores (4) herbivores, autotrophs, and omnivores. Senario 4 -Ensure there is suction in the room, and check Scenario 4 Health Change Increased acuity Strict I&O and strain all urine, filters in bathroom. Vital re-assessment They would also like to start Radium-223. Verify Call Light/Bed Safety precautions Notify family as to when they may come and visit. Document results and findings The nurse performs tilt test, Patient vital signs lying flat, BP 118/62, P 92, R 20, T 98.5, SpO2 97. Readiness for Self-Care Enhancement True Imbalanced Fluid Volume, Risk for True The bed arrives tomorrow. Decreased Cardiac/perfusion False Evaluate learning Deficient knowledge: True Alert and cooperative. Lithia Monson Fall, Risk for True Scenario 4 Compromised Family Coping False Virginia Smith She has just been transported from recovery. Neuro WNL alert and cooperative. Put the patient on O2 NC and Fentanyl 25mcg IVP for pain. Contact head nurse or supervisor in the OR to evaluate new situation Peripheral Neurovascular Dysfunction False Vital signs are to be taken BID, and it is now time. Knowledge Deficit True Fall, risk for: True Notify housekeeping. -Have patient remain in bed, head elevated 30 degrees Scenario 3 He is having some difficulty hearing and complains of ringing in his ears. -Start an IV Physiological- Scenario 2 Family at beside. You are concerned about preventing the patient from falling. Acute Confusion False Noncompliance: False Upon entering room, you find Mr. Sturgess is quiet, appears tense and rigid but states, "I am feeling fine." . Fall Risk Increased acuity Amount:________ Ms. Rails shares with you her fear of being discharged home to an abusive husband. -Remove the lunch tray and ensure pre-operative consent has been signed. Awaiting diagnostic labs. Safety Document results and findings Auscultate peripheral pulses and ROM. Deficient Fluid Volume False Lithia Monson, 93 years old, c/o head injury, r/o subdural hematoma. The patient describes this pain as a heavy pressure with intermittent stabbing. Peripheral Neurovascular Dysfunction True. Ineffective Coping False Scenario 5 Acute Pain True Skin warm and, dry, all vital signs in WNL except 115 pulse, which is normal for him. -Ensure patient privacy and call for help and assist patient to bed once help arrives : beach pearl), in walking distance of the velgnne ferry stop, is considered the mother of all urban beach clubs. -Perform neuro assess Blood Pressure, 7a-7p Total: 7p-7a Total: Offer assistance in providing more information about treatment options for newly diagnosed AIDS patients. How does the Med-surg simulator work? -Set-up for stat portable chest x-ray The oncologist is recommending Docetaxel as opposed to an orchiectomy. Self-Care Deficit False Document results Ms. Getts is being transferred as an emergency to Critical Care. Pupils: PERRLA Size: R: mm L: _mm Unequal Sluggish Non-reactive Disturbed Sensory Perception True Provide information for MD to call family at home and explain what has just happened Assess for bowel sounds Scenario 1 Use therapeutic communication/Active Listening Acute Pain True The impedance per phase in the load ist 14+j1214+j 12 \Omega14+j12. Encourage to ambulate with assistance to void if needed All our products can be personalised to the highest standards to carry your message or logo. Document results and findings She has received a dose of Hydrocodone for PRN pain 20 minutes ago. Combien gagne t il d argent ? #ozerysnackingrounds I am so excited to be partnering with Ozery Family Bakery today. -Explain procedure to the patient Safety Scenario 1 Report to charge nurse/ head nurse the need for staff education. -Assess the patient's anxiety level while using therapeutic communication to decrease patients' stress. Robert Domenic Waist belt restraint PRN; family sitter at bedside, assist with bath. Acute Pain True Bleeding, Risk for True Scenario 2 Viola Cumble Sleep Deprivation False. -Reassess patient Deficient knowledge: True 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. Esteem You arrive in room to find Ms. Monson talking to herself. Perform pain re-assessment Bleeding, Risk for True Encourage fluids/fiber/ambulation 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. 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Offer nutrition and/ or toileting jessdevan. Oriented to: Person Place Time -Check patency of Foley catheter, urine color, and ensure it is secure to the patient's leg Scenario 4 Remain with patient Decreased Cardio Tissue Perfusion False -Restart the IV and draw CBC Stoma Status: Pink-Red/Moist Dusky Retracted Excessive bulging Leave to break room and not continue in conversation. Scenario 2 Fall Risk Increased acuity Mr. Burgundy now has his cameraman filming in the ED and is attempting to do a live report. Safety- Obtain urinary screen Mrs. Pittmon states she has had numbness for years but "now I can't . Dyspnea at rest Dyspnea with minimal activity Use of accessory muscles The nurse arrives and sees a tent is being erected as a triage area, and ambulances are lined up delivering trauma patients. Stoma status: Pink-Red/Moist Dusky Retracted Excessive bulging They feel that you should share with them if he was a "real AIDS" patient or not. The emergency bathroom light goes off and the nurse finds Mr. Greer on the floor in the bathroom. Sarah Getts Ronald Burgundy Reorient Patient to person, place, & time Isolative, appears fearful, crying, and refusing to see her husband. Senario 3 Document and provide copy for Mr. Dominec to share with his follow up appointment tomorrow. Scenario 4 Mr. Dominec leaves the room and you discharge him and escort him and his partner to the car. Grieving: True -Using therapeutic communication inform Mr. Greer that there are many treatment options, and not to leave until the HCP can come and speak with him -Ensure patients is positioned in bed properly Administer antipyretic meds NG tube to low suction possibly D/C'd today after Dr. Levine rounds. 1. Evaluate outcome of dietary plan Administer PRN constipation medications He has not had his BP medication today. Acute Confusion: True IV maintenance fluids with D5 1/4 NS @ 150 ml/hr X 3 then reduce rate to 75 ml/hr. Educate patient regarding changes to POC Take vital signs before leaving the hospital again. Provide for physical and thermal comfort. Remain with patient A GI cocktail was administered, and the patient stated that it decreased his pain to a 6/10. -Reassess patient q 5 minutes until awake, then 15 minutes until they are fully awake (not Drowsy). The cycle of freezing and thawing damages the abnormal cells. You are told that he has intermittent chest pain with substernal burning that radiates to his mid-back. Risk for Infection True Non-significant past medical history. He also has metal fragments on his left side on his leg arm and torso. He told the nurse that he has had some changes in his bowel habits and his stools have been very dark. Obtain vital signs machine He chooses to go home and see the doctor tomorrow in his office. Verbal command = 3 Request time she can arrive and staff to help with transfer It is determined that Mr. Sturgess could achieve better pain control w/ a PCA pump When you enter the room, the patient is having chest pain again, and they are pale and diaphoretic. -Tell the patient that they are being admitted to r/o any cardiac issues Seek clarification Shock, Risk for False -Assess if the contents of lunch tray are intact. It is now the second day post op and he is given discharge information. Anxiety True Esteem Wash and glove hands Deficient knowledge: True Acute Pain: True IV D5 1/2 NS with 20 KCL @ 125 ml/hr in left forearm. Scenario 5 Grieving False Senario 2 You are the now the Surgical ICU nurse assigned to her. To access your Swift River Virtual Clinicals login to ATI's Student Portal and access the Virtual Clinical card in My ATI. 1. References; Access My Virtual Clinicals; Medical-Surgical. Elevate Extremity Failure to Thrive False. No Known allergies (NKA). -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. Senario 5 -Elevate head of bed and place the patient on Pulse oximetry. Scenario #2. Neuro WNL alert and cooperative. -Ask the patient if it is okay to discuss his care in front of his children. Disturbed Sensory Perception False Grieving: False Noncompliance False Background Robert Sturgess the client was admitted with Metastatic cancer of Colon, with history of diabetes. Pain Level Increased acuity You, his prior nurse, notice the family and respond to them. Vital signs -Temp 98.6, BP 114/62, P 100, RR 20, SaO2 94%. Ruth Cummings Trustee Vice Chair Audit Chair . Hopelessness False. Mr. Wright is pleasant and cooperative, but needs to be reminded to avoid pressure on his heel and sacrum. Localizes pain = 5 3Check surgical consent for correct procedure and make sure operative site is marked. Provide comfort measures Refer call to contact health department You also notice the patient is more difficult to orient. It is determined that Mr. Sturgess could achieve better pain control with a PCA pump. Assist physician in physical exam of patient Vital signs- Upon entering the room, you find Ms. Rails sleeping. Explain to Mr. Dominec your concern for this opportunistic infection and usual treatment. You determine to apply the restraint now. Scenario 3 The nurse observes an elderly lady who is crying and has not been taken care of yet. Scenario 5 -Offer nutrition/toilet Vital sign assessments Upon assessment, you determined that she is confused to person, time, and place but is easily directable. Abdominal Pain: Non-tender Tender/Pain Describe: Obtain translatorT Scenario 5 Review pain medication order -Reorient Patient to person, place, & time -Explain that Docetaxel is a hormone therapy that suppresses the testosterone that your testicles produce producing similar results as surgical intervention. Ineffective self-health mgmt: False, Disturbed body: False Mr. Dominec has a male partner and has been married for the past ten years and share their three children to the marriage. Wife at bedside. Notify family Scenario 5 Ambulates with assistance. -Notify HCP of neuro findings Safety Scenario 1 RLE: ______________ LLE: ______________, Casts/Splits: ____________________________, Motor response Verbal command = 6 Virginia Smith, 57-year-old who has elected to have a total mastectomy based on consultation with her surgeon, a total mastectomy removes all breast tissue but leaves all or most of axillary lymph nodes and chest muscles intact. Scenario 5 Verify call light/bed safety precautions Vital assessment Discuss follow up with his doctor. Document results Full assessment Amount: _______ Notify lead nurse/doctor 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. Love and Belonging Vital signs -Temp 97.2, BP 96/74, P 82, RR 20, SaO2 97%. He requests no visitors at this time, but later asks for his family to be called to discuss a plan of care. 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. Ramona Stukes, 69 yr-old, third day post-op cholecystectomy. Impaired Skin Integrity, Risk for False -Evaluate patient's understanding of teaching The patient is asking you where her son is, the last place she saw him was right before the explosion. Pain Level: Increased acuity Skin warm and dry, all vital signs in WNL except 115 pulse, which is normal for him. Mr. Gonzalez has been admitted to the floor to determine that his chest pain is not related to a cardiac event.
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