-Tell the wife that you will speak to the husband, and this is apprehension is expected with this surgery/diagnosis. He is having some difficulty hearing and complains of ringing in his ears. -Advise patient not to get up and walk on his own Vital signs -Temp 98.8, BP 102/76, P 102- irregular, RR 22, SaO2 90%, cardiovascular on telemetry with Sinus irregular rhythm. Several hours later, Mr. Duncan is now complaining of nausea. Impaired Comfort True Scenario 3 Skip to document Ask an Expert Sign inRegister Sign inRegister Home Ask an ExpertNew My Library Discovery Institutions StuDocu University Keiser University Western Governors University Seek clarification 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. The sister of Mr. Mancia calls from home to speak with you. Notify doctor if condition is abnormal Date of insertion: _________________________ Date of dressing: _________________________________ Assess for bowel sounds Nutritional Intake: Adequate Inadequate BMI: Your response to all of them would be: Scenario 1 She has IV access and has received a small dose of Valium to reduce apprehension. You, his prior nurse, notice the family and respond to them. Document results Sensorium Normal acuity, Physiological Lung sounds are worse. , a 58-year-old male patient presents to the ER CO CP 10/10. PT to educate patient Senario 2 It is now two weeks later; Mrs. Smith has returned. Skin integrity at risk True John Duncan, 56yr-old male, Dx- Gastroenteritis, returned yesterday from Cancun, c/o intractable diarrhea, weak, pale, and refusing to eat. No response = 1, Range of Motion: Full, Limited Scenario 3 LOC Normal acuity Provide emesis basin/cloth -Have patient remain in bed, head elevated 30 degrees Scenario 4 Sensorium: Normal acuity, Bleeding, risk for: False He has a history of hypertension and is not compliant with medication. Fall, Risk for True The patient was placed on 2 L O2 NC, EKG monitoring to include a 12 lead, Pulse Oximeter. Oral Care Ramona Stukes, 69 yr-old, third day post-op cholecystectomy. school system of the host country and may not know how to choose the programme, Question 34 Correct Mark 100 out of 100 Flag question Question text hr tag, efefefefefefefefefefefefefefefefefefefefefefefefefefefefefefefefefefefefefefefef, arbitrary parameters a b will be a complete solution of 38 The main problem then, Reduces costs of providing on site office space To individual Makes more time, METHYLXANTHINE DRUGS-Chemistry FinalsExam PrepNotes.docx, 237 Mitzel Corporation has provided its contribution format income statement for, looks like a lack of focus B In short what is stimulating to one person may be, MAN4162 - Verbal and Nonverbal Communication COPY.docx, Recall that in the Black Scholes model the stock price follows the SDE dS t S, make SOAPE and SBAR Ramona Stukes Room301 Ramona Stukes,69 yr-old, third day post-op cholecystectomy. Apply restraint -Check on patient/sitter hourly Offer assistance You are about to call the Surgical ICU and give report. Crutches at bedside adjusted for height. Vital signs -BP 124/82, Temp 98.2, P 84, RR 22, SaO2 96%. Scenario 2 You explain that he is receiving a higher level of care and was he was sedated before leaving the floor to make him more comfortable. 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? He has not had his BP medication today. Skin warm and dry, all vital signs in WNL Abdomen: Flat Rounded Scaphoid Distended Palpation: Soft Taut Rigid Students will prioritize medical surgical . Obtain urinary screen DSD (dry sterile dressing), forehead laceration clean and dry intact. Scenario 4 Vital assessment All opinions are mine alone. Notify doctor Dr. Sangerstien, Viola Cumble, 92yr-old, second day post-op hip repair, Allergic to Penicillin. Love and belonging Teach patient about safety when getting out of bed Request sitter/family member to bedside Family at beside. Today, clubs like Hamburg City Beach Club, Lago Bay, Hamburg del Mar and StrandPauli provide a relaxed summer atmosphere with a view over the Elbe. Dr. Jones. Offer masks to visitors Deficient Fluid Volume False NPO with small amount of ice chips only. -Assess if the contents of lunch tray are intact. Spanish interpreter available at extension 61178. -Check patency of Foley catheter, urine color, and ensure it is secure to the patient's leg Document results Document teaching moment. Document results and findings He is emotionally distraught and is insisting that he be allowed to report what is going on from the ER. Scenario 4 Senario 5 Recent blood gases demonstrate falling PaO2 (hypoxemia) and increasing CO2 (Hypercapnia). Toggle navigation Swift River. Wash and glove hands Psychological Needs Normal acuity Scenario 1 Assist patient Safety -Ensure there is a full O2 tank on the gurney, place patient on Nasal Cannula Self-Actualization Scenario 4 Scenario 4 Stoma Status: Pink-Red/Moist Dusky Retracted Excessive bulging The cancer was more advanced than they previously had thought so inguinal lymph nodes were removed. Evaluation patient after consult His partner is not with him at this time but will arrive soon to facilitate his discharge home. 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. Tibial: _____ + Bilateral Other: ______________ Generalized: Pedal: ______ + Bilateral Other: ____________ Sacrum: Non-pitting Pitting ___ +. Disoriented, confused = 4 Raspberry and Cream Cheese Stuffed Blueberry French Toast with Ozery. Reassure patient and help explain any new orders from physician to patient Swift River Medical-Surgical. Respiratory Rhythm: Regular Rhythmic Irregular Periods of Apnea Cheyne-Stokes Senario 3 Explain that he will probably not be going home at least until his doctor sees him. Hypothermia False Vital sign assessments Chronic Sorrow False Perform circulatory evaluation Use therapeutic communication/Active Listening Head/Face: Symmetric Asymmetric Drooping 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 Pain affecting: N/A Sleep Activity Exercise Relationships Appetite Concentration Background Robert Sturgess the client was admitted with Metastatic cancer of Colon, with history of diabetes. This information is HIPAA protected and you cannot share anything with them. Scenario 5 The dinner tray is waiting for the patient in his room, and the nurse notices it is a regular diet. Obtain Spanish signs & brochure Scenario 4 He is experiencing new onset of shortness of breath and has a nasal cannula with 2L of Oxygen in place. Physiological- Nathaniel Gonzalez Health Change Increased acuity Tear, Ecchymosis, Contusions, Bruising Scenario 2 -Perform admission assessment Explain to physician what interventions you have recently initiated Combien gagne t il d argent ? Validate NPO Status Place call light and check bed for safety Scenario 2 Inform his partner that everything is being done to keep him comfortable. Activity as tolerated with assistance. 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. Senario 5 Scenario 4 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. and the GI cocktail given in the ER did relieve his CP but not completely. Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. Assessment of bowel movement Disturbed Body True Scenario 5 Bleeding, Risk for: True -Inform patient to not get out of bed without assistance and place call light in reach She has arrived in pre-op and about to have surgery this morning. In the interim, start an IV and start infusing Ringers Lactate. Grieving: False. -Notify HCP of neuro findings Acute Confusion True NKDA Assessment The client vital signs are: Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%, Neuro WNL alert and cooperative. GI WNL. His VS are BP 122/64, P 89, R 12, SpO2 93%. Document results/findings Therapeutic communication Impaired Skin Integrity, Risk for False Notify family -Evaluate patient's understanding of teaching 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! Put the patient on O2 NC and Fentanyl 25mcg IVP for pain. Palliative care. You call his doctor to inform him the family has arrived. Senario 3 He told the nurse that he has had some changes in his bowel habits and his stools have been very dark. Cross), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Forecasting, Time Series, and Regression (Richard T. O'Connell; Anne B. Koehler), Week #7 Assignment - Incentive Spriometer . Provide a few chairs if possible for her family to also be comfortable Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. Notify doctor Mr. Gonzalez has returned from his EGD and is still sleeping from the sedation. Scenario 1 Reorient Patient to person, place, & time Then the bus splashed into the river for a cruise. Nausea/Vomiting: Yes No Bleeding, Risk for False Cryotherapy, which uses an endoscope to apply a cold liquid or gas to abnormal cells in the esophagus. 2Provide comfort in pre-surgical room Mr. Dominec. Scenario 3 Scenario 1 Combien gagne t il d argent ? Viola Cumble Robert Sturgess Robert Sturgess 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. Ms. Gestalt capillary refilling is now 6 secs below cast site, extremity is swollen and cold to the touch. Palliative care. Mr. Dominec leaves the room and you discharge him and escort him and his partner to the car. -Begin q15 minute neuro checks Skin: Warm/dry Clammy/diaphoretic Skin Turgor: Brisk Tenting Other: _______________________________ Senario 4 Awaiting transport. Educational Needs Increased acuity Robert Domenic Administer protocol antidiarrheal medication Impaired Skin Integrity False Grieving False Talk with her stating surgery is over and she did great. She has received a dose of Hydrocodone for PRN pain 20 minutes ago. -Complete incident report. -Take initial vital signs (room air Pulse Ox) Fatigue True Release restraints/full range of motion Scenario 3 -Call security for assistance and compliance officer palliative care. Glasgow Coma Scale 0-15 Musculoskeletal Infection, risk for: False. Senario 4 river part Answers to the questions; Fillable SOC 1 DLA 1; Fillable SOC 1 DLA 2 - Notes on Environmental effects through sociology . Scenario 1 Pain, Acute True Blood, Glucose 185, 4 units of insulin sliding scale for coverage. Encourage fluids/fiber/ambulation Acute Pain True Scenario 1 Peripheral Neurovascular Dysfunction False Scenario 3 -Discuss and determine sitter availability Determine from medical record if partner is aware of his recent AIDS diagnosis. Your coworkers are asking you questions about Mr. Dominec. Safety- Scenario 3 Normal Sinus Rhythm on telemetry. Sensorium Normal acuity, Physiological No known allergies (NKA). Mr. Richardson is now pain free and questioning why he is plagued with recurring urinary stones. View Swift River Reflection Questions (1).docx from NRSG 4412 at South College. Hopelessness False. Scenario 2 Assess Cardiovascular Assessment Generalized weakness, blood tinged urine and severe pain upon urination, GI- n/v. Respiratory Effort: Relaxed, Regular, Non-labored Pursed lip breathing Labored -Give NS liter bolus RUE: ______________ LUE: ______________ Infection, Risk for False Safety -Document and contact nursing supervisor/Charge nurse Pain Level Normal acuity Fall Risk Increased acuity Tubes: None Salem Sump Nasoduodenal PEG J-Tube pH: ______ Scenario 2 Filmotka filmu Najvyia ponuka (2013). Notify Physical Therapy (PT) #1: _________, No In reassessing Ms. Monson, her vital signs are: BP -106/82, Temp-98.2, P-106, RR-18, SaO2-88. Mrs. Pittmon states she has had numbness for years but "now I can't . Psychological Needs Increased acuity She has been admitted to the floor with complaints of numbness in her right foot and ankle. Document Results/Findings Disturbed Sensory Perception True Vital signs -Temp 97.2, BP 96/74, P 82, RR 20, SaO2 97%. All our products can be personalised to the highest standards to carry your message or logo. When completing the shift change neuro check, you notice the patient's left pupil is sluggish. Wash and glove hands Deficient Diversional Activity False Wound clean dry and intact. Mr. Gonzalez has been admitted to the floor to determine that his chest pain is not related to a cardiac event. Document and provide copy for Mr. Dominec to share with his follow up appointment tomorrow. The nurse was told by the gastroenterology nurse that they really struggled before they called anesthesia and they may have caused an esophageal abrasion. 2. The patient describes this pain as a heavy pressure with intermittent stabbing. -Place patient on 100% O2 Love and belonging- He also has a history of hypertension and takes Tenormin (Atenolol) and Atorvastatin (Lipitor). D/C plan- decrease pain and restore normal gait. Educate patient Nausea: False Allow husband to come into recovery for a quick one-minute visit. Provide information for MD to call family at home and explain what has just happened The bed arrives tomorrow. Love and Belonging Scenario 4 Mr. Mancia's vital signs upon assessment are Temp 101.2, P 94, RR 20, BP 122/82, SaO2-91%. -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 Nausea False Safety Increased acuity, Physiological Document results. Report and document results Senario 3 -Explain procedure to the patient Eye opening Spontaneous = 4 Notify lead nurse/doctor Scenario 3 Scenario 3 Assess -Ask the patient if it is okay to discuss his care in front of his children. Scenario 3 He does not have an IV nor is he on oxygen. Fear/Anxiety True. 1. Ineffective Peripheral Tissue Perfusion False Seznam uivatel, kte vlastn, prodvaj nebo shnj film. His partner is at the bedside asking, "how much longer will he have to wait until taken to surgery?" Give verbal report Offer nutrition and/ or toileting Her husband and children remain with her in the surgical holding area awaiting transport to the OR. Skin integrity, impaired True Linen Change Remain with patient IV Assessment/ N/A The patient asks the nurse to explain about these medications and why they are in such a hurry. -Complete secondary assessment once the patient is in bed focusing on complaint of pain resulting from the fall Skin Color: Consistent with ethnicity pinkish-tan light-tan dark-tan light-brown dark-brown Obtain translator Neck: ______________ -Explain to Mr. Greer that it may take several days for healing, and he may have temporary incontinence, but it will resolve over time. His original lymph node biopsy was negative. -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. Scenario 4 He has been ruled out for an MI. She is also to receive radiation, chemotherapy, and hormone therapy post operatively. Educational needs: Increased acuity Scenario 5 Document Procedure Capillary Refill: _________ seconds Offer assistance in providing more information about treatment options for newly diagnosed AIDS patients. The nurse observes an elderly lady who is crying and has not been taken care of yet. Regular diet. Pain Level Increased acuity -Reassure patient that he will be moved to a private room as soon as possible Strict I&O and strain all urine, filters in bathroom. Obtain vital signs machine Dyspnea at rest Dyspnea with minimal activity Use of accessory muscles Alleviating Factors: Last pain medication: Contact Social Services Provide for physical and thermal comfort. Her pitcher has already been filled three times this shift. Fall, Risk for False LUE: Non-pitting Pitting ___+ Scenario 5 The patient tells the nurse that yesterday he was, "concerned about having an erection, and now they want to cut off my testicels".