Senario 2 Determine from medical record if partner is aware of his recent AIDS diagnosis. Sensorium Normal acuity, Physiological Infection, risk for: False. Skin cool to touch and appears pale. Increased fall risk. Normal Sinus Rhythm on telemetry. Impaired skin integrity: False, Anxiety: True Dr. Suculo, Physiological Safety Increased acuity, Physiological 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. Encourage fluids and fiber diet Assist patient out of bed Scenario 5 -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. Date of insertion: _________________________ Date of dressing: _________________________________ Mr. Gonzalez has been admitted to the floor to determine that his chest pain is not related to a cardiac event. Scenario 2 Mrs. Stukes is feeling nauseated. Attempt to orient to person, place, and time Health Change Increased acuity Robert Strurgess Document results and findings Radial: ____ + Bilateral Other: _____________ RLE: Non-pitting Pitting ___ + Scenario 5 Safety Increased acuity, Physiological Fall, Risk for True IV Fluids: INT lock IV Fluids ______________@ _____________ mL/hr Date on tubing: Copyright 2023 StudeerSnel B.V., Keizersgracht 424, 1016 GC Amsterdam, KVK: 56829787, BTW: NL852321363B01, Chronic Pain, Risk for constipation, impaired nutrition, anxie, 4 units on insulin sliding scale for coverage, Campbell Biology (Jane B. Reece; Lisa A. Urry; Michael L. Cain; Steven A. Wasserman; Peter V. Minorsky), The Methodology of the Social Sciences (Max Weber), Civilization and its Discontents (Sigmund Freud), Educational Research: Competencies for Analysis and Applications (Gay L. R.; Mills Geoffrey E.; Airasian Peter W.), Chemistry: The Central Science (Theodore E. Brown; H. Eugene H LeMay; Bruce E. Bursten; Catherine Murphy; Patrick Woodward), Give Me Liberty! Vital signs -Temp 98.4,BP 178/105, P 112, RR 28, SaO2 94%; Neuro- WNL's. Impaired Skin Integrity, Risk for False Oriented to: Person Place Time Place pt on PCA pump Chronic Pain False Infection, Risk for False Senario 2 Encourage fluids/fiber/ambulation Seek clarification Evaluate understanding -Place patient on O2 Nasal Canula Scenario 3 It is unclear if he lost consciousness. -Reassess patient -Reassess patients' vital signs, and place on q5 minutes continuous monitoring Skin warm dry, bruises on forehead with small laceration. Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. Scenario 3 IV maintenance fluids with D5 1/4 NS @ 150 ml/hr X 3 then reduce rate to 75 ml/hr. Recent blood gases demonstrate falling PaO2 (hypoxemia) and increasing CO2 (Hypercapnia). Nathaniel Gonzalez Disoriented to time and place, speech slurred. Nr 325 final exam quizlet chamberlain - gqqa.wikinger-turnier.de There is an initial triage provider written set of orders at her bedside for a STAT Chest X-ray, IV with NS, O2 NC, and STAT CBC and Chemistry. Alert and cooperative. Scenario 5 Request sitter/family member to bedside Stat lithotripsy treatment ordered. Impaired Gas Exchange True Notify doctor Physiological Verify call light/bed safety precautions Stay with patient for surgeon's arrival to explain intended surgical procedure #ozerysnackingrounds I am so excited to be partnering with Ozery Family Bakery today. Mr. Dominec decides he does not want to see Infectious Disease doctor about his new cough. Perform pain re-assessment Color:__________ Apical pulse rhythm: Regular Irregular Location: student name date: nur 113 assessment swift river patient: robert sturgess handoff robert sturgess, 81 years old, metastatic ca of colon, hx of diabetes. Notify Physical Therapy (PT) Scenario 2 : an American History (Eric Foner), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. 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. Dr. Roopes, Estelle Hatcher, 31yr-old, r/o appendicitis, 1st day post-op appendectomy; No known allergies (NKA); Vital signs - Temp 101.2, BP 108/74, P 92, RR 20, SaO2 99%, alert and cooperative. A few hours after speaking with the sitter about the patient needing complete observation, you notice the sitter outside of the room talking on the phone. -Reassess patient q 5 minutes until awake, then 15 minutes until they are fully awake (not Drowsy). She has received a dose of Hydrocodone for PRN pain 20 minutes ago. Electrolyte Imbalance True Scenario 1 Lithia Monson, 93 years old, c/o head injury, r/o subdural hematoma. Sa fortune s lve 2 216,00 euros mensuels Document Results/Findings Purposive Communication Module 2, Chapter 1 - Summary Give Me Liberty! His overall health is good, and he has known he has been HIV positive for the past five years. Teach patient about safety when getting out of bed Scenario 2 Stoma: N/A Colostomy Ileostomy Effluent Consistency: Administer pain medications -Assess patients' pain and rule out cardiac pain. Insert Foley catheter Use therapeutic communication/Active Listening Impaired Home Maintenance Management r/t Client or Family False Provide emotional support. She has been documented as being obese, new onset. Assist patient Observe closely first hour Impaired Gas Exchange False GI WNL. The nest morning the gastroenterologist informs Mr. Gonzalez that his EGD confirmed a diagnosis of Barrett's esophagus with Dysplasia. Scenario 4 Skin warm and pale. They would also like to start Radium-223. Offer assistance Activity as tolerated with assistance. Clinical 2 Flashcards | Quizlet At Risk, Impaired Comfort False Peripheral Neurovascular Dysfunction False Infection, Risk for False Failure to Thrive: True. Scenario 5 Inform and educate spouse of dietary orders Impaired Skin Integrity, Risk for False Pain re-assessment Upon entering the room, you find Mr. Sturgess is quiet, appears tense and rigid but states, Waist belt restraint PRN; family sitter at bedside, assist with bath. -Ask the patient to verbalize understanding of teaching and reassure them that yourself or any member of their care team will be available to answer questions. Next time we'll spend our 60 on some food and nice beers. Suprapubic Insertion site: WNL S/S Infection : ____________________ Tunneled, site _______________ Implanted port, accessed _____________________ Hx of dementia, from nursing home, fall one day ago. You return to the break room on your floor. Impaired comfort: True Fall Risk Increased acuity Type of Line: Peripheral, location ______________ CVL, location _____________ PICC, location _______________ Do not disturb Regardez le Salaire Mensuel de New King James Bible Download For Windows 7 en temps rel. Notify doctor Explain to Mr. Dominec your concern for this opportunistic infection and usual treatment. Combien gagne t il d argent ? Educational Needs Increased acuity Hx of dementia, from nursing home, fall one day ago. 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. Diet as tolerated. 00 Comments Please sign inor registerto post comments. He has been taking his HIV medication daily. Report current urinary output quantify per hour and color of urine 20ga. Tubes: None Salem Sump Nasoduodenal PEG J-Tube pH: ______ 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. 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. Fortune Salaire Mensuel de Tthuchicago Org Combien gagne t il d argent Apical/Radial Pulse Deficit: No Yes Murmur Valve Click Senario 1 Health Change Increased acuity He is aware that he may not have an erection and may need depends for bladder incontinence. 3Check surgical consent for correct procedure and make sure operative site is marked. Upon assessment, you determined that she is confused to person, time, and place but is easily directable. 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. Vital signs -Temp 98.6, BP, Erma Willis, a 65-year-old woman with a history of adenocarcinoma and multiple past episodes of related secondary infections, was admitted to the medical-surgical unit this morning with a diagnosis, Reflective Journal VCBC Post work Cellular Regulation VCBC Post Work Start Assignment Due No Due Date Points 10 Submitting a file upload Please submit your post work to Canvas within 48 hours of, Typically the concept of cellular regulation Involves the study of cancer and related diagnoses. Roger Clinton, 57-year-old male construction worker arrives at 0600 to be prepared for a partial thyroidectomy to determine if he has cancer. Swift River Reflection Questions 1 - Swift River - Course Hero Wash and glove hands Impaired Mobility False Because of the fall the provider has recommended that he stay in the hospital another night. Severe pain (10/10) medicated q 30 minutes x4 with IV Morphine 2mg with little relief. Provide comfort measures Wash and glove hands Self-Care Deficit True Psychological Needs Increased acuity Contact Social Services 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. Disturbed Body Image True The cancer was more advanced than they previously had thought so inguinal lymph nodes were removed. Ask patient to explain to you what procedure she was expecting to have this morning. Document results Vital sign Temp 98.4, BP 136/78, P 72, RR 20, SaO2 97%. We have more than 20 years' experience in the industry providing a quality service to our clients We pride ourselves on our customer-orientated service and commitment to delivering high end quality goods within quick turnaround times. Evaluate understanding Provide comfort in pre-surgical room Mr. Dominec. He was recently treated for a URI with a Z pack, prednisone, and Motrin for pain. Scenario 4 Scenario 1 -Perform admission assessment Robert Sturgess 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. Deficient Knowledge False Provide information for MD to call family at home and explain what has just happened 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. Record intake and output Regardez le Salaire Mensuel de Tthuchicago Org en temps rel. The impedance per phase in the load ist 14+j1214+j 12 \Omega14+j12. Adjust crutches Document results and findings Tear, Ecchymosis, Contusions, Bruising Mr. Sturgess is recently dx w/ metastatic cancer of colon and he and his family have chosen only Document Results, Robert Sturgess, 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. Senario 4 Need frequent reminder to stay in room and maintain mask precautions. Answers to the questions - 1. Linda Yu Acuities Educational - Studocu Cryotherapy, which uses an endoscope to apply a cold liquid or gas to abnormal cells in the esophagus. -If cardiac is suspected call the provider and the rapid response team. High fall risk. Lithia Monson Vital assessment 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. Vital signs -Temp 99.1, BP 124/62, P 77, RR 20, SaO2 91%. -Complete secondary assessment once the patient is in bed focusing on complaint of pain resulting from the fall Mr. Greer has just been visited by his wife. Pain Level Normal acuity Replace oxygen nasal cannula that had become disconnected Deficient knowledge: True Document and provide copy for Mr. Dominec to share with his follow up appointment tomorrow. Encourage fluids Apply restraint They feel that you should share with them if he was a "real AIDS" patient or not. Ineffective breathing pattern False Palliative care. Safety Therapeutic Communication He is pale, weak, diaphoretic, and appears anxious. Remain with patient Comfort/Pain Assessment Scenario 1 Give verbal report Compromised Family Coping: False 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. Senario 1 RUE: ______________ LUE: _____________ Scenario 4 Diet as tolerated, up ad lib after gait training. Palliative care. Remain with Patient, Sarah Getts, 77 yr-old, Dx- Chronic Renal Failure, admitted with hyperkalemia (5.9, Eq/L)/hyponatremia (128mEq/L). Dr. Altace, Physiological- She shares concern about patient's wife who is now coughing and having night sweats. Contact head nurse or supervisor in the OR to evaluate new situation Neuro WNL alert and cooperative. Medical-Surgical - Swift River Online Learning Fall, Risk for True No Known allergies (NKA). Check PRN pain order -Verify that discharge orders have been written, provide discharge instructions, and in inform provider about the chest pain. Genitourinary Assessment Inappropriate words = 3 Scenario 3 She is also to receive radiation, chemotherapy, and hormone therapy post operatively. The Elbe River - hamburg.com Nausea: False Document and prepare to transfer to Surgical ICU Verbal response Oriented converses = 5 Family in room with patient very concerned. She has arrived in pre-op and about to have surgery this morning. Health Change Increased acuity Water/Flush: Scenario 5 Notify doctor Family Health III-Pediatrics (NSG 6435) Emergency Medical Technician (EMS 1150) Applied Research In Business (MIS 781) Anatomy & Physiology I With Lab (BIOS-251) Molecular Biology (BP 723) Newest Marketing Management (D174) Professional Application in Service Learning I (LDR-461) Professional Capstone Project (PSY-495) Theology (104) Failure to Thrive False. An abc-phase-sequence three-phase balanced wye-connected source supplies power to a balanced wye-connected load. Use therapeutic communication/Active Listening Grieving True Scenario 5 SBAR assignment.docx - SBAR(situation, background, - Course Hero Swift River Reflection Questions day 7 Answer each question thoroughly in multiple sentences. Disturbed Body True Pain, Acute True Evaluate understanding Document Procedure He is complaining of pain in his left arm, and pain in his left chest when he tries to take a deep breath. Request time she can arrive and staff to help with transfer Failure to Thrive True. Mr. Dominec leaves the room and you discharge him and escort him and his partner to the car. Primary: Check LOC, Orientation, Breathing, Circulation, Brief Neuro assessment to include spinal pain or deformities, Obvious injuries. Dx- urinary stones with 3 episodes/5yrs. 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? is a 57 y/o who has been admitted for a radical prostatectomy. Sensorium Increased acuity, Physiological Hopelessness False. Impaired Gas Exchange True Compromised Family Coping False Med Surg - Swift River_2020 | NURS 320 Med_Surg_Swift_River_Graded A -Complete neuro checks as ordered Decreased cardio tissue perfusion: False Bowel Movement Total: x________________, Hygiene Times 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. Swift River Nursing Simulation - Homework Writing Services Scenario 2: 1Educate about recovery from appendectomy and care to wound. Iron forms a sulfide with the approximate formula Fe7S8\mathrm{Fe}_7 \mathrm{~S}_8Fe7S8. Oral Care Gastrointestinal Assessment Administer antipyretic meds There is an order to apply a waist belt restraint if needed. His difficulty voiding finally motivated him to seek care. -Notify charge nurse of patient's deteriorating condition No known allergies (NKA). -Elevate head of bed and place the patient on Pulse oximetry. RS Flashcards | Quizlet No response = 1, Range of Motion: Full, Limited Evaluate/modify plan of care Reapply restraints Scenario 1 Acute Confusion False Dr. Donofrio, Physiological Lithia Monson Acute pain: False Full assessment Mr. Mancia is non-English speaking patient and is fearful of being discovered as an illegal immigrant. Deficient Fluid Volume True Ms. Gestalt is now complaining of fever and chills. Non-significant past medical Hx. Re-assess patient Physiological- While assessing the patient, Mr. Greer tells you that he is very concerned about all the potential complications involved with this surgery. Seznam uivatel, kte vlastn, prodvaj nebo shnj film. It is determined that Mr. Sturgess could achieve better pain control w/ a PCA pump 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. The cells are allowed to warm up and then are frozen again. Health Change Increased acuity Yes Productive Non-productive Describe Sputum: _______________________ Skin Color: Consistent with ethnicity pinkish-tan light-tan dark-tan light-brown dark-brown 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. Deficient knowledge: True Eye opening Spontaneous = 4 Document results Full assessment 20ga. Release restraints/full range of motion Grieving False Ineffective airway clearance True Safety Awaiting transport. Apical Pulse Rate: Heart Sounds: Normal S 1 S 2 S 3 Scenario 2 Mr. Duncan's wife meets you in hall asking what she could bring her husband to eat from home. Scenario 4 Wound site clean, dry and intact NPO, NG-tube to low continuous suction. Now, meeting the CDC definition, he has full blown AIDS but is asymptomatic at this time. Remind physician to wash his hands before examining the patient He tells the nurse he has called his wife and wants to be discharged now. Educational Needs Increased acuity Notify lead nurse/doctor Tube Feeding: Type:_________________________ Amount/Rate: ________________________ Bolus/Infusion Procedure is canceled for the day and rescheduled later allowing for new consent. Fall Risk Increased acuity Safety Acute Confusion True Educate patient Scenario 4 Stools are decreasing but patient remains very weak. She is with her physician. Make-Up Clinic Day 3 MS - Swift River Assignment: Make-up Day 3 Swift His wife tells the nurse that he seemed very distant and did not want to talk much. What is the ratio of Fe\mathrm{Fe}Fe (II) atoms to Fe(III) atoms in this compound? Educate caller regarding HIPAA Ramona Stukes, 69 yr-old, third day post-op cholecystectomy. She is having some difficulty breathing. You are about to call the Surgical ICU and give report. 45 terms. Evaluate learning Scenario 4 Elevate Extremity Impaired Comfort True Chronic pain: True He was initially sedated with versed 2mg, and Fentanyl 100 mg by the EGD nurse, but the patient was not tolerating the procedure, so anesthesia was called to administer propofol. Acute Confusion True 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! The nurse observes an elderly lady who is crying and has not been taken care of yet. Fall, Risk for True Contact dietary consult Blood-tinged mucous, productive cough. Due to this, the provider would like him to stay in the hospital for observation. r/o Tuberculosis. Bleeding, Risk for False It was diagnosed by a portable X-ray and quickly splinted by the ER staff. Grieving: False Reorient Patient to person, place, & time -Begin q15 minute neuro checks Assess for bowel sounds Scenario 1 Senario 2 Scenario 1 Scenario 3 Acute Pain: True Document results Three hours later, Ms. Getts is unsteady when standing by her bedside. Educate patient regarding patient care Excess Fluid Volume, Risk for False Medical Surgical Flashcards | Quizlet Swift River Medical-Surgical. You are concerned about preventing the patient from falling. You correctly diagnosed 11 out of 16 options. Sa fortune s lve 1 900,00 euros mensuels
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