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Assign nursing diagnosis and plan the appropriate intervention and evaluate outcomes while working through time pressure and distractions, including random call light requests. Assess Tibial: _____ + Bilateral Other: ______________ Generalized: Pedal: ______ + Bilateral Other: ____________ Sacrum: Non-pitting Pitting ___ +. Fall Risk Increased acuity Obtain recent chest X-ray reports and recent ABG's for physician to review Acquire daily weight and food intake Type of Line: Peripheral, location ______________ CVL, location _____________ PICC, location _______________ Spiritual Distress False. Scenario 2 1Perform full assessment and provide anti-nausea medicine. Impaired Home Maintenance management r/t client or family False Combien gagne t il d argent ? Document and prepare to transfer to Surgical ICU Administer new pain medz Scenario 1 All our products can be personalised to the highest standards to carry your message or logo. Primary: Check LOC, Orientation, Breathing, Circulation, Brief Neuro assessment to include spinal pain or deformities, Obvious injuries. All opinions are mine alone. Disturbed Sensory Perception True Peripheral Neurovascular Dysfunction False. Read PT report Impaired comfort: True You have them remain with you, seated in comfortable place, while you call ICU and attempt to locate physician for them. Educational needs: Increased acuity -Ask Mr. Burgundy to lower his tone as it can be disturbing to other patients Infection, Risk for True Upon assessment, you determined that she is confused to person, time, and place but is easily directable. Robert Sturgess Scenario 1 Mr. Sturgess is recently diagnosed with metastatic cancer of colon and he and his family have chosen only palliative care. Full assessment Skin warm and dry, daily dressing changes, T-tube without drainage. 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. Notify Physical Therapy (PT) Notify lead nurse Obtain translator Safety Scenario 2 Therapeutic Communication You are told that he has intermittent chest pain with substernal burning that radiates to his mid-back. Provide comfort and pain measures No known allergies (NKA). Visual assessment Obtain Spanish signs & brochure Non-significant past medical history. BP 154/89, P 94 F, R 22, T 98.3F, SaO2 95% on room air. Construct dietary consult (plan) Nausea False Her pitcher has already been filled three times this shift. Scenario 3 She has arrived in pre-op and about to have surgery this morning. Full assessment of patient. Notify doctor Blood Glucose 185, 4 units of insulin sliding scale for coverage. Bladder distention Pelvic pain Low back/flank pain DSD (dry sterile dressing), forehead laceration clean and dry intact. Provide comfort in pre-surgical room Mr. Dominec. Upon assessment, you determined that she is confused to person, time, and place but is easily directable. Scenario 5 Full assessment including both lying/standing Dr. Donofrio, Physiological Upon entering the room, you find Mr. Sturgess is quiet, appears tense and rigid but states, Toileting, Medications List/Times of Medications/Routes of medication, Neurological Assessment Scenario 3 Electrolyte Imbalance True Scenario 5 -Complete full assessment, to include neuro Observe closely first hour He is excited and tells the nurse he is starving and glad that he finally gets to eat. He is a local TV news reporter that was filming an event at the county fair when there was an explosion. Students will prioritize medical surgical . His difficulty voiding finally motivated him to seek care. Virginia Smith Today's weight 226. NKDA Assessment The client vital signs are: Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%, Neuro WNL alert and cooperative. Scenario #3. Where is my camera man!! -Check on patient/sitter hourly IV Assessment/ N/A Elevate head of bed Powerlessness: True, Scenario 1 Recent chest X-ray shows diffuse bilateral interstitial infiltrates in all lobes. You arrive in room to find Ms. Monson talking to herself. You call his doctor to inform him the family has arrived. Inform and educate spouse of dietary orders Don Personal Protective Equipment 1. Place pt on PCA pump Explain to her family and provide contact information. Pain Level Increased acuity Chronic Confusion False -Explain to patient why his throat may be sore Scenario 4 Mr. Mancia is holding Catholic Rosary in hand and is crying as you enter the room. Scenario 3 ExplanationAnxiety/ fear True He requests no visitors at this time, but later asks for his family to be called to discuss a plan of care. 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. Mr. Greer has just been visited by his wife. Skin: Warm/dry Clammy/diaphoretic Skin Turgor: Brisk Tenting ADA diet, intake 25%. Safety -Advise patient not to get up and walk on his own Fall, Risk for True Scenario 3 Recently he manifested an unusual black lesion on his thigh and developed an opportunistic fungal mouth infection which was treated successfully. 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. Safety Scenario 5 -Start IV No Known allergies (NKA). He insists that he is not hungry and refuses assistance with his meal. Listen to patient concerns She shares concern about patient's wife who is now coughing and having night sweats. Document results and findings Encourage Mr. Dominec to discuss with his partner his best treatment options. Remain with patient Heterotrophs include (1) autotrophs, saprophytes, and herbivores (2) omnivores, carnivores, and autotrophs (3) saprophytes, herbivores, and carnivores (4) herbivores, autotrophs, and omnivores. Aggravating Factors: Then the bus splashed into the river for a cruise. What order are you providing the information to the receiving nurse? Scenario 4 -Call security for assistance and compliance officer -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 Fall, Risk for True The ER nurse reports that his cardiac enzymes were borderline, (Troponin?, CK/CKMB?) Apply oxygen Impaired comfort: True Scenario 4 Pain Level Increased acuity Mrs. Pittmon states she has had numbness for years but "now I can't . Comfort/Pain Assessment Mr. Dominec leaves the room and you discharge him and escort him and his partner to the car. Document Results, Robert Sturgess, 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. Deficient knowledge: True He asks to speak to a clergy member. Disturbed Sensory Perception False He is emotionally distraught and is insisting that he be allowed to report what is going on from the ER. Fall, Risk for True Acute pain: False Safety- Acute Confusion False Fall, risk for: True Re-assess patient 3. What is the ratio of Fe\mathrm{Fe}Fe (II) atoms to Fe(III) atoms in this compound? He has partial thickness burns to his left arm and the left side of his face. Discuss follow up with his doctor. Breath Sounds: Clear bilaterally. Acute Pain True Scenario 3 Cardiovascular Assessment Spanish interpreter available at extension 61178. Mr. Richardson is requesting assistance to ambulate to bathroom. Re-assess patient -Explain that Radium-223 mimics calcium and is absorbed during new bone growth. PT to educate patient The MD on site makes the decision to intubate the patient and start ventilatory assistance and move the patient to Respiratory Intensive Care. Educational Needs Increased acuity -Perform admission assessment Tubes: None Salem Sump Nasoduodenal PEG J-Tube pH: ______ Outline an experimental approach to demonstrate the average RNA chain growth rate during transcription of a cloned gene in vitro. Mr. Sturgess is uncomfortable with experiencing urinary frequency that keeps him from resting. Scenario 3 Urination: WNL Burning Frequency Urgency Notify doctor -Recheck Tilts after the NS bolus is complete.T 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. Love and belonging Sleep Deprivation False. -Ensure there is suction in the room, and check Mr. Wright is pleasant and cooperative, but needs to be reminded to avoid pressure on his heel and sacrum. Vital signs -Temp 98.4, BP 116/76, P 96, RR 20, SaO2 99%. Diet as tolerated. Ineffective breathing pattern False Scenario 1 Stay with patient for surgeon's arrival to explain intended surgical procedure Impaired mobility: False -Complete head-to-toe assessment while patient is on the floor. Assess for bowel sounds 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 5 The lesion was identified as Kaposi's Sarcoma. Abdomen: Flat Rounded Scaphoid Distended Palpation: Soft Taut Rigid IV D5 1/2 NS @150ml/hr. 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. -Administer the medication with a small sip of water and place an NPO sign at the entrance of the patient's room. Students will assign correct nursing diagnosis for patients in a medical surgical virtual clinical environment. Ineffective Airway Clearance True Pain Scale: 0 to 10: _______________ In the interim, start an IV and start infusing Ringers Lactate. Impaired skin integrity: False, Anxiety: True Scenario 1 Increased fall risk. She has been documented as being obese, new onset. Your coworkers are asking you questions about Mr. Dominec. Impaired Skin Integrity, Risk for False -Place patient on 100% O2 156 terms. Anxiety False -Restart the IV and draw CBC Dr. Anderson, Educational Needs Increased acuity The surgeon has suggested Androgen-deprivation therapy (ADT) with surgical castration (orchiectomy). Nutrition True Check pedal capillary refill Demerol 25mg SIVP for pain, patient reports 7/10 on pain scale. Carlos Mancia Check monitor Pupils: PERRLA Size: R: mm L: _mm Unequal Sluggish Non-reactive Senario 2 Scenario 3 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. Attempt to orient to person, place, and time Non-significant past medical history. Love and belonging- Check PRN pain order Sensorium: Normal acuity, Bleeding, risk for: False Linen Change Scenario 1 Paul Greer Mr. Dominec has a male partner and has been married for the past ten years and share their three children to the marriage. Dr. Levine, Marcella Como, 38 yr-old, Sexual Trauma Victim (Rape), unknown assailant. Scenario 4 Impaired Skin Integrity, Risk for False Perform full assessment and provide anti-nausea medicine. Her husband who is present states, "I thought it was just a lumpectomy she was having this morning." -Complete initial post-op assessment Arthur Thomason, 56-year-old MVA victim, fourth day post op with a splenectomy and femur repair. Scenario 3 Adjust crutches -Elevate head of bed and place the patient on Pulse oximetry. Impaired Mobility False His past symptoms for three months have been that he noticed a slight hoarseness in speaking, a slight dry cough not related to a cold, and upon examination had a "pea-size lump on the center of his neck". They were also concerned about the next patient going into that room and the use of the lavatory. Mrs. Stukes is a failed laparoscopic cholecystectomy that resulted in a bowel resection with a temporary ileostomy in place. Scenario 2 Scenario 4 Evaluate outcome of dietary plan -Assess patient's ABC (airway, breathing, circulation) Allow family to remain Bleeding False Chronic Pain True Full assessment Scenario 2 Dr. Jones. 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 . Grieving: False Scenario 4 The nurse was told by the gastroenterology nurse that they really struggled before they called anesthesia and they may have caused an esophageal abrasion. He chooses to go home and see the doctor tomorrow in his office. Obtain translatorT Scenario 5 Stoma: N/A Colostomy Ileostomy Effluent Consistency: Report to charge nurse/ head nurse the need for staff education. Scenario 3 -Reassess patient The pain makes him short of breath. -Explain to Mr. Greer that it may take several days for healing, and he may have temporary incontinence, but it will resolve over time. Peripheral Neurovascular Dysfunction False Vital Assessment Verify call light/bed safety precautions Document results She is with her physician. Amount: _______ Skin integrity at risk True Scenario 3 Apply nasal cannula Document pt's statements. Neuro WNL alert and cooperative. Educate patient regarding condition Scenario 4 palliative care. Abnormal left leg weakness, gait unsteady, 5/10 on numeric pain scale. He does not have an IV nor is he on oxygen. No known allergies (NKA). You observe Ms. Getts being assisted by another nurse who is being blatantly rude and disrespectful to her. He is experiencing new onset of shortness of breath and has a nasal cannula with 2L of Oxygen in place. Ms. Getts is now complaining of sudden sharp, substernal chest pain, very short of breath and is profusely diaphoretic. 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) -Medicate for pain Skin warm and dry, all vital signs in WNL except 115 pulse, which is normal for him. No known allergies (NKA). Wash and glove hands Students will form a preliminary assessment based on reported assessment data for medical surgical patients in a virtual clinical environment. Scenario 2 Encourage fluids and fiber diet Strict I&O, regular diet, intake 50%. 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. 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. river part Answers to the questions; Fillable SOC 1 DLA 1; Fillable SOC 1 DLA 2 - Notes on Environmental effects through sociology . Scenario 4 Monitor and evaluate fluid intake Electrolyte Imbalance, Risk for True Scenario 5 Scenario 2 IV maintenance fluids with D5 1/2 NS at 125ml per hour in left forearm. Sarah Getts Love and Belonging Assume role in response team of documenter Pain: No Yes: Location: ______________________ Acute Chronic Constant Intermittent Clear liquid diet. Remain with patient Scenario 5 Shock, Risk for False Rapid Response team arrived including anesthesia. Robert Sturgess 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. This will treat any cancer that may have metastasized to the bone. Mr. Duncan's wife meets you in hall asking what she could bring her husband to eat from home. Patient and family upset regarding dx. Explain reason for assessment and procedure Deficient Knowledge False Stat lithotripsy treatment ordered. Health Change: Increased acuity Safety- Deficient Fluid Volume True Therapeutic communicationT Upon entering room, you wash/glove hands. The heartburn has become worse since he started treatment for his URI. Scenario 5 Three hours later, Ms. Getts is unsteady when standing by her bedside. Report this activity immediately to the hospital privacy officer Pain Level Normal acuity Apply restraint Report current urinary output quantify per hour and color of urine Psychological Needs Normal acuity Psychological Needs Increased acuity Bed Bath: Assist or Total 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. Dx- urinary stones with 3 episodes/5yrs. John Duncan, 56yr-old male, Dx- Gastroenteritis, returned yesterday from Cancun, c/o intractable diarrhea, weak, pale, and refusing to eat. Scenario 3 Notify lead nurse/doctor Assess food consumption and intake and output Pain Level Increased acuity The patient describes this pain as a heavy pressure with intermittent stabbing. -Reassure patient that he will be moved to a private room as soon as possible Cross), Chemistry: The Central Science (Theodore E. Brown; H. Eugene H LeMay; Bruce E. 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Neuro WNL, except leg pain upon movement. Disturbed Body Image True Senario 4 Anterior: ___________________________________ Posterior: ____________________________________ -Continue to observe urine for hematuria and document findings Scenario 4 Impaired Urinary Elimination True Wash and glove hands Scenario 4 DSD (dry sterile dressing), forehead laceration clean and dry intact. Wound site clean, dry and intact NPO, NG-tube to low continuous suction. Use therapeutic communication/Active Listening 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 Deficient Diversional Activity False Deficient knowledge: True Ann Rails Offer assistance in providing more information about treatment options for newly diagnosed AIDS patients. Scenario 2 -Reassess patient's physical status prior to leaving him in the hallway Senario 2 Scenario 5 Description: Sharp Stabbing Throbbing Aching Cramping Other: -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 -Perform neuro assess Senario 3 -Ensure there is a full O2 tank on the gurney, place patient on Nasal Cannula Educate patient Deficient Fluid Volume False No response = 1, Muscle Strength: WNL, Flaccid, Contracted Robert Domenic Full assessment Senario 4 Wash and glove hands RLE: ______________ LLE: _____________ -Provide a diversional activity to pass the time while waiting on the HCP and inform wife that the HCP will be coming soon Emergency intubation and assisted breathing is provided for Mr. Thomason Compromised Family Coping: False Scenario 1 Sensorium Normal acuity, Physiological Scenario 3 Odor: __________, *Types: Abrasion, Burn, Laceration, Puncture, Surgical, Pressure Ulcer, Vascular Ulcer, Maceration, Excoriation, Skin Ineffective Peripheral Tissue Perfusion False An abc-phase-sequence three-phase balanced wye-connected source supplies power to a balanced wye-connected load. Hopelessness: True Iron forms a sulfide with the approximate formula Fe7S8\mathrm{Fe}_7 \mathrm{~S}_8Fe7S8. Use therapeutic communication/Active Listening Water/Flush: Combien gagne t il d argent ? Insertion site: Dry/Intact Redness Tenderness/Pain Warmth Coolness Swelling Drainage Color:__________ Assist physician in physical exam of patient Temperature is 98.3, HR is 87, RR is16, BP is 121/74, PaO2 is 98%. Senario 3 Waist belt restraint PRN; family sitter at bedside, assist with bath. Imbalance nutrition: True Fall Risk: Increased acuity Airborne Isolation. You arrive in room to check on her, after washing hands. He also complains that his throat is still very sore. Peripheral Neurovascular Dysfunction: False Home; Our Focus; Our Legacy; Our Partners; Our People; Our Fellows; Our Investments Provide emotional support. Sa fortune s lve 1 900,00 euros mensuels Safety In reassessing Ms. Monson, her vital signs are: BP -106/82, Temp-98.2, P-106, RR-18, SaO2-88. Self-Care Deficit True Contact dietary consult Needs frequent reminding due to determination to do things herself without assistance. Gastrointestinal Assessment Scenario 3 Ineffective Coping False Bleeding: True Bleeding, Risk for True Assist patient out of bed Oral Care Senario 2 Use therapeutic communication/Active Listening Document teaching moment. Scenario 1 Self-Care Deficit: True 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. Encourage to ambulate with assistance to void if needed Excess Fluid Volume, Risk for False Suprapubic Insertion site: WNL S/S Infection : ____________________ Education of Foley Cath Procedure Obtain vital signs machine Senario 5 She has received a dose of Hydrocodone for PRN pain 20 minutes ago. Mr. Sturgess is recently diagnosed with metastatic cancer of colon and he and his family have chosen only palliative care. 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No response = 1, Range of Motion: Full, Limited Tunneled, site _______________ Implanted port, accessed _____________________ Anxiety True His partner is at the bedside asking, "how much longer will he have to wait until taken to surgery?"