He requests no visitors at this time, but later asks for his family to be called to discuss a plan of care. He states, "This is not serious." 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. -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. Document teaching moment. Bowel sounds: Active, Hyperactive, Hypoactive, Absent (listen for full 5 minutes) Sleep Deprivation False. Scenario 2 Educate patient Provide comfort in pre-surgical room Mr. Dominec. Deficient Knowledge True Sleep Deprivation False You call his doctor to inform him the family has arrived. Sensorium: Normal acuity, Bleeding, risk for: False Insertion site: Dry/Intact Redness Tenderness/Pain Warmth Coolness Swelling Drainage Notify charge nurse that discharge will probably not occur today. Observe closely first hour Evaluate understanding Pain Level Increased acuity Educational Needs Increased acuity Mrs. Stukes is a failed laparoscopic cholecystectomy that resulted in a bowel resection with a temporary ileostomy in place. You determine to apply the restraint now. Mr. Richardson is now pain free and questioning why he is plagued with recurring urinary stones. He has not had his BP medication today. Document results and findings If patient statement differs from the surgical consent she has signed, notify surgeon immediately Sarah Getts Outline an experimental approach to demonstrate the average RNA chain growth rate during transcription of a cloned gene in vitro. Increased fall risk. Self-Care Deficit False Wash and glove hands Encourage fluids LOC Increased acuity Dr. Altace, Educational Needs Increased acuity Urine Color: Clarity: Odor: Your responsibilities are: Scenario 1 Evaluate understanding IV maintenance fluids with D5 1/2 NS with 20 KCL @ 125ml/hr in left forearm. Two hours later, Mr. Duncan is asked how frequent his stools have been today. He warns the patient that if he does not comply with the treatment and preventive measures, he will need other treatments that may include. An abc-phase-sequence three-phase balanced wye-connected source supplies power to a balanced wye-connected load. Scenario 1 Scenario 1 Acute Confusion True Lithia Monson, 93 years old, c/o head injury, r/o subdural hematoma. Mr. Gonzalez has been admitted to the floor to determine that his chest pain is not related to a cardiac event. Chronic Pain True Skin warm and pale. Psychological Needs Normal acuity Powerlessness True. Document results and findings Acute Confusion: True Senario 1 Mr. Duncan is now complaining of feeling "dizzy" when he stands. Neuro WNL alert and cooperative. Place patient on PCA pump They were also concerned about the next patient going into that room and the use of the lavatory. Scenario 3 Health Change Increased acuity You now arrive in the recovery unit one hour post-surgery and you are told that the surgery went well. Abnormal left leg weakness, gait unsteady, 5/10 on numeric pain scale. Decisional Conflict False Scenario 1 Safety Fall, Risk for True Pupils PERRLA, eyes clear. Home; Our Focus; Our Legacy; Our Partners; Our People; Our Fellows; Our Investments Senario 4 Scenario 2 Pain affecting: N/A Sleep Activity Exercise Relationships Appetite Concentration Mr. Mancia is holding Catholic Rosary in hand and is crying as you enter the room. -Ensure there is suction in the room, and check 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. -Reassess patient Scenario 2 Upon entering room, you find Mr. Sturgess is quiet, appears tense and rigid but states, "I am feeling fine." I need to be reporting!" Deficient Knowledge True She has received a dose of Hydrocodone for PRN pain 20 minutes ago. -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 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. Document findings/results, Ann Rails, 38 years old, c/o back pain, non-significant past medical history. Robert Sturgess Scenario 1 Mr. Sturgess is recently diagnosed with metastatic cancer of colon and he and his family have chosen only palliative care. Scenario 3 The patient is asking you where her son is, the last place she saw him was right before the explosion. Identify patient 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. Offer assistance Now, third day post-op, Mrs. Stukes appears sad and depressed upon entering the room. Mr. Duncan's wife meets you in hall asking what she could bring her husband to eat from home. Stoma: N/A Colostomy Ileostomy Effluent Consistency: Deficient Diversional Activity False Acute pain: True Educate patient Tibial: _____ + Bilateral Other: ______________ Generalized: Pedal: ______ + Bilateral Other: ____________ Sacrum: Non-pitting Pitting ___ +. Breath Sounds: Clear bilaterally. Scenario 2 Self-Actualization Obtain vital signs machine -Explain procedure to the patient Perform circulatory evaluation Failure to Thrive True. Scenario 3 Kathy Gestalt Use therapeutic communication/Active Listening Senario 3 The patient describes this pain as a heavy pressure with intermittent stabbing. Scenario 4 Assume role in response team of documenter Psychological Needs Increased acuity Safety Vital re-assessment Allergic to sulfa drugs. Regardez le Salaire Mensuel de Ticketmaster Beyonce Koln en temps rel. All our products can be personalised to the highest standards to carry your message or logo. Ineffective Coping False You arrive in room to find Ms. Monson talking to herself. 156 terms. Upon assessment, you determined that she is confused to person, time, and place but is easily directable. Use therapeutic communication/active listening -Document and contact nursing supervisor/Charge nurse Temp 98, BP 114/67, P 115, RR 20, SaO2 98%. Mr. Richardson is requesting assistance to ambulate to bathroom. Provide for physical and thermal comfort. Viola Cumble -Explain to Mr. Greer that it may take several days for healing, and he may have temporary incontinence, but it will resolve over time. Cardiovascular Assessment No Known allergies (NKA). Mr. Sturgess is recently dx w/ metastatic cancer of colon and he and his family have chosen only Impaired Skin Integrity, Risk for False Self-Care Deficit: True Start secondary large bore IV line -Reapply the NC that he was admitted with at 2L Noncompliance: False -Assess patient LOC, by walking patient and asking them to take deep breaths. List the nursing care order. Demerol 25mg SIVP for pain, patient reports 7/10 on pain scale. Peripheral Neurovascular Dysfunction: False 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. You arrive in room to check on her, after washing hands. No Known allergies (NKA). Family in room with patient very concerned. Iron forms a sulfide with the approximate formula Fe7S8\mathrm{Fe}_7 \mathrm{~S}_8Fe7S8. Some hair on the left side of his head has been burned off, as well. 3Check surgical consent for correct procedure and make sure operative site is marked. Scenario 4 Love and Belonging Dr. Brown, Educational Needs Increased acuity Your notice Mr. Thomason is lying supine, appears slightly cyanotic in his lips, is exhibiting more effort to breathe, and is increasingly restless. Your response to all of them would be: Scenario 1 Document results Infection, Risk for True Scenario 5 Scenario 1 The provider explains that it is a pre-cancerous stage in where the cell develops abnormal features. Diet as tolerated, up ad lib after gait training. Skin warm and dry, all vital signs in WNL except 115 pulse, which is normal for him. Why is cysteine such an important amino acid for defining the tertiary structure of some proteins? Scenario 2 Remind physician to wash his hands before examining the patient Senario 5 Impaired Mobility True Non-significant past medical Hx. Check surgical consent for correct procedure and make sure operative site in marked. Blood, Glucose 185, 4 units of insulin sliding scale for coverage. Full assessment including both lying/standing Scenario 5 Replace oxygen nasal cannula that had become disconnected -Complete secondary assessment once the patient is in bed focusing on complaint of pain resulting from the fall Inform patient about the progression and risk a PCP infection has for a patient with AIDS. Psychological Needs Increased acuity Notify doctor His CP is 7/10 and his BP is 165/96, P 92, R 18, SaO2 98 on 2L NC. Document results and findings Document results/findings Then the bus splashed into the river for a cruise. 20 ga. Hep-Lock in right forearm, skin warm and dry, generalized weakness with recent weight loss. Scenario 5 It is determined that Mr. Sturgess could achieve better pain control with a PCA pump. Health Change Increased acuity Refer call to contact health department Continent: Yes No Occasional Incontinence Frequent Incontinence Brief LOC Normal acuity Neuro WNL, alert, and cooperative. Robert Sturgess Robert Sturgess 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. Upon entering the room, you find Ms. Rails sleeping. 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 After 24 hours, Ms. Gestalt fever and chills have subsided but now states she is feeling like her cast is too tight. Ms. Rails was medicated with hydrocodone 5 mg PO two hours ago and is now complaining of pain (8/10 pain scale). Communication/Speech: Clear Non-verbal Slurred Aphasia Other Scenario 3 -Assess for fall risk Dr. Anderson, Educational Needs Increased acuity His difficulty voiding finally motivated him to seek care. Respiratory Rhythm: Regular Rhythmic Irregular Periods of Apnea Cheyne-Stokes 2Provide comfort in pre-surgical room Mr. Dominec. Full assessment Mrs. Pittmon states she has had numbness for years but "now I can't . Validate NPO Status Deficient knowledge: True Scenario 1 Aggravating Factors: 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 . 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! Acquire daily weight and food intake You question her while reviewing her operative consent and determine that everything is correct. -Transport Mr. Burgundy to his room No response = 1, Range of Motion: Full, Limited The nurse identifies self to the nurse triaging patients and is directed to trauma room 4. Scenario 4 The client is onDemerol 25mgSlow Intravenous Push (SIVP) for pain. He has a 20-year one pack history of smoking. Regardez le Salaire Mensuel de Ubah Kalimat Efektif Online en temps rel. Full assessment -Medicate for pain Safety Deficient Knowledge False Vital signs -Temp 98.4,BP 178/105, P 112, RR 28, SaO2 94%; Neuro- WNL's. -Reorient Patient to person, place, & time Deficient Knowledge False 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. Attempt to orient to person, place, and time Impaired Gas Exchange True Constipation False 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. Scenario 3 His coughing, to clear his airway, appears ineffective. Continent: Yes No Brief/Diaper Impaired Mobility, Risk for True Safety Notify housekeeping. Ineffective Airway Clearance True The MD on site makes the decision to intubate the patient and start ventilatory assistance and move the patient to Respiratory Intensive Care. Vital signs -Temp 98.4, BP 116/76, P 96, RR 20, SaO2 99%. Scenario 3 No known allergies (NKA). Fall, risk for True Verbal response Oriented converses = 5 Airborne Isolation. Remain with patient Request time she can arrive and staff to help with transfer Nausea False -Perform neuro assess He also has a history of hypertension and takes Tenormin (Atenolol) and Atorvastatin (Lipitor). Safety- Readiness for Self-Care Enhancement True Document results, Care of the Patient with a Cardiovascular or, NCLEX - Care of Patient with an Immune Disord, Quiz: Chapter 54, Care of the Patient with an, Chapter 54: Care of the Patient with an Immun, Chapter 17, Section 5; Providing First Aid fo. Noncompliance False Scenario 3 Listen to patient concerns The charge nurse tells you to get the Mr. Burgundy to the hallway because six more patients are inbound, and we need to clear out our trauma-bays. Combien gagne t il d argent ? Constipation, Risk for True Skin integrity, impaired True GI WNL. Pain Level Increased acuity Pain Level Increased acuity Educate about recovery from appendectomy and care to wound. Chronic Sorrow False Wash and glove hands Isolative, appears fearful, crying, and refusing to see her husband. Evaluate/Modify Mobility Plan, Carlos Mancia, 48yr-old, Spanish speaking migrant worker with no known past medical Hx. Ms. Monson has been in restraints for the past two hours with a nursing assistant remaining with her. Color:__________ Apply restraint Arthur Thomason -Reassure patient that he will be moved to a private room as soon as possible ADA diet, intake, 25%. You explain that his condition has worsened and now he has been taken to ICU. Kathy Gestalt, 33yr-old, Dx- second day post-op open right Tibia/Fibula fracture, plaster cast in place on right lower leg. Odor: __________, No Scenario 3 They would also like to start Radium-223. Scenario 4 Scenario 2 -Reinforce to the patient to not get out of bed Vital sign assessments He is restless with slight confusion but is easily orientated with attempts from nurse. Check PRN pain order Educate patient Palliative care. Evaluation patient after consult Employ therapeutic communication: present reality Remain with Patient, Sarah Getts, 77 yr-old, Dx- Chronic Renal Failure, admitted with hyperkalemia (5.9, Eq/L)/hyponatremia (128mEq/L). DSD (dry sterile dressing), forehead laceration clean and dry intact. Respirations Excess Fluid Volume, Risk for False -Provide a diversional activity to pass the time while waiting on the HCP and inform wife that the HCP will be coming soon Document results and findings Robert Domenic What order are you providing the information to the receiving nurse? Scenario 5 After two hours, Mr. Dominec is alert and cooperative, nauseated and concerned about impending surgery this evening. Scenario 3 The oncologist is recommending Docetaxel as opposed to an orchiectomy. Esteem After leaving the room the provider tells the nurse that he hopes that he scared him into compliance with the treatment options. Wash and glove hands Mr. Dominec decides he does not want to see Infectious Disease doctor about his new cough. Biopsies were sent to determine the treatment. Full head to toe neuro assessment. Wash and glove hands Pain Level Normal acuity Scenario 3 Hx of dementia, from nursing home, fall one day ago. Health Change Increased acuity IV fluids of D5 1/2 NS are infusing at 100 mL/hour to his right forearm. Senario 4 Palliative care. The surgeon has suggested Androgen-deprivation therapy (ADT) with surgical castration (orchiectomy). Scenario 3 Scenario 1 Scenario 1 Renal diet. Scenario 4 Grieving: False Notify doctor and charge nurse Notify lead nurse/doctor You are told that he has intermittent chest pain with substernal burning that radiates to his mid-back. Offer nutrition and/ or toileting LOC Normal acuity Record intake and output You are now preparing for discharge, place steps in order: Senario 1 -Remove the lunch tray and ensure pre-operative consent has been signed. Urination: WNL Burning Frequency Urgency Allow for non-compliance of request Skin warm and dry, daily dressing changes, T-tube without drainage. Wash and glove hands No known allergies (NKA). Deficient Fluid Volume True Scenario 3 Oriented to: Person Place Time Document results He does not want to return to the nursing home, and does not wish to burden or live with his children. Nursing questions and answers. Discuss his understanding about the plan of care. Roger Clinton, 57-year-old male construction worker arrives at 0600 to be prepared for a partial thyroidectomy to determine if he has cancer. -Notify charge nurse of patient's deteriorating condition Document results. Notify lead nurse/doctor She shares concern about patient's wife who is now coughing and having night sweats. Administer protocol antidiarrheal medication Mr. Dominec has a male partner and has been married for the past ten years and share their three children to the marriage. Wound site clean, dry and intact NPO, NG-tube to low continuous suction. She is also investigating bone marrow transplantation. You escort them with you to the ICU. His left humerus is fractured and splinted. Health Change Increased acuity Request sitter/family member to bedside Scenario 4 The patient is awake, alert, and oriented. Describe the physical changes from aging and the care required. Robert Sturgess, 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. This information is HIPAA protected and you cannot share anything with them. -Complete incident report. Mr. Gonzales H/H is 12.7/38. 3. Decisional Conflict True Fall Risk Increased acuity Demerol 25mg SIVP for pain, patient reports 7/10 on pain scale. Document conversation The patient is awake alert and oriented. Patient, and family upset regarding dx. -Assess patient's ABC (airway, breathing, circulation) 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. -Reassess patient q 5 minutes until awake, then 15 minutes until they are fully awake (not Drowsy). -Remove the dinner tray and make sure the diet is soft food. Auscultate peripheral pulses and ROM. Notify lead nurse/doctor Social Isolation, Risk for True Amount: _______ Continue.Robert Sturgess Room 305 Robert Sturgess, 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. Social worker with patient this morning. Imbalanced Fluid Volume, Risk for True Vital signs -Temp 98.8, BP 102/76, P 102- irregular, RR 22, SaO2 90%, cardiovascular on telemetry with Sinus irregular rhythm.