Acute Pain True Abdominal Pain: Non-tender Tender/Pain Describe: Document findings Scenario 3 Love and belonging- Combien gagne t il d argent ? Bowel Movement Total: x________________, Hygiene Times Your Swift River Virtual Clinicals account has been linked to your ATI Student account. Fear True Hopelessness True Use therapeutic communication/Active Listening Activity as tolerated with assistance. Shock False Palliative care. -Provide the patient with the time when HCP will come discuss options with him Some hair on the left side of his head has been burned off, as well. Notify housekeeping. Vital signs taken by automatic B/P Cuff q 15 minutes Scenario 5 Upon assessment, you determined that she is confused to person, time, and place but is easily directable. Assume role in response team of documenter Mr. Gonzalez has returned from his EGD and is still sleeping from the sedation. Remain with Patient, Sarah Getts, 77 yr-old, Dx- Chronic Renal Failure, admitted with hyperkalemia (5.9, Eq/L)/hyponatremia (128mEq/L). Outline an experimental approach to demonstrate the average RNA chain growth rate during transcription of a cloned gene in vitro. Scenario 4 Peripheral Neurovascular Dysfunction False Grieving: True Allow family to remain The patient has sustained an injury to her head, that is bandaged, and is bleeding from a wound to her right arm and chest area. Nausea False IV fluids of D5 1/2 NS are infusing at 100 mL/hour to his right forearm. Notify family Pain Level Increased acuity Noncompliance: False Ann Rails Assist patient out of bed Full assessment Offer assistance in providing more information about treatment options for newly diagnosed AIDS patients. Vital signs -Temp 97.2, BP 96/74, P 82, RR 20, SaO2 97%. Identify patient Wash and glove hands Where is my camera man!! Sa fortune s lve 1 900,00 euros mensuels Impaired Home Maintenance management r/t client or family False Powerlessness: True, Scenario 1 Educate patient/family Noncompliance True He chooses to go home and see the doctor tomorrow in his office. 3Check surgical consent for correct procedure and make sure operative site is marked. 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. Sensorium Normal acuity, Physiological You are now preparing for discharge, place steps in order: Senario 1 Patient demonstrates urine strain procedure. The patient asks the nurse to explain about these medications and why they are in such a hurry. Imbalanced Nutrition False No weight bearing today. Reapply restraints Family at beside. You are the now the Surgical ICU nurse assigned to her. RUE: ______________ LUE: _____________ Seek clarification Your notice Mr. Thomason is lying supine, appears slightly cyanotic in his lips, is exhibiting more effort to breathe, and is increasingly restless. Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. Scenario 1 Senario 4 Tom Richardson Patients vital signs are BP: 100/58, P: 106, R: 28, PaO2: 92%, T: 97.1 F, 36.2 C. I need to be reporting!" Ms. Gestalt is now complaining of fever and chills. Scenario 2 Safety Mr. Richardson is now pain free and questioning why he is plagued with recurring urinary stones. Scenario 2 Senario 4 He is currently febrile with temperature 100.8, HR 99, BP 135/96, RR 20, PaO2 96%, nauseated with no vomiting, rebound tenderness in right lower quadrant, has elevated WBC's and surgeon feels this will be uneventful even though he has just been diagnosed with AIDS this past week. Incomprehensible He has been ruled out for an MI. Disturbed body False Acute pain: True Bladder distention Pelvic pain Low back/flank pain 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. Educate patient The cells are allowed to warm up and then are frozen again. Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. Contact dietary consult Document and prepare to transfer to Surgical ICU RLE: ______________ LLE: _____________ Acute Pain True Give verbal report His wife tells the nurse that he seemed very distant and did not want to talk much. Document and provide copy for Mr. Dominec to share with his follow up appointment tomorrow. Fall, Risk for True Place pt on PCA pump Recent blood gases demonstrate falling PaO2 (hypoxemia) and increasing CO2 (Hypercapnia). Discription, Table 4 Cross-sectional, Longitudinal, and Sequential Developmental Designs, Engagement 1 Recognizing Research Strategies, A mental health worker with a Christian worldview.docx (Auto Recovered), NPO Breakfast: __________% Lunch ______________ %, Ethics and Social Responsibility (PHIL 1404), Care of the childrearing family (nurs420), Advanced Care of the Adult/Older Adult (N566), Business Professionals In Trai (BUSINESS 2000), Microsoft Azure Architect Technologies (AZ-303), Nurs & Healthcare I: Foundations [Lec] (NURS356), Accounting Information Systems (ACCTG 333), Bachelor of Secondary Education Major in Filipino (BSED 2000, FIL 201), Methods of Structured English Immersion for Elementary Education (ESL-440N), Professional Application in Service Learning I (LDR-461), Advanced Anatomy & Physiology for Health Professions (NUR 4904), Principles Of Environmental Science (ENV 100), Operating Systems 2 (proctored course) (CS 3307), Comparative Programming Languages (CS 4402), Business Core Capstone: An Integrated Application (D083), C228 Task 2 Cindy - Bentonville - Passed with no revisions, Lesson 4 Modern Evidence of Shifting Continents, MMC2604 Chapter 1 Notesm - Media and Culture: Mass Communication in a Digital Age, Lesson 17 Types of Lava and the Features They Form, Lesson 9 Seismic Waves; Locating Earthquakes, Analysis of meaning and relevance of History from the millennial point of view, Entrepreneurship Multiple Choice Questions, (Ybaez, Alcy B.) Safety sounds= 2 Document Results/Findings Readiness for Self-Care Enhancement True Encourage Mr. Dominec to discuss with his partner his best treatment options. -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 Bleeding Risk for: False Non-significant past medical history. When she moves him to the hallway, Mr. Burgundy begins yelling at you "Do you know who I am, I demand a room! Psychological Needs Increased acuity Impaired Home Maintenance Management False Compromised Family Coping False Notify Doctor for pain medz Wash and glove hands Health Change Increased acuity Use therapeutic communication/Active Listening Pain and numbness in legs for one week. Skin warm and dry, daily dressing changes, T-tube without drainage. Pain: No Yes: Location: ______________________ Acute Chronic Constant Intermittent He does not want to return to the nursing home, and does not wish to burden or live with his children. Assess for bowel sounds Safety Use therapeutic communication/Active Listening Scenario 2 Deficient knowledge: True Next time we'll spend our 60 on some food and nice beers. Disturbed Sensory Perception False Today's weight 226. Educate patient Neuro WNL, alert, and cooperative but worried about scarring and is reluctance regarding walking on leg. 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 No Known allergies (NKA). How was this Scenario 3 156 terms. 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. Scenario 2 Strict I&O, regular diet, intake 50%. View Swift River Reflection Questions (1).docx from NRSG 4412 at South College. Vital signs Temp 99.4, BP 106/72, P 96, RR 20, SaO2 91%. Dr. Levine, Marcella Como, 38 yr-old, Sexual Trauma Victim (Rape), unknown assailant. He has partial thickness burns to his left arm and the left side of his face. Evaluate understanding -Place patient on O2 Nasal Canula Flexes abnormally = 3 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. Escort patient to vehicle Airborne Isolation. IV maintenance fluids with D5 1/2 NS with 20 KCL @ 125ml/hr in left forearm. Safety- Fall Risk: Increased acuity No response = 1, Mobility: 1Perform full assessment and provide anti-nausea medicine. An abc-phase-sequence three-phase balanced wye-connected source supplies power to a balanced wye-connected load. Electrolyte Imbalance True 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. student name date: nur 113 assessment swift river patient: robert sturgess handoff robert sturgess, 81 years old, metastatic ca of colon, hx of diabetes. -Explain that Radium-223 mimics calcium and is absorbed during new bone growth. Sitting, BP 109/60, P 114, Standing the patient becomes very lightheaded and the nurse has them lay back down. Arthur Thomason, 56-year-old MVA victim, fourth day post op with a splenectomy and femur repair. Scenario 2 Scenario 3 It is determined that Mr. Sturgess could achieve better pain control w/ a PCA pump Educate pt regarding changes to POC Safety Suprapubic Insertion site: WNL S/S Infection : ____________________ Offer nutrition/toilet She has arrived in pre-op and about to have surgery this morning. Scenario 3 Ineffective Coping False Administer PRN constipation medications Wife at bedside. Remain with patient and reassure The charge nurse asks you to assume the patient's nursing care. -Reapply the NC that he was admitted with at 2L Constipation False Clinical 2. Esteem Discuss his understanding about the plan of care. Safety Scenario 3 Scenario 1 Remind the nursing staff that the patient is NPO. Intermittent/Continuous Other: -Reassess patients' vital signs, and place on q5 minutes continuous monitoring Neuro WNL, except leg pain upon movement. He is excited and tells the nurse he is starving and glad that he finally gets to eat. Imbalance nutrition: True Scenario 5 -Restart the IV and draw CBC -Ensure patients is positioned in bed properly Verbal response Oriented converses = 5 Wound clean dry and intact. Mr. Thomason appears now better oriented and MD arrives unexpectedly to examine him. Deficient knowledge: False Swift River Reflection Questions day 7 Answer each question thoroughly in multiple sentences. Senario 5 Wash and glove hands Seek clarification He is questioning the nurse as to why he has been admitted for heartburn. Acute Pain True Scenario 3 Skin warm and pale. Health Change Increased acuity Lithia Monson, 93 years old, c/o head injury, r/o subdural hematoma. -Continue to observe urine for hematuria and document findings Safety Senario 5 When you enter the room, the patient is having chest pain again, and they are pale and diaphoretic. Apply nasal cannula Senario 3 -Offer nutrition and/ or toileting Deficient Fluid Volume False Social worker with patient this morning. Sexuality: True. Sarah Getts Psychological Needs Normal acuity Excess Fluid Volume, Risk for False Stay with patient for surgeon's arrival to explain intended surgical procedure Anxiety True Skin cool to touch and appears pale. Scenario 3 Psychological Needs Increased acuity Cardiovascular has pacer with rate of 82bpm on demand. He has been readmitted for a red spot on his sacrum of 1 cm and a 2 cm blister on his right heel. It is unclear if he lost consciousness. Palliative care. Full assessment Document results The nurse observes an elderly lady who is crying and has not been taken care of yet. Senario 2 The surgeon has suggested Androgen-deprivation therapy (ADT) with surgical castration (orchiectomy). Scenario 2 Diet as tolerated. Deficient Knowledge True Inform his partner that everything is being done to keep him comfortable. Pain Level Normal acuity Gown and mask Scenario 4 Evaluate understanding. 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. and the GI cocktail given in the ER did relieve his CP but not completely. 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. Wash and glove hands -Reassess patient Demerol 25mg SIVP for pain, patient reports 7/10 on pain scale. Notify Physical Therapy (PT) Head/Face: Symmetric Asymmetric Drooping 50% intake. 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? Students will assign correct nursing diagnosis for patients in a medical surgical virtual clinical environment. The dinner tray is waiting for the patient in his room, and the nurse notices it is a regular diet. She shares concern about patient's wife who is now coughing and having night sweats. IV D5 1/2 NS with 20 KCL @ 125 ml/hr in left forearm. Acute Confusion: True SANE nurse to make second visit today. Mr. Gonzalez has been admitted to the floor to determine that his chest pain is not related to a cardiac event. 0800 1200 You enter room one hour after the physician has left the patient. -Reassure patient that he will be moved to a private room as soon as possible Esteem Scenario 5 Document results and findings Cryotherapy, which uses an endoscope to apply a cold liquid or gas to abnormal cells in the esophagus. Infection, Risk for True Vital assessment Because of the fall the provider has recommended that he stay in the hospital another night. IV Assessment/ N/A Pulse Ox: ___________ % on ____________FiO2; Room Air; Delivery Device Perform circulatory evaluation -Evaluate patient's understanding of teaching Her pitcher has already been filled three times this shift. Fall Risk Increased acuity Bleeding, Risk for False Notify doctor of change in condition in particular: unproductive cough and low-grade fever. Leave to break room and not continue in conversation. Regardez le Salaire Mensuel de Tthuchicago Org en temps rel. Continent: Yes No Brief/Diaper Hx of dementia, from nursing home, fall one day ago. Scenario 5 Dr. Suculo, Physiological Encourage fluids Alert and cooperative. Explain that he will probably not be going home at least until his doctor sees him. Insert Foley catheter He is emotionally distraught, and is insisting that he be allowed to report what is going on from the ED. Scenario 2 Upon entering the room with a translator to admit him to the hospital, he is asked for address and phone number but refuses to comply. Mr. Sturgess does not have a living will or durable power of care completed. Notify lead nurse/doctor Obtain patient record and follow patient as he is transferred to ICU Stoma: N/A Colostomy Ileostomy Effluent Consistency: Other: _______________________________ Fear: True Report and document results Scenario 3 Acute pain: False Vital Assessment His left humerus is fractured and splinted. Isolative, appears fearful, crying, and refusing to see her husband. Document Results, Robert Sturgess, 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. NG tube to low suction possibly D/C'd today after Dr. Levine rounds. Safety Wash and glove hands Evaluation patient after consult Deficient knowledge: True Document results and findings Hopelessness: True Provide verbal report to team members who respond to rapid response It was diagnosed by a portable X-ray and quickly splinted by the ER staff. Dr. Donofrio. Radial: ____ + Bilateral Other: _____________ RLE: Non-pitting Pitting ___ + Reassure patient of options The Swift River Nursing Simulation involves artificially representing real-world processes with sufficient fidelity to enable learning through immersion, practice, reflection, and feedback without facing the risks inherent in a similar real-life situation. Perform full assessment and provide anti-nausea medicine. -Notify charge nurse Knowledge Deficit True Generalized weakness, blood tinged urine and severe pain upon urination, GI- n/v. No response = 1, Range of Motion: Full, Limited -Complete head-to-toe assessment while patient is on the floor. Demerol 25mg SIVP for pain, patient reports 7/10 on pain scale. Arthur Thomason Apply restraint Disturbed Body True -Start an IV "I am feeling fine." Flexes & withdraws = 4 Ms. Getts is requesting water to drink. Your coworkers are asking you questions about Mr. Dominec. Vital Signs: B: 160/92, P: 96, R: 22, SpO2: 98, T: 98.9F, 37.1C. They wanted to know and pressure you for the information. -Perform admission assessment Pupils: PERRLA Size: R: mm L: _mm Unequal Sluggish Non-reactive Scenario 2 Diet as tolerated. Mr. Thomason is anxious and is obviously worsened from the shift before in overall condition. Sleep Deprivation False Demerol 25mg SIVP for pain, patient reports 7/10 on pain scale. -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 High fall risk. Safety Allergic to sulfa drugs. Scenario 3 -Notify HCP of neuro findings Evaluate caller understanding Health Change Increased acuity Scenario 5 Visual assess Continue.Robert Sturgess Room 305 Robert Sturgess, 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. r/o Tuberculosis. The nurse arrives and sees a tent is being erected as a triage area, and ambulances are lined up delivering trauma patients. Deficient Diversional Activity False