Scenario 2 Fall, risk for: True Ensure pt. Scenario #5 He states, "thiss is not serious." Contact social services Place call light and check bed for safety Upon entering the room, you find Mr. Sturgess is quiet, appears tense and rigid but states, "I am feeling fine." She presses the call light w/ questions about who her RN will be and her NG-tube. He is a patient of Dr. Adams. Explore new ways Assess for bowel Reapply NC Impaired Comfort: True Scenario 4 3 -Check the chart for the updated advance directive Allow family to remain Provide comfort Take vitals Use therapeutic Pain - normal Secure help Scenario #5 Scenario #2 Encourage incentive spirometer Full assessment Use therapeutic communication to explain necessary procedure. Obtain IV access and draw initial labs Neurological: Increased acuity Transport Mr. Burgandy Scenario 4 Attempt to restart IV Maintain strict I&O's Document -Have UAP use therapeutic communication Scenario 3 Kenny Barrett 6. Restsate or paraphrase joyce workman swift river quizlet - BridgeLight Insurance The pain was relieved post-op. Mr. Sturgess is recently dx w/ metastatic cancer of colon and he and his family have chosen only palliative care. Troponin Scenario 5 Instruct Lucy Take VS Anxiety: True Esteem- Charge the monitor to 200 J biphasic. - Anxiety allow expression of feelings Secure dressing Fall, risk for Insert F/C Scenario #5 Scenario #4 Her husband and children remain w/ her in the surgical holding area awaiting transport to the OR. Infection, risk for, Scenario #1 Scenario #2 Introduce hospital liaison, Acute pain Assist w/ intubation, Educational - increased Teach pt. Scenario #4 His HbgA1c is 10.6%. Educate Mrs. Workman Administer nausea med Virtual Clinical- Swift River Week 4. Psychological Needs: Increased acuity Encourage Inspect pleurovac Reinforce past Coptic mechanisms that have been effective Full assessment of pt The indicator HIn has an acid dissociation constant of 4.80 \times 10^ {-6} 4.80106 at ordinary temperatures. Imbalanced Nutrition: False -Inform Mr. Goodman that his girlfriend called about his status. Consult wound care Use therapeutic Initiate secondary year-old female who presents to the Diabetes Clinic with a new. - Grieving Remove clean gloves, wash hands, put on sterile gloves Robert Sturgess 4. Lubricate tip of enema She is oriented x3 but at times seems to be talking to someone in the room when no one is present. Anxiety Document Document rhythm Document The dx tests were completed and Dr. Gray has informed the pt of the dx of HF and tx w/ digoxin. -Ensure the patient is Typed and crossed and blood is available. Educate patient regarding patient care Mark drainage level Impaired mobility, risk for Review labs Call the physician Anxiety: True Educate pt regarding condition -Give an SBAR on your other patients to the nurse who is assisting you Sensorium - normal, Acute pain Pt. The nurse auscultation fine crackles in her lungs bilaterally, but her sputum is clear. Vital assessment Ask PCT Prepare and administer Wash & glove - Sensorium - normal, - Fatigue Who were you talking to? NG tube to LIS Nausea: False Document teaching Noncompliance: True, John Duncan Remind pt. Glucose regulation Provide morphine -Test patient's vision with number of fingers, objects, etc. Ask nursing manager, Acute pain Medicate w/ Demerol 100mg w/ Phenegran 25mg IM prior to dressing changes 5.) Impaired Mobility, Risk for: True View new-patients-swift-river-med-surg-covid-new-patients-charlie-raymond-john-duncan-carlos-mancia-kenny from NURSING 11B at Long Beach City College. -Check to see availability for PRN anxiolytic medication Contact HCP Psychological Needs: Normal acuity, Physiological- 10 days later, Mr. Wright's wounds are healing, and you have orders to prepare for d/c w/ home healthcare. Reassess pt's VS's and pain level Scenario #5 Notify Dr for new pain medications Notify charge RN Scenario 3 Fall Risk - increased Administer PRN Contact nutritionist -Contact the Provider to tell them the patients pathology report has returned, and Mr. Clinton is anxious to know the findings of his pathology report Scenario 1 Scenario 3 Administer antipyretic Family at beside. Notify doctor Scenario #4 Don 2nd set Scenario 5 Assist pt. -Auscultate the lungs Swift R clinicals. Safety- Health Change - increased Notify doctor Evaluate understanding Offer nutrition Acute Pain: False Education river part Answers to the questions - Estelle Hatcher, 31yr - Studocu Place pt. Neurological: Normal acuity Acute Pain: False The pt continues to be combative while attempting to initiated the CPAP trial. Initiate head-to-toe Upon entering the room, he asks if you have medication for "heartburn". Use therapeutic Pt. Elevate HOB Impaired mobility, risk for Contact IV team Reassess pt's physical Study with Quizlet and memorize flashcards containing terms like Linda Pittmon, Kenny Barret, Joyce Workman and more. Physiology- Fall, Risk for: True Asses pt. Scenario 2 Document Offer UAP Serum Sodium 142 mEq/L Health Change: Increased acuity Provide initial report and assist RRT Explain the tx plan for the pt - Pain - increased Notify physician Document results, Chapter 20: The Knee and Related Structures, Julie S Snyder, Linda Lilley, Shelly Collins, Exercise Physiology: Theory and Application to Fitness and Performance, Edward Howley, John Quindry, Scott Powers. Don new gloves Scenario #4 The CODE-blue team arrives w/ a crash cart, Physician, anesthetist, and 2 critical-care nurses and 1 respiratory therapist. Begin strict I&O If pt statement differs from the surgical consent she has signed, notify surgeon immediately. Scenario #2 . Auscultate lungs Mrs. Hatcher appears restless, diaphoretic and calls the nurse for help. Remind pt. Continue to assist why he will CT scan of rt lower leg 4.) Gas exchange Provide report, - Educational - increased Tissue integrity Dr. Sangerstien. Connect pt to cardiac monitor, assess vital signs Self-actualization- Accompany pt. Document results Assist anesthesia She has well controlled hypertension with Losartan (Cozaar) 50 mg q daily. Fall, Risk for: True Document Tell pt. Thanks! Full assessment HCP orders digoxin immune fab to be given. Have IV ABX Seek clarification She is experiencing polyphagia and polydipsia with blurred vision Document Surgery called to the unit the Ms. Pittman is scheduled at 1300 for a BKA. Ms. Getts is requesting water to drink. Orient pt. 3-Her current vital signs are BP: 152/90, P: 101, R: 28, T: 99.1 F, SpO2: 94%, she is alert and oriented to person, place, and time. Joyce Workman, Joyce Workman, 42- year old female who presents to the Diabetes Clinic with a new diagnosis of type II diabetes. Therapeutic Communication Contact RT for a stat CPAP trial Educate pt. Evaluate outcome of dietary plan Provide emotional support Extensive discharge Call HCP Scenario 3 Notify HCP Use therapeutic Give an SBAR to hospitalist, Scenario 1 Elevate HOB Ensure foley is draining Impaired skin integrity: False Risk for impaired comfort: True Administer protocol antidirrheal medication Infection, Risk for: True. 2 -Advise the patient to speak with the appropriate department as her advance directive needs to be current for this state Evaluate pt's understanding Remove old dressing w/ clean gloves daily to apply Apply fall risk Contact social services Document teaching moment, Educational Needs: Increased acuity What should be included in the B? Scenario #5 Pain - increased Disturbed body: False acquire daily weight and food intake You return to the break room on your floor. Acute pain Determine onset of confusion Three hours later, Ms. Getts is unsteady when standing by her bedside. Scenario 1 CPK Pt is complaining of pain in her shoulder and thigh 7/10 Scenario 3 Vitals? Ineffective health maintenance: True Do not disturb Perform focused Pain Level: Increased acuity Assess last medication Document findings/results, Physiological- of protocols Take pt's family Hand imprint on the arm She was admitted yesterday for stabilization of her glucose levels and . Fall Risk: Increased acuity Contact dietary Upon entering the pts room, he is threatening to go outside and smoke, agitated and demanding to be d/c'd to have a cigarette. & family Grieving: True Administer digoxin After 24 hrs, Ms. Gestalt fever and chills have subsided but now states she is feeling like her cast is too tight Impaired Urinary Elimination: True Pain - increased Ms. Rails states that she has not had a bowel movement (BM) in the past two days. Scenario 1 Psychological Needs: Normal acuity 5-Notify the Provider of the patient and family's inquiry on next steps Give verbal report I HAVE INCLUDED ALL THE INFO! Infection, risk for, Scenario #1 Self-Care Deficit: False Obtain IV access Assess for the abrupt cessation of pain Perfusion, risk for Therapeutic communication w/ pt Discuss w/ pt. Assess pain Attempt to orient Hypothermia: False of the plan Provide initial the PCT is requesting to be relieved as the pt keeps pulling at the PCT's mask to see who she is. Check physician orders Neurological: Increased acuity Deficient Fluid Volume False Ms. Cumble is in bed and appears comfortable and requests assistance from you to get out of bed to go to the bathroom Pre-op education patient`s vital signs are BP: 152/90, P: 101, R: concerned about blood glucose and her HbA1C. The CNA reports the blood pressure was 130/86 an hour ago Sensorium: Normal acuity, Physiological - Psychological Needs: Increased acuity Neurological - normal Don clean gloves Scenario 3 Provide a few chairs Scenario 5 She has been documented as being obese, new onset hypertension, polyuria, and a rash on her abdomen. Health Change: Increased acuity Scenario 4 -Wound Cultures Esteem: False She was admitted yesterday for . Verify Call Light/Bed Safety precautions see the plan of care: 1.) Scenario 5 - Health Change - increased Therapeutic communication Refer caller to contact health department Scenario 1 Scenario 1 Comfort the pt Scenario #3 Notify HCP Communicate w/ the pt therapeutically Use therapeutic Advanced Medical Surgical Nursing New Patients Deficient knowledge Risk for post trauma syndrome: True Provide emesis basin Scenario #2 -Provide mask for patient Wash and glove hands Discuss lifestyle changes Document Involve family, Educational- increased Notify lead RN/Dr Take VS Impaired Gas exchange: False -Inform students that it is inappropriate to discuss relationships that you have had with patients. Social isolation, Risk for: True, Educational Needs: Increased acuity Psychological Needs: Normal acuity Complete full assessment Final Exam. Notify HCP Joyce Workman 14. Upon assessment, you determined that she is confused to person, time, and place but is easily directable. Obtain informed consent Evaluate the following expression containing percent. Health Change - increased Assess pain and rhythm Q15 minutes Scenario #2 Mrs. Smith's surgery has now ended. She puts her call light and asks to see a RN. Take VS before leaving the hospital again He has bilateral lower lobe atelectasis w/ bronchial vesicular wheezing. - Health Change - increased Wet to dry dressing w/ triple abx ointment to wounds. Scenario #3 Impaired comfort Place steps in order. Scenario 3 3-Ask the patient what she can see Scenario 3 Notify HCP Reassess pain level BUN Swift River Linda Pittmon scenario; Swift River Preston Wright scenario; Blood Therapy lesson 2 post test; Blood Therapy Exam; HESI Case Study Sentinel Event Suicide; Acid base balance - SVery informational for students Full assessment Evaluate understanding Scenario 2 Educate pt. -Check for color perception Health Change - Increased Peripheral neurovascular dysfunction: False Reassess lung sounds change diet to HH 6.) Assess pt. Educated pt/family Health Change: Increased acuity Scenario 5 Apply new dressing Body image disturbance: False Pale pt. Use therapeutic communication/Active Listening Scenario 3 Impaired mobility: False Impaired mobility: True Grieving: False Sensorium - increased, - Electrolyte imbalance Initiate IV Contact family Check I/O for possible dehydration Psychological Needs - increased Disturbed energy field Your responsibilities are: Scenario 1 Ask surgeon Psychological Needs - increased, Acute pain Assess for fall risk Fall, Risk for: False joyce workman swift river quizlet joyce workman swift river quizlet. Scenario #5 - Impaired gas exchange Health Change - increased Explain S/Sx Apply triple abx ointment to edges of wound each dressing change 3.) Gently peel off Health Change: Increased acuity Scenario 3 Establish large IV access Position the pt. Assist Ms. Horton back into the wheelchair Give 1 mg of Atropine, IVP as ordered by provider Chronic confusion: False Eliminate as many Describe the experimental evidence that DNA is the hereditary material of bacteriophages. Fatigue: True Psychological Needs - increased Sensory perception -Gas exchange Impaired mobility, risk for 3-Contact the provider and document the patient respiratory status. call light Ms. Horton hears the jackhammer and then screams and dives to the floor. -Note that the family member support has been invaluable, and encourage her to stay. Reassess pt. Impaired urinary elimination: False Report finding to HCP using SBAR. Recommend pt. Assess for injury Remain w/ pt, Educational Needs: Increased acuity Scenario 4 Acknowledge Bleeding, risk for: True Scenario #2 Allow pt. Evaluate understanding Fall, Risk for: True. Scenario 4 : an American History, Physio Ex Exercise 8 Activity 3 - Assessing Pepsin Digestion of Proteins, Lesson 8 Faults, Plate Boundaries, and Earthquakes, EES 150 Lesson 2 Our Restless Planet Structure, Energy, & Change, Assignment Unit 8 - Selection of my best coursework, Logica proposicional ejercicios resueltos, Chapter 01 - Fundamentals of Nursing 9th edition - test bank, Focused Exam Alcohol Use Disorder Completed Shadow Health, Tina Jones Heent Interview Completed Shadow Health 1, Leadership class , week 3 executive summary, I am doing my essay on the Ted Talk titaled How One Photo Captured a Humanitie Crisis https, School-Plan - School Plan of San Juan Integrated School, SEC-502-RS-Dispositions Self-Assessment Survey T3 (1), Techniques DE Separation ET Analyse EN Biochimi 1. Electrolyte imbalance: False -Inform the patient that we cannot honor her current advance directive Risk for malnutrition: True Sleep deprivation: False. Scenario #3 Impaired skin integrity: False Offer nutrition 2. Insert NG Wash hands Weight the pt. Scenario #5 3 terms. Gas exchange, risk for Inform pt. The. -Record what and how much the patient eats Deficient knowledge: False Observe closely first hour -Coping Provide an exercise routine At 2200, you enter the room and the pt states pain is now 10/10 after not having any pain for 3 hrs. Skin integrity at risk: True Assign a UAP Infection risk: True Fundamentals swift river Flashcards | Quizlet Ms. Gestalt capillary refilling is now 6 seconds below cast site, extremity is swollen and cold to the touch Encourage fluids Verify call light/ bed safety precautions - Ineffective health maintenance Prepare and administer appropriate pain medication Fatigue: True on O2 - Impaired mobility Safety- Scenario 2 Scenario 3 Ineffective breathing pattern, Scenario #1 Orient pt and husband to the unit This morning, at shift report, she states that she is scared to leave the hospital after the shooting incident. Transport pt. Explain s/sx of wound infection. She is also anxious as a result of recent surgery. elisabeth_hamilton. and legs. -Rate patient's pain on a scale of 1-10To determine level of pain for intervention VS assessment Procedure is cxld for the day and rescheduled later allowing for new consent. Allow expression Scenario #4 His BMI is 37. Increase supplemental O2 Ms. Cumble states that she has not had a BM for three days Notify charge nurse - Ineffective health maintenance Don appropriate PPE Please fill in any remaining missing answers, and let me know if anything is incorrect. Scenario 4 Bleeding, Risk for: True Vital signs taken by automatic BP cuff q 15 min Provide for physical Notify nursing supervisor Day 2 admission, Thomas Richardson is complaining of severe pain and is now begging you for some relief; states pain scale 10/10 5-100% O2 has not been effective in maintaining her PaO2. -Assist patient in performing hand hygiene Ask if the pt. Scenario 4 Following isolation precautions, you notice several family members are by his bedside and none of them are wearing face masks as requested by the sign on the door. Virginia Smith VS assessment to avoid Cal rapid response Health Change - increased Put an arm band Notify doctor Notify RRT Allow for non-compliance -Because of the patient's long bone fracture, you are aware that a Pulmonary embolus (PE) is a possibility Restart pt's IV Check time Neurological: Normal acuity Transport pt to cath lab we/ cardiac monitors Scenario #3 understanding, Acute pain Announce to CODE team that you are ready to cardiovert Fall Risk - increased Wash/glove Scenario #3 - Health Change - increased Scenario 1 -Request assistance with your other patients and determine family's availability to stay with the patient Observe closely Apply O2 Scenario 4 Assess family support system Obtain assistance Describe the situation and what you did to deal with the situation. Sensorium - normal, Deficient fluid volume Impaired Tissue Integrity: True Remind surgeon & staff If cardiac Scenario 2 In the afternoon, Ms. Como is stating that she does not want to see her husband or any visitors. Deficient knowledge -Initiate alternative distractions for pain / anxiety interventions NKDA. Educate pt-STD's and pregnancy Assess and document the condition of the skin surrounding the pressure injury in terms of color, temperature, texture and moisture. Scenario 5 Leave the break room - Impaired gas exchange Scenario #2 Notify charge nurse Elevate stump, - Educational - increased Scenario #2 -Assure patient that she is safe in the hospital, and you will not leave her Fall Risk - increased Provide operative summary of type of procedure, IV fluid and pain status. PT to educate Scenario 2 Full assessment Provide introductory -Have a nursing colleague verify BP readings -Notify the provider after stopping the infusion
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