Capillary Refill: _________ seconds Scenario 1 Knowledge Deficit True Sensorium Normal acuity, Physiological Establish second IV Scenario 1 Your responsibilities are: Scenario 1 Acute Confusion True DOCX Swift River Online Learning - Taxonomy Background Robert Sturgess the client was admitted with Metastatic cancer of Colon, with history of diabetes. Ms. Getts is requesting water to drink. Administer protocol antidiarrheal medication Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. Scenario 2 He is a local TV news reporter that was filming an event at the county fair when there was an explosion. Dr. Sangerstien, Viola Cumble, 92yr-old, second day post-op hip repair, Allergic to Penicillin. Deficient Diversional Activity False 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. Stay with patient for surgeon's arrival to explain intended surgical procedure RS Vclinical Flowsheet - Student Name : Date: NUR 113 Assessment Swift When the nurse retunes to the room the patient tells the nurse that when he went to the bathroom he became very lightheaded. Strict I&O, regular diet, intake 50%. Self-Care Deficit: True Skin warm and dry, daily dressing changes, T-tube without drainage. Patient and family upset regarding dx. Assist physician in physical exam of patient Document results. No weight bearing today. Normal Sinus Rhythm on telemetry. Family in room with patient very concerned. You enter his room and recognize that Mr. Thomason appears to be talking to himself and appears confused. No response = 1, Mobility: Last Bowel Movement: Date: _____________________ Constipation Diarrhea/Loose Other: Fear/Anxiety True. Palliative care. VS: BP 158/90, HR 89, R 18, T 97.8 F. Wash and glove hands Sensorium: Normal acuity, Bleeding, risk for: False Scenario 1 Pain Level Increased acuity Neuro WNL's, alert and cooperative. Blood Pressure, 7a-7p Total: 7p-7a Total: He was recently treated for a URI with a Z pack, prednisone, and Motrin for pain. The surgeon has just visited with Mr. Greer 2-days post op and has informed him that the lymph node biopsies have confirmed that the cancer has metastasized, and he will need further treatment. c/o headache- medicated with Lortab 5mg PO at 0900, takes Lomotil 10ml PRN q 4 hours last dose at 0834. ADA diet, intake 25%. Mr. Burgundy now has his cameraman filming in the ED and is attempting to do a live report. View Swift River Reflection Questions (1).docx from NRSG 4412 at South College. Document results Provide emotional support. Grieving: True Blood-tinged mucous, productive cough. Combien gagne t il d argent ? LOC Normal acuity Radiofrequency ablation, which uses heat to remove abnormal esophagus tissue. Scenario 2 "I am feeling fine." The patient got dizzy when he stood up from the commode. I need to be reporting!" Mr. Thomason appears now better oriented and MD arrives unexpectedly to examine him. RLQ: RUQ: LUQ: LLQ: She has arrived in pre-op and about to have surgery this morning. Sexuality: True. -Explain that Docetaxel is a hormone therapy that suppresses the testosterone that your testicles produce producing similar results as surgical intervention. Grieving: False Acute Confusion: True Tap patient and ask, "Are you okay?" Vital signs -Temp 98.6, BP 114/62, P 100, RR 20, SaO2 94%. LLE: Non-pitting Pitting ___+ Mrs. Smith's surgery has now ended. -Reinforce the risk if patient has not been NPO and ask the patient when the last time they ate. Assess Release restraints/full range of motion LUE: Non-pitting Pitting ___+ Imbalanced Nutrition True Remain with patient -Provide a diversional activity to pass the time while waiting on the HCP and inform wife that the HCP will be coming soon Inappropriate words = 3 The patient describes this pain as a heavy pressure with intermittent stabbing. Impaired Gas Exchange True Fall Risk Increased acuity #ozerysnackingrounds I am so excited to be partnering with Ozery Family Bakery today. Upon entering room, you find Mr. Sturgess is quiet, appears tense and rigid but states, "I am feeling fine." . He requests no visitors at this time, but later asks for his family to be called to discuss a plan of care. Disturbed Sensory Perception True 2021-22, Historia de la literatura (linea del tiempo), Respiratory Completed Shadow Health Tina Jones, CH 02 HW - Chapter 2 physics homework for Mastering, BI THO LUN LUT LAO NG LN TH NHT 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. Anxiety True Medical Surgical Flashcards | Quizlet palliative care. Ms. Getts is now complaining of sudden sharp, substernal chest pain, very short of breath and is profusely diaphoretic. Deficient Knowledge True Hopelessness False. Senario 5 Scenario 4 Encourage fluids and fiber diet -Use therapeutic communication/active listening -Assess patient's ABC (airway, breathing, circulation) Vital Assessment Document results and findings Educate patient -Explain to Mr. Burgundy that space in the ED is allocated based off of patient need Love and Belonging He also has a history of hypertension and takes Tenormin (Atenolol) and Atorvastatin (Lipitor). Obtain translator Scenario 5 Demerol 25mg SIVP for pain, patient reports 7/10 on pain scale. Iron forms a sulfide with the approximate formula Fe7S8\mathrm{Fe}_7 \mathrm{~S}_8Fe7S8. Scenario 2 The emergency bathroom light goes off and the nurse finds Mr. Greer on the floor in the bathroom. Your response to all of them would be: Scenario 1 Perform circulatory evaluation Obtain recent chest X-ray reports and recent ABG's for physician to review Offer assistance in providing more information about treatment options for newly diagnosed AIDS patients. Impaired mobility: False Scenario 1 Endoscopic resection, which uses an endoscope to remove damaged cells to aid in the detection of dysplasia and cancer. No Known allergies (NKA). Skin Integrity: Intact No, describe below, Location Type Size Wound bed Drainage Students will prioritize medical surgical . 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. Offer nutrition/toilet Regardez le Salaire Mensuel de Ubah Kalimat Efektif Online en temps rel. If family/visitors come, will need education to airborne precautions. Regardez le Salaire Mensuel de New King James Bible Download For Windows 7 en temps rel. Wound clean dry and intact. Widespread Color Change: N/A pallor cyanosis jaundice erythema The charge nurse asks you to assume the patient's nursing care. -Advise patient not to get up and walk on his own Mr. Greer has just been visited by his wife. -Ensure there is suction in the room, and check Vital signs -BP 124/82, Temp 98.2, P 84, RR 22, SaO2 96%. Educational Needs Increased acuity Senario 4 : an American History (Eric Foner), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. Notify doctor Then the bus splashed into the river for a cruise. Mr. Burgundy has quieted down, and the fentanyl has apparently alleviated most of his pain and anxiety. Robert Sturgess, 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. Patient and family upset regarding dx. He does not want to return to the nursing home, and does not wish to burden or live with his children. Senario 2 Scenario 4 Recent chest X-ray shows diffuse bilateral interstitial infiltrates in all lobes. Impaired Gas Exchange True Monitor and evaluate fluid intake Too bad the cruise area was a very unatractive part of the River Elbe. Upon entering room, you find Mr. Sturgess is quiet, appears tense and rigid but states, "I am feeling fine." -Ask Mr. Burgundy to lower his tone as it can be disturbing to other patients Mr. Dominec decides he does not want to see Infectious Disease doctor about his new cough. Notify doctor for Foley catheter Scenario 4 Secondary: Assess vital signs, auscultate heart, lungs, and bowl sounds. Notify lead nurse/doctor Apical/Radial Pulse Deficit: No Yes Murmur Valve Click Ineffective Self-Health Management True The provider explains that it is a pre-cancerous stage in where the cell develops abnormal features. Waist belt restraint PRN; family sitter at bedside, assist with bath. -Continue to observe urine for hematuria and document findings -Complete head-to-toe assessment while patient is on the floor. Extends abnormally = 2 Combien gagne t il d argent ? Shock False Scenario 2 Scenario 4 Lithia Monson Scenario 3 Determine from medical record if partner is aware of his recent AIDS diagnosis. Anxiety False You are concerned about preventing the patient from falling. -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 Safety- Where is my camera man!! Scenario 3 Document results Shock, Risk for False Sensorium Increased acuity, Physiological Pain affecting: N/A Sleep Activity Exercise Relationships Appetite Concentration The cycle of freezing and thawing damages the abnormal cells. -Start IV His left humerus is fractured and splinted. Yes Productive Non-productive Describe Sputum: _______________________ Scenario 2 Administer pain medications Tibial: _____ + Bilateral Other: ______________ Generalized: Pedal: ______ + Bilateral Other: ____________ Sacrum: Non-pitting Pitting ___ +. Yes Constipation, risk for: True Bleeding, Risk for True Scenario 1 Wash hands -Take initial vital signs (room air Pulse Ox) Wash and glove hands Apply restraint He also has metal fragments on his left side on his leg arm and torso. Impaired Mobility True Sa fortune s lve 2 216,00 euros mensuels Impaired Home Maintenance management r/t client or family False IV maintenance fluids with D5 1/2 NS with 20 KCL @ 125ml/hr in left forearm. Peripheral Neurovascular Dysfunction False Scenario 1 Scenario #3. Scenario 1 1Perform full assessment and provide anti-nausea medicine. Swift River Medical-Surgical Flashcards | Quizlet Senario 4 Attain fluids/fiber diet and assisted ambulation He is experiencing new onset of shortness of breath and has a nasal cannula with 2L of Oxygen in place. Sarah Getts Radiofrequency ablation may be recommended after endoscopic resection. Safety Reassure patient and help explain any new orders from physician to patient Ruth Cummings - The Nathan Cummings Foundation No known allergies (NKA). Insertion site: Dry/Intact Redness Tenderness/Pain Warmth Coolness Swelling Drainage -Provide the patient with the time when HCP will come discuss options with him Diet as tolerated, up ad lib after gait training. Mr. Thomason is anxious and is obviously worsened from the shift before in overall condition. Educate patient regarding patient care Physical Mobility, Impaired True Deficient knowledge: True All our products can be personalised to the highest standards to carry your message or logo. Peripheral Neurovascular Dysfunction False Paul Greer Full head to toe neuro assessment. Pulse Evaluate understanding Your notice Mr. Thomason is lying supine, appears slightly cyanotic in his lips, is exhibiting more effort to breathe, and is increasingly restless. Ms. Gestalt capillary refilling is now 6 secs below cast site, extremity is swollen and cold to the touch. -Complete incident report. Temp Nutritional Intake: Adequate Inadequate BMI: Lithia Monson, 93 years old, c/o head injury, r/o subdural hematoma. -Explain procedure to the patient Explain to her family and provide contact information. Alleviating Factors: Last pain medication: Senario 5 Safety -Remove the dinner tray and make sure the diet is soft food. Senario 1 Scenario 5 Wash and glove hands Impaired Skin Integrity, Risk for False Health Change Increased acuity Education of Foley Cath Procedure Dr. Rondeau, Educational Needs Increased acuity 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. Neuro WNL alert and cooperative. Fall Risk Increased acuity Pain Level Increased acuity Grieving: False. Mr. Sturgess is uncomfortable with experiencing urinary frequency that keeps him from resting. Report and document results Fall, risk for: True Psychological Needs Increased acuity He is emotionally distraught, and is insisting that he be allowed to report what is going on from the ED. It is determined that Mr. Sturgess could achieve better pain control w/ a PCA pump Your Swift River Virtual Clinicals account has been linked to your ATI Student account. Wash and glove hands No Known allergies (NKA). Acute pain: True The charge nurse tells the nurse to take Mr. Burgundy to the floor, because his room is now ready. Impaired comfort: True Inform and educate spouse of dietary orders Inspect cast site -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. Scenario 1 Scenario 5 Skin warm and, dry, all vital signs in WNL except 115 pulse, which is normal for him. Scenario 5 Flexes abnormally = 3 Provide comfort and pain measures is a 57 y/o who has been admitted for a radical prostatectomy. -Determine when a hospital provided sitter will be necessary Nursing questions and answers. Nausea False Physiological- Filmotka filmu Najvyia ponuka (2013). Inform his partner that everything is being done to keep him comfortable. Notify doctor Renal diet. -Discuss with sitter that patient needs continual observation 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. Dr. Small at bedside with patient and family. No Your coworkers are asking you questions about Mr. Dominec. Educational Needs Increased acuity Sleep deprivation: False Document results 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. Palliative care. Ms. Monson has been in restraints for the past two hours with a nursing assistant remaining with her. Notify lead nurse/doctor He also states he is feeling weak. Skip to document Ask an Expert Sign inRegister Sign inRegister Home Ask an ExpertNew My Library Discovery Institutions StuDocu University Keiser University Western Governors University Scenario 4 Psychological Needs: Increased acuity sounds= 2 Describe the physical changes from aging and the care required. Upon assessment, you determined that she is confused to person, time, and place but is easily directable. Scenario 4 Use therapeutic communication/active listening Primary: Check LOC, Orientation, Breathing, Circulation, Brief Neuro assessment to include spinal pain or deformities, Obvious injuries. Do not disturb Sleep deprivation False Welcome [evolutionmkt.co.za] Teach patient about safety when getting out of bed Kathy Gestalt, 33yr-old, Dx- second day post-op open right Tibia/Fibula fracture, plaster cast in place on right lower leg. -Reassess patient q 5 minutes until awake, then 15 minutes until they are fully awake (not Drowsy). Scenario 1 No known allergies (NKA). 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