Deficient knowledge: True Inform his partner that everything is being done to keep him comfortable. Scenario 5 Place patient on PCA pump Remain with patient Allow husband to come into recovery for a quick one-minute visit. Health Change Increased acuity Verify call Light/bed safety precautions Scenario 4 Consult Social Service 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. Color:__________ Elevate head of bed Dr. Suculo, Physiological Neuro WNL, except leg pain upon movement. Scenario 4 Love and belonging Acute Pain: True Type of Line: Peripheral, location ______________ CVL, location _____________ PICC, location _______________ Senario 5 Disoriented to time and place, speech slurred. Regular diet. Safety He is complaining of pain in his left arm, and pain in his left chest when he tries to take a deep breath. Re-assess patient Discharge instructions Vital signs taken by automatic B/P Cuff q 15 minutes Offer masks to visitors VS: BP 158/90, HR 89, R 18, T 97.8 F. Filmotka filmu Najvyia ponuka (2013). Recent blood gases demonstrate falling PaO2 (hypoxemia) and increasing CO2 (Hypercapnia). Scenario 3 Therapeutic communication. -Evaluate patient's understanding of teaching Encourage Mr. Dominec to discuss with his partner his best treatment options. However, these abnormal cells do not have the capability to spread to other parts of the body. Assess for bowel sounds 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 Neuro WNL, alert, and cooperative. Scenario 5 -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 The bed arrives tomorrow. Blood Glucose 185, 4 units of insulin sliding scale for coverage. Hopelessness: True -Inform patient to not get out of bed without assistance and place call light in reach IV maintenance fluids with D5 1/2 NS with 20 KCL @ 125ml/hr in left forearm. Document results The patient has been scheduled for an EGD today and has an order for Omeprazole (Prilosec) and Carafate (sucralfate). Scenario 2 -Explain that Docetaxel is a hormone therapy that suppresses the testosterone that your testicles produce producing similar results as surgical intervention. Purposive Communication Module 2, Chapter 1 - Summary Give Me Liberty! Lithia Monson Check monitor Imbalanced Nutrition True Encourage fluids/fiber/ambulation 97.4, Resp 16 and Pulse Ox 94%. Clinical 2. Impaired Skin Integrity, Risk for False Physiological Acute Pain True Anxiety True Amount: _______ Obtain Spanish signs & brochure Hx of dementia, from nursing home, fall one day ago. Dr. Rondeau, Educational Needs Increased acuity Validate NPO Status Scenario 2 Fall Risk Increased acuity You also notice the patient is more difficult to orient. Mr. Gonzalez has returned from his EGD and is still sleeping from the sedation. Upon entering room, you wash/glove hands. Begin post op education for day one Document results and findings Ronald Burgundy Seznam uivatel, kte vlastn, prodvaj nebo shnj film. -Ensure the bed is in lowest position, the side rails are up, the call light is in reach, and ask the patient if they need anything before you leave the room Combien gagne t il d argent ? Impaired mobility: False How was this When the nurse enters the room later that day to inform him that the procedure is scheduled for 1430, they see Mr. Gonzalez is sitting in front of a lunch tray. Impaired Mobility True Electrolyte Imbalance, Risk for True Mr. Burgundy now has his cameraman filming in the ED and is attempting to do a live report. Bowel Movement Total: x________________, Hygiene Times Report this activity immediately to the hospital privacy officer Document teaching moment. Decisional Conflict True His wife tells the nurse that he seemed very distant and did not want to talk much. D/C plan- decrease pain and restore normal gait. Ms. Gestalt is second day post-op and has requested to get out of bed and to ambulate to bathroom. Mr. Dominec has a male partner and has been married for the past ten years and share their three children to the marriage. swift river assignment: day swift river assignments dosage minimum score 90 med minimum score 80 minimum score 90 robert sturgess linda yu linda pittmon carlos Skip to document Ask an Expert Sign inRegister Sign inRegister Home Ask an ExpertNew My Library Discovery Institutions Keiser University Silver Creek High School (Colorado) Dr. Starks, Physiological Hopelessness False. Scenario 4 Chronic pain: True Health Change Increased acuity Notify lead nurse Senario 3 Gastrointestinal Assessment Perform full assessment and provide anti-nausea medicine. Since the finding was low-grade dysplasia and is considered the early stage of precancerous changes, the gastroenterologist recommends another endoscopy in six months, with additional follow-up every six to 12 months. He has not had his BP medication today. Skin warm and dry, all vital signs in WNL except 115 pulse, which is normal for him. Skin moist, respiratory bilateral wheezes and rhonchi. Observe closely first hour Anxiety False -Advise patient not to get up and walk on his own Seek clarification He is pale, weak, diaphoretic, and appears anxious. IV fluids of D5 1/2 NS are infusing at 100 mL/hour to his right forearm. BP 154/89, P 94 F, R 22, T 98.3F, SaO2 95% on room air. Do not probe further Skin warm and dry, may sit up on edge of bed today. Perform circulatory evaluation Acute Confusion False Scenario 5 Powerlessness True. The patient describes this pain as a heavy pressure with intermittent stabbing. Sensorium Normal acuity, Physiological 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. Deficient knowledge: False Neuro WNL. Robert Sturgess 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. -Give NS liter bolus Patient, and family upset regarding dx. Breath Sounds: Clear bilaterally. Obtain urinary screen 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. Fall Risk: Increased acuity Two housekeepers, who were refusing to clean the room, are in the break room. You discuss this cough with Mr. Dominec to determine how long he has had it. GI WNL. Strict I&O, regular diet, intake 50%. Ms. Getts is being transferred as an emergency to Critical Care. Dr. Altace, Physiological- Pain = 2 Grieving True Upon assessment, you determined that she is confused to person, time, and place but is easily directable. Mr. Greer has just been visited by his wife. Document results and findings -Assess for fall risk Radiofrequency ablation, which uses heat to remove abnormal esophagus tissue. Vital signs -Temp 99.1, BP 124/62, P 77, RR 20, SaO2 91%. Fall, Risk for True Ruth Cummings Trustee Vice Chair Audit Chair . Educational Needs Increased acuity Scenario #3. Last pain medicine 2hrs ago at 1300(Demerol 50mg/ Zofran 4mg IV). Auscultate peripheral pulses and ROM. Family at beside. Electrolyte Imbalance False Respiratory Rhythm: Regular Rhythmic Irregular Periods of Apnea Cheyne-Stokes Perform circulatory evaluation Impaired Skin Integrity, Risk for False -Complete neuro checks as ordered Scenario 3 He states, "This is not serious." Scenario 1 RUE: ______________ LUE: ______________ Physiological- 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 Regardez le Salaire Mensuel de Ticketmaster Beyonce Koln en temps rel. Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. Mr. Sturgess is recently dx w/ metastatic cancer of colon and he and his family have chosen only Chronic Confusion False Skin integrity, impaired True Scenario 2 Urostomy: N/A Urostomy/Ileal conduit Too bad the cruise area was a very unatractive part of the River Elbe. Temperature is 98.3, HR is 87, RR is16, BP is 121/74, PaO2 is 98%. He also complains that his throat is still very sore. Surrounding skin: Moist/Intact Red/Erythema Irritation No Known allergies (NKA). Senario 1 Provide comfort in pre-surgical room Mr. Dominec. Deficient Knowledge False Pain Level Increased acuity -Obtain chest tube tray and set-up pleurovac Urine Color: Clarity: Odor: Explain to her family and provide contact information. Skin warm dry, bruises on forehead with small laceration. Educate patient regarding patient care Neuro WNL, alert, and cooperative but worried about scarring and is reluctance regarding walking on leg. Impaired Skin Integrity False Scenario 3 Tunneled, site _______________ Implanted port, accessed _____________________ You arrive in room to find Ms. Monson talking to herself. After 24 hours, Ms. Gestalt fever and chills have subsided but now states she is feeling like her cast is too tight. Anterior: ___________________________________ Posterior: ____________________________________ You question her while reviewing her operative consent and determine that everything is correct. Fall, risk for True Reassure patient and help explain any new orders from physician to patient Spanish interpreter available at extension 61178. PT to educate patient It is determined that Mr. Sturgess could achieve better pain control with a PCA pump. Deficient Knowledge True Isolative, appears fearful, crying, and refusing to see her husband. Allow for non-compliance of request Bladder distention Pelvic pain Low back/flank pain Senario 3 Pupils PERRLA, eyes clear. Check PRN pain order Imbalanced Nutrition False Dr. Roopes, Estelle Hatcher, 31yr-old, r/o appendicitis, 1st day post-op appendectomy; No known allergies (NKA); Vital signs - Temp 101.2, BP 108/74, P 92, RR 20, SaO2 99%, alert and cooperative. You are the now the Surgical ICU nurse assigned to her. Decreased Cardio Tissue Perfusion False Evaluate caller understanding Document results -Reorient Patient to person, place, & time Document results. Scenario 4 Fall, Risk for True Deficient Knowledge False Nathaniel Gonzalez 20ga. You enter patient's room. The patient was placed on 2 L O2 NC, EKG monitoring to include a 12 lead, Pulse Oximeter. Leave to break room and not continue in conversation. Remind staff that Universal Precautions are practiced at this hospital for all patients regardless of known infectious diseases. Fall Risk Increased acuity Verbal command = 3 Deficient Knowledge False Senario 3 When completing the shift change neuro check, you notice the patient's left pupil is sluggish. 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. Home; Our Focus; Our Legacy; Our Partners; Our People; Our Fellows; Our Investments Document results and findings Scenario 3 LOC Normal acuity Skin integrity at risk True -Assess patients' pain and rule out cardiac pain. 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 Notify doctor of change in condition in particular: unproductive cough and low-grade fever. -Take initial vital signs (room air Pulse Ox) The patient tells the nurse that yesterday he was, "concerned about having an erection, and now they want to cut off my testicels". Inspect cast site Ineffective self-health mgmt: False, Disturbed body: False -Check patency of Foley catheter, urine color, and ensure it is secure to the patient's leg -Ensure bed is in lowest position, and rails are in place Neuro WNL alert and cooperative. Sexuality: True. Use therapeutic communication/active listening You arrive in room to check on her, after washing hands. Scenario 5 Full assessment Senario 4 If patient statement differs from the surgical consent she has signed, notify surgeon immediately Non-significant past medical history. -Continue to observe urine for hematuria and document findings Nausea False 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) The charge nurse tells you she will send someone to assist you, and to get out 2mg of Versed to have ready to sedate the patient at time of procedure. -Ensure there is suction in the room, and check Scenario #2. Mr. Gonzalez has been admitted to the floor to determine that his chest pain is not related to a cardiac event. -Offer nutrition and/ or toileting The nurse performs tilt test, Patient vital signs lying flat, BP 118/62, P 92, R 20, T 98.5, SpO2 97. Scenario 1 Explain that he will probably not be going home at least until his doctor sees him. LOC Normal acuity Scenario 4 No known allergies (NKA). -Place patient on O2 Nasal Canula Love and Belonging Provide emesis basin/cloth Recent chest X-ray shows diffuse bilateral interstitial infiltrates in all lobes. The nurse was told by the gastroenterology nurse that they really struggled before they called anesthesia and they may have caused an esophageal abrasion. Patient and family upset regarding dx. Dyspnea at rest Dyspnea with minimal activity Use of accessory muscles Fall Risk Increased acuity All opinions are mine alone. Bleeding, Risk for False IV Assessment/ N/A : an American History (Eric Foner), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham), Psychology (David G. Myers; C. Nathan DeWall), Biological Science (Freeman Scott; Quillin Kim; Allison Lizabeth), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. Enter the email address you signed up with and we'll email you a reset link. Sensorium Increased acuit, Physiological Acute Pain True He is excited and tells the nurse he is starving and glad that he finally gets to eat. The patient got dizzy when he stood up from the commode. Ann Rails Today, clubs like Hamburg City Beach Club, Lago Bay, Hamburg del Mar and StrandPauli provide a relaxed summer atmosphere with a view over the Elbe. Scenario 2 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. But that's changing. -Reassess patient q 5 minutes until awake, then 15 minutes until they are fully awake (not Drowsy). References; Access My Virtual Clinicals; Medical-Surgical. Now, third day post-op, Mrs. Stukes appears sad and depressed upon entering the room. 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No response = 1, Mobility: Tibial: _____ + Bilateral Other: ______________ Generalized: Pedal: ______ + Bilateral Other: ____________ Sacrum: Non-pitting Pitting ___ +. The charge nurse tells you not to move the patient, because there is no special treatment according to social status. Noncompliance: False He replies, "six times in the past four hours". Pain re-assessment Strict I&O, regular diet, intake 50%. Pain: No Yes: Location: ______________________ Acute Chronic Constant Intermittent Apply fall risk bracelet He does not want to return to the nursing home, and does not wish to burden or live with his children. Until the recent diagnosis of cancer, the patient had only seen a physician once in the last ten years. 00 Comments Please sign inor registerto post comments. Scenario 4 Scenario 4 Senario 5 IV D5 1/2 NS @150ml/hr. Viola Cumble NPO with small amount of ice chips only. Procedure is canceled for the day and rescheduled later allowing for new consent. Diet as tolerated. Esteem The patient is awake alert and oriented. Grieving False Palliative care. Place call light and check bed for safety Therapeutic communication Scenario 3 The patient has a Foley catheter in place and is reporting 8/10 incisional pain and he is asking why his throat is sore. Awaiting diagnostic labs. Encourage to ambulate with assistance to void if needed Taking HIV Meds prophylaxis. Deficient knowledge: True -Remove the lunch tray and ensure pre-operative consent has been signed. Scenario 5 Love and belonging- Decreased Cardiac/perfusion False Notify doctor Cross), Chemistry: The Central Science (Theodore E. Brown; H. Eugene H LeMay; Bruce E. Bursten; Catherine Murphy; Patrick Woodward), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Educational Research: Competencies for Analysis and Applications (Gay L. R.; Mills Geoffrey E.; Airasian Peter W.), Campbell Biology (Jane B. Reece; Lisa A. Urry; Michael L. Cain; Steven A. 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Notify family Administer new pain medz The patient will be discharged today, and he will be ordering new prescriptions. Remain with patient and reassure You are told that he has intermittent chest pain with substernal burning that radiates to his mid-back. Vital Signs: B: 160/92, P: 96, R: 22, SpO2: 98, T: 98.9F, 37.1C. -Ask Mr. Burgundy to lower his tone as it can be disturbing to other patients Disturbed Sensory Perception True Ambulates with minimal assistance. Verify call light/bed safety precautions Senario 2 Impaired Mobility True Insert Foley catheter IV maintenance fluids with D5 1/4 NS @ 150 ml/hr X 3 then reduce rate to 75 ml/hr. -Start IV Capillary Refill: _________ seconds Chronic Pain False You escort them with you to the ICU. Scenario 1 Mr. Duncan is now complaining of feeling "dizzy" when he stands. His partner is not with him at this time but will arrive soon to facilitate his discharge home. -Discuss effectiveness of sitter Oriented to: Person Place Time Scenario 5 This information is HIPAA protected and you cannot share anything with them. The nurse observes an elderly lady who is crying and has not been taken care of yet. 20ga. Genitourinary Assessment Administer antiemetic medication Constipation False Take vital signs before leaving the hospital again. Provide emotional support. Fall, Risk for True Sensorium Normal acuity, Physiological 4Inform his partner that everything is being done to keep him comfortable. Verify Call Light/Bed Safety precautions In reassessing Ms. Monson, her vital signs are: BP -106/82, Temp-98.2, P-106, RR-18, SaO2-88. Document findings Scenario 2 Her husband and children remain with her in the surgical holding area awaiting transport to the OR. Evaluation patient after consult Non-significant past medical history. : an American History (Eric Foner), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. Radial: ____ + Bilateral Other: _____________ RLE: Non-pitting Pitting ___ + Where is my camera man!! -Call security for assistance and compliance officer Safety Offer nutrition and/ or toileting Tear, Ecchymosis, Contusions, Bruising Administer antipyretic medication Esteem Robert Sturgess, 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. Patients vital signs are BP: 100/58, P: 106, R: 28, PaO2: 92%, T: 97.1 F, 36.2 C. Impaired Urinary Elimination True Virginia Smith What order are you providing the information to the receiving nurse? Dr. Anderson, Educational Needs Increased acuity Urinary Catheter: N/A Indwelling Short-term Indwelling Long-term Date of Insertion:________ Size: _____F When she moves him to the hallway, Mr. Burgundy begins yelling at you "Do you know who I am, I demand a room! Administer PRN constipation medications Mr. Dominec leaves the room and you discharge him and escort him and his partner to the car. Pain and numbness in legs for one week. Eye opening Spontaneous = 4 You determine to apply the restraint now. Chronic Pain True Acute Confusion True Oral Mucosa: Tongue: Teeth: Skin warm and, dry, all vital signs in WNL except 115 pulse, which is normal for him. Safety Scenario 5 Respirations Verify call light/ bed safety precautions Administer antipyretic medication Fatigue True Vital assessment His orthostasis is normalized after a second liter of NS was administered. Scenario 1 Skin warm and dry, daily dressing changes, T-tube without drainage. Scenario 1 No known allergies (NKA). Full head to toe neuro assessment. Scenario 2 Mrs. Stukes is feeling nauseated. Neuro WNL alert and cooperative. Ambulates with assistance. When the nurse retunes to the room the patient tells the nurse that when he went to the bathroom he became very lightheaded. Vital sign Temp 98.4, BP 136/78, P 72, RR 20, SaO2 97%. Document results The ER nurse reports that his cardiac enzymes were borderline, (Troponin?, CK/CKMB?) Bleeding, Risk for True Fall, Risk for True Physical Mobility, Impaired True Remain with patient -Ask the patient if it is okay to discuss his care in front of his children. Strict I&O and strain all urine, filters in bathroom. -Reassess patient's physical status prior to leaving him in the hallway Our Swift River Simulations are designed to help students and practicing nurses master their skills of Prioritization, Delegation, and Sequential thinkingwithout the requirement of being onsiteor even having to download software.
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