Full assessment Dr. Brown, Educational Needs Increased acuity -Reorient Patient to person, place, & time Put the patient on O2 NC and Fentanyl 25mcg IVP for pain. Swift River Medical-Surgical. Verify Call Light/Bed Safety precautions Notify family as to when they may come and visit. Scenario 1 Wash hands He is emotionally distraught, and is insisting that he be allowed to report what is going on from the ED. Senario 4 The patient is asking you where her son is, the last place she saw him was right before the explosion. The dinner tray is waiting for the patient in his room, and the nurse notices it is a regular diet. No weight bearing today. He is questioning the nurse as to why he has been admitted for heartburn. Scenario 3 Safety- Impaired comfort: True She is also investigating bone marrow transplantation. Encourage Mr. Dominec to discuss with his partner his best treatment options. She is also to receive radiation, chemotherapy, and hormone therapy post operatively. Senario 3 This will treat any cancer that may have metastasized to the bone. Palliative care. Robert Strurgess Scenario 2 Impaired Mobility False Educational Needs Increased acuity Extends abnormally = 2 The patient is awake, alert, and oriented. No Robert Domenic Ineffective Coping False Scenario 2 Demerol 25mg SIVP for pain, patient reports 7/10 on pain scale. 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. Your response to all of them would be: Scenario 1 Respirations Electrolyte Imbalance False DSD (dry sterile dressing), forehead laceration clean and dry intact. He replies, "six times in the past four hours". Educate patient/family It is now two weeks later; Mrs. Smith has returned. Describe the physical changes from aging and the care required. Full assessment of patient. Temperature is 98.3, HR is 87, RR is16, BP is 121/74, PaO2 is 98%. Neuro WNL, alert, and cooperative but worried about scarring and is reluctance regarding walking on leg. Secondary: Assess vital signs, auscultate heart, lungs, and bowl sounds. His original lymph node biopsy was negative. The cancer was more advanced than they previously had thought so inguinal lymph nodes were removed. Check input/output for possible dehydration Scenario 2 Scenario 4 Vital signs are to be taken BID, and it is now time. Infection, Risk for False -Perform admission assessment Head/Face: Symmetric Asymmetric Drooping Notify Doctor for pain medz Evaluate understanding Allergic to sulfa drugs. Notify housekeeping. Safety His partner is at the bedside asking, "how much longer will he have to wait until taken to surgery?" Mr. Sturgess is recently dx w/ metastatic cancer of colon and he and his family have chosen only The 'Strandperle' (lit. Skin warm and dry, all vital signs in WNL except 115 pulse, which is normal for him. Yes Ineffective Self-Health Management True Psychological Needs Increased acuity Acute Pain True Esteem Use therapeutic communication/active listening Scenario 4 Social Isolation, Risk for True Demerol 25mg SIVP for pain, patient reports 7/10 on pain scale. 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. Safety Leave to break room and not continue in conversation. 3. Provide for physical and thermal comfort. Ineffective breathing pattern False Continent: Yes No Brief/Diaper Safety Love and Belonging Vital re-assessment Mr. Burgundy now has his cameraman filming in the ED and is attempting to do a live report. -Evaluate patient's understanding of teaching Dr. Jones. Document results Safety- #1: _________, No -Reassess patients' vital signs, and place on q5 minutes continuous monitoring He does not want to return to the nursing home, and does not wish to burden or live with his children. Physiological- 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. Scenario 1 He insists that he is not hungry and refuses assistance with his meal. Scenario 2 Upon assessment, you determined that she is confused to person, time, and place but is easily directable. Scenario 5 Mr. Richardson is now pain free and questioning why he is plagued with recurring urinary stones. 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? Day 2 admission, Thomas Richardson is complaining of severe pain and is now begging you for some relief; states pain scale 10/10. Ineffective Peripheral Tissue Perfusion False Scenario 1 Incomprehensible Perform pain reassessment Shock, Risk for False Regular diet. Dr. Small at bedside with patient and family. Senario 2 Pain Level Increased acuity nursing care plan for Linda Pittmon, a 74 -year old female patient who is a noncompliant diabetic, and frequently stays at the local homeless shelter. Two hours later, Mr. Duncan is asked how frequent his stools have been today. Esteem -Remind patient to call for help is he need to get up and provide patient with a urinal. Neuro WNL alert and cooperative. The provider advises the Nurse to draw a stat CBC, give a liter bolus of NS, and repeat CBC. Vital Assessment 20ga. Ramona Stukes, 69 yr-old, third day post-op cholecystectomy. Safety Needs frequent reminding due to determination to do things herself without assistance. Type of Line: Peripheral, location ______________ CVL, location _____________ PICC, location _______________ Tube Feeding: Type:_________________________ Amount/Rate: ________________________ Bolus/Infusion It is determined that Mr. Sturgess could achieve better pain control with a PCA pump. Vital signs -Temp 99.1, BP 124/62, P 77, RR 20, SaO2 91%. Chronic Pain False The patient asks the nurse to explain about these medications and why they are in such a hurry. Upon entering the room, you find Mr. Sturgess is quiet, appears tense and rigid but states, If the source voltage for the a phase is Van=12080V\mathbf{V}_{a n}=120 \angle{ 80^{\circ}} \mathrm{V}Van=12080V, and the line impedance is zero, find the phase currents in the wye-connected source. Self-Actualization RLE: ______________ LLE: ______________, Casts/Splits: ____________________________, Motor response Verbal command = 6 Scenario 1 Impaired Skin Integrity, Risk for True You now arrive in the recovery unit one hour post-surgery and you are told that the surgery went well. Senario 5 Self-Care Deficit True Risk for Infection True Provide emesis basin/cloth GI WNL. Sensorium Normal acuity, Physiological -Reapply the NC that he was admitted with at 2L Hep-Lock in place left AC. Urine Color: Clarity: Odor: His orthostasis is normalized after a second liter of NS was administered. Estimate the length of the Neptunian year given that the Earth is 1.50108km1.50 \times 10^{8} \mathrm{km}1.50108km from the Sun on the average. Skin warm and dry, all vital signs in WNL except 115 pulse, which is normal for him. Robert Sturgess Scenario 1 Mr. Sturgess is recently diagnosed with metastatic cancer of colon and he and his family have chosen only palliative care. Senario 1 Pulses: Strength & Symmetry Edema: -Place patient on 100% O2 Mr. Gonzales H/H is 12.7/38. Senario 5 Imbalanced Fluid Volume, Risk for True Decreased cardio tissue perfusion: False -Place patient on O2 Nasal Canula He also has a history of hypertension and takes Tenormin (Atenolol) and Atorvastatin (Lipitor). Senario 2 -Assess patient's ABC (airway, breathing, circulation) Scenario 1 Notify doctor Wound clean dry and intact. -Determine when a hospital provided sitter will be necessary He is emotionally distraught and is insisting that he be allowed to report what is going on from the ER. Senario 1 Students will form a preliminary assessment based on reported assessment data for medical surgical patients in a virtual clinical environment. You correctly diagnosed 11 out of 16 options. Mr. Mancia is non-English speaking patient and is fearful of being discovered as an illegal immigrant. The sister of Mr. Mancia calls from home to speak with you. Electrolyte Imbalance, Risk for True Students will assign correct nursing diagnosis for patients in a medical surgical virtual clinical environment. Safety Allow family to remain Mr. Duncan's wife meets you in hall asking what she could bring her husband to eat from home. Scenario 4 Pain Level Increased acuity Fall, risk for: True They wanted to know and pressure you for the information. Skin integrity, impaired True Scenario 5 Scenario 3 Decreased Cardio Tissue Perfusion False Scenario 2 Stools are decreasing but patient remains very weak. Ms. Cumble states that she has not had a BM for three days. You arrive in room to find Ms. Monson talking to herself. Grieving: False Evaluate outcome of dietary plan Notify charge nurse that discharge will probably not occur today. Verify call light/bed safety precautions Therapeutic communication. Remind physician to wash his hands before examining the patient Amount:________ References; Access My Virtual Clinicals; Medical-Surgical. Bowel Movement Total: x________________, Hygiene Times Imbalanced Nutrition: True Knowledge Deficit True -Ensure patient privacy and call for help and assist patient to bed once help arrives -Remove the lunch tray and ensure pre-operative consent has been signed. Skin Color: Consistent with ethnicity pinkish-tan light-tan dark-tan light-brown dark-brown Offer bedpan Diet as tolerated. Carotid:____ + Bilateral Other: _____________ RUE: Non-pitting Pitting ___+ Impaired Mobility True Educational Needs Increased acuity 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. 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. Scenario 5 Peripheral Neurovascular Dysfunction: False Scenario 1 Your coworkers are asking you questions about Mr. Dominec. No response = 1, Muscle Strength: WNL, Flaccid, Contracted Educate patient Hep-Lock in place left AC. Acute Confusion False -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 Offer nutrition/toilet Peripheral Neurovascular Dysfunction False. Robert Sturgess 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. -Check on patient/sitter hourly IV fluids of D5 1/2 NS are infusing at 100 mL/hour to his right forearm. Fall, Risk for False Vital assessment -Instruct Mr. Burgundy and his cameraman to stop immediately Deficient knowledge: True After 24 hours, Ms. Gestalt fever and chills have subsided but now states she is feeling like her cast is too tight. The charge nurse asks you to assume the patient's nursing care. Awaiting transport. Visual assess Notify doctor if condition is abnormal Scenario 2 Background Robert Sturgess the client was admitted with Metastatic cancer of Colon, with history of diabetes. -Ensure there is a full O2 tank on the gurney, place patient on Nasal Cannula Assess for bowel sounds Love and belonging Contact Social Services Decreased Cardiac/perfusion: False Description: Sharp Stabbing Throbbing Aching Cramping Other: His left humerus is fractured and splinted. Bleeding, Risk for False Disturbed Sensory Perception True Love and belonging No known allergies (NKA). You also notice the patient is more difficult to orient. Flexes & withdraws = 4 Inform his partner that everything is being done to keep him comfortable. **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 (for older swift river patients see other pdf files loaded at the bottom of this file) Preston Wright Room . Acute Confusion True Acute Pain False Endoscopic resection, which uses an endoscope to remove damaged cells to aid in the detection of dysplasia and cancer. -Give NS liter bolus Call rapid response Perform circulatory evaluation Regardez le Salaire Mensuel de New King James Bible Download For Windows 7 en temps rel. Continent: Yes No Occasional Incontinence Frequent Incontinence Brief Odor: __________, No Bleeding Risk for: False She has arrived in pre-op and about to have surgery this morning. Scenario 4 No Known allergies (NKA). 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. Palliative care. Abdominal Pain: Non-tender Tender/Pain Describe: Swallowing: Intact Dysphagia Aspiration Precautions sounds= 2 Scenario 4 Scenario 2 Grieving True He was recently diagnosed with stage III prostate cancer. 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. Next time we'll spend our 60 on some food and nice beers. Pupils PERRLA, eyes clear. The patient has a pneumothorax that requires a chest tube placement. -Reassess patient Students also viewed Culture Concept notebook Development concept notebook Elimination concept notebook Gas Exchange concept notebook It was diagnosed by a portable X-ray and quickly splinted by the ER staff. Students will prioritize medical surgical . Notify lead nurse/doctor Perineal Care Anterior: ___________________________________ Posterior: ____________________________________ If patient statement differs from the surgical consent she has signed, notify surgeon immediately Document results and findings Deficient Knowledge False Check surgical consent for correct procedure and make sure operative site in marked. A new graduate nurse receives a call from the hospital telling them to report to the ER immediately for a disaster. Need frequent reminder to stay in room and maintain mask precautions. Ms. Cumble is in bed and appears comfortable and requests assistance from you to get out of bed to go to the bathroom. You question her while reviewing her operative consent and determine that everything is correct. Palliative care. Full assessment Color:__________ Therapeutic communicationT The emergency bathroom light goes off and the nurse finds Mr. Greer on the floor in the bathroom. Paul Greer Scenario 5 -Explain to Mr. Greer that it may take several days for healing, and he may have temporary incontinence, but it will resolve over time. The Swift River is one of the most unique and popular trout fishing destinations in Massachusetts, yet the dynamics of this exceptional fishery have not been well understood. Pulse Ox: ___________ % on ____________FiO2; Room Air; Delivery Device Sit at an eye level. Constipation False Pain and numbness in legs for one week. Scenario 2 Vital assessment Today's incentive spirometry Tidal Volume is 1250ml, improvement over yesterday's 900ml. Document results Ms. Getts is being transferred as an emergency to Critical Care. -Ensure there is suction in the room, and check -Document and contact nursing supervisor/Charge nurse Shock False Shock, Risk for: False Scenario 4 Provide verbal report to team members who respond to rapid response Offer nutrition and/ or toileting Clinical 2. Sa fortune s lve 1 900,00 euros mensuels No known allergies (NKA). -Notify HCP of fall, complete incident report Mr. Richardson is requesting assistance to ambulate to bathroom. Stat lithotripsy treatment ordered. Acute Pain: True Provide information for MD to call family at home and explain what has just happened Diet as tolerated, up ad lib after gait training. -Verify that discharge orders have been written, provide discharge instructions, and in inform provider about the chest pain. Upon entering the room, the patient appears to be trying to get out of bed Lithia Monson, 93 years old, c/o head injury, r/o subdural hematoma. Scenario 4 Palliative care. -Complete neuro checks as ordered DSD (dry sterile dressing), forehead laceration clean and dry intact. He chooses to go home and see the doctor tomorrow in his office. -Assess if the contents of lunch tray are intact. Bleeding False Fear True Skin warm and pale. He also complains that his throat is still very sore. However, these abnormal cells do not have the capability to spread to other parts of the body. Arthur Thomason Powerlessness: True, Scenario 1 Scenario 3 Scenario 1 Scenario 4 Imbalanced Nutrition False Scenario 4 Full assessment including both lying/standing Determine clinical decisions based on listening to an audible client report. Neuro WNL alert and cooperative. Failure to Thrive False. Ask patient to explain to you what procedure she was expecting to have this morning. Reasses temp in 1 hour. Imbalance nutrition: True Scenario 1 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. He is aware that he may not have an erection and may need depends for bladder incontinence. The patient has a Foley catheter in place and is reporting 8/10 incisional pain and he is asking why his throat is sore. He has not had his BP medication today. Until the recent diagnosis of cancer, the patient had only seen a physician once in the last ten years. Listen to patient concerns Clear liquid diet. Ronald Burgundy -Ensure IV is patent, Lithia Monson Mr. Gonzalez has been admitted to the floor to determine that his chest pain is not related to a cardiac event. Read PT report Mr. Dominec had his surgical procedure and is doing great. She has been documented as being obese, new onset. He warns the patient that if he does not comply with the treatment and preventive measures, he will need other treatments that may include. Impaired Comfort True Neuro WNL alert and cooperative. -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 Esteem -Take initial vital signs (room air Pulse Ox) Rich Dad, Poor Dad (Robert T. Kiyosaki) The Methodology of the Social Sciences (Max Weber) Educational Research: Competencies for Analysis and Applications (Gay L. R.; Mills Geoffrey E.; Airasian Peter W.) . Aggravating Factors: LLE: Non-pitting Pitting ___+ His wife tells the nurse that he seemed very distant and did not want to talk much. -Continue to observe urine for hematuria and document findings Where is my camera man!! -Notify charge nurse of patient's deteriorating condition The bed arrives tomorrow. Document findings Scenario 2 Last Bowel Movement: Date: _____________________ Constipation Diarrhea/Loose Other: Educate patient Viola Cumble Impaired skin integrity: False, Anxiety: True She receives the pre-op medication. His partner is not with him at this time but will arrive soon to facilitate his discharge home. Remain with patient and reassure Cardiovascular Assessment Educate caller regarding HIPAA Senario 4 Virginia Smith
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