Evaluate patient understanding The patient asks the nurse to explain about these medications and why they are in such a hurry. Oral Care Monitor and evaluate fluid intake Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. 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. LLE: Non-pitting Pitting ___+ Combien gagne t il d argent ? -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 Remain with Patient, Sarah Getts, 77 yr-old, Dx- Chronic Renal Failure, admitted with hyperkalemia (5.9, Eq/L)/hyponatremia (128mEq/L). Skin warm dry, bruises on forehead with small laceration. Palliative care. -Provide a diversional activity to pass the time while waiting on the HCP and inform wife that the HCP will be coming soon Obtain vital signs machine Robert Sturgess Robert Sturgess 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. Stoma: N/A Colostomy Ileostomy Effluent Consistency: Senario 4 Scenario 2 A GI cocktail was administered, and the patient stated that it decreased his pain to a 6/10. Psychological Needs Increased acuity Wash and glove hands #1: _________, No Capillary Refill: _________ seconds Encourage to ambulate with assistance to void if needed Nutrition True No Known allergies (NKA). GI WNL. 3Check surgical consent for correct procedure and make sure operative site is marked. A new graduate nurse receives a call from the hospital telling them to report to the ER immediately for a disaster. Impaired Skin Integrity, False Endoscopic resection, which uses an endoscope to remove damaged cells to aid in the detection of dysplasia and cancer. Imbalance nutrition: True Yes Productive Non-productive Describe Sputum: _______________________ Mr. Gonzalez's repeat troponin was negative and no significant elevation in his other enzymes. Explain to physician what interventions you have recently initiated Acute Confusion False He chooses to go home and see the doctor tomorrow in his office. Sensorium Increased acuity, Physiological Severe pain (10/10) medicated q 30 minutes x4 with IV Morphine 2mg with little relief. -Attempt to orient to person, place, and time Sleep Deprivation False Her husband and children remain with her in the surgical holding area awaiting transport to the OR. In reassessing Ms. Monson, her vital signs are: BP -106/82, Temp-98.2, P-106, RR-18, SaO2-88. Dysfunctional Gastrointestinal Motility False The charge nurse tells you to get the Mr. Burgundy to the hallway because six more patients are inbound, and we need to clear out our trauma-bays. Impaired home maintenance mgmg r/t client or family: False Anxiety False No response = 1, Muscle Strength: WNL, Flaccid, Contracted Sa fortune s lve 2 216,00 euros mensuels Due to this, the provider would like him to stay in the hospital for observation. Enter the email address you signed up with and we'll email you a reset link. -Remove the dinner tray and make sure the diet is soft food. Scenario 2 Mr. Sturgess is now declining, and family members are requesting to remain in room past normal visiting hours. Encourage fluids 20ga. 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. Love and belonging 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. **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 . Grieving: True Chronic Confusion False Safety- Radiofrequency ablation, which uses heat to remove abnormal esophagus tissue. He warns the patient that if he does not comply with the treatment and preventive measures, he will need other treatments that may include. 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 Scenario 2 Impaired Skin Integrity False Clear liquid diet. You are about to call the Surgical ICU and give report. Scenario 1 Read PT report Safety Scenario 1 Fall, risk for: True Scenario 5 Senario 2 Vital signs -Temp 97.2, BP 96/74, P 82, RR 20, SaO2 97%. Scenario 1 Assess for bowel sounds Consult Social Service IV maintenance fluids with D5 1/2 NS at 125ml per hour in left forearm. Wash and glove hands He has not had his BP medication today. -Discuss and determine sitter availability Safety LOC Normal acuity Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. Sleep Deprivation False. -Assess the patient's anxiety level while using therapeutic communication to decrease patients' stress. She has been documented as being obese, new onset. Remind the nursing staff that the patient is NPO. Vital signs -Temp 98.6, BP 114/62, P 100, RR 20, SaO2 94%. Acute pain: True The patient was placed on 2 L O2 NC, EKG monitoring to include a 12 lead, Pulse Oximeter. Isolative, appears fearful, crying, and refusing to see her husband. All opinions are mine alone. Educate patient regarding patient care Dr. Altace, Educational Needs Increased acuity Document results/findings Noncompliance: False Safety Explain to Mr. Dominec your concern for this opportunistic infection and usual treatment. Physical Mobility, Impaired True Document results/findings -Place patient on 100% O2 Genitourinary Assessment Document results and findings Love and belonging Ineffective Renal Perfusion, Risk for True Diet as tolerated. Ms. Getts is requesting water to drink. -Reassess patient -Ensure patient privacy and call for help and assist patient to bed once help arrives Scenario 2 This shop has been compensated by Inmar Intelligence and its advertiser. Assess While assessing the patient, Mr. Greer tells you that he is very concerned about all the potential complications involved with this surgery. Ask patient to explain to you what procedure she was expecting to have this morning. Provide comfort and pain measures Encourage fluids and fiber diet Water/Flush: Scenario 3 Bed Bath: Assist or Total Administer protocol antidiarrheal medication Cryotherapy, which uses an endoscope to apply a cold liquid or gas to abnormal cells in the esophagus. Pain Level Increased acuity -Notify charge nurse of patient's deteriorating condition The nurse was told by the gastroenterology nurse that they really struggled before they called anesthesia and they may have caused an esophageal abrasion. Heterotrophs include (1) autotrophs, saprophytes, and herbivores (2) omnivores, carnivores, and autotrophs (3) saprophytes, herbivores, and carnivores (4) herbivores, autotrophs, and omnivores. Mr. Greer has just returned from surgery. Scenario 4 Vital assessment Acute Confusion True Your notice Mr. Thomason is lying supine, appears slightly cyanotic in his lips, is exhibiting more effort to breathe, and is increasingly restless. Demerol 25mg SIVP for pain, patient reports 7/10 on pain scale. Full assessment including both lying/standing Pulse Yes The patient is awake, alert, and oriented. Perform neuro assess Pain Level Increased acuity Fall Risk Increased acuity 20ga. Administer antiemetic medication Ann Rails Evaluate understanding Safety Surrounding skin: Moist/Intact Red/Erythema Irritation Carlos Mancia LOC Normal acuity Inappropriate words = 3 -Complete secondary assessment once the patient is in bed focusing on complaint of pain resulting from the fall Skin integrity at risk True Senario 5 Call rapid response Administer antipyretic medication Neuro WNL alert and cooperative. Dr. Donofrio, Physiological Acute Pain False Love and Belonging -Assess if the contents of lunch tray are intact. Full assessment Request sitter/family member to bedside Safety- Excess Fluid Volume, Risk for False Scenario 4 Mr. Dominec had his surgical procedure and is doing great. Document results. Scenario 2 Respiratory Rhythm: Regular Rhythmic Irregular Periods of Apnea Cheyne-Stokes Disturbed Sensory Perception True His overall health is good, and he has known he has been HIV positive for the past five years. 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. Sa fortune s lve 10 000,00 euros mensuels Evaluate understanding Grieving False -Inform Mr. Burgundy that he cannot report from the ED, as patient privacy is strictly protected by HIPPA Awaiting transport. Educate pt regarding changes to POC Airborne Isolation. Elevate Extremity Scenario 5 Sa fortune s lve 2 216,00 euros mensuels Aggravating Factors: Knowledge Deficit True Remind staff that Universal Precautions are practiced at this hospital for all patients regardless of known infectious diseases. Acute Pain True -Ensure patients is positioned in bed properly Auscultate peripheral pulses and ROM. Respiratory Effort: Relaxed, Regular, Non-labored Pursed lip breathing Labored Procedure is canceled for the day and rescheduled later allowing for new consent. : 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. You enter room and find Ms. Gestalt crying because she has just learned her medical insurance has lapsed and she is already two months behind on her car payments. You have them remain with you, seated in comfortable place, while you call ICU and attempt to locate physician for them. Scenario 1 She shares concern about patient's wife who is now coughing and having night sweats. Decisional Conflict True The charge nurse asks you to assume the patient's nursing care. They wanted to know and pressure you for the information. -Reorient Patient to person, place, & time Nursing questions and answers. Document results and findings Vital assessment His original lymph node biopsy was negative. -When the HCP arrives, stay in the room to determine whether you can continue care with the patient : beach pearl), in walking distance of the velgnne ferry stop, is considered the mother of all urban beach clubs. 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. Ms. Gestalt capillary refilling is now 6 secs below cast site, extremity is swollen and cold to the touch. 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. Obtain Clinical Hours 24/7/365 In-Class and Lab Learning Resource Improve Clinical Practice Scenario 5 Explain to her family and provide contact information. Virginia Smith Perform pain reassessment You notify the charge nurse that you have never taken part in inserting a chest tube. -Explain to Mr. Greer that it may take several days for healing, and he may have temporary incontinence, but it will resolve over time. -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 After leaving the room the provider tells the nurse that he hopes that he scared him into compliance with the treatment options. Elevate head of bed Bowel Movement Total: x________________, Hygiene Times Notify family Senario 4 Inspect cast site Vital signs are: B/P 112/78, temp. Family at beside. Background Robert Sturgess the client was admitted with Metastatic cancer of Colon, with history of diabetes. Evaluate/Modify Mobility Plan, Carlos Mancia, 48yr-old, Spanish speaking migrant worker with no known past medical Hx. Color:__________ Decreased cardio tissue perfusion: False Waist belt restraint PRN; family sitter at bedside, assist with bath. Skin warm and dry, all vital signs in WNL except 115 pulse, which is normal for him. Vital sign Temp 98.4, BP 136/78, P 72, RR 20, SaO2 97%. The patient got dizzy when he stood up from the commode. His left humerus is fractured and splinted. Scenario 4 Fatigue True -Assess patient's ABC (airway, breathing, circulation) -Explain to patient why his throat may be sore Senario 1 Acute pain: False Scenario 2 Safety Bleeding: True Notify family as to when they may come and visit. -Complete initial post-op assessment -Administer the medication with a small sip of water and place an NPO sign at the entrance of the patient's room. Widespread Color Change: N/A pallor cyanosis jaundice erythema river part Answers to the questions; Fillable SOC 1 DLA 1; Fillable SOC 1 DLA 2 - Notes on Environmental effects through sociology . IV Assessment/ N/A Oral Mucosa: Tongue: Teeth: Safety Increased acuity, Physiological Pain and numbness in legs for one week. His children are visiting, and they are very supportive. Vital signs -Temp 97.2, BP 96/74, P 82, RR 20, SaO2 97%. Leave to break room and not continue in conversation. Fall, Risk for True Scenario 4 Impaired Comfort True No known allergies (NKA). Students will assign correct nursing diagnosis for patients in a medical surgical virtual clinical environment. Temperature is 98.3, HR is 87, RR is16, BP is 121/74, PaO2 is 98%. Scenario 5 At Risk, Impaired Comfort False You correctly diagnosed 11 out of 16 options. You are now preparing for discharge, place steps in order: Senario 1 Disturbed Body True IV NS is started, and lab work is sent. Don Personal Protective Equipment Notify housekeeping. Senario 5 She has received a dose of Hydrocodone for PRN pain 20 minutes ago. Awaiting diagnostic labs. Hx of dementia, from nursing home, fall one day ago. Visual assessment Listen to patient concerns Validate NPO Status Wash and glove hands Perform full assessment and provide anti-nausea medicine. Fatigue True Pain Level Increased acuity -Reinforce the risk if patient has not been NPO and ask the patient when the last time they ate. Notify Doctor for pain medz Skin warm and dry, all vital signs in WNL except 115 pulse, which is normal for him. Vital signs -BP 124/82, Temp 98.2, P 84, RR 22, SaO2 96%. The patient will be discharged today, and he will be ordering new prescriptions. Carotid:____ + Bilateral Other: _____________ RUE: Non-pitting Pitting ___+ The cycle of freezing and thawing damages the abnormal cells. Wound clean dry and intact. Recent chest X-ray shows diffuse bilateral interstitial infiltrates in all lobes. -Give NS liter bolus RLQ: RUQ: LUQ: LLQ: Fall, risk for True Senario 1 Ms. Cumble states that she has not had a BM for three days. 50% intake. The bed arrives tomorrow. Scenario 3 -Offer nutrition and/ or toileting Scenario 1 Scenario 4 Verify call light/bed safety precautions The patient tells the nurse that yesterday he was, "concerned about having an erection, and now they want to cut off my testicels". You now arrive in the recovery unit one hour post-surgery and you are told that the surgery went well. -Medicate for pain Peripheral Neurovascular Dysfunction False Skin warm and, dry, all vital signs in WNL except 115 pulse, which is normal for him. Tom Richardson, 46yr-old. Senario 2 Also worth mentioning is the 'Alter Schwede' - a 217t . How does the Med-surg simulator work? You escort them with you to the ICU. Nausea False Attempt to orient to person, place, and time Review pain medication order No Known allergies (NKA). Hopelessness: True Acute Confusion True jessdevan. Cross), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Forecasting, Time Series, and Regression (Richard T. O'Connell; Anne B. Koehler), Week #7 Assignment - Incentive Spriometer . "I am feeling fine." Scenario 5 We have more than 20 years' experience in the industry providing a quality service to our clients We pride ourselves on our customer-orientated service and commitment to delivering high end quality goods within quick turnaround times. Blood Pressure, 7a-7p Total: 7p-7a Total: Pulse Ox: ___________ % on ____________FiO2; Room Air; Delivery Device Hopelessness False. Tom Richardson Vital assessment Cough: Decreased Cardiac/perfusion False -Complete full assessment, to include neuro Perform pain re-assessment Scenario 5 Verify call Light/bed safety precautions The patient has a Foley catheter in place and is reporting 8/10 incisional pain and he is asking why his throat is sore. -Discuss with family sitter if there are any other family members who can help with monitoring Lithia Scenario 5 -Ask Mr. Burgundy to lower his tone as it can be disturbing to other patients Put the patient on O2 NC and Fentanyl 25mcg IVP for pain. Evaluate understanding Regardez le Salaire Mensuel de Ubah Kalimat Efektif Online en temps rel. Document results and findings Senario 2 The patient describes this pain as a heavy pressure with intermittent stabbing. Evaluation patient after consult Scenario 4 Peripheral Neurovascular Dysfunction True. Offer bedpan He is restless with slight confusion but is easily orientated with attempts from nurse. Discuss his understanding about the plan of care. Bleeding, Risk for False -Instruct Mr. Burgundy and his cameraman to stop immediately #ozerysnackingrounds I am so excited to be partnering with Ozery Family Bakery today. The provider advises the Nurse to draw a stat CBC, give a liter bolus of NS, and repeat CBC. Dr. Small at bedside with patient and family. Nathaniel Gonzalez Upon entering the room, you find Ms. Rails sleeping. Deficient knowledge: True Full assessment of patient. 0800 1200 You call his doctor to inform him the family has arrived. Verify Call Light/Bed Safety precautions Wash and glove hands Place call light and check bed for safety Neuro WNL, except leg pain upon movement. Nausea False Anxiety True Other: _______________________________ Deficient Knowledge False Remain with patient Document results, Care of the Patient with a Cardiovascular or, NCLEX - Care of Patient with an Immune Disord, Quiz: Chapter 54, Care of the Patient with an, Chapter 54: Care of the Patient with an Immun, Chapter 17, Section 5; Providing First Aid fo. Upon assessment, you determined that she is confused to person, time, and place but is easily directable. Senario 4 Verbal command = 3 Until the recent diagnosis of cancer, the patient had only seen a physician once in the last ten years. Next time we'll spend our 60 on some food and nice beers.