No response = 1, Range of Motion: Full, Limited Full assessment Vital signs Temp 99.4, BP 106/72, P 96, RR 20, SaO2 91%. Fall, Risk for True Dr. Starks, Physiological 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. Wasserman; Peter V. Minorsky), Principles of Environmental Science (William P. 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Failure to Thrive True. Sa fortune s lve 2 216,00 euros mensuels 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? Radiofrequency ablation, which uses heat to remove abnormal esophagus tissue. Deficient knowledge: True Powerlessness True. Explain reason for assessment and procedure Grieving: True His, Joyce Workman Room 303 Joyce Workman Joyce Workman, 42- year old female who presents to the Diabetes Clinic with a new diagnosis of type II diabetes. Tap patient and ask, "Are you okay?" Scenario 2 Safety Increased acuity, Physiological Scenario 1 Perform full assessment and provide anti-nausea medicine. Purposive Communication Module 2, Chapter 1 - Summary Give Me Liberty! Mr. Sturgess is recently dx w/ metastatic cancer of colon and he and his family have chosen only Scenario 1 They were also concerned about the next patient going into that room and the use of the lavatory. Scenario 2: 1Educate about recovery from appendectomy and care to wound. Scenario 2 Combien gagne t il d argent ? Upon entering room, you find Mr. Sturgess is quiet, appears tense and rigid but states, "I am feeling fine." . He is currently febrile with temperature 100.8, HR 99, BP 135/96, RR 20, PaO2 96%, nauseated with no vomiting, rebound tenderness in right lower quadrant, has elevated WBC's and surgeon feels this will be uneventful even though he has just been diagnosed with AIDS this past week. He is aware that he may not have an erection and may need depends for bladder incontinence. Ineffective Coping False Disoriented, confused = 4 Endoscopic resection, which uses an endoscope to remove damaged cells to aid in the detection of dysplasia and cancer. Evaluate understanding Mr. Dominec has a male partner and has been married for the past ten years and share their three children to the marriage. Oral Mucosa: Tongue: Teeth: Discharge instructions Comfort/Pain Assessment Hopelessness: True Skin warm and dry, all vital signs in WNL except 115 pulse, which is normal for him. Senario 2 The patient has a Foley catheter in place and is reporting 8/10 incisional pain and he is asking why his throat is sore. Re-assess patient Electrolyte Imbalance False Scenario 2 Scenario 3 Sitting, BP 109/60, P 114, Standing the patient becomes very lightheaded and the nurse has them lay back down. Sensorium Increased acuity, Physiological What order are you providing the information to the receiving nurse? Scenario 5 Pain and numbness in legs for one week. Shock, Risk for False Mr. Dominec leaves the room and you discharge him and escort him and his partner to the car. Love and Belonging Opening Title Production company Cast and crew Genre J A N U A R Y 2: The Killing of John Lennon: IFC First Take: Andrew Piddington (director/screenplay); Jonas Ball, Krisha Fairchild, Gunter Stern, Gail Kay Bell, Mie Omori, Robert C. Kirk: Crime, Drama: 4: One Missed Call: Warner Bros. Pictures / Alcon Entertainment / Kadokawa Pictures: Eric Valette (director); Andrew Klavan (screenplay . Neptune is an average distance of 4.5109km4.5 \times 10^{9} \mathrm{km}4.5109km from the Sun. You also notice the patient is more difficult to orient. Roger Clinton, 57-year-old male construction worker arrives at 0600 to be prepared for a partial thyroidectomy to determine if he has cancer. Scenario 5 Stat lithotripsy treatment ordered. Wash and glove hands -Tell the patient that they are being admitted to r/o any cardiac issues Verbal command = 3 Nathaniel Gonzalez 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. is a 57 y/o who has been admitted for a radical prostatectomy. Mr. Mancia is holding Catholic Rosary in hand and is crying as you enter the room. Obtain translator Fear True Clinical 2. -Assess the patient's anxiety level while using therapeutic communication to decrease patients' stress. Assessment of bowel movement Her husband and children remain with her in the surgical holding area awaiting transport to the OR. Mr. Gonzalez has returned from his EGD and is still sleeping from the sedation. -Tell the wife that you will speak to the husband, and this is apprehension is expected with this surgery/diagnosis. Scenario 3 No Known allergies (NKA). Paul Greer Hopelessness False. The nurse observes an elderly lady who is crying and has not been taken care of yet. Escort patient "I am feeling fine." Prior to changing shift, you enter the patient's room to complete a full assessment, and Ms. Monson is now crying asking to for someone to take her home! Scenario 3 Robert Sturgess, 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. Psychological Needs Normal acuity Mr. Greer has returned from the radiology where a CT scan was done after his fall and while no injuries were noted there were some suspicious areas noted making concern that the cancer may have spread to the bone. He requests no visitors at this time, but later asks for his family to be called to discuss a plan of care. Vital signs -Temp 97.2, BP 96/74, P 82, RR 20, SaO2 97%. Encourage fluids/fiber/ambulation Scenario 3 The MD on site makes the decision to intubate the patient and start ventilatory assistance and move the patient to Respiratory Intensive Care. Check surgical consent for correct procedure and make sure operative site in marked. Esteem Fall Risk Increased acuity Sleep Deprivation False -Offer nutrition and/ or toileting Imbalanced Nutrition True She is with her physician. Impaired Skin Integrity, Risk for False Why is cysteine such an important amino acid for defining the tertiary structure of some proteins? His VS are BP 122/64, P 89, R 12, SpO2 93%. He also has a history of hypertension and takes Tenormin (Atenolol) and Atorvastatin (Lipitor). Scenario 3 -Reassess patient q 5 minutes until awake, then 15 minutes until they are fully awake (not Drowsy). Perform circulatory evaluation Vital signs- Scenario 2 You are the now the Surgical ICU nurse assigned to her. -Evaluate patient's understanding of teaching Swift River Reflection Questions day 7 Answer each question thoroughly in multiple sentences. Acute Pain True Senario 5 Decisional Conflict False Acute Confusion True The patient is being prepared for discharge and his IV has been removed. Stoma status: Pink-Red/Moist Dusky Retracted Excessive bulging Health Change Increased acuity Mr. Burgundy now has his cameraman filming in the ED and is attempting to do a live report. Palliative care. You arrive in room to find Ms. Monson talking to herself. Offer bedpan Skin integrity at risk True Nausea False Incomprehensible Safety Increased acuity, Physiological Respiratory Assessment Primary: Check LOC, Orientation, Breathing, Circulation, Brief Neuro assessment to include spinal pain or deformities, Obvious injuries. Notify lead nurse/doctor Request time she can arrive and staff to help with transfer Verify call light/ bed safety precautions Also worth mentioning is the 'Alter Schwede' - a 217t . Scenario 2 Intermittent/Continuous Other: Tunneled, site _______________ Implanted port, accessed _____________________ Students will assign correct nursing diagnosis for patients in a medical surgical virtual clinical environment. Ms. Getts is now complaining of sudden sharp, substernal chest pain, very short of breath and is profusely diaphoretic. 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. You determine to apply the restraint now. Inform and educate spouse of dietary orders ADA diet, intake, 25%. Paul Greer 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. Full assessment Normal Sinus Rhythm on telemetry. Dr. Jones. No known allergies (NKA). Pain, Acute True Remind physician to wash his hands before examining the patient Fall, Risk for True Scenario 3 The oncologist is recommending Docetaxel as opposed to an orchiectomy. If family/visitors come, will need education to airborne precautions. Senario 2 Therapeutic Communication Background Robert Sturgess the client was admitted with Metastatic cancer of Colon, with history of diabetes. Scenario 2 IV maintenance fluids with D5 1/4 NS @ 150 ml/hr X 3 then reduce rate to 75 ml/hr. Encourage to ambulate with assistance to void if needed Wash and glove hands Document results and findings Self-Actualization Scenario 1 Scenario 4 Pain Level Normal acuity Impaired mobility: False Patient, and family upset regarding dx. Allow for non-compliance of request -Notify charge nurse of patient's deteriorating condition No known allergies (NKA). 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. Perform neuro assess Document Procedure Peripheral Neurovascular Dysfunction True. Pain: No Yes: Location: ______________________ Acute Chronic Constant Intermittent His CP is 7/10 and his BP is 165/96, P 92, R 18, SaO2 98 on 2L NC. Health Change Increased acuity Lung sounds are worse. Request sitter/family member to bedside -Assess patient's understanding of the teaching and discuss home support, os de la main et de la ceinture pelvienne, Julie S Snyder, Linda Lilley, Shelly Collins. Full assessment Oriented to: Person Place Time 2. The pain makes him short of breath. Self-Care Deficit True Constipation, Risk for True -Document and contact nursing supervisor/Charge nurse Educational Needs Increased acuity Your responsibilities are: Scenario 1 Swallowing: Intact Dysphagia Aspiration Precautions Present health assessment including B/P and LOC and dressing. Blood Glucose 185, 4 units of insulin sliding scale for coverage. Record intake and output Noncompliance True. John Duncan -Check on patient/sitter hourly Scenario 4 The surgeon believes that the surgery was successful but recommends the patient have chemotherapy and radiation postoperatively. Scenario 1 Chronic Pain True Discuss his understanding about the plan of care. Constipation False Deficient Diversional Activity False Color:__________ There is an order to apply a waist belt restraint if needed. Mrs. Smith's surgery has now ended. Scenario 4 The patient will be discharged today, and he will be ordering new prescriptions. Rapid Response team arrived including anesthesia. Pain affecting: N/A Sleep Activity Exercise Relationships Appetite Concentration Anxiety True 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. Combien gagne t il d argent ? Check physician orders Deficient Knowledge True Disturbed Sensory Perception False Scenario 5 Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. Neck: ______________ Ambulates with minimal assistance. Respiratory Rhythm: Regular Rhythmic Irregular Periods of Apnea Cheyne-Stokes You escort them with you to the ICU. Vital assessment Scenario 5 Acute Pain True Increased fall risk. -Ask the patient to verbalize understanding of teaching and reassure them that yourself or any member of their care team will be available to answer questions. Imbalanced Nutrition True -Give NS liter bolus Notify doctor for Foley catheter Report and document results You notify the charge nurse that you have never taken part in inserting a chest tube. Encourage fluids Sa fortune s lve 2 216,00 euros mensuels Vital signs -Temp 98.8, BP 102/76, P 102- irregular, RR 22, SaO2 90%, cardiovascular on telemetry with Sinus irregular rhythm. Vital assessment However, he quit three years ago when he remarried; he and his wife have a nine-month-old baby. Skin warm and dry, daily dressing changes, T-tube without drainage. Report current urinary output quantify per hour and color of urine Deficient knowledge: False Non-significant past medical Hx. Deficient knowledge: True Dr. Small at bedside with patient and family. -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 Radial: ____ + Bilateral Other: _____________ RLE: Non-pitting Pitting ___ + She is having some difficulty breathing. Provide comfort and pain measures Isolative, appears fearful, crying, and refusing to see her husband. Risk for Infection True The sister of Mr. Mancia calls from home to speak with you. 2Provide comfort in pre-surgical room Mr. Dominec. Skin warm and dry, all vital signs in WNL except 115 pulse, which is normal for him. Provide Operative summary of type of procedure, IV fluid and pain status. Heterotrophs include (1) autotrophs, saprophytes, and herbivores (2) omnivores, carnivores, and autotrophs (3) saprophytes, herbivores, and carnivores (4) herbivores, autotrophs, and omnivores. Robert Sturgess 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. Scenario 2 Assess for fall risk Acute Confusion False You enter patient's room. Ms. Cumble states that she has not had a BM for three days. Scenario 3 He was recently treated for a URI with a Z pack, prednisone, and Motrin for pain. Wash and glove hands -Place patient on O2 Nasal Canula Document results/findings Acute pain: False -Assess for fall risk Nausea: False Verify call light/bed safety precautions SANE nurse to make second visit today. -Remind patient to call for help is he need to get up and provide patient with a urinal. Vital Signs: B: 160/92, P: 96, R: 22, SpO2: 98, T: 98.9F, 37.1C. -Explain that Docetaxel is a hormone therapy that suppresses the testosterone that your testicles produce producing similar results as surgical intervention. Ineffective Renal Perfusion, Risk for True Assess food consumption and intake and output Robert Sturgess Scenario 1 Mr. Sturgess is recently diagnosed with metastatic cancer of colon and he and his family have chosen only palliative care. Skin warm and dry, all vital signs in WNL 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. -Medicate for pain Explain to her family and provide contact information. Scenario 5 Mr. Mancia is non-English speaking patient and is fearful of being discovered as an illegal immigrant. Ms. Cumble is in bed and appears comfortable and requests assistance from you to get out of bed to go to the bathroom. Upon entering the room, the patient appears to be trying to get out of bed Scenario 3 Ms. Getts is being transferred as an emergency to Critical Care. Scenario #3. Esteem ADA diet, intake 25%. -Obtain chest tube tray and set-up pleurovac Mr. Mancia's vital signs upon assessment are Temp 101.2, P 94, RR 20, BP 122/82, SaO2-91%. Do not disturb Explain to Mr. Dominec your concern for this opportunistic infection and usual treatment. Connect telemetry You are about to call the Surgical ICU and give report. Inform his partner that everything is being done to keep him comfortable. -Recheck Tilts after the NS bolus is complete.T Safety Ronald Burgundy Acute pain: True Skin cool to touch and appears pale. Decisional Conflict True Notify Physical Therapy (PT) Evaluate/Modify Mobility Plan, Carlos Mancia, 48yr-old, Spanish speaking migrant worker with no known past medical Hx. You have them remain with you, seated in comfortable place, while you call ICU and attempt to locate physician for them. Neuro WNL alert and cooperative. Dr. Suculo, Physiological Senario 3 -Perform admission assessment Document and prepare to transfer to Surgical ICU Skin moist, respiratory bilateral wheezes and rhonchi. -Teach the patient that there are several interventions for complications post-prostatectomy to include erectile dysfunction, post-op prostatectomies, and self-care involved with a foley catheter at home. As you enter the room, Mr. Duncan is refusing to eat foods from bland diet. Ms. Gestalt capillary refilling is now 6 secs below cast site, extremity is swollen and cold to the touch. 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. It is unclear if he lost consciousness. Generalized weakness, blood tinged urine and severe pain upon urination, GI- n/v. The patient is awake alert and oriented. Bed Bath: Assist or Total No known allergies (NKA). Start secondary large bore IV line Reorient Patient to person, place, & time Document conversation Increased fall risk. Arthur Thomason, 56-year-old MVA victim, fourth day post op with a splenectomy and femur repair. Refer call to contact health department Knowledge Deficit True Water/Flush: You call his doctor to inform him the family has arrived. Ms. Gestalt is now complaining of fever and chills. Following isolation precautions, you notice several family members are by his bedside and none of them are wearing face masks as requested by sign on door. Wash and glove hands All our products can be personalised to the highest standards to carry your message or logo. Pulse Ox: ___________ % on ____________FiO2; Room Air; Delivery Device The Physician tells you to have everything ready including a 22 French chest tube, and he will be in shortly to position the chest tube. Bleeding Risk for: False Senario 4 This shop has been compensated by Inmar Intelligence and its advertiser. Shock False A GI cocktail was administered, and the patient stated that it decreased his pain to a 6/10. Robert Sturgess Robert Sturgess 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. Explain to physician what interventions you have recently initiated Until the recent diagnosis of cancer, the patient had only seen a physician once in the last ten years. She receives the pre-op medication. Skin warm and dry, all vital signs in WNL except 115 pulse, which is normal for him. Chronic Pain False Reasses temp in 1 hour. -Check patency of Foley catheter, urine color, and ensure it is secure to the patient's leg Ask patient to explain to you what procedure she was expecting to have this morning. No known allergies (NKA). 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. Wound site clean, dry and intact NPO, NG-tube to low continuous suction. His wife tells the nurse that he seemed very distant and did not want to talk much. Hep-Lock in place left AC. He has been ruled out for an MI. Educate patient Strict I&O and strain all urine, filters in bathroom. Hopelessness False. Continent: Yes No Brief/Diaper I need to be reporting!" Assess for bowel sounds Neuro WNL, alert, and cooperative but worried about scarring and is reluctance regarding walking on leg. -Medicate for pain While assessing the patient, Mr. Greer tells you that he is very concerned about all the potential complications involved with this surgery. Last pain medicine 2hrs ago at 1300(Demerol 50mg/ Zofran 4mg IV). All opinions are mine alone. Noncompliance: False Fall Risk Increased acuity Elevate head of bed Waist belt restraint PRN; family sitter at bedside, assist with bath. Regardez le Salaire Mensuel de Tthuchicago Org en temps rel. Awaiting transport. Clear liquid diet. Oral Care Hep-Lock in place left AC. Palliative care. Pupils PERRLA, eyes clear. Scenario 2 Bleeding, Risk for: True After two hours, Mr. Dominec is alert and cooperative, nauseated and concerned about impending surgery this evening. Temperature is now 102.8. No known allergies (NKA). Blood Pressure, 7a-7p Total: 7p-7a Total: Carlos Mancia Sa fortune s lve 10 000,00 euros mensuels Full head to toe neuro assessment. References; Access My Virtual Clinicals; Medical-Surgical. Educate patient regarding condition Grieving False -Restart the IV and draw CBC Chronic pain: True Health Change Increased acuity Recent blood gases demonstrate falling PaO2 (hypoxemia) and increasing CO2 (Hypercapnia). Scenario 5 Evaluate outcome of dietary plan Dr. Rondeau, Educational Needs Increased acuity Mr. Sturgess does not have a living will or durable power of care completed. Electrolyte Imbalance, Risk for True Sa fortune s lve 2 000,00 euros mensuels -Discuss effectiveness of sitter Notify doctor of change in condition in particular: unproductive cough and low-grade fever. Temp Scenario 5 Sleep deprivation: False 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. Scenario 2 Document results Ineffective airway clearance True Provide verbal report to team members who respond to rapid response Provide information for MD to call family at home and explain what has just happened The pathology report shows no cancerous lesions. Urination: WNL Burning Frequency Urgency He is questioning the nurse as to why he has been admitted for heartburn.