-Assess patients' pain and rule out cardiac pain. Vital assessment Waist belt restraint PRN; family sitter at bedside, assist with bath. Scenario 2: 1Educate about recovery from appendectomy and care to wound. Grieving True He requests no visitors at this time, but later asks for his family to be called to discuss a plan of care. You arrive in room to find Ms. Monson talking to herself. Safety Increased acuity, Physiological Arthur Thomason Dr. Donofrio, Physiological Scenario 3 The charge nurse tells you not to move the patient, because there is no special treatment according to social status. Leave to break room and not continue in conversation. Vital signs- 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 Reapply restraints Ineffective Coping False IV fluids of D5 1/2 NS are infusing at 100 mL/hour to his right forearm. After washing and gloving hands, you then identify yourself and the patient, Ann Rails. Scenario 5 Excess Fluid Volume, Risk for False Vital signs -Temp 98.8, BP 102/76, P 102- irregular, RR 22, SaO2 90%, cardiovascular on telemetry with Sinus irregular rhythm. He asks to speak to a clergy member. Bed Bath: Assist or Total -Reassess patient's physical status prior to leaving him in the hallway Scenario 2 He is questioning the nurse as to why he has been admitted for heartburn. Vital signs Temp 99.4, BP 106/72, P 96, RR 20, SaO2 91%. Mr. Dominec has a male partner and has been married for the past ten years and share their three children to the marriage. You are about to call the Surgical ICU and give report. DSD (dry sterile dressing), forehead laceration clean and dry intact. -Explain procedure to the patient #ozerysnackingrounds I am so excited to be partnering with Ozery Family Bakery today. Review pain medication order A GI cocktail was administered, and the patient stated that it decreased his pain to a 6/10. Demerol 25mg SIVP for pain, patient reports 7/10 on pain scale. Robert Domenic Therapeutic Communication -Tell the patient that they are being admitted to r/o any cardiac issues Lithia Monson Paul Greer Scenario 3 and the GI cocktail given in the ER did relieve his CP but not completely. Fall, risk for: True Why is cysteine such an important amino acid for defining the tertiary structure of some proteins? Scenario 4 Physical Mobility, Impaired True 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. Scenario 5 Decreased cardio tissue perfusion: False He is married, and his wife is requesting to stay at his side. Assist patient Neuro WNL alert and cooperative. Vital signs -Temp 97.2, BP 96/74, P 82, RR 20, SaO2 97%. -Notify charge nurse Mr. Mancia is non-English speaking patient and is fearful of being discovered as an illegal immigrant. Neck: ______________ Disturbed Sensory Perception True 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. The oncologist is insistent that the treatment begin immediately. Pain Level Increased acuity Neuro WNL alert and cooperative. Observe closely first hour Wash and glove hands No weight bearing today. Senario 1 Scenario 4 Remain with patient Acute Pain True Report this activity immediately to the hospital privacy officer Hep-Lock in place left AC. Psychological Needs Increased acuity -Draw a repeat CBC per HCP order to determine current Hemoglobin status The nurse arrives and sees a tent is being erected as a triage area, and ambulances are lined up delivering trauma patients. Impaired Home Maintenance management r/t client or family False His CP is 7/10 and his BP is 165/96, P 92, R 18, SaO2 98 on 2L NC. Senario 3 Glasgow Coma Scale 0-15 Musculoskeletal Wash and glove hands Vital assessment Allergic to sulfa drugs. Deficient Fluid Volume False Fall, Risk for True Pulse Ox: ___________ % on ____________FiO2; Room Air; Delivery Device Skin warm and pale. Senario 3 He also complains that his throat is still very sore. Call rapid response Purposive Communication Module 2, Chapter 1 - Summary Give Me Liberty! Crutches at bedside adjusted for height. ASA is held but morphine 4 mg was given after his GI cocktail. Psychological Needs Increased acuity NG tube to low suction possibly D/C'd today after Dr. Levine rounds. 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. -Check patency of Foley catheter, urine color, and ensure it is secure to the patient's leg -Ensure there is suction in the room, and check Bladder distention Pelvic pain Low back/flank pain Scenario 5 Scenario 4 Home; Our Focus; Our Legacy; Our Partners; Our People; Our Fellows; Our Investments Impaired Skin Integrity, Risk for False You are now preparing for discharge, place steps in order: Senario 1 Decreased Cardio Tissue Perfusion False No response = 1, Range of Motion: Full, Limited Oral Care Urine Color: Clarity: Odor: 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. Dr. Altace, Educational Needs Increased acuity -If gastric reflux is suspected administer PRN antacids (GI cocktail) Skin cool to touch and appears pale. Ms. Rails shares with you her fear of being discharged home to an abusive husband. Provide verbal report to team members who respond to rapid response Diet as tolerated, up ad lib after gait training. Then the bus splashed into the river for a cruise. Nutritional Intake: Adequate Inadequate BMI: -Perform admission assessment Dysfunctional Gastrointestinal Motility False Scenario 2 Senario 5 No known allergies (NKA). He is excited and tells the nurse he is starving and glad that he finally gets to eat. Pain and numbness in legs for one week. Document results and findings Health Change Increased acuity RLE: ______________ LLE: ______________, Casts/Splits: ____________________________, Motor response Verbal command = 6 Obtain recent chest X-ray reports and recent ABG's for physician to review -Transport Mr. Burgundy to his room Skin integrity at risk True Love and belonging Fear/Anxiety True. You now arrive in the recovery unit one hour post-surgery and you are told that the surgery went well. RUE: ______________ LUE: _____________ Neuro WNL alert and cooperative. Gait: ______________________________, Skin Integrity Assessment Combien gagne t il d argent ? Scenario 1 No Known allergies (NKA). Full assessment of patient. Health Change Increased acuity -Give NS liter bolus I need to be reporting!" Students will assign correct nursing diagnosis for patients in a medical surgical virtual clinical environment. Ms. Gestalt capillary refilling is now 6 secs below cast site, extremity is swollen and cold to the touch. Evaluate outcome of dietary plan Self-Care Deficit: True Two housekeepers, who were refusing to clean the room, are in the break room. Mr. Dominec leaves the room and you discharge him and escort him and his partner to the car. Senario 2 His partner is not with him at this time but will arrive soon to facilitate his discharge home. Safety- Pulses: Strength & Symmetry Edema: Offer bedpan No known allergies. There is an initial triage provider written set of orders at her bedside for a STAT Chest X-ray, IV with NS, O2 NC, and STAT CBC and Chemistry. He has a 20-year one pack history of smoking. Vital Signs: B: 160/92, P: 96, R: 22, SpO2: 98, T: 98.9F, 37.1C. Assess food consumption and intake and output Senario 5 Disoriented, confused = 4 Bleeding Risk for: False Electrolyte Imbalance, Risk for True Your responsibilities are: Scenario 1 Palliative care. When completing the shift change neuro check, you notice the patient's left pupil is sluggish. Mr. Burgundy has quieted down, and the fentanyl has apparently alleviated most of his pain and anxiety. Capillary Refill: _________ seconds Document Procedure Obtain and provide the infectious disease doctor's contact information for him. Ms. Rails states that she has not had a bowel movement (BM) in the past two days. 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 pale, weak, diaphoretic, and appears anxious. -Tell the wife that you will speak to the husband, and this is apprehension is expected with this surgery/diagnosis. Odor: __________, *Types: Abrasion, Burn, Laceration, Puncture, Surgical, Pressure Ulcer, Vascular Ulcer, Maceration, Excoriation, Skin Ineffective Peripheral Tissue Perfusion False Tibial: _____ + Bilateral Other: ______________ Generalized: Pedal: ______ + Bilateral Other: ____________ Sacrum: Non-pitting Pitting ___ +. Amount:________ Psychological Needs Normal acuity Report current urinary output quantify per hour and color of urine Mr. Gonzalez has returned from his EGD and is still sleeping from the sedation. The patient has a pneumothorax that requires a chest tube placement. The patient has been scheduled for an EGD today and has an order for Omeprazole (Prilosec) and Carafate (sucralfate). Psychological Needs Normal acuity Scenario 2 You escort them with you to the ICU. Your response to all of them would be: Scenario 1 Widespread Color Change: N/A pallor cyanosis jaundice erythema 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 . Vital sign Temp 98.4, BP 136/78, P 72, RR 20, SaO2 97%. Yes Productive Non-productive Describe Sputum: _______________________ Deficient Knowledge False Determine clinical decisions based on listening to an audible client report. Pain Level Increased acuity Powerlessness: True, Scenario 1 Pain Level Normal acuity Peripheral Neurovascular Dysfunction False Adjust crutches The nurse was told by the gastroenterology nurse that they really struggled before they called anesthesia and they may have caused an esophageal abrasion. Disturbed Body Image True The sister of Mr. Mancia calls from home to speak with you. -Advise sitter to notify nurse when leaving the room Document results Ms. Getts is now complaining of sudden sharp, substernal chest pain, very short of breath and is profusely diaphoretic. Multiple abrasions, bruising Head, chest, and inner thigh. Scenario 1 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? Raspberry and Cream Cheese Stuffed Blueberry French Toast with Ozery. Psychological Needs Increased acuity Ineffective airway clearance True No Evaluate understanding Refer call to contact health department Abdomen: Flat Rounded Scaphoid Distended Palpation: Soft Taut Rigid -Ensure patient privacy and call for help and assist patient to bed once help arrives Pain re-assessment What is the ratio of Fe\mathrm{Fe}Fe (II) atoms to Fe(III) atoms in this compound? Genitalia: WNL (skin intact, no lesions) Abnormalities Describe: __________________________ Dr. Suculo, Physiological Upon entering the room, you find Ms. Rails sleeping. He is aware that he may not have an erection and may need depends for bladder incontinence. Increased fall risk. Scenario 5 20ga. How does the Med-surg simulator work? Sleep Deprivation False -Complete secondary assessment once the patient is in bed focusing on complaint of pain resulting from the fall -Assess the patient's anxiety level while using therapeutic communication to decrease patients' stress. Scenario 3 Notify Physical Therapy (PT) Notify doctor Genitourinary Assessment They would also like to start Radium-223. Record intake and output -Reinforce to the patient to not get out of bed He also states he is feeling weak. If family/visitors come, will need education to airborne precautions. Pregnancy and labor and delivery are not typically associated with the concept of cellular regulation, Patient: Donald Lyles,52-year old male, was admitted yesterday evening for stabilization of his uncontrolled type II diabetes. Perform pain re-assessment Perform circulatory evaluation Background Robert Sturgess the client was admitted with Metastatic cancer of Colon, with history of diabetes. Esteem Document results She receives the pre-op medication. Administer antipyretic medication Love and Belonging Educate caller regarding HIPAA Senario 2 Self-Actualization Document results/findings Neuro WNL. Dr. Donofrio, Chronic Pain, Risk for constipation, impaired nutrition, anxiety, fear, grieving, hopelessness, powerlessness, Daily Flowsheet & Physical Assessment, Vital Signs Intake & Output Document results and findings Swift River Clinical Practice Chamberlain University Expert James Moore Category: Nursing Description Full Document Jose Martinez Room 301 Jose Martinez, Jose Martinez, 43- year old male experiencing chest pain while watching a state rival football game earlier in the evening. August 13, 2020 // by Angela McGowan. jessdevan. -Discuss and determine sitter availability Pain Level Increased acuity Ronald Burgundy Notify housekeeping. Constipation, Risk for True -Discuss effectiveness of sitter IV maintenance fluids with D5 1/2 NS with 20 KCL @ 125ml/hr in left forearm. Safety Swift River Medical-Surgical. Love and belonging Bleeding, Risk for True Neuro WNL, alert, and cooperative. Assist patient out of bed Ineffective Airway Clearance True He is emotionally distraught and is insisting that he be allowed to report what is going on from the ER. -Explain to the patient that he has a procedure, and he cannot eat. He is experiencing new onset of shortness of breath and has a nasal cannula with 2L of Oxygen in place. You enter his room and recognize that Mr. Thomason appears to be talking to himself and appears confused.

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