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View Swift River Reflection Questions (1).docx from NRSG 4412 at South College. Senario 4 Scenario 1 IV Fluids: INT lock IV Fluids ______________@ _____________ mL/hr Date on tubing: Copyright 2023 StudeerSnel B.V., Keizersgracht 424, 1016 GC Amsterdam, KVK: 56829787, BTW: NL852321363B01, Chronic Pain, Risk for constipation, impaired nutrition, anxie, 4 units on insulin sliding scale for coverage, Campbell Biology (Jane B. Reece; Lisa A. Urry; Michael L. Cain; Steven A. Wasserman; Peter V. Minorsky), The Methodology of the Social Sciences (Max Weber), Civilization and its Discontents (Sigmund Freud), Educational Research: Competencies for Analysis and Applications (Gay L. R.; Mills Geoffrey E.; Airasian Peter W.), Chemistry: The Central Science (Theodore E. Brown; H. Eugene H LeMay; Bruce E. Bursten; Catherine Murphy; Patrick Woodward), Give Me Liberty! His coughing, to clear his airway, appears ineffective. Discuss follow up with his doctor. Neuro WNL alert and cooperative. -Evaluate patient's understanding of teaching No Known allergies (NKA). Fall, Risk for True river part Answers to the questions; Fillable SOC 1 DLA 1; Fillable SOC 1 DLA 2 - Notes on Environmental effects through sociology . Read PT report Allow husband to come into recovery for a quick one-minute visit. Failure to Thrive: 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. 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. -Use therapeutic communication/active listening Grieving False Acute Pain True Sarah Getts Health Change Increased acuity Evaluate/Modify Mobility Plan, Carlos Mancia, 48yr-old, Spanish speaking migrant worker with no known past medical Hx. His partner is not with him at this time but will arrive soon to facilitate his discharge home. Home; Our Focus; Our Legacy; Our Partners; Our People; Our Fellows; Our Investments Dr. Altace, Educational Needs Increased acuity Compromised Family Coping: False Mrs. Smith's surgery has now ended. Psychological Needs Increased acuity Palliative care. Scenario 3 Deficient Fluid Volume True You are told that he has intermittent chest pain with substernal burning that radiates to his mid-back. Airborne Isolation. Evaluate caller understanding Check surgical consent for correct procedure and make sure operative site in marked. Chronic pain: True Blood-tinged mucous, productive cough. Ineffective Self-Health Management False Therapeutic communication. Virginia Smith, 57-year-old who has elected to have a total mastectomy based on consultation with her surgeon, a total mastectomy removes all breast tissue but leaves all or most of axillary lymph nodes and chest muscles intact. Educate about recovery from appendectomy and care to wound. Dr. Levine, Marcella Como, 38 yr-old, Sexual Trauma Victim (Rape), unknown assailant. Educate patient Apical Pulse Rate: Heart Sounds: Normal S 1 S 2 S 3 She receives the pre-op medication. Scenario 1 Deficient Diversional Activity False -Medicate for pain Regular diet. Demerol 25mg SIVP for pain, patient reports 7/10 on pain scale. You arrive in room to check on her, after washing hands. Upon entering the room, the patient appears to be trying to get out of bed Dr. Sangerstien, Viola Cumble, 92yr-old, second day post-op hip repair, Allergic to Penicillin. Neuro WNL alert and cooperative. Yes You have them remain with you, seated in comfortable place, while you call ICU and attempt to locate physician for them. except 115 pulse, which is normal for him. Provide comfort measures She is having some difficulty breathing. 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. Wife at bedside. Acute Pain True Rapid Response team arrived including anesthesia. Scenario 1 Skin integrity at risk True Roger Clinton, 57-year-old male construction worker arrives at 0600 to be prepared for a partial thyroidectomy to determine if he has cancer. You are concerned about preventing the patient from falling. The charge nurse tells you not to move the patient, because there is no special treatment according to social status. Your coworkers are asking you questions about Mr. Dominec. Blood Pressure, 7a-7p Total: 7p-7a Total: A new graduate nurse receives a call from the hospital telling them to report to the ER immediately for a disaster. Check pedal capillary refill Pain affecting: N/A Sleep Activity Exercise Relationships Appetite Concentration Kathy Gestalt You arrive in room to find Ms. Monson talking to herself. Extends abnormally = 2 Grieving: False Vital signs Temp 99.4, BP 106/72, P 96, RR 20, SaO2 91%. Scenario 2 The provider explains that it is a pre-cancerous stage in where the cell develops abnormal features. Until the recent diagnosis of cancer, the patient had only seen a physician once in the last ten years. Awaiting transport. Neuro WNL alert and cooperative. 0800 1200 Scenario 4 The patient is awake alert and oriented. Vital signs- -Have patient remain in bed, head elevated 30 degrees 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. -When the HCP arrives, stay in the room to determine whether you can continue care with the patient Seznam uivatel, kte vlastn, prodvaj nebo shnj film. 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. Students will prioritize medical surgical . Filmotka filmu Najvyia ponuka (2013). 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? How was this Scenario #3. Skin Integrity: Intact No, describe below, Location Type Size Wound bed Drainage Offer assistance c/o headache- medicated with Lortab 5mg PO at 0900, takes Lomotil 10ml PRN q 4 hours last dose at 0834. 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. Fall, risk for: False Deficient knowledge: True Raspberry and Cream Cheese Stuffed Blueberry French Toast with Ozery. fallout 4 save wizard quick codes death and wheel of fortune tarot combination; gambling meaning in english urdu alpine spiced apple cider gluten free; how to use v2ray samsonas sequential gearbox subaru; lg magic remote power light stays on Educate patient She shares concern about patient's wife who is now coughing and having night sweats. Scenario 3 -Contact HCP to determine when they are available to speak with the patient Vital signs -Temp 98.6, BP 114/62, P 100, RR 20, SaO2 94%. -Provide the patient with the time when HCP will come discuss options with him Decreased Cardiac/perfusion: False -Reassure patient that he will be moved to a private room as soon as possible Virginia Smith Needs frequent reminding due to determination to do things herself without assistance. Evaluate outcome of dietary plan Diet as tolerated. Eye opening Spontaneous = 4 Genitalia: WNL (skin intact, no lesions) Abnormalities Describe: __________________________ Upon entering room, you find Mr. Sturgess is quiet, appears tense and rigid but states, "I am feeling fine." Document results Nathaniel Gonzalez Robert Domenic This information is HIPAA protected and you cannot share anything with them. Constipation False Place patient on PCA pump Notify family Safety Increased acuity, Physiological Validate NPO Status Scenario 3 IV maintenance fluids with D5 1/4 NS @ 150 ml/hr X 3 then reduce rate to 75 ml/hr. Provide comfort in pre-surgical room Mr. Dominec. Hypothermia False Scenario 2 ADA diet, intake 25%. Assist physician in physical exam of patient Pain Level Increased acuity Evaluation patient after consult Report current urinary output quantify per hour and color of urine References; Access My Virtual Clinicals; Medical-Surgical. The cells are allowed to warm up and then are frozen again. You, his prior nurse, notice the family and respond to them. He is emotionally distraught, and is insisting that he be allowed to report what is going on from the ED. 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. Scenario 3 Senario 4 He is complaining of pain in his left arm, and pain in his left chest when he tries to take a deep breath. Apply nasal cannula Scenario 4 Impaired Skin Integrity, Risk for False Intermittent/Continuous Other: He tells the nurse he has called his wife and wants to be discharged now. Evaluate/modify plan of care Verbal command = 3 Compromised Family Coping False Verify call light/bed safety precautions His overall health is good, and he has known he has been HIV positive for the past five years. Evaluate understanding Apply oxygen Swift River Medical-Surgical. Discharge instructions 97.4, Resp 16 and Pulse Ox 94%. Fear True Impaired Skin Integrity, False Stat lithotripsy treatment ordered. -Perform neuro assess Senario 4 Your response to all of them would be: Scenario 1 Dr. Starks, Physiological Vital assessment No known allergies (NKA). The oncologist is recommending Docetaxel as opposed to an orchiectomy. 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. Abdominal Pain: Non-tender Tender/Pain Describe: Scenario 1 Powerlessness True. Failure to Thrive True. Hx of dementia, from nursing home, fall one day ago. -Explain that Radium-223 mimics calcium and is absorbed during new bone growth. John Duncan Scenario 2 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. Document results Scenario 5 LOC Increased acuity -Discuss and determine sitter availability Obtain translator Dr. Altace, Physiological- Cardiovascular Assessment The patient describes this pain as a heavy pressure with intermittent stabbing. Scenario 3 The nurse arrives and sees a tent is being erected as a triage area, and ambulances are lined up delivering trauma patients. Elevate Extremity Scenario 2 Acute Pain: True Mr. Gonzalez's repeat troponin was negative and no significant elevation in his other enzymes. -Complete head-to-toe assessment while patient is on the floor. Sitting, BP 109/60, P 114, Standing the patient becomes very lightheaded and the nurse has them lay back down. Recently he manifested an unusual black lesion on his thigh and developed an opportunistic fungal mouth infection which was treated successfully. Senario 4 Constipation, Risk for True Gastrointestinal Assessment Mrs. Pittmon states she has had numbness for years but "now I can't . -Administer the medication with a small sip of water and place an NPO sign at the entrance of the patient's room. NG tube to low suction possibly D/C'd today after Dr. Levine rounds. Elevate head of bed Notify Doctor for pain medz Scenario 1 Mr. Richardson is requesting assistance to ambulate to bathroom. -Assess for fall risk Combien gagne t il d argent ? It is now the second day post op and he is given discharge information. Dysfunctional Gastrointestinal Motility False Scenario 2 Impaired Comfort True Scenario 2 Fall, Risk for True -Advise sitter to notify nurse when leaving the room Senario 2 Acquire daily weight and food intake An abc-phase-sequence three-phase balanced wye-connected source supplies power to a balanced wye-connected load. Odor: __________, No 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! The patient is being prepared for discharge and his IV has been removed. No response = 1, Range of Motion: Full, Limited Anxiety True He states, "This is not serious." Fall, Risk for True Assess Provide Operative summary of type of procedure, IV fluid and pain status. Scenario 2 Sa fortune s lve 2 216,00 euros mensuels They would also like to start Radium-223. Ineffective Peripheral Tissue Perfusion False Scenario 5 He was recently treated for a URI with a Z pack, prednisone, and Motrin for pain. Document results and findings No known allergies (NKA). You take his vital signs which are: Temp 101.3, Pulse 88, Resp 24, B/P 116/84. Skip to document Ask an Expert Sign inRegister Sign inRegister Home Ask an ExpertNew My Library Discovery Institutions StuDocu University Keiser University Western Governors University Procedure is canceled for the day and rescheduled later allowing for new consent. Other: _______________________________ Scenario 1 Full head to toe neuro assessment. Mr. Mancia is holding Catholic Rosary in hand and is crying as you enter the room. Scenario 2 Listen to patient concerns Alleviating Factors: Last pain medication: Fall, Risk for False -Reassess patient q 5 minutes until awake, then 15 minutes until they are fully awake (not Drowsy). Reasses temp in 1 hour. Safety Demerol 25mg SIVP for pain, patient reports 7/10 on pain scale. Encourage fluids The nurse identifies self to the nurse triaging patients and is directed to trauma room 4. The pathology report shows no cancerous lesions. -If gastric reflux is suspected administer PRN antacids (GI cocktail) Linen Change No Known allergies (NKA). -Explain procedure to the patient Scenario 2 Palliative care. Deficient Knowledge True Mr. Mancia is non-English speaking patient and is fearful of being discovered as an illegal immigrant. Apply restraint No known allergies (NKA). Obtain and provide the infectious disease doctor's contact information for him. Bleeding False Administer antipyretic medication Re-assess patient -Assess patient LOC, by walking patient and asking them to take deep breaths. Provide verbal report to team members who respond to rapid response Scenario 1 Skin moist, respiratory bilateral wheezes and rhonchi. As you enter the room, Mr. Duncan is refusing to eat foods from bland diet. Today's incentive spirometry Tidal Volume is 1250ml, improvement over yesterday's 900ml. -Reorient Patient to person, place, & time Regular diet. Compromised Family Coping False Present health assessment including B/P and LOC and dressing. Attain fluids/fiber diet and assisted ambulation Activity as tolerated with assistance. is a 57 y/o who has been admitted for a radical prostatectomy. 50% intake. #ozerysnackingrounds I am so excited to be partnering with Ozery Family Bakery today. Patients vital signs are BP: 100/58, P: 106, R: 28, PaO2: 92%, T: 97.1 F, 36.2 C. Self-Care Deficit False Assist patient Identify patient RUE: ______________ LUE: _____________ 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. Insertion site: Dry/Intact Redness Tenderness/Pain Warmth Coolness Swelling Drainage Administer antipyretic meds Safety When completing the shift change neuro check, you notice the patient's left pupil is sluggish. Radial: ____ + Bilateral Other: _____________ RLE: Non-pitting Pitting ___ + Take vital signs before leaving the hospital again. Scenario 4 Strict I&O, regular diet, intake 50%. Scenario 2: 1Educate about recovery from appendectomy and care to wound. Fall, Risk for True Shock, Risk for False Document results/findings Scenario 4 Educate patient Wash and glove hands Impaired Mobility False Continue.Robert Sturgess Room 305 Robert Sturgess, 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. Check physician orders Inform and educate spouse of dietary orders Senario 2 Palliative care. Safety Increased acuity, Physiological Ms. Rails shares with you her fear of being discharged home to an abusive husband. Mr. Sturgess is recently diagnosed with metastatic cancer of colon and he and his family have chosen only palliative care. Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. Scenario 3 Vital Signs: B: 160/92, P: 96, R: 22, SpO2: 98, T: 98.9F, 37.1C. Lung sounds are worse. Scenario 2 -Reassess patient's physical status prior to leaving him in the hallway Check PRN pain order Ronald Burgundy Senario 5 The patient got dizzy when he stood up from the commode. LOC Normal acuity The patient will be discharged today, and he will be ordering new prescriptions. Scenario 1 Notify doctor Ms. Rails was medicated with hydrocodone 5 mg PO two hours ago and is now complaining of pain (8/10 pain scale). Sensorium Normal acuity, Physiological -Reapply the NC that he was admitted with at 2L Safety Start secondary large bore IV line Noncompliance True. Yes Productive Non-productive Describe Sputum: _______________________ Chronic Sorrow False Obtain translator Evaluate understanding Insert Foley catheter Capillary Refill: _________ seconds -Recheck Tilts after the NS bolus is complete.T Fear True 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 2 Health Change Increased acuity -Check patency of Foley catheter, urine color, and ensure it is secure to the patient's leg Ineffective Coping False Scenario 2 Administer pain medications Notify doctor and charge nurse Vital signs -Temp 98.8, BP 102/76, P 102- irregular, RR 22, SaO2 90%, cardiovascular on telemetry with Sinus irregular rhythm. His CP is 7/10 and his BP is 165/96, P 92, R 18, SaO2 98 on 2L NC. 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 . Pulse Ox: ___________ % on ____________FiO2; Room Air; Delivery Device Document pt's statements. Mr. Thomason appears now better oriented and MD arrives unexpectedly to examine him. Health Change Increased acuity Mr. Greer is on the floor still but is awake and oriented and is complaining of back pain below his right scapula. Electrolyte Imbalance True Hx of dementia, from nursing home, fall one day ago. In reassessing Ms. Monson, her vital signs are: BP -106/82, Temp-98.2, P-106, RR-18, SaO2-88. Emergency intubation and assisted breathing is provided for Mr. Thomason Genitourinary Assessment The cancer was more advanced than they previously had thought so inguinal lymph nodes were removed. High fall risk. Observe closely first hour Therapeutic communication Ann Rails Odor: __________, *Types: Abrasion, Burn, Laceration, Puncture, Surgical, Pressure Ulcer, Vascular Ulcer, Maceration, Excoriation, Skin Connect telemetry Bleeding, Risk for: True Perform pain re-assessment Educate patient regarding changes to POC Fear: True Report and document results Powerlessness: True, Scenario 1 Evaluate patient understanding palliative care. Ms. Cumble is in bed and appears comfortable and requests assistance from you to get out of bed to go to the bathroom. Remind the nursing staff that the patient is NPO. Verify Call Light/Bed Safety precautions Scenario 3 Regardez le Salaire Mensuel de Tthuchicago Org en temps rel. Communication/Speech: Clear Non-verbal Slurred Aphasia Other Stoma Status: Pink-Red/Moist Dusky Retracted Excessive bulging Inappropriate words = 3 After leaving the room the provider tells the nurse that he hopes that he scared him into compliance with the treatment options. They wanted to know and pressure you for the information. Provide comfort and pain measures Contact dietary consult It is now third day post-op, the order is for Ms. Cumble to stand by bedside on both legs for 5 minutes, three times a day. Your notice Mr. Thomason is lying supine, appears slightly cyanotic in his lips, is exhibiting more effort to breathe, and is increasingly restless. Vital signs -Temp 98.4, BP 116/76, P 96, RR 20, SaO2 99%. Scenario 5 Two hours later, Mr. Duncan is asked how frequent his stools have been today. He also has metal fragments on his left side on his leg arm and torso. Temperature is 98.3, HR is 87, RR is16, BP is 121/74, PaO2 is 98%. Sensorium Normal acuity, Physiological Bleeding: True Skin warm and dry, daily dressing changes, T-tube without drainage. Bed Bath: Assist or Total Remain with patient -Reassess patient The oncologist is insistent that the treatment begin immediately. Chronic Pain False Use therapeutic communication/active listening Skin warm dry, bruises on forehead with small laceration. Notify lead nurse Scenario 5 You are about to call the Surgical ICU and give report. Constipation False Physiological- Report this activity immediately to the hospital privacy officer Senario 4 Fall, Risk for True Health Change Increased acuity His orthostasis is normalized after a second liter of NS was administered. Verify call light/bed safety precautions Stoma status: Pink-Red/Moist Dusky Retracted Excessive bulging No known allergies (NKA). Pain Scale: 0 to 10: _______________ Full assessment including both lying/standing Impaired mobility: False -Begin q15 minute neuro checks Anxiety True Impaired Mobility True Upon entering the room, you find Ms. Rails sleeping. Due to this, the provider would like him to stay in the hospital for observation. Robert Sturgess 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. Her husband and two grown children are also with her as she is prepared with gown and head cap awaiting transport to the operating room. -Explain that Docetaxel is a hormone therapy that suppresses the testosterone that your testicles produce producing similar results as surgical intervention. You escort them with you to the ICU. The patient was placed on 2 L O2 NC, EKG monitoring to include a 12 lead, Pulse Oximeter. Need frequent reminder to stay in room and maintain mask precautions. Notify doctor His children are visiting, and they are very supportive. 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. Deficient Fluid Volume False Cryotherapy, which uses an endoscope to apply a cold liquid or gas to abnormal cells in the esophagus. Scenario 3, Copyright 2023 StudeerSnel B.V., Keizersgracht 424, 1016 GC Amsterdam, KVK: 56829787, BTW: NL852321363B01, Civilization and its Discontents (Sigmund Freud), Forecasting, Time Series, and Regression (Richard T. O'Connell; Anne B. Koehler), Psychology (David G. Myers; C. Nathan DeWall), Biological Science (Freeman Scott; Quillin Kim; Allison Lizabeth), The Methodology of the Social Sciences (Max Weber), Give Me Liberty! Chronic Pain False Senario 3 Grieving False After washing and gloving hands, you then identify yourself and the patient, Ann Rails.