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Med Surg Swift River Correct Questions
& Answers
Trey Johnson admitted for abdominal pain, HIV positive, returned from trip to Asia - ANSWER Education - Increased Fall Risk - Normal Health Change - Increased Pain Level - Increased Psychological Needs - Increased Sensorium - Normal Physiological - Acute pain, nausea Safety - Deficient knowledge Trey Johnson - ANSWER Scenario 1 - Vital signs, collect stool, IV, I&O, Teach Scenario 2 - Resp. isolation, re-locate, contact HCP, PRN meds, continue strict I&O Scenario 3 - Notify infection control, educate, initiate meds, continue meds, discuss coping strategies Scenario 4 -Express feelings, educate on prognosis, evaluate understanding, notify HCP, document Scenario 5 - Educate on protocols, educate on transmission, evaluate potential barriers, 30 day labs, evaluate understanding Sarah Getts, 77 yr-old, Dx- Chronic Renal Failure, admitted with hyperkalemia (5.9, Eq/L)/hyponatremia (128mEq/L). No known allergies (NKA). Vital signs -Temp 98.8, BP 102/76, P 102- irregular, RR 22, SaO2 90%, cardiovascular on telemetry with Sinus irregular rhythm. Disoriented to time and place, speech slurred. Pupils PERRLA, eyes clear. 20 ga. Hep-Lock in right forearm, skin warm and dry, generalized weakness with recent weight loss. 50% intake. High fall risk. Renal diet. Family in room with patient very concerned. Dr. Brown - ANSWER Education - Increased Fall Risk - Increased Health Change - Increased Pain Level - Normal Psychological Needs - Increased Sensorium - Increased Physiological - Deficient knowledge, risk for imbalanced Fluid Volume, risk for Ineffective Renal Perfusion Safety - Acute Confusion, Risk for fall Love and belonging - Failure to Thrive Sarah Getts - ANSWER Scenario 1 - was hands, assessment, monitor, educate, document Scenario 2 - was hands, assessment, apply fall bracelet, document
Scenario 3 - assist, remain, thera communication, notify, document Scenario 4 - assess, call, apply, IV, remain with patient Scenario 5 - report, escort patient, notify, document Nathaniel Gonzalez, , a 58-year-old male patient presents to the ER CO CP 10/10. He is pale, weak, diaphoretic, and appears anxious. He has a history of well controlled GERD with over-the-counter Tagamet (Cimetidine), and Tums. He also has a history of hypertension and takes Tenormin (Atenolol) and Atorvastatin (Lipitor). He was recently treated for a URI with a Z pack, prednisone, and Motrin for pain. BP 154/89, P 94 F, R 22, T 98.3F, SaO2 95% on room air. The patient was placed on 2 L O2 NC, EKG monitoring to include a 12 lead, Pulse Oximeter. IV NS is started, and lab work is sent. ASA is held but morphine 4 mg was given after his GI cocktail. A GI cocktail was administered, and the patient stated that it decreased his pain to a 6/10. - ANSWER Educational Needs Increased acuity Fall Risk Increased acuity Health Change Increased acuity Pain Level Increased acuity Psychological Needs Increased acuity Sensorium Normal acuity Physiological - Acute pain Safety - Deficient knowledge, risk for fall Nathaniel Gonzalez Scenarios - ANSWER Scenario 1- Pt admitted, assessment, tell pt, explain to pt, ensure bed in lowest position Scenario 2- Explain pt can not eat, reinforce the risk, administer med, assess lunch tray, remove lunch tray Scenario 3- Assess, elevate HOB, reapply the NC, remove dinner tray, reassess pt q minutes Scenario 4- Restart IV, give NS, recheck tilts, remind pt, draw a repeat CBC Scenario 5- Assess pain, gastric reflux, cardiac, assess anxiety, verify discharge orders Linda Yu Room 302 Linda Yu, was admitted to your unit after surgery on her left hip due to a fall. She is 2 days post-op. She is 85 years old and has a history of osteoarthritis and cataracts. PT has been getting the patient up with a walker and she is able to take a few steps. She is aware of self and situation, but not time or day. Her family lives out of state, but the daughter was here for the surgery, she left yesterday. The plan is to discharge Ms. Yu back to her assisted living facility. Her daily medications at home include: Prednisone 5 mg, Furosemide 20 mg, and ASA 81 mg daily. The surgeon added oxycodone 5mg q 4- 6 hours prn pain. NKDA. - ANSWER Educational Needs Increased acuity Fall Risk Increased acuity Health Change Increased acuity Neurological Increased acuity Pain Level Increased acuity Psychological Needs Increased acuity
resulting in burns to 18% of his body. Patient arrived via ambulance in critical condition and was intubated upon arrival. The assessment is vital signs are BP: 142/91, T: 99.4 F, 37.4 C, P: 102, R: 28, PaO2: 96% on room air. Patient is AAO x4. He is receiving 5mg Morphine IV q3 hours PRN for pain control. IV at 150 mL/hr D5 ½ NS to a right subclavian. Foley catheter is draining clear urine, I&O in chart. Patient requires dressing changes every shift. Recommendation is patient is ready to be tra - ANSWER Educational Needs Increased acuity Fall Risk Increased acuity Health Change Increased acuity Pain Level Increased acuity Psychological Needs Normal acuity Sensorium Normal acuity Physiological - Acute pain, Risk for Impaired mobility, Risk for Nausea Safety - Deficient knowledge Glenn Massey, Scenarios - ANSWER Scenario 1- Ensure room cleaned, Disinfect call light, clean IV pole, obtain burn sheets, notify infection control nurse. Scenario 2- Obtain vital signs, assessment, administer pain meds, educate patient, check patient's chart. Scenario 3- Hand hygiene, set-up supplies, apply clean gloves, peel off old dressing, clean wound, apply new dressing Scenario 4- Notify HCP, inform new plan of care, initiate cardiac telemetry, give 1L NS, empty foley bag Scenario 5- Why patient is anxious to return to work, educate patient, evaluate patient, contact social services, involve family Nathaniel Gonzalez Room 301 Julia Monroe Scenarios - ANSWER Scenario 1- Assessment, pt had the procedure previously, metal in body, pt understands, informed consent signed Scenario 2- Comfort pt, education, explain treatment, evaluate understanding, document Scenario 3- Assist pt back to bed, assessment, draw labs, telemetry order, call light Scenario 4- Assess, IV line, digoxin, monitor, request repeat lab Scenario 5- Check leads, assessment, start O2, call rapid response, educate pt
