Robert Domenic He is excited and tells the nurse he is starving and glad that he finally gets to eat. Therapeutic communicationT Pain Level Increased acuity Scenario 2 You arrive in room to check on her, after washing hands. Document results and findings Today's incentive spirometry Tidal Volume is 1250ml, improvement over yesterday's 900ml. Present health assessment including B/P and LOC and dressing. Impaired Skin Integrity, Risk for False No weight bearing today. Pain Level Increased acuity Document Results/Findings Water/Flush: Inform and educate spouse of dietary orders Filmotka filmu Najvyia ponuka (2013). Scenario 5 IV fluids of D5 1/2 NS are infusing at 100 mL/hour to his right forearm. Scenario 4 Chronic Pain False Mr. Greer has just returned from surgery. 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. Scenario 2 Scenario 3 Fear/Anxiety True. Safety Shock, Risk for: False Sensorium: Normal acuity, Bleeding, risk for: False PT to educate patient No response = 1, Range of Motion: Full, Limited Acute Confusion True Consult Social Service He also states he is feeling weak. Educational needs: Increased acuity Purposive Communication Module 2, Chapter 1 - Summary Give Me Liberty! Scenario 4 Esteem She is with her physician. Scenario 2 -Tell the wife that you will speak to the husband, and this is apprehension is expected with this surgery/diagnosis. When the nurse retunes to the room the patient tells the nurse that when he went to the bathroom he became very lightheaded. Offer nutrition and/ or toileting He is having some difficulty hearing and complains of ringing in his ears. You now arrive in the recovery unit one hour post-surgery and you are told that the surgery went well. Diet as tolerated. Pain: No Yes: Location: ______________________ Acute Chronic Constant Intermittent She has arrived in pre-op and about to have surgery this morning. At Risk, Impaired Comfort False She is also to receive radiation, chemotherapy, and hormone therapy post operatively. 20 ga. Hep-Lock in right forearm, skin warm and dry, generalized weakness with recent weight loss. r/o Tuberculosis. -Complete secondary assessment once the patient is in bed focusing on complaint of pain resulting from the fall -Reassess patient's physical status prior to leaving him in the hallway Record intake and output Bed Bath: Assist or Total Sensorium Normal acuity, Physiological Evaluate/Modify Mobility Plan, Carlos Mancia, 48yr-old, Spanish speaking migrant worker with no known past medical Hx. Microeconomics And Behavior Robert Frank 9th Edition Author: old.bubbies.com-2022-05-03T00:00:00+00:01 Subject: Microeconomics And Behavior Robert Frank 9th Edition Keywords: microeconomics, and, behavior, robert, frank, 9th, edition Created Date: 5/3/2022 7:02:15 AM Encourage to ambulate with assistance to void if needed Scenario 3 Assist physician in physical exam of patient Strict I&O, regular diet, intake 50%. Infection, risk for: False. IV maintenance fluids with D5 1/2 NS with 20 KCL @ 125ml/hr in left forearm. Scenario 1 Combien gagne t il d argent ? Peripheral Neurovascular Dysfunction True. Document results and findings He also complains that his throat is still very sore. Flexes abnormally = 3 Administer antiemetic medication Educational Needs Increased acuity Viola Cumble Glasgow Coma Scale 0-15 Musculoskeletal -If cardiac is suspected call the provider and the rapid response team. Scenario 4 -Explain procedure to the patient Apical pulse rhythm: Regular Irregular Location: Perform neuro assess Mr. Gonzalez has been admitted to the floor to determine that his chest pain is not related to a cardiac event. Document findings -Reassess patients' vital signs, and place on q5 minutes continuous monitoring Amount: _______ Safety Hx of dementia, from nursing home, fall one day ago. Palliative care. No Known allergies (NKA). Discharge instructions Fatigue True Ineffective Self-Health Management True Robert Sturgess 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. Dr. Altace, Physiological- No known allergies (NKA). Remain with patient Senario 1 Breath Sounds: Clear bilaterally. Social worker with patient this morning. Educate patient regarding condition He is emotionally distraught, and is insisting that he be allowed to report what is going on from the ED. Decreased Cardiac/perfusion: False -Start IV -Remove the dinner tray and make sure the diet is soft food. Psychological Needs Increased acuity If family/visitors come, will need education to airborne precautions. Impaired Home Maintenance Management r/t Client or Family False Scenario 3 Notify family Apply restraint Place pt on PCA pump Discription, Table 4 Cross-sectional, Longitudinal, and Sequential Developmental Designs, Engagement 1 Recognizing Research Strategies, A mental health worker with a Christian worldview.docx (Auto Recovered), NPO Breakfast: __________% Lunch ______________ %, Ethics and Social Responsibility (PHIL 1404), Care of the childrearing family (nurs420), Advanced Care of the Adult/Older Adult (N566), Business Professionals In Trai (BUSINESS 2000), Microsoft Azure Architect Technologies (AZ-303), Nurs & Healthcare I: Foundations [Lec] (NURS356), Accounting Information Systems (ACCTG 333), Bachelor of Secondary Education Major in Filipino (BSED 2000, FIL 201), Methods of Structured English Immersion for Elementary Education (ESL-440N), Professional Application in Service Learning I (LDR-461), Advanced Anatomy & Physiology for Health Professions (NUR 4904), Principles Of Environmental Science (ENV 100), Operating Systems 2 (proctored course) (CS 3307), Comparative Programming Languages (CS 4402), Business Core Capstone: An Integrated Application (D083), C228 Task 2 Cindy - Bentonville - Passed with no revisions, Lesson 4 Modern Evidence of Shifting Continents, MMC2604 Chapter 1 Notesm - Media and Culture: Mass Communication in a Digital Age, Lesson 17 Types of Lava and the Features They Form, Lesson 9 Seismic Waves; Locating Earthquakes, Analysis of meaning and relevance of History from the millennial point of view, Entrepreneurship Multiple Choice Questions, (Ybaez, Alcy B.) Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. Insertion site: Dry/Intact Redness Tenderness/Pain Warmth Coolness Swelling Drainage Full assessment of patient. jasmine . Demerol 25mg SIVP for pain, patient reports 7/10 on pain scale. Noncompliance: False How does the Med-surg simulator work? His orthostasis is normalized after a second liter of NS was administered. -Discuss with family sitter if there are any other family members who can help with monitoring Lithia Full assessment Senario 3 Alleviating Factors: Last pain medication: She has been admitted to the floor with complaints of numbness in her right foot and ankle. 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. Wound site clean, dry and intact NPO, NG-tube to low continuous suction. Strict I&O and strain all urine, filters in bathroom. Educate caller regarding HIPAA Too bad the cruise area was a very unatractive part of the River Elbe. Provide emotional support. Aggravating Factors: Genitalia: WNL (skin intact, no lesions) Abnormalities Describe: __________________________ Tap patient and ask, "Are you okay?" Non-significant past medical Hx. Scenario 5 -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 Verify call light/bed safety precautions Wash and glove hands c/o headache- medicated with Lortab 5mg PO at 0900, takes Lomotil 10ml PRN q 4 hours last dose at 0834. Observe closely first hour Several hours later, Mr. Duncan is now complaining of nausea. Senario 1 When the nurse enters the room later that day to inform him that the procedure is scheduled for 1430, they see Mr. Gonzalez is sitting in front of a lunch tray. Skin: Warm/dry Clammy/diaphoretic Skin Turgor: Brisk Tenting Palliative care. Diet as tolerated, up ad lib after gait training. Safety She is having some difficulty breathing. Cryotherapy, which uses an endoscope to apply a cold liquid or gas to abnormal cells in the esophagus. His partner is at the bedside asking, "how much longer will he have to wait until taken to surgery?" Vital assessment Respirations Urinary Catheter: N/A Indwelling Short-term Indwelling Long-term Date of Insertion:________ Size: _____F Grieving: True Scenario 4 -Place patient on O2 Nasal Canula Psychological Needs Increased acuity Peripheral Neurovascular Dysfunction False. 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. Mr. Duncan is now complaining of feeling "dizzy" when he stands. Self-Care Deficit False Neuro WNL alert and cooperative. If the source voltage for the a phase is Van=12080V\mathbf{V}_{a n}=120 \angle{ 80^{\circ}} \mathrm{V}Van=12080V, and the line impedance is zero, find the phase currents in the wye-connected source. Gastrointestinal Assessment -Notify charge nurse of patient's deteriorating condition You escort them with you to the ICU. Scenario 4 Nausea: False Assess toe movement and capillary refilling -Evaluate patient's understanding of teaching Impaired Gas Exchange False Infection, Risk for False Senario 5 Acute Confusion True Reorient Patient to person, place, & time She has been documented as being obese, new onset. Scenario 1 Provide a few chairs if possible for her family to also be comfortable Scenario 2 Ms. Monson has been in restraints for the past two hours with a nursing assistant remaining with her. Scenario 4 Nausea False Sensorium Increased acuity, Physiological The dinner tray is waiting for the patient in his room, and the nurse notices it is a regular diet. He is restless with slight confusion but is easily orientated with attempts from nurse. Sleep deprivation False Isolative, appears fearful, crying, and refusing to see her husband. -Use therapeutic communication/active listening Ms. Rails states that she has not had a bowel movement (BM) in the past two days. Release restraints/full range of motion The patient has sustained an injury to her head, that is bandaged, and is bleeding from a wound to her right arm and chest area. Educational Needs Increased acuity Full assessment The nurse identifies self to the nurse triaging patients and is directed to trauma room 4. Deficient Knowledge True DSD (dry sterile dressing), forehead laceration clean and dry intact. The charge nurse tells you she will send someone to assist you, and to get out 2mg of Versed to have ready to sedate the patient at time of procedure. Request time she can arrive and staff to help with transfer Patient demonstrates urine strain procedure. Widespread Color Change: N/A pallor cyanosis jaundice erythema There is an order to apply a waist belt restraint if needed. Provide verbal report to team members who respond to rapid response Senario 2 The heartburn has become worse since he started treatment for his URI. You observe Ms. Getts being assisted by another nurse who is being blatantly rude and disrespectful to her. Family Health III-Pediatrics (NSG 6435) Emergency Medical Technician (EMS 1150) Applied Research In Business (MIS 781) Anatomy & Physiology I With Lab (BIOS-251) Molecular Biology (BP 723) Newest Marketing Management (D174) Professional Application in Service Learning I (LDR-461) Professional Capstone Project (PSY-495) Theology (104) Impaired mobility: False Comfort/Pain Assessment Senario 1 Family in room with patient very concerned. Course Hero is not sponsored or endorsed by any college or university. Skin warm and dry, all vital signs in WNL except 115 pulse, which is normal for him. Fear True Ronald Burgundy Patient and family upset regarding dx. Document results Arthur Thomason -Reorient Patient to person, place, & time Perform full assessment and provide anti-nausea medicine. Urostomy: N/A Urostomy/Ileal conduit Explain reason for assessment and procedure Excess Fluid Volume, Risk for False Deficient Knowledge False Why is cysteine such an important amino acid for defining the tertiary structure of some proteins? Bleeding, Risk for False Hopelessness: True -Restart the IV and draw CBC Validate NPO Status He does not have an IV nor is he on oxygen. It is now the second day post op and he is given discharge information. Educate patient Scenario 5 Offer assistance His coughing, to clear his airway, appears ineffective. Alert and cooperative. Assist patient Neuro WNL, alert, and cooperative but worried about scarring and is reluctance regarding walking on leg. Provide comfort measures Scenario 1 -Explain to Mr. Burgundy that space in the ED is allocated based off of patient need Cough: Obtain translatorT Carlos Mancia Respiratory Rhythm: Regular Rhythmic Irregular Periods of Apnea Cheyne-Stokes Apply fall risk bracelet Verify call light/bed safety precautions Allow family to remain RLE: ______________ LLE: ______________, Casts/Splits: ____________________________, Motor response Verbal command = 6 Leave to break room and not continue in conversation. Psychological Needs Normal acuity Insert Foley catheter Encourage fluids and fiber diet The patient is awake, alert, and oriented. Psychological Needs Normal acuity Evaluate understanding. Scenario 2 -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 Mr. Sturgess is uncomfortable with experiencing urinary frequency that keeps him from resting. The patient tells the nurse that yesterday he was, "concerned about having an erection, and now they want to cut off my testicels". Document results and findings Clinical 2. Ms. Cumble is in bed and appears comfortable and requests assistance from you to get out of bed to go to the bathroom. Self-Actualization Connect telemetry Scenario 4 -Notify charge nurse Patients vital signs are BP: 100/58, P: 106, R: 28, PaO2: 92%, T: 97.1 F, 36.2 C. The pathology report shows no cancerous lesions. Assess vital results Non-significant past medical history. Senario 5 Description: Sharp Stabbing Throbbing Aching Cramping Other: Increased fall risk. Love and belonging Evaluate learning Color:__________ Radiofrequency ablation, which uses heat to remove abnormal esophagus tissue. 2. Scenario 1 Provide comfort in pre-surgical room Mr. Dominec. Students also viewed Culture Concept notebook Development concept notebook Elimination concept notebook Gas Exchange concept notebook Mr. Thomason is anxious and is obviously worsened from the shift before in overall condition. Scenario 3 Neuro WNL. -Assess patient LOC, by walking patient and asking them to take deep breaths. Ask patient to explain to you what procedure she was expecting to have this morning. ADA diet, intake, 25%. Describe the physical changes from aging and the care required. The patient is being prepared for discharge and his IV has been removed. 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. An abc-phase-sequence three-phase balanced wye-connected source supplies power to a balanced wye-connected load. Scenario 4 The patient is asking you where her son is, the last place she saw him was right before the explosion. Scenario 5 Mr. Mancia's vital signs upon assessment are Temp 101.2, P 94, RR 20, BP 122/82, SaO2-91%. Observe closely first hour Regardez le Salaire Mensuel de New King James Bible Download For Windows 7 en temps rel. Use therapeutic communication/active listening -Discuss and determine sitter availability -Check on patient/sitter hourly Request sitter/family member to bedside Recent blood gases demonstrate falling PaO2 (hypoxemia) and increasing CO2 (Hypercapnia). 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 . Safety Seek clarification Vital signs -Temp 97.2, BP 96/74, P 82, RR 20, SaO2 97%. Teach patient about safety when getting out of bed Inspect cast site Readiness for Self-Care Enhancement True However, he quit three years ago when he remarried; he and his wife have a nine-month-old baby. Check monitor This will treat any cancer that may have metastasized to the bone. Anxiety True Deficient Knowledge False Visual assessment Scenario 1 Psychological Needs Increased acuity Students will assign correct nursing diagnosis for patients in a medical surgical virtual clinical environment. Scenario 5 Scenario 5 -Discuss effectiveness of sitter Administer antipyretic medication Scenario 3 Senario 4 -Ensure there is suction in the room, and check Mr. Dominec had his surgical procedure and is doing great. Electrolyte Imbalance False Toggle navigation Swift River. Senario 5 -Transport Mr. Burgundy to his room Health Change Increased acuity 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. Skin warm and pale. student name date: nur 113 assessment swift river patient: robert sturgess handoff robert sturgess, 81 years old, metastatic ca of colon, hx of diabetes. -Discuss with sitter that patient needs continual observation -Determine when a hospital provided sitter will be necessary Remind staff that Universal Precautions are practiced at this hospital for all patients regardless of known infectious diseases. Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. You are now preparing for discharge, place steps in order: Senario 1 In reassessing Ms. Monson, her vital signs are: BP -106/82, Temp-98.2, P-106, RR-18, SaO2-88. Vital signs -Temp 98.6, BP, Erma Willis, a 65-year-old woman with a history of adenocarcinoma and multiple past episodes of related secondary infections, was admitted to the medical-surgical unit this morning with a diagnosis, Reflective Journal VCBC Post work Cellular Regulation VCBC Post Work Start Assignment Due No Due Date Points 10 Submitting a file upload Please submit your post work to Canvas within 48 hours of, Typically the concept of cellular regulation Involves the study of cancer and related diagnoses. jessdevan. Obtain vital signs machine Rich Dad, Poor Dad (Robert T. Kiyosaki) The Methodology of the Social Sciences (Max Weber) Educational Research: Competencies for Analysis and Applications (Gay L. R.; Mills Geoffrey E.; Airasian Peter W.) . Scenario 2 Two housekeepers, who were refusing to clean the room, are in the break room. Notify doctor Scenario 2 Self-Care Deficit: True Pain and numbness in legs for one week. You take his vital signs which are: Temp 101.3, Pulse 88, Resp 24, B/P 116/84. Knowledge Deficit True Decreased Cardiac/perfusion False Pain Scale: 0 to 10: _______________ 0800 1200 Notify doctor -Explain to the patient that because of his weakness and unknown cardiac status as well as the IV, he is a fall risk and should not get out of bed without assistance. Upon entering the room, you find Mr. Sturgess is quiet, appears tense and rigid but states, Chronic Confusion False RUE: ______________ LUE: _____________ 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. Tear, Ecchymosis, Contusions, Bruising No response = 1, Mobility: -Ask Mr. Burgundy to lower his tone as it can be disturbing to other patients Color:__________ After washing and gloving hands, you then identify yourself and the patient, Ann Rails. Assess pain 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. -Explain that Docetaxel is a hormone therapy that suppresses the testosterone that your testicles produce producing similar results as surgical intervention. #ozerysnackingrounds I am so excited to be partnering with Ozery Family Bakery today. You correctly diagnosed 11 out of 16 options. Expresses fatigue, fear, concern, and desire for recovery. Her husband and children remain with her in the surgical holding area awaiting transport to the OR. Temperature is 98.3, HR is 87, RR is16, BP is 121/74, PaO2 is 98%. Scenario 2 His partner is not with him at this time but will arrive soon to facilitate his discharge home. Impaired Skin Integrity, False Chronic Pain False Pain affecting: N/A Sleep Activity Exercise Relationships Appetite Concentration A special lowbed has been ordered that will lower to the ground. Encourage fluids/fiber/ambulation Pain Level Increased acuity Educate patient Impaired Comfort True Evaluate understanding Scenario 3 Scenario 4 Safety Increased acuity, Physiological You explain that his condition has worsened and now he has been taken to ICU. Notify doctor IV maintenance fluids with D5 1/4 NS @ 150 ml/hr X 3 then reduce rate to 75 ml/hr. No known allergies (NKA). Impaired comfort: True Scenario 1 Remain with patient -Perform admission assessment Call rapid response ExplanationAnxiety/ fear True Fall, Risk for True Senario 3 -Advise sitter to notify nurse when leaving the room You have them remain with you, seated in comfortable place, while you call ICU and attempt to locate physician for them. Needs frequent reminding due to determination to do things herself without assistance. The patient was placed on 2 L O2 NC, EKG monitoring to include a 12 lead, Pulse Oximeter. Elevate head of bed Ineffective airway clearance True Vital signs taken by automatic B/P Cuff q 15 minutes She has IV access and has received a small dose of Valium to reduce apprehension. 2Provide comfort in pre-surgical room Mr. Dominec. Document results Begin post op education for day one Deficient Diversional Activity False Deficient knowledge: False She is also investigating bone marrow transplantation. Scenario 5 Acquire daily weight and food intake -Assess for fall risk The client is onDemerol 25mgSlow Intravenous Push (SIVP) for pain. Scenario 1 Full assessment Disturbed Sensory Perception False Ms. Gestalt is second day post-op and has requested to get out of bed and to ambulate to bathroom. Health Change Increased acuity Evaluate patient understanding References; Access My Virtual Clinicals; Medical-Surgical. Neuro WNL alert and cooperative. Assessment of bowel movement Love and belonging Scenario 3 Extends abnormally = 2 "I am feeling fine." He is a local TV news reporter that was filming an event at the county fair when there was an explosion. Scenario 3 Shock False Senario 5 Robert Strurgess Tibial: _____ + Bilateral Other: ______________ Generalized: Pedal: ______ + Bilateral Other: ____________ Sacrum: Non-pitting Pitting ___ +. Scenario 1 Scenario 3 Reasses temp in 1 hour. Scenario 2 Senario 4 -When the HCP arrives, stay in the room to determine whether you can continue care with the patient Therapeutic communication Suprapubic Insertion site: WNL S/S Infection : ____________________ He insists that he is not hungry and refuses assistance with his meal. The charge nurse asks you to assume the patient's nursing care. Ineffective self-health mgmt: False, Disturbed body: False Vital signs are: B/P 112/78, temp. Skin warm and, dry, all vital signs in WNL except 115 pulse, which is normal for him. Remind physician to wash his hands before examining the patient Urination: WNL Burning Frequency Urgency Nutritional Intake: Adequate Inadequate BMI: Anxiety True Assume role in response team of documenter Hx of dementia, from nursing home, fall one day ago. Stools are decreasing but patient remains very weak. Cardiovascular has pacer with rate of 82bpm on demand. Health Change Increased acuity Notify charge nurse that discharge will probably not occur today. Surrounding skin: Moist/Intact Red/Erythema Irritation Impaired Mobility False Safety Self-Care Deficit False Scenario 4 Palliative care. Electrolyte Imbalance True -Explain to the patient that he has a procedure, and he cannot eat. is a 57 y/o who has been admitted for a radical prostatectomy. Fatigue True Skin warm dry, bruises on forehead with small laceration. Blood Glucose 185, 4 units of insulin sliding scale for coverage. Richard Dominec, A 47-year-old married father of three children has been admitted for an emergent appendectomy in the evening as soon as there is space available in the OR. Scenario 2 -Inform Mr. Burgundy that he cannot report from the ED, as patient privacy is strictly protected by HIPPA Two hours later, Mr. Duncan is asked how frequent his stools have been today. sounds= 2 Scenario 1 Explain to her family and provide contact information. List the nursing care order. Bleeding False Impaired comfort: True Fall, risk for: True Impaired Mobility True Oral Mucosa: Tongue: Teeth: The nurse arrives and sees a tent is being erected as a triage area, and ambulances are lined up delivering trauma patients. The patient got dizzy when he stood up from the commode. Deficient knowledge: True Palliative care. Toileting, Medications List/Times of Medications/Routes of medication, Neurological Assessment Deficient Knowledge False VS: BP 158/90, HR 89, R 18, T 97.8 F. Upon assessment, you determined that she is confused to person, time, and place but is easily directable. Verbal command = 3 Report to charge nurse/ head nurse the need for staff education. Hopelessness False. Fall Risk Increased acuity Scenario 3 Scenario 5 Heterotrophs include (1) autotrophs, saprophytes, and herbivores (2) omnivores, carnivores, and autotrophs (3) saprophytes, herbivores, and carnivores (4) herbivores, autotrophs, and omnivores. RLE: ______________ LLE: _____________ No known allergies (NKA). Recently he manifested an unusual black lesion on his thigh and developed an opportunistic fungal mouth infection which was treated successfully. Anxiety True Urine Color: Clarity: Odor: Physiological- 4Inform his partner that everything is being done to keep him comfortable. Deficient Knowledge True Nausea: False The cycle of freezing and thawing damages the abnormal cells. Use therapeutic communication/active listening Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. Evaluate understanding Re-assess patient You enter patient's room. Sa fortune s lve 2 216,00 euros mensuels Waist belt restraint PRN; family sitter at bedside, assist with bath. Administer protocol antidiarrheal medication -Reinforce the risk if patient has not been NPO and ask the patient when the last time they ate. Date of insertion: _________________________ Date of dressing: _________________________________ Head/Face: Symmetric Asymmetric Drooping Regular diet. Ambulates with minimal assistance. Document results/findings His wife tells the nurse that he seemed very distant and did not want to talk much. Upon entering the room, the patient appears to be trying to get out of bed Impaired Mobility True Yes Educational Needs Increased acuity Odor: __________, *Types: Abrasion, Burn, Laceration, Puncture, Surgical, Pressure Ulcer, Vascular Ulcer, Maceration, Excoriation, Skin Scenario 5 He is married, and his wife is requesting to stay at his side. Scenario 3 Other: _______________________________ Peripheral Neurovascular Dysfunction False Decreased Cardio Tissue Perfusion False Contact head nurse or supervisor in the OR to evaluate new situation LOC Increased acuity Scenario 3 Educate patient His CP is 7/10 and his BP is 165/96, P 92, R 18, SaO2 98 on 2L NC. -Assess patients' pain and rule out cardiac pain. Notify doctor of change in condition in particular: unproductive cough and low-grade fever. Mr. Sturgess is now declining, and family members are requesting to remain in room past normal visiting hours. 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. Enter the email address you signed up with and we'll email you a reset link. Ms. Getts is now complaining of sudden sharp, substernal chest pain, very short of breath and is profusely diaphoretic. Vital signs -Temp 99.1, BP 124/62, P 77, RR 20, SaO2 91%. Scenario 4 Remain with patient Regardez le Salaire Mensuel de Ticketmaster Beyonce Koln en temps rel. Physiological Scenario 4 Renal diet. 2021-22, Historia de la literatura (linea del tiempo), Respiratory Completed Shadow Health Tina Jones, CH 02 HW - Chapter 2 physics homework for Mastering, BI THO LUN LUT LAO NG LN TH NHT 1, Leadership class , week 3 executive summary, I am doing my essay on the Ted Talk titaled How One Photo Captured a Humanitie Crisis https, School-Plan - School Plan of San Juan Integrated School, SEC-502-RS-Dispositions Self-Assessment Survey T3 (1), Techniques DE Separation ET Analyse EN Biochimi 1. Imbalanced Fluid Volume, Risk for True The nurse observes an elderly lady who is crying and has not been taken care of yet. Scenario 5 Replace oxygen nasal cannula that had become disconnected Fall, Risk for True Home; Our Focus; Our Legacy; Our Partners; Our People; Our Fellows; Our Investments Blood Pressure, 7a-7p Total: 7p-7a Total: Mr. Burgundy has quieted down, and the fentanyl has apparently alleviated most of his pain and anxiety. GI WNL. Educate patient Fall, risk for: False Decisional Conflict True Intermittent/Continuous Other: Bowel sounds: Active, Hyperactive, Hypoactive, Absent (listen for full 5 minutes) -Document and contact nursing supervisor/Charge nurse The bed arrives tomorrow. Scenario 4 Discuss follow up with his doctor. Hopelessness True Acute Pain True Assess Wash and glove hands
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