Swift R clinicals

Julia Monroe

Educational Needs Increased Fall Risk Increased Health change Increased Neurological Normal Pain level Increased Psychological Needs Normal acuity Acute Pain True Grieving False Impaired Comfort True Impaired Mobility True Nausea False Deficient Knowledge True Fall, Risk for True Scenario 1 1Perform initial assessment 2Ask the patient if she has had the procedures previously 3Ask the patient about any metal in or on her body 4Ask if the patient understands the procedures scheduled for this AM 5Ensure informed consent for procedures is signed. Scenario 2 1Comfort the patient. 2Provide education regarding heart failure 3Explain the treatment plan for the patient 4Evaluate patient understanding 5Document in the patient record. Scenario 3 1Assist the patient back to bed 2Perform a focused assessment 3Draw digoxin/ CMP labs as ordered 4Request order for telemetry 5Place call light within reach. Scenario 4 1Assess the patient 2Establish an IV line. 3Administer Digoxin Immune Fab 240 mg (6 vials). 4Monitor for adverse effects. 5Request repeat Potassium lab. Scenario 5 1Check leads to ensure they are in the correct place. 2Perform a focused assessment. 3Start O2 at 2L via NC. 4Call the Rapid Response Team. 5Educate the patient regarding the rapid response team's purpose.

Karen Cole

Educational Needs Increased Fall Risk Normal Health change Increased Pain level Normal Psychological Needs Normal Sensorium Normal Acute Pain False Impaired coping True Nausea False Risk for impaired comfort True Fall, for Risk False Infection risk True Risk for constipation False Risk for injury True Scenario 1 Apply O2 at 2 L nasal-cannula. Connect patient to cardiac monitor, assess vital signs. Complete full assessment. Obtain IV access and draw initial labs. Orient patient and husband to the unit. Scenario 2 Give IV morphine, 2mg IVP. Reassess vital signs and chest pain. Notify Cath Lab for stat cardiac cath. Obtain informed consent for cardiac cath. Transport patient to Cath lab with Cardiac monitors. Scenario 3 Take vital signs. Post-op assessment. Ensure pressure dressing is in place. Instruct patient to lie in supine position for 6 hours. Assess pain and cardiac rhythm Q 15 minutes. Scenario 4 Explain the necessary procedure. Perform hand hygiene and don gloves Remove infiltrated IV. Don new gloves. Insert new IV above prior site or opposite limb. Scenario 5 Assess patient and families readiness to learn. Provide patient post MI education. Patient and family should verbalize understanding of discharge instructions. Schedule cardiac rehab. Document.

Jose Martinez

Educational Needs Increased Fall Risk Increased acuity Health change Increased acuity Neurological Normal acuity Pain level Normal acuity Psychological Needs Normal acuity Acute Pain False Altered body image False Anxiety False Disturbed thought process True Impaired gas exchange True Impaired tissue perfusion True Ineffective health maintenance False Powerlessness False Drug therapy True Risk for social isolation False Scenario 1 1Assess airway, breathing, circulation. 2Ensure continuous EKG monitoring. 3Administer oxygen therapy to make sure oxygen saturation is greater than 90% 4Provide Morphine Sulfate IVP as prescribed 5Reassess patient's vital signs and pain level. Scenario 2 1Assess for the abrupt cessation of pain 2Initiate IV Heparin 3Give ASA 4Observe for bleeding. 5Monitor aPTT Scenario 3 1Provide emotional support 2Assess Mr. Martinez's willingness to learn 3Provide introductory information on prescribed antithrombotic medication 4Report Mr. Martinez's emotional distress to Case Management 5Document all findings. Scenario 4 1Troponin 1.0 mg/mL. 2CPK: 360 mcg/mL 3CK-MB6.8 4Serum Potassium 4.2 mEq/L 5Serum Sodium 142 mEq/L Scenario 5 1Clarify with Mrs. Martinez that she is asking if it is okay to resume sexual relations with her husband upon discharge. 2Promote open communication between Mr. and Mrs. Martinez 3Explain to Mr. and Mrs. Martinez the disease process following myocardial infarction 4Discuss physical limitations following myocardial infarction 5Provide information to Mr. and Mrs. Martinez regarding support groups.