Swift River: Medical-Surgical

Carlos Mancia Scenario 1 Carlos ManciaUpon entering the room, you wash/glove hands. Following isolation precautions, you notice several family members are by his bedside and none of them are wearing face masks as requested by the sign on the door.

1- Obtain translator 2- Offer masks to visitors 3- Educate patient 4- Evaluate understanding 5- Obtain Spanish signs & brochure

Carlos Mancia Scenario 5 Carlos ManciaMr. Mancia is holding a Catholic Rosary in his hand and is crying as you enter the room.

1- Obtain translator 2- Use therapeutic communication/Active Listening 3- Educate patient regarding diagnosis and inform him of potiental for full recovery 4- Evaluate learning 5- Document teaching moment

Carlos Mancia Scenario 3 Carlos ManciaBefore entering Carlos Mancia room to administer his antipyretic medication for his recent temp of 101.2

1- Obtain translator 2- Wash Hands 3- Put on gown and mask 4- Don Gloves 5- Administer antipyretic medication

Sarah Getts Scenario 3 Sarah GettsYou observe Ms. Getts being assisted by another nurse who is being blatantly rude and disrespectful to her.

1- Offer assistance 2- Remain with patient 3- Therapeutic Communication 4- Notify lead nurse 5- Document results

Calvin Umbyuma Scenario 3 Calvin UmbyumaMr. U does not want to give up his traditional herbal medications. He tells the nurse that his father died in the best hospital in Kenya receiving the newest treatment. The nurse inquires as to the father's illness and Mr. U tells the nurse that he believes it was Tuberculosis. He does not know what his mother is suffering from as she refuses to seek modern treatment. Mr. U is also concerned about his wife as she has been having difficulty with her Visa and is still trying to come back to the US

1- Ask patient what he knows about Tuberculosis 2- Ask patient what his mother's symptoms are 3- Educate patient to the signs/symptoms of Tuberculosis 4- Evaluate effectiveness of patient education 5- Report findings to the HCP, notify infection control and social services

Paul Greer Scenario 5 Paul GreerMr. Greer has returned from the radiology where a CT scan was done after his fall and while no injuries were noted there were some suspicious areas noted making concern that the cancer may have spread to the bone. Because of the fall the provider has recommended that he stay in the hospital another night. The oncologist is recommending Docetaxel as opposed to an orchiectomy. They would also like to start Radium-223. The oncologist is insistent that the treatment begin immediately. The patient asks the nurse to explain about these medications and why they are in such a hurry. His children are visiting, and they are very supportive.

1- Ask the patient if it is okay to discuss his care in front of his children. 2- Explain that Docetaxel is a hormone therapy that suppresses the testosterone that your testicles produce producing similar results as surgical intervention. 3- Explain that Radium-223 mimics calcium and is absorbed during new bone growth. This will treat any cancer that may have metastasized to the bone. 4- Ask the patient to verbalize understanding of teaching and reassure them that yourself or any member of their care team will be available to answer questions. 5- Evaluate patient's understanding of the teaching and discuss home support

John Duncan Scenario 1 John DuncanAs you enter the room, Mr. Duncan is refusing to eat foods from bland diet.

1- Assess intake and output and possible reasoning 2- Construct dietary consult (plan) 3- Acquire daily weight and food intake 4- Evaluate outcome of dietary plan

Cameron Daniels Scenario 5 Cameron DanielsThe nurse is preparing to discharge Cameron the next day. The mother and father want to hear the discharge instructions. Cameron asks to be allowed to speak with her parents privately. After a few minutes there are shouts heard from the room with the patient screaming, "No"! The father is seen by the nurse running out of the room and heard stating, "I'm going to kill that bastard"! The nurse runs in the room and Cameron is sobbing with the mother at her side. The IV has been pulled out and there is blood on the floor.

1- Assess patient, apply a dressing over the IV site to stop the bleeding, and call for additional support to the room. 2- Perform a rapid assessment of the patient to ensure she was not injured 3- Ask the patient if she was physically assaulted by her father 4- Inform the charge nurse to call a code Gray (Security) 5- Call the local law enforcement to make a report

John Davis Scenario 5 John DavisThe doctor has chosen to pursue a more aggressive chemotherapy agent related to metastasizing cancer and side effects (muscle cramps and gastrointestinal discomfort). The patient will continue chemotherapy after discharge and is being counseled for the placement of a peripherally inserted central catheter (PICC) and why he needs it. The patient will be receiving his chemotherapy from an outpatient infusion clinic. The patient is still not eating and seems complacent in his care. When inquiring about his support system the patient states that running a business does not allow much time for friends or family.

1- Assess patients concerns and understanding plan of care and current treatment 2- Teach patient about the benefits of a picc line with chemotherapeutic agents 3- Make referral to the infusion clinic to verify appointments 4- Discuss with patient if he has any transportation 5- Have patient verbalize understanding of treatment and future needs and services

John Davis Scenario 2 John DavisThe patient has been made aware that he has advanced basal cell carcinoma and has a poor prognosis. The largest dressing is saturated with serous sanguineous fluid. The patient is complaining of 8/10 pain from two of the partial thickness incisions on his back (he will need skin graft soon). Patient states the larger dressings on his back that are full thickness do not hurt at all. The patient has an order for dressing changes PRN. The patient is awaiting orders for chemotherapy. VS BP 162/90, P 99, R 20, T 98.9.

1- Assess the large dressing site (full thickness) 2- Administer pain medication as ordered 3- Assess dressing supply needs and obtain 4- Assess patient's need for emotional support and evaluate effectiveness of pain medication 5- Document color and amount of wound drainage on dressing

Donald Lyles Scenario 2 Donald LylesThe CODE-blue team arrives with a crash cart, Physician, Anesthetist, and 2 critical-care nurses, and 1 Respiratory therapist.

1- Assist with airway management. 2- Assist with applying ECG leads. 3- Establish large IV access. 4- Provide patient history of event to team. 5- Provide medical history - including medication history and allergies.

Wight Goodman Scenario 5 Wight GoodmanThe attending maxillofacial surgeon comes to see the patient before his discharge at the nurse's insistence. He agrees that the visual acuity is a concern and consults an ophthalmologist. It is discovered that Mr. Goodman has increased intraocular pressure, and it may be a result of suborbital edema which will require STAT surgical decompression to preserve his sight. Mr. Goodman is irate, starts yelling at the nurse, and accidentally pulls out his IV. He believes they have caused him permanent disfigurement and now blindness. The nurse must restart his IV and obtain another surgical consent.

1- Assure patient that surgery is necessary to preserve his sight, and that this should not be permanent 2- Take vital signs and position patient 30 degrees upright 3- Restart patients IV 4- Obtain surgical consent 5- Remain with patient

Donald Lyles Scenario 3 Donald LylesYou have now been assigned to document the ongoing event as the CODE team continues with the resuscitation.

1- Check time from one source. 2- Establish when the cardiac event time began. 3- Document rhythm used to determine medications to be administered. 4- Begin list of medications and time/dose given. 5- Remind CODE team to stop CPR and check for pulse Q5 minutes.

Wight Goodman Scenario 3 Mr. Goodman is first day post-op from his suborbital rim fracture repair, and his orbital edema has been greatly reduced. His CSF with rhinorrhea has subsided. The neurosurgeon has decided to continue to observe his recovery, instead of surgical intervention to repair the orbital roof fracture. The patients VS are stable, and he is afebrile. Patient does not have medical insurance, so he is wanting to leave today. The patient is emotionally distraught, and angry as face appears to have drooping of his eyelid and his visual acuities have not improved. While the swelling has decreased there is still periorbital edema (Ptosis).

1- Complete Neurological Assessment 2- Educate patient and family of necessity for q2 hour neuro checks and visual acuities 3- Inform Healthcare Provider that patient is medically indigent, and wanting to go home today 4- Contact social services to discuss options for payment 5- Extensive discharge planning and education

Wight Goodman Scenario 2 Wight GoodmanThe blood from the nose was positive for CSF. An MRI is ordered, and reveals a small Orbital roof fracture. The neurosurgeon is consulted. The maxillofacial surgeon will repair the suborbital rim fracture first, and the neurosurgeon will monitor the patient postoperatively as well as be available to assist if the orbital roof fracture becomes unstable. IV antibiotics are ordered to be administered ASAP. The patient will need to sign another surgical consent for potential neurosurgery. The surgeon also orders Neuro checks q2 hours, his Glasgow Coma Score is 15.

1- Complete Neurological assessment 2- Educate patient of plan of care 3- Evaluate patients understanding of care 4- Administer IV antibiotics 5- Sign additional surgical consent

John Davis Scenario 4 John DavisThe nurse is still concerned about the patient's appetite the next day, 3 days post-op. The patient will be seeing an oncologist before his discharge and the surgeon has stated that he will need to have several more lesions removed ASAP. The patient has learned that his cancer is stage 4 basal cell and has metastasized. He has not been ambulating and has been laying on his back most of the time. When changing the dressings, the nurse notices that the one of wounds on his back appears inflamed and reddened as well. VS BP 150/80, P 82, R 14, T 100.8

1- Complete full assessment and inspect patient's wounds 2- Apply clean dressing to all wounds 3- Encourage patient to change body position and not lie on wounds 4- Continue to encourage nutrition and fluids 5- Document and inform HCP of wound changes

Lithia Monson Scenario 4 Lithia MonsonPrior 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!

1- Complete full assessment, to include neuro 2- Use therapeutic communication/active listening 3- Attempt to orient to person, place, and time 4- Offer nutrition and/ or toileting 5- Ensure bed is in lowest position, and rails are in place

Paul Greer Scenario 4 Paul GreerThe emergency bathroom light goes off and the nurse finds Mr. Greer on the floor in the bathroom. The patient got dizzy when he stood up from the commode. Mr. Greer is on the floor still but is awake and oriented and is complaining of back pain below his right scapula.

1- Complete head-to-toe assessment while patient is on the floor. 2- Ensure patient privacy and call for help and assist patient to bed once help arrives 3- Complete secondary assessment once the patient is in bed focusing on complaint of pain resulting from the fall 4- Reinforce to the patient to not get out of bed 5- Notify HCP of fall, complete incident report

Paul Greer Scenario 1 Paul GreerMr. Greer has just returned from surgery. The cancer was more advanced than they previously had thought so inguinal lymph nodes were removed. The surgeon believes that the surgery was successful but recommends the patient have chemotherapy and radiation postoperatively. The patient has a Foley catheter in place and is reporting 8/10 incisional pain and he is asking why his throat is sore. VS: BP 158/90, HR 89, R 18, T 97.8 F.

1- Complete initial post-op assessment 2- Check patency of Foley catheter, urine color, and ensure it is secure to the patient's leg 3- Medicate for pain 4- Explain to patient why his throat may be sore 5- Inform patient to not get out of bed without assistance and place call light in reach

Lithia Monson Scenario 2 Lithia MonsonA special lowbed has been ordered that will lower to the ground. The bed arrives tomorrow. You are concerned about preventing the patient from falling.

1- Complete neuro checks as ordered 2- Discuss and determine sitter availability 3- Check on patient/sitter hourly 4- Advise sitter to notify nurse when leaving the room 5- Determine when a hospital provided sitter will be necessary

Hannah Knox Scenario 5 Hannah KnoxAt 2am, Ms. Knox expires. The daughter is grief stricken and questions, "should we do something?". The granddaughter is sitting outside the door crying. Her boyfriend has just shown up and is pacing outside the door and seems agitated. The nurse is challenged to provide post-mortem care for Ms. Knox's body and comfort the family.

1- Contact HCP 2- Take patient's family to a quiet room 3- Contact chaplain 4- Prepare Ms. Knox body for final viewing 5- Notify social services that boyfriend is present

Carlos Mancia Scenario 2 Carlos ManciaMr. Mancia is a non-English speaking patient and is fearful of being discovered as an illegal immigrant. 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.

1- Don Personal Protective Equipment 2- Obtain translator 3- Allow for non-compliance of patient and do not probe further 4- Verify call Light/bed safety precautions 5- Document results

Carlos Mancia Scenario 4 Carlos ManciaThe sister of Mr. Mancia calls from home to speak with you. She shares her concerns about the patient's wife who is now coughing and having night sweats.

1- Educate caller regarding HIPAA 2- Evaluate caller understanding 3- Refer caller to contact health department 4- Notify doctor 5- Document conversation

Calvin Umbyuma Scenario 5 Calvin UmbyumaMr. U's condition continues to deteriorate, and his tests come back positive for TB. The nurse is informed by the CNA that his pulse-oximetry is 89 on room air and he looks very dusky. The CNA also tells the nurse that while they were taking his VS, he coughed up bloody sputum.

1- Elevate head of bed 2- Initiate O2 at 4L nasal canula 3- Reassess vital Signs 4- Reevaluate amount of blood lost by coughing 5- Contact HCP and nursing supervisor

Donald Lyles Scenario 4 Donald LylesAfter 15 minutes, the patients rhythm returns, but he is still unresponsive. He is now in Ventricular tachycardia with a weak pulse, and a BP of 70/40. Prepare to initiate Cardio-version.

1- Ensure cardio-pads are in place anterior chest and posterior back. 2- Charge the monitor to 200 J biphasic. 3- Announce to CODE team that you are ready to cardiovert. 4- Announce "CLEAR, CLEAR, EVERYONE CLEAR". 5- Ensure no one in the room is touching the patient or the bed and cardiovert.

Donald Lyles Scenario 1 Donald LylesMr. Lyles calls you via the call light. Upon entering the room, he asks if you have medication for "heartburn". He says, "I take TUMS at home when this happens." You tell the patient you will be glad to check-on what is available for relief of his "heartburn" after you complete his physical assessment. You begin his assessment, and he falls back in the bed and becomes unresponsive. You shout, "Are you okay? Are you okay?"

1- Establish responsiveness. 2- Call for Rapid Response/CODE-blue. 3- Check for breathing and carotid pulse. 4- Begin continuous chest-compressions until help arrives. 5- When help arrives, pass off chest compressions and begin respirations.

Hannah Knox Scenario 4 Hannah KnoxAfter a family conference with the provider and the social worker it is decided that Ms. Knox is an official DNR and will not be intubated. Ms. Knox is complaining of worsening pain, but her respirations are very shallow and her SpO2 is 89%. The provider tells the nurse to increase her basal morphine rate to 8mg/hour, and place patient on 100% non-rebreather mask. The nurse is concerned as she understands that she is in respiratory failure, but she does not want to precipitate the patient's death because of her increasing the morphine rate.

1- Full assessment 2- Place patient on 100% non-rebreather/10L ensuring the reservoir bag is fully expanded 3- Review PCA pump history 4- DNR armband and tag on patient's bed/wall 5- Discuss with HCP concerns of morphine dose and respiratory status

John Duncan Scenario 2 John DuncanMr. Duncan is now complaining of feeling "dizzy" when he stands.

1- Full assessment including both lying/standing 2- Check input/output for possible dehydration 3- Teach patient about safety when getting out of bed 4- Document findings

Hannah Knox Scenario 1 Hannah KnoxWhile assessing Ms. Knox, the nurse is unable to flush the pic line. She has been diagnosed with pneumonia, and antibiotics have been ordered. IV to include a morphine PCA for pain. A foley catheter is ordered to manage incontinence. Ms. Knox seems upset with her daughter for bringing her to the hospital as she wanted to die at home. The nurse has reviewed the hospice nurse notes but has determined that the DNR and advanced directives are out of date. Ms. Knox's mental state is questionable as she has been receiving Morphine.

1- Full assessment, focused on mental status 2- Contact IV team 3- Set-up PCA 4- Contact HCP to see if they can apply a PureWick, female external catheter 5- Contact social services

Donald Lyles Scenario 5 Donald LylesMr. Lyles responded to the first cardioversion, and is now in sinus-bradycardia with a second-degree heart block. He is still unresponsive. Vital signs are BP:80/40, P: 46, R:16 (patient now intubated, and ventilated by Respiratory Therapy).

1- Give 1mg of Atropine, IVP as ordered by Provider. 2- Reassess patients vital signs in 3-5 minutes: BP: 85/44, P: 52, R:16 (patient intubated, and ventilated by Respiratory Therapy). 3- Repeat 1mg of Atropine administration within 3-5 minutes of first dose. 4- Prepare for external pace-maker placement. 5- Document and accompany patient to ICU immediately, and handoff report to receiving ICU nurse.

Cameron Daniels Scenario 1 Cameron DanielsCameron is on the Med-Surg floor and complaining of 9/10 abdominal pain. Her pregnancy test is positive, and the provider is concerned that it may be ectopic and has scheduled an ultrasound. She has an order for Tylenol 1 gm for T > 99.0. The IV barely running and the IV pump keeps alarming occluded. She has only received 500 ml of her Liter bolus. She also has an order for Cefotan (Cefotetan) 2 g intravenously IV every 12 hours and Oracea (Doxycycline) 100 mg by mouth every 12 hours. VS BP 96/58, P 116, R 18, T 101.2 PaO2 98%.

1- Give Tylenol 1g 2- Start another IV then DC the first. 3- Initiate bolus and medications 4- Request additional pain med order from the HCP 5- Reassess temperature in 1hr

Sarah Getts Scenario 5 Sarah GettsMs. Getts is being transferred as an emergency to Critical Care. Your responsibilities are:

1- Give verbal report 2- Escort patient 3- Notify family 4- Document results

Dana Fitzgerald Scenario 2 Dana FitzgeraldMs. Fitzgerald returns from surgery. The surgery went well, and multiple large fibroid masses were found on her uterus with several ovarian cysts. There were no signs of cancer, and the initial pathology report was negative. She is very stoic, but the nurse suspects she is in severe pain. She was given 100 mg of fentanyl IVP in the PACU. The patient has an order for Fentanyl 25 mg IVP q two hours for pain. A PCA pump has been ordered, but no PCA pumps are available on the floor—advance diet as tolerated. The nurse notices that there is no order for Colace. The patient states need to void, but she has a foley catheter in place. VS BP 139/79, P 88, R 18, T 99.2.

1- Head to toe assessment to include surgical site 2- Inspect catheter to ensure it is not obstructed/kinked 3- Teach patient that the catheter makes it feel like she needs to void 4- Instruct patient not to get up without assistance. Administer pain medication and ensure side rails are up, the bed is in the lowest position, and the call light is within reach. 5- Ask the charge nurse for help locating a PCA from another floor. Then, obtain an order for Colace and inform the provider that you are trying to find a PCA pump.

John Duncan Scenario 5 John DuncanMr. Duncan's wife meets you in hall asking what she could bring her husband to eat from home.

1- Inform and educate spouse of dietary orders 2- Evaluate/modify plan of care 3- Assess food consumption and intake and output 4- Document findings/results

Paul Greer Scenario 2 Paul GreerWhile assessing the patient, Mr. Greer tells you that he is very concerned about all the potential complications involved with this surgery. He is aware that he may not have an erection and may need Depends Briefs for bladder incontinence.

1- Inform the patient his apprehension is expected with this surgery/diagnosis. 2- Explain to Mr. Greer that it may take several days for healing, and he may have temporary incontinence, but it will resolve over time. 3- Teach the patient that there are several interventions for complications post-prostatectomy to include erectile dysfunction, post-op prostatectomies, and self-care involved with a foley catheter at home. 4- Evaluate patient's understanding of teaching 5- Continue to observe urine for hematuria and document findings

Dana Fitzgerald Scenario 5 Dana FitzgeraldThe provider ordered a KUB, revealing a large amount of stool and gas, with no free air under the diaphragm.. A digital rectal exam reveals some very hardened stool and internal hemorrhoids. The provider tells the nurse Ms. Fitzgerald is severely constipated and orders a fleets enema. In addition, the provider will be sending her home with medication for opioid-induced constipation, Prucalopride, a prokinetic drug that has been commercially available in recent years for the treatment of chronically constipated patients.

1- Inform the patient that the pain medication worsens her constipation, and the fleets' enema has been ordered. 2- Provide patient privacy and lay the patient on their left lateral side. 3- Lubricate the tip of the enema tip or catheter and insert it into the rectum gently. 4- Squeeze the content into the rectum while telling her to take slow deep breaths 5- Have the patient lay on their side and retain an enema if they can tolerate it. Then, assist the patient to commode or onto a bedpan.

Dana Fitzgerald Scenario 4 Dana FitzgeraldOn the third day post-op, Ms. Fitzgerald's pain is 9 /10, and the patient states it is a stabbing pain that comes in waves. She has not been eating due to nausea and has only drunk 100 ml in the past 8 hours. The patient states her last bowel movement was two days before her operation. The nurse needs to perform an abdominal examination and encourage ambulation. The husband has become very concerned about surgical complications and insists that she be given pain medication and left alone to rest. The nurse is concerned that she is severely constipated and must rule out bowel obstruction.

1- Inspect the patient's abdomen 2- Auscultate starting at the right lower quadrant beginning at the right lower and continuing to all others 3- Percuss and palpate all quadrants as tolerated. 4- Contact provider before administering additional pain medication. 5- Tell the husband and patient you have notified the HCP and are doing further assessments

Cameron Daniels Scenario 4 Cameron DanielsThe ultrasound was positive for an ectopic pregnancy and the provider has ordered methotrexate 1.0 mg/kg in two divided doses. Cameron's' mother comes to visit and is insisting that she be allowed to talk to the doctor in private. She also asks if she can spend the night. The mother states that they are very religious, and she has invited their pastor to come by to pray for her daughter. The mother does not know about the ectopic pregnancy nor understand Cameron's diagnosis or social circumstances. She is requesting information about Cameron's diagnosis.

1- Make sure you have an accurate weight on the patient and verify the prescribed dosing. 2- Explain the reason for the medication (in private) to include potential side effects, to include nausea, vomiting, headaches, fatigue, and an overall "blah" feeling. 3- Tell the mother that you understand her concern as a mother, but her daughter is an adult and discussing her diagnosis would violate HIPAA 4- Tell the mother that visitors are welcome, but she can only spend the night if her daughter approves 5- Be honest with Cameron concerning the need for family support and inform her that the mother is very concerned and has asked to spend the night. Inform her that her mother has also asked the pastor to come pray with her.

Lithia Monson Scenario 5 Lithia MonsonWhen completing the shift change neuro check, you notice the patient's left pupil is sluggish. You also notice the patient is more difficult to orient.

1- Notify HCP of neuro findings 2- Notify charge nurse of patient's deteriorating condition 3- Begin q15 minute neuro checks 4- Have patient remain in bed, head elevated 30 degrees 5- Ensure IV is patent

John Davis Scenario 1 John DavisThe surgery went well, he had one partial thickness lesion on his shoulder and one of the lesions on his back are full thickness that will require staged closure or a possible skin graft. He has a 4x4 dressing on his right shoulder, two large dressings, and two smaller dressings on his back. His vital signs are stable. He has an IV NS to his left hand @ TKO. He received 2 liters intraoperatively. He was given Fentanyl 100 mg and Zofran 4mg in the PACU. The patient asks if he can go to the bathroom because he needs to void immediately.

1- Offer patient a urinal and assist to bedside, if needed 2- Perform post-op assessment to include visual inspection of dressings, vital signs, pain 3- Assist patient to a comfortable position in bed 4- Tell patient not to get out of bed without assistance 5- Ensure side rails are up and call light is within reach

Calvin Umbyuma Scenario 4 Calvin UmbyumaMr. U test positive for TB and new medications are ordered (kanamycin and moxifloxacin). His T-cell count is 160 with CD4 cell at 16%. A consult has been ordered for an infectious disease provider to manage his TB and HIV. The nurse is very concerned that this his TB is a resistant strain as this can be carried with HIV infected patients. The nurse is also concerned about the social contacts that Mr. U has had in the recent past including his visitor that was not wearing a mask. The nurse has received multiple diagnostic orders that need to be done ASAP. Current vital signs are: 100.6 F, 38.1 C, R:22, P:86, PaO2: 91% Prioritize the following: Blood Gases, Bronchoscopy, Western blot and Elisa test, Chest x-ray, provide patient teaching about diagnostic testing,

1- Patient teaching about diagnostic testing (Bronchoscopy) 2- Contact Respiratory therapy to obtain ABG's 3- Chest x-ray 4- Western blot and Elisa test 5- Bronchoscopy

Lithia Monson Scenario 1 Lithia MonsonYou arrive in room to find Ms. Monson talking to herself. Upon assessment, you determined that she is confused to person, time, and place but is easily directable.

1- Perform neuro assess 2- Reorient Patient to person, place, & time 3- Assess for fall risk 4- Offer nutrition/toilet 5- Discuss effectiveness of sitter

Calvin Umbyuma Scenario 1 Calvin UmbyumaThe nurse is doing the admission and has trouble pronouncing the patient's name. He tells the nurse to call him U. Mr. U starts coughing, his sputum is greenish-yellow with blood tinge. He tells the nurse that it is very painful to cough. The nurse asks him if he has night sweats, and he says yes, for the past 4 weeks. Mr. U has traveled back to Kenya twice this year as his mother has been very ill. He tried to convince her to seek medical attention, but his family is very traditional and believes in other methods of treatment. Mr. U admitted he also has been using traditional methods to treat his HIV. The nurse has an order for an IV with antibotics q6hr., blood cultures x2, and Tylenol for pain and fever.

1- Place on respiratory isolation 2- Ask Mr. U about the traditional methods he is currently receiving 3- Obtain blood cultures x2 4- Start IV and antibotics 5-Collect sputum culture and remind the provider that a sputum culture order is needed. This will allow check sputum for acid-fast bacilli

Hannah Knox Scenario 2 Hannah KnoxThe Pic-line has been replaced by the IV team, but the nurse is concerned about the plan to send Ms. Knox home again. She caught the granddaughter rummaging through Ms. Knox's belongings, and asked the nurse where the pain medication is. The nurse explained that she is taking care of the patient's pain, and has a gut feeling that granddaughter may be a drug seeker. The granddaughter asks if she can give her grandma a cigarette.

1- Place patient on continuous pulse ox 2- Administer antibiotics and start Morphine PCA with a basal rate of 4mg/hour, and demonstrate to patient how to administer 3- Reassess effectiveness of PCA 4- Review medical history of pain medications for dosage, frequency, and effectiveness 5- Document

Cameron Daniels Scenario 3 Cameron DanielsThe provider is visiting with Cameron and informs her that her pregnancy test is positive, and they are concerned that it may be ectopic. The patient becomes very upset and admits that she has been also seeing more than one individual as she also had sex with a boy from her high school, "but it was just one time". She asks the nurse not to tell her mother. Later that day Cameron is visited by a young man who brings her flowers. The nurse overhears the patient telling her visitor that she had appendicitis and she will be well soon.

1- Provide emotional support and ask open ended nonjudgmental questions. The nurse should establish trust first. 2- Assure patient that as an adult her medical information is private unless she gives consent for release to other individuals. Cameron has just turned 18 but still lives at home, therefore she is transitioning into the mindset off an adult. 3- Explain to the patient that she has a sexually transmitted infection and while her patient information is private this type of infection is required to be reported to the Department of Health. As an adult she she has the right to privacy but this disease has consequences. 4- Stress the importance of informing any sexual partners of her STI as they may transmit the infection. 5- Inform patient that you will set-up a one-on-one with a pregnancy counselor to discuss her pregnancy to include a description of an ectopic pregnancy

Lithia Monson Scenario 3 Lithia MonsonA few hours after speaking with the sitter about the patient needing complete observation, you notice the sitter outside of the room talking on the phone. Upon entering the room, the patient appears to be trying to get out of bed

1- Reassess patient 2- Ensure patients is positioned in bed properly 3- Discuss with sitter that patient needs continual observation 4- Discuss with family sitter if there are any other family members who can help with monitoring Lithia 5- Document and contact nursing supervisor/Charge nurse

Hannah Knox Scenario 3 Hannah KnoxMs. Knox's respiratory status has deteriorated over the last 24 hours. She has been placed on a simple face mask at 6L and is audibly wheezing. There is an order for resp therapy to give her albuterol breathing treatments and prepare her for possible intubation. The daughter wants everything to be done but the patient has made it clear in the hospice plan that she did not want to be intubated. The social worker has told the nurse that being at the hospital is the best thing for the patient as the living conditions at home are less than desirable. The granddaughter's boyfriend has a warrant out for his arrest.

1- Reassess vital signs and elevate head of bed 2- Provide palliative care 3- Call respiratory therapy and assist with treatments 4- Seek clarification about advanced directives and DNR status 5- Provide emotional support for patient and family and ask if they would like you to contact a hospital chaplain

Wight Goodman Scenario 4 Wight GoodmanThe resident has been rounding on Mr. Goodman and is preparing his discharge. Mr. Goodman is still very upset about his appearance. He is also complaining of nasal congestion and insists on trying to blow his nose. The nurse informs the resident that his visual acuities are worse, patient's eyelid is drooping, and his left-eye (OS) pain is increasing . The resident tells the nurse that is a common complication with this type of injury, and they will see him in the clinic for a follow-up.

1- Repeat Neurological assessment and contrast your latest findings 2- Reemphasize to patient that he cannot blow his nose 3- Approach Resident again, and explain that you feel his condition is worsening 4- Contact Nursing Supervisor of disagreement of patients readiness for discharge 5- Document

John Davis Scenario 3 John DavisThe nurse's aide reports that the Mr. J did not eat any of his lunch or dinner. The surgeon and oncologist had visited with the patient that morning. When the patient is asked about his appetite the patient states that he is nauseated. The SL is occluded. The orders came to initiate Chemotherapy: vismodegib (Erivedge) is 150mg orally daily. The sonidegib (Odomzo) dose is 200 mg orally daily taken on an empty stomach, at least 1 hour before or 2 hours after a meal. Zofran 4mg IV PRN

1- Restart new IV 2- Administer nausea medicine 3- Assess for contraindications to Chemotherapy 4- Weigh the patient and verify dosage 5- Take VS and provide patient teaching on chemotherapy prior to infusion.

Cameron Daniels Scenario 2 Cameron DanielsThe nurse is speaking with the Cameron about her diagnosis. The cultures were positive for chlamydia and gonorrhea. She asks the nurse how she got this infection. The patient had denied being sexually active in the ER. Cameron finally tells the nurse that she has been seeing an older married man from their church for few years, and they are in love. Once realizing the patient just turned 18 the nurse asks her how many years this relationship has been going and the patient tells her 3 years.

1- Sit at an eye level with the patient using nonjudgmental therapeutic communication 2- Teach Cameron concerning the complications of PID, STIs, and infectious disease. 3- Evaluate patient understanding of STIs and unprotected sex 4- Contact the charge nurse / law enforcement and inform them about the potential legal issues. 5- Document patients' statement and prepare a written report.

Dana Fitzgerald Scenario 1 Dana FitzgeraldPreoperatively Ms. Fitzgerald is very nervous. When the nurse enters the room, she appears to have been crying. She confides in the nurse that she was hoping to try one more time to have a baby, but now there is no hope. She tells the nurse they are in the process of adopting but is concerned that the mass may be cancerous, although the surgeon has assured her that they do not expect any malignancy

1- Sit with the patient and provide emotional support by using open-ended questions. 2- Reinforce provider teaching that fibroid uterine masses are rarely cancerous. 3- Reassure the patient that she can make a full recovery from surgery, and it should not interfere with the adoption process. 4- Assess adequate family support system prior to discharge 5- Ask the patient if they would like to speak with a clinical counselor or chaplain.

Dana Fitzgerald Scenario 3 Dana FitzgeraldMs. Fitzgerald has been resistant to ambulation post-op day 2. Her abdominal pain is 8/10, and her husband tells the nurse she just needs to rest and get her pain medication on time. She has been resistant to use the incentive spirometer as well. When the nurse inspects her abdomen, the dressing is dry and intact, but her abdomen is rigid and slightly distended. Her bowel sounds are hypoactive, and her urine is very dark. VS BP 132/80, P 95, R 20, T 100.2.

1- Teach the patient that the pain medication works best if she ambulates and uses the incentive spirometer after the pain medication is administered. 2- Explain to the patient the importance of the incentive spirometer q15 minutes. Instruct the patient and husband that she does not ambulate without assistance and to call for help. 3- Administer pain medication and have the patient demonstrate incentive spirometer technique. Teach patient how to use a pillow as an abdominal splint while coughing and deep breathing 4- Tell the patient that she must drink plenty of fluid To be hydrated for ambulation. 5- Have the patient ambulate a short distance with your assistance.

Paul Greer Scenario 3 Paul GreerThe surgeon has just visited with Mr. Greer 2-days post op and has informed him that the lymph node biopsies have confirmed that the cancer has metastasized, and he will need further treatment. The surgeon has suggested Androgen-deprivation therapy (ADT) with surgical castration (orchiectomy). The patient tells the nurse that yesterday he was, "concerned about having an erection, and now they want to cut off my testicles". He tells the nurse he has called his wife and wants to be discharged now.

1- Using therapeutic communication inform Mr. Greer that there are many treatment options, and not to leave until the HCP can come and speak with him 2- Contact HCP to determine when they are available to speak with the patient 3- Provide the patient with the time when HCP will come discuss options with him 4- Provide a diversional activity to pass the time while waiting on the HCP and inform wife that the HCP will be coming soon 5- When the HCP arrives, stay in the room to determine whether you can continue care with the patient

Sarah Getts Scenario 4 Sarah GettsMs. Getts is now complaining of sudden sharp, substernal chest pain, very short of breath and is profusely diaphoretic.

1- Visual assess 2- Call rapid response 3- Apply oxygen 4- Establish second IV 5- Remain with patient

John Duncan Scenario 4 John DuncanTwo hours later, Mr. Duncan is asked how frequent his stools have been today. He replies, "six times in the past four hours". He also states he is feeling weak.

1- Vital sign assessment 2- Assessment of bowel movement 3- Administer protocol antidiarrheal medication 4- Document results/findings 5- Include patient condition change in shift report

Sarah Getts Scenario 2 Sarah GettsThree hours later, Ms. Getts is unsteady when standing by her bedside.

1- Wash and glove hands 2- Full assessment 3- Apply fall risk bracelet 4- Document results

Sarah Getts Scenario 1 Sarah GettsMs. Getts is requesting water to drink. Her pitcher has already been filled three times this shift.

1- Wash and glove hands 2- Full assessment 3- Monitor and evaluate fluid intake 4- Educate patient 5- Document results

John Duncan Scenario 3 John DuncanSeveral hours later, Mr. Duncan is now complaining of nausea.

1- Wash and glove hands 2- Provide emesis basin/cloth 3- Vital sign assessment 4- Administer antiemetic medication 5- Evaluate medication effectiveness

Wight Goodman Scenario 1 Wight GoodmanMr. Goodman has been scheduled for surgery to repair a supraorbital rim fracture, but he is very concerned about any scaring that may affect his appearance. He is alert and oriented and has signed the surgical consent. The nurse notices a small amount of blood coming from the patient's nose. He does not remember his nose bleeding initially or in the ER. VS BP140/82 P74 R 20 T 98.7 F, 37.1 C.

1- Wash hands and assess 2- Complete Neurological assessment 3- Check the blood from his nose for CSF 4- Pre-op education 5- Ask Surgeon to discuss with patient the potential facial scarring

Calvin Umbyuma Scenario 2 Calvin UmbyumaMr. U calls the nurse to his room complaining of severe pain when he coughs, and his shortness of breath has become worse. A visitor is in the room without a mask and has delivered Mr. U's medication from home to include his traditional herbal remedies. Mr. U admits that he was trying to take his medicine when he experienced an episode of uncontrollable cough. Upon review of Mr. U's previous chest X-ray, you have identified an abnormal chest X-ray showing a patchy shadowing in the right upper lobe.

1- Wash hands, don PPE 2- Explain to the visitor that a mask must be worn, and they need to wash their hands 3- Respiratory assessment and assess vital signs 4- Ask Mr. U for his medication and explain to Mr. U why he can't take his other medication while admitted to the hospital 5- Place signage on door and above bed reminder to wear a mask and wash hands

Wight Goodman Wight Goodman Patient was admitted to the floor last night from the ER for an orbital fracture. He was hit in the left eye by a softball yesterday. Apparently, he was pitching, and the batter hit a line drive hitting him in the right side of the face. They applied some ice to his face, and he decided to go to the post game keg party instead of coming to the ER. The patient stated that there was significant swelling, but his vision was fine, and the pain was controlled with beer and 800mg of Motrin. He was unable to sleep later in the evening as the pain became worse, and his vision became more impaired. Patient states, "I'm afraid I will be permanently scarred"! The Maxillofacial surgeon was consulted, and they will see him this morning. They were not concerned as his intraocular pressure was normal in the ER. There is significant edema and discoloration to the left side of his face, and his left eye is almost completely swollen shut. His visual acuity is diminished, and the whites of his eyes are hemorrhaged. His pain has been well controlled with IV morphine 4 mg, q3 hours. He has a 20g SL to his right hand, that was started in the ER. He has no other health concerns. He's being admitted for pain control, close observation of his intralocular pressure, and head injury.

Acute discomfort Alteration in comfort Potential for bleeding Knowledge deficit Potential for infection

Cameron Daniels Cameron Daniels just turned 18 y/o. She is being admitted from the ER with a diagnosis of pelvic inflammatory disease (PID). She has heavy vaginal discharge with an unpleasant odor. She is complaining of abdominal pain and looks pale. She was seen by OBGYN in the ER and a culture was sent to the lab for Chlamydia and Neisseria Gonorrhea. She was a very difficult IV start and has a 23g saline lock (SL) in her right hand. They have ordered a liter bolus of LR, but it is running very slowly and the IV is positional. VS BP 96/58, P 116, R 18, T 101.2 PaO2 98%.

Acute discomfort Alteration in mobility Knowledge deficit Potential for falls Potential for infection

Calvin Umbyuma Calvin Umbyuma Mr. Umbyuma is a 42 y/o male who has been admitted for complaints of shortness of breath with pleuritic chest pain. He was diagnosed with HIV positive antibodies over a year ago. He has recently been traveling back to his home country of Kenya to visit his sick mother. He received traditional medical treatment at his village. His temp is 100.9 F, 38.3 C, R 22, P92, BP 152/89 PaO2 91%. Inflammatory markers - Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) are elevated at 78.9 mm/h and 67.2 mg/L. He has been placed in a room at the end of the hall.

Acute discomfort Knowledge deficit

Hannah Knox Hannah Knox is a 62 y/o patient who has been receiving hospice care for metastatic lung cancer. She continued to smoke until recently. The plan was for her to die at home, but her daughter couldn't handle having her in her home after 2 weeks of hospice care. The daughter was complaining that her mother was in an extreme amount of pain, and her family could not cope. Ms. Knox is frail, weak, and apprehensive about her care. Her lung sounds are diminished in her lower lobes bilaterally, and she has crackles in her upper lobes. She is on 4L O2 nasal canula. She has a pic-line in her right arm. Vital signs BP: 98/52, P: 92, R: 30, SpO2: 91, T:100.2F, 37.8 C

Alteration in comfort Chronic discomfort Fear Knowledge deficit Potential for alteration in gas exchange Potential for infection

Paul Greer Paul Greer is a 57 y/o who has been admitted for a radical prostatectomy. He was recently diagnosed with stage III prostate cancer. His original lymph node biopsy was negative. He has a history of hypertension and is not compliant with medication. Until the recent diagnosis of cancer, the patient had only seen a physician once in the last ten years. He has a 20-year one pack history of smoking. However, he quit three years ago when he remarried; he and his wife have a nine-month-old baby. His difficulty voiding finally motivated him to seek care.

Alteration in comfort Knowledge deficit Potential for ineffective sexuality patterns

Carlos Mancia Carlos Mancia 48yr-old, Spanish speaking migrant worker with no known past medical Hx. r/o Tuberculosis. Vital signs -Temp 99.1, BP 124/62, P 77, RR 20, SaO2 91%. Airborne Isolation. Neuro WNL. Skin moist, respiratory bilateral wheezes and rhonchi. Blood-tinged mucous, productive cough. Diet as tolerated. IV maintenance fluids with D5 1/4 NS @ 150 ml/hr X 3 then reduce rate to 75 ml/hr. Expresses fatigue, fear, concern, and desire for recovery. Need frequent reminder to stay in room and maintain mask precautions. If family/visitors come, will need education to airborne precautions. Spanish interpreter available at extension 61178. Dr. Rondeau

Alteration in gas exchange Exhaustion Ineffectual airway clearance Anxiety Fear Knowledge deficit Potential for falls Potential for becoming socially isolated Noncompliance Readiness for improved self-care

Lithia Monson Lithia Monson 93 years old, came to us yesterday with a fall at the nursing home with a suspected subdural hematoma. She seems stable, difficult to determine her level of confusion as she has dementia. She has a bump on her head. Ms. Monson is cooperative, direct-able, and we do not see any changes. Vital signs are stable -Temp 97.2, BP 96/74, P 82, RR 20, SaO2 97%. She is oriented with some direction to time and place. Her speech is clear. She did not recognize her son today when he came to see her, but that is not new for her. Q1 hour nuero assessments and we are watching her closely. We have asked the family to stay with her 100% of the time so she does not fall. Strict I&O, Hep-Lock in place left AC although no IV therapy going. Ms. Monson is a patient of Dr. Altace

Alteration in nutrition Potential for bleeding Self-care deficiency Acute Confusion Potential for falls Failure to Thrive

John Duncan John Duncan 56yr-old male, Dx- Gastroenteritis, returned yesterday from Cancun, c/o intractable diarrhea, weak, pale, and refusing to eat. No known allergies (NKA). Non-significant past medical Hx. Vital signs Temp 99.4, BP 106/72, P 96, RR 20, SaO2 91%. Neuro WNL's, alert and cooperative. IV maintenance fluids with D5 1/2 NS at 125ml per hour in left forearm. c/o headache- medicated with Lortab 5mg PO at 0900, takes Lomotil 10ml PRN q 4 hours last dose at 0834. Stools are decreasing but patient remains very weak. Wife at bedside. Diet as tolerated. Dr. Jones.

Decrease in fluid volume Exhaustion Potential for alteration in electrolyte balance Potential for falls Noncompliance

Wight Goodman | Room 301 Patient Overview wight_goodman.jpgWight GoodmanPatient was admitted to the floor last night from the ER for an orbital fracture. He was hit in the left eye by a softball yesterday. Apparently, he was pitching, and the batter hit a line drive hitting him in the right side of the face. They applied some ice to his face, and he decided to go to the post game keg party instead of coming to the ER. The patient stated that there was significant swelling, but his vision was fine, and the pain was controlled with beer and 800mg of Motrin. He was unable to sleep later in the evening as the pain became worse, and his vision became more impaired. Patient states, "I'm afraid I will be permanently scarred"! The Maxillofacial surgeon was consulted, and they will see him this morning. They were not concerned as his intraocular pressure was normal in the ER. There is significant edema and discoloration to the left side of his face, and his left eye is almost completely swollen shut. His visual acuity is diminished, and the whites of his eyes are hemorrhaged. His pain has been well controlled with IV morphine 4 mg, q3 hours. He has a 20g SL to his right hand, that was started in the ER. He has no other health concerns. He's being admitted for pain control, close observation of his intralocular pressure, and head injury.

Educational Needs- Increased Fall Risk- Increased Health Change- Increased Neurological- Increased Pain Level- Increased Psychological Needs- Increased

Hannah Knox | Room 302 Patient Overview hannah_knox.jpgHannah Knoxis a 62 y/o patient who has been receiving hospice care for metastatic lung cancer. She continued to smoke until recently. The plan was for her to die at home, but her daughter couldn't handle having her in her home after 2 weeks of hospice care. The daughter was complaining that her mother was in an extreme amount of pain, and her family could not cope. Ms. Knox is frail, weak, and apprehensive about her care. Her lung sounds are diminished in her lower lobes bilaterally, and she has crackles in her upper lobes. She is on 4L O2 nasal canula. She has a pic-line in her right arm. Vital signs BP: 98/52, P: 92, R: 30, SpO2: 91, T:100.2F, 37.8 C

Educational Needs- Increased Fall Risk- Increased Health Change- Increased Neurological- Normal Pain Level- Increased Psychological Needs- Increased

Cameron Daniels | Room 301 Patient Overview cameron_daniels.jpgCameron Danielsjust turned 18 y/o. She is being admitted from the ER with a diagnosis of pelvic inflammatory disease (PID). She has heavy vaginal discharge with an unpleasant odor. She is complaining of abdominal pain and looks pale. She was seen by OBGYN in the ER and a culture was sent to the lab for Chlamydia and Neisseria Gonorrhea. She was a very difficult IV start and has a 23g saline lock (SL) in her right hand. They have ordered a liter bolus of LR, but it is running very slowly and the IV is positional. VS BP 96/58, P 116, R 18, T 101.2 PaO2 98%.

Educational Needs- Increased Fall Risk- Increased Health Change- Increased Neurological- Normal Pain Level- Increased Psychological Needs- Normal

John Duncan | Room 303 Patient Overview john_duncan.jpgJohn Duncan56yr-old male, Dx- Gastroenteritis, returned yesterday from Cancun, c/o intractable diarrhea, weak, pale, and refusing to eat. No known allergies (NKA). Non-significant past medical Hx. Vital signs Temp 99.4, BP 106/72, P 96, RR 20, SaO2 91%. Neuro WNL's, alert and cooperative. IV maintenance fluids with D5 1/2 NS at 125ml per hour in left forearm. c/o headache- medicated with Lortab 5mg PO at 0900, takes Lomotil 10ml PRN q 4 hours last dose at 0834. Stools are decreasing but patient remains very weak. Wife at bedside. Diet as tolerated. Dr. Jones.

Educational Needs- Increased Fall Risk- Increased Health Change- Increased Pain Level- Increased Psychological Needs- Normal Sensorium- Normal

Lithia Monson | Room 301 Patient Overview lithia_monson.jpgLithia Monson93 years old, came to us yesterday with a fall at the nursing home with a suspected subdural hematoma. She seems stable, difficult to determine her level of confusion as she has dementia. She has a bump on her head. Ms. Monson is cooperative, direct-able, and we do not see any changes. Vital signs are stable -Temp 97.2, BP 96/74, P 82, RR 20, SaO2 97%. She is oriented with some direction to time and place. Her speech is clear. She did not recognize her son today when he came to see her, but that is not new for her. Q1 hour nuero assessments and we are watching her closely. We have asked the family to stay with her 100% of the time so she does not fall. Strict I&O, Hep-Lock in place left AC although no IV therapy going. Ms. Monson is a patient of Dr. Altace

Educational Needs- Increased Fall Risk- Increased Health Change- Increased Pain Level- Normal Psychological Needs- Increased Sensorium- Increased

Sarah Getts | Room 303 Patient Overview sarah_getts.jpgSarah Getts77 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

Educational Needs- Increased Fall Risk- Increased Health Change- Increased Pain Level- Normal Psychological Needs- Increased Sensorium- Increased

Carlos Mancia | Room 303 Patient Overview carlos_mancia.jpgCarlos Mancia48yr-old, Spanish speaking migrant worker with no known past medical Hx. r/o Tuberculosis. Vital signs -Temp 99.1, BP 124/62, P 77, RR 20, SaO2 91%. Airborne Isolation. Neuro WNL. Skin moist, respiratory bilateral wheezes and rhonchi. Blood-tinged mucous, productive cough. Diet as tolerated. IV maintenance fluids with D5 1/4 NS @ 150 ml/hr X 3 then reduce rate to 75 ml/hr. Expresses fatigue, fear, concern, and desire for recovery. Need frequent reminder to stay in room and maintain mask precautions. If family/visitors come, will need education to airborne precautions. Spanish interpreter available at extension 61178. Dr. Rondeau

Educational Needs- Increased Fall Risk- Increased Health Change- Increased Pain Level- Normal Psychological Needs- Increased Sensorium- Normal

Calvin Umbyuma | Room 304 Patient Overview Calvin_Umbsya.jpgCalvin UmbyumaMr. Umbyuma is a 42 y/o male who has been admitted for complaints of shortness of breath with pleuritic chest pain. He was diagnosed with HIV positive antibodies over a year ago. He has recently been traveling back to his home country of Kenya to visit his sick mother. He received traditional medical treatment at his village. His temp is 100.9 F, 38.3 C, R 22, P92, BP 152/89 PaO2 91%. Inflammatory markers - Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) are elevated at 78.9 mm/h and 67.2 mg/L. He has been placed in a room at the end of the hall.

Educational Needs- Increased Fall Risk- Normal Health Change- Increased Neurological- Normal Pain Level- Increased Psychological Needs- Normal

Dana Fitzgerald | Room 302 Patient Overview Dana_Fitzgerald.jpgDana Fitzgeraldis a 42-year-old gravida 5 para 0 patient admitted for a total abdominal hysterectomy with bilateral saplingo-oophorectomy (TAHBSO). She has a history of endometriosis and uterine fibroids for ten years. She has a background history of subfertility with multiple miscarriages. She has been experiencing abdominal pain with heavy menses over the last 6 months. A mass has become palatable just below her umbilicus. She has also been experiencing dyspareunia during intercourse. She also has a history of IBS with opioid-induced chronic constipation. She is otherwise healthy with some minor anemia. VS: BP 128/62, P 72, R 16, T 98.6 F.

Educational Needs- Increased Fall Risk- Normal Health Change- Increased Neurological- Normal Pain Level- Increased Psychological Needs- Normal

Donald Lyles | Room 302 Patient Overview donald_lyles.jpgDonald Lyles52-year old male, was admitted yesterday evening for stabilization of his uncontrolled type II diabetes. He is married, and his wife is requesting to stay at his side. His HbgA1c is 10.6%. He has a history of a Myocardial Infarction, MI, one year ago, and has refused all cardiac rehab, and has not had another cardiac event. He refuses to comply with dietary recommendations. His BMI is 37. Vital signs are: BP: 146/94, P: 88, R: 22, T: 99.2, PaO2: 94% Blood glucose upon admission is 340 mg/dl

Educational Needs- Increased Fall Risk- Normal Health Change- Increased Neurological- Normal Pain Level- Normal Psychological Needs- Normal

John Davis | Room 304 Patient Overview John_Davis.jpgJohn Davisis a 54 y/o male admitted for surgical resection and biopsy of multiple lesions on his back and shoulders. The patient is fair skinned with multiple moles on his shoulders and anterior and posterior torso. The patient is high risk for basal cell carcinoma and has had mole - mapping. Mr. Davis is very thin and reports an 8 lbs. weight loss over the last four months. He owns a landscape business, works outside, he also enjoys being out on his boat. He had a basil cell carcinoma removed from his forehead four years ago (Mohs micrographic surgery) which has left a large scar. Mr. Davis is concerned about potential scars from these lesions. He denies any other health issues. The patient does not smoke, but drinks 2 beers after work daily and more on the weekends. VS BP 150/89, P 62, R 14, T 98.2.

Educational Needs- Increased Fall Risk- Normal Health Change- Increased Neurological- Normal Pain Level- Normal Psychological Needs- Normal

Paul Greer | Room 304 Patient Overview Paul Greeris a 57 y/o who has been admitted for a radical prostatectomy. He was recently diagnosed with stage III prostate cancer. His original lymph node biopsy was negative. He has a history of hypertension and is not compliant with medication. Until the recent diagnosis of cancer, the patient had only seen a physician once in the last ten years. He has a 20-year one pack history of smoking. However, he quit three years ago when he remarried; he and his wife have a nine-month-old baby. His difficulty voiding finally motivated him to seek care.

Educational Needs- Increased Fall Risk- Normal Health Change- Increased Pain Level- Normal Psychological Needs- Normal Sensorium- Normal

Sarah Getts 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

Electrolyte Imbalance Ineffectual renal perfusion, risk for Potential for imbalanced fluid volume Acute Confusion Potential for falls Failure to Thrive

Donald Lyles Donald Lyles 52-year old male, was admitted yesterday evening for stabilization of his uncontrolled type II diabetes. He is married, and his wife is requesting to stay at his side. His HbgA1c is 10.6%. He has a history of a Myocardial Infarction, MI, one year ago, and has refused all cardiac rehab, and has not had another cardiac event. He refuses to comply with dietary recommendations. His BMI is 37. Vital signs are: BP: 146/94, P: 88, R: 22, T: 99.2, PaO2: 94% Blood glucose upon admission is 340 mg/dl

Knowledge Deficit Potential for infection

John Davis John Davis is a 54 y/o male admitted for surgical resection and biopsy of multiple lesions on his back and shoulders. The patient is fair skinned with multiple moles on his shoulders and anterior and posterior torso. The patient is high risk for basal cell carcinoma and has had mole - mapping. Mr. Davis is very thin and reports an 8 lbs. weight loss over the last four months. He owns a landscape business, works outside, he also enjoys being out on his boat. He had a basil cell carcinoma removed from his forehead four years ago (Mohs micrographic surgery) which has left a large scar. Mr. Davis is concerned about potential scars from these lesions. He denies any other health issues. The patient does not smoke, but drinks 2 beers after work daily and more on the weekends. VS BP 150/89, P 62, R 14, T 98.2.

Knowledge deficit

Dana Fitzgerald Dana Fitzgerald is a 42-year-old gravida 5 para 0 patient admitted for a total abdominal hysterectomy with bilateral saplingo-oophorectomy (TAHBSO). She has a history of endometriosis and uterine fibroids for ten years. She has a background history of subfertility with multiple miscarriages. She has been experiencing abdominal pain with heavy menses over the last 6 months. A mass has become palatable just below her umbilicus. She has also been experiencing dyspareunia during intercourse. She also has a history of IBS with opioid-induced chronic constipation. She is otherwise healthy with some minor anemia. VS: BP 128/62, P 72, R 16, T 98.6 F.

Knowledge deficit Potential for grief Potential for infection