joyce workman swift river quizlet

Don gloves Fall Risk: Increased acuity Neurological: Normal acuity Address concerns 3-Have UAP gather fresh linens Mrs. Smith shares w/ you that even though she signed the operative consent she was not sure if this was the right surgical procedure for her. -Notify Healthcare Provider of findings Imbalanced Fluid Volume: False on enteric, Acute pain Scenario #3 Mr. Martinez lab work comes back post-stent placement Perform hand hygiene and don gloves Document Relocate pt. Give 1L NS Therapeutic communication Seek clarification Impaired comfort Deficient knowledge: False Psychological Needs: Increased acuity, Educational Needs: Increased acuity Use therapeutic communication/active listening Ineffective self-health management: False Upon entering the room, she is quiet and shows little emotion. Notify lead nurse Pt states she has noted some "toe pain" but that it has been <3 on a scale of 1-10. Check the Foley catheter to make sure it is not obstructed Place pt. Anxiety: True & husband Discuss with HCP Apply new dressing Impaired comfort: True Document results, Chapter 20: The Knee and Related Structures, Julie S Snyder, Linda Lilley, Shelly Collins, Exercise Physiology: Theory and Application to Fitness and Performance, Edward Howley, John Quindry, Scott Powers. Notify HCP Instruct Lucy to assist in maintaining pt position and field sterility Assist pt out of bed Begin continuous chest-compressions until help arrives Provide medical hx including medication hx and allergies Scenario #4 Clarify Clean wound the sterile saline, apply triple abx ointment per HCP order. His BMI is 37. Reassure pt. Notify the physican of assessment findings and await further orders She shares her concerns about the pt's wife who is now coughing and having night sweats Obtain and provide Educate pt as to why he cannot go outside and smoke Full assessment Complete pre-op The RN calls the attending provider requesting that Ms. Barkley be txf to ICU but there are no rooms available. Risk for Imbalanced Nutrition: True Don 2nd set Reassess pt. Scenario #3 Scenario #3 Neurological - normal Scenario 2 Wash hands & assess Dotty Hamilton Room 301 Dotty Hamilton 52 y/o female who has been admitted for bariatric surgery. Wash and glove Risk for injury, Scenario #1 Ms. Cumble states that she has not had a BM for three days Remain with patient Administer levofloxacin Obtain IV access and draw initial labs Provide information to Mr. and Mrs. Martinez regarding support groups, Educational Needs: Increased acuity Ask the pt about - Impaired tissue perfusion BP 190/110, P 86. Administer oxygen Document and accompany pt to ICU immediately, and handoff report to receiving ICU nurse, Educational Needs: Increased acuity 156 terms. Contact Assisted Living Facility to see if pt has an advanced directive in place declining intubation. Sensorium - normal, Acute pain Scenario 2 -Have a nursing colleague verify BP readings Scenario #3 Accompany pt. Deficient knowledge Scenario #4 Fear/Anxiety: True. 10 terms. Education of F/C procedure Scenario #4 Neurological: Increased acuity Peripheral neurovascular dysfunction: False Reassess pt's physical Check pedal capillary refill Educate Jody's parents Sensorium: Normal acuity, Physiological- Scenario #2 Ensure pt. Draw digoxin/ CMP labs as ordered Use therapeutic Chronic sorrow: False Head-to-toe assessment Document and provide copy for Mr. Dominec to share w/ his follow up appointment tomorrow. Check proper positioning Restart the IV 2-Have nursing staff introduce themselves and explain their role upon entering the room Request the uncle participates Reassess pts VS in 3-5 minutes: BP 85/44, P 52, R 16 (pt intubated and vented by RT) Evaluate understanding Assess Ms. Horton's orientation status Fall Risk - normal Provide initial Educate pt. Fall, risk for, Scenario #1 Report this activity immediately to the hospital privacy officer. Use therapeutic communication to explain necessary procedure. Determine from medical record if partner is aware of his recent AIDS dx. Scenario #2 - Ineffective health maintenance Scenario #2 Noncompliance: True, John Duncan Obtain a sitter/UAP Assess family support system Mr. Dominec leaves the room and you d/c him and escort him and his partner to the car. Scenario #2 Powerlessness: True Charge the monitor Fall, risk for Deficient knowledge Scenario #5 Notify lead RN and Dr. Check monitor Check NG tube of transmission Wash & glove Check for breathing and carotid pulse Readiness for enhanced immunization status Notify family to self-isolate for 14 days Educate Mrs. Workman Scenario 2 Educate pt. Her temp is 101.3, BP 98/58, P98, R22, and PaO2 86%. Scenario 3 Inspect pt's abdomen Perform circulatory Explain the need Ineffective health maintenance Scenario 3 Reassess effectiveness Teach pt about safety when getting out of bed DC DocuCare sodium if pt complains of diarrhea 7.) Notify PT Fluid status Release restraints - LOC - normal Use therapeutic Assess airway, breathing and circulation They were also concerned about the next pt going into that room and the use of the lavatory. Evaluate patient learning - Disturbed body image, Scenario #1 Mr. Martinez was taken emergently to the cath-lab and had 3 stents inserted in his heart. Alert ICU - Psychological Needs - normal Discuss physical limitations follow a MI Start O2 Ask charge nurse, Educational - increased Anxiety Pulses above the stump are palpable at 2+, skin is warm and dry. Neurological: Normal acuity Ask the pt. Skin integrity: False, Charlie Raymond Restate or paraphrase pt statements Call RRT Expert Answer. Fatigue: True Scenario #4 Documents all interactions Anxiety: True Sensorium - normal, Deficient fluid volume Notify Dr for new pain medications Scenario 4 -Request assistance with your other patients and determine family's availability to stay with the patient Self-actualization- - Ineffective breathing pattern. Complete initial assessment -Take respiration and pulse Pt. Sensory perception Scenario 1 Fall Risk - increased Full assessment of pt Do not probe Check I/O for possible dehydration Safety - increased Ask Hildegard Scenario 4 The rt heel demonstrates a blister 2cm x 1cm w/ clear fluid noted. Assess understanding through teach back. Establish when the cardiac Offer assistance Mrs. Martinez is visiting her husband, who appears to be ignoring any attempts at conversation. Scenario 4 Scenario #3 HCP orders digoxin immune fab to be given. Complete secondary Scenario 4 Advanced Medical-Surgical Nursing New Patients Swift River. Scenario 2 Assist Mr. Jones mary_heath32. Ensure the pt. Tim Jones 8. Fall Risk: Increased acuity Start a saline lock Mr. Wright insists that he watches TV from the Hight Fowler's position. Don gloves Readiness for self-care enhancement: True Pain - increased Scenario #5 156 terms. He is a patient of Dr. Adams. Gather supplies needed for dressing change Assess pt's sputum Physical mobility, impaired: True Evaluate understanding Educate pt Mr. Richardson is now pain free and questioning why he is plagued w/ recurring urinary stones. Notify the social worker, Acute pain Remove NG Educate pt. 500 mL NS Connect pt. Scenario 2 Complete full pt. Upon entering the room, what is the appropriate order of events for the RN to take? Establish when the cardiac event time began Administer antiemetic You are about to call the Surgical ICU and give report. joyce workman is newly diagnosed with type 2 diabetes. Initiate cardiac telemetry Assess pt's preferred Pt. -Draw labs and watch for signs of hypokalemia and hyponatremia Mrs. Stukes is feeling nauseated. Sensorium - increased, - Electrolyte imbalance Assess pt's ABCs Verify call light 5-100% O2 has not been effective in maintaining her PaO2. understanding, Acute pain Scenario 2 Acute pain Vital signs are Temp 98.9F, BP 178/90, P 88, RR 18 SaO2 95% on Room air. Impaired skin integrity, risk for: True Peripheral neurovascular dysfunction: True. Health Change - increased RBC Scenario 4 arrival The sister of Mr. Mancia calls from home to speak w/ you. Educate pt Mr. Raymond continues to deteriorate and becomes confused. Fall, Risk for True -Gas exchange Perform Communicate w/ the pt therapeutically Perform pain reassessment Concepts of Nursing IV 100% (2) Deanna Concept Map Assignment 1. Refer caller Mrs. Smith's surgery has now ended. Percuss & palpate Educational needs: Increased acuity Health Change: Increased acuity -Rate patient's pain on a scale of 1-10To determine level of pain for intervention Scenario 2 Check the blood 1Suggest that the family Facetime/video chat, Coping Escort patient Document results Verify with blood bank Inform the pt. Ms. Getts is requesting water to drink. Read PT Obtaintelemetry Mrs. Barkley is becoming more adamant about leaving while her physical condition continues to deteriorate. Assess VS & UO Scenario 3 You have now been assigned to document the ongoing event as the CODE team continues w/ the resuscitation. Call Report, Educational - increased Provide report, - Educational - increased Scenario 4 Contact HCP Scenario 5 Assist RT Elevate extremity Scenario 4 Obtain additional support 1 Administer a mini-mental state exam Clean and obtain IV pole Acquire daily weight Sarah Kathryn Horton 13. Offer to assist Electrolyte imbalance, risk for The CNA reports the blood pressure was 130/86 an hour ago Place pt. Use therapeutic Psychological Needs: Normal acuity, Physiological Final Exam. Complete head-to-toe - Powerlessness, Scenario #1 Document on the MAR and education in the chart. Scenario 5 Give verbal report Mark Robinson 17. Call HCP for change in health status and receive orders for anxiety medication 3-Comfort and orient patient to person, place, and time. Check the client Scenario 3 Reemphasize to pt. Sit with the pt. Wash handa Scenario #5 Begin strict Educate caller regarding HIPAA Psychological Needs: Increased acuity Therapeutic communication Infection, Scenario #1 Scenario #2 Report Prepare pt. Sensorium: Normal acuity, Physiological- Complete bed bath Review medication Vital signs taken by automatic BP cuff q 15 min Ask Mrs. Workman for 24-hour diet Call rapid response Fall, Risk for: True Fall Risk: Increased acuity Reassess pt. Provide report to ER RN, Educational Needs: Increased acuity Reassure pt. Administer nebulizer Instruct pt. Use therapeutic Psychological Needs: Increased acuity Notify family Ask if the pt understands the procedures scheduled for this AM Scenario 4 Practice using IS Reassure pt. - Pain - normal Don appropriate PPE Announce to CODE -Check the chart for the presence of a DNR order to provide the code team 1-Introduce yourself to the patient and explain who you are Explain HIPAA Provide the pt. Educate about recovery Scenario 3 Explain to surgeon Scenario 3 Functional ability Administer antipyretic meds Scenario 4 Scenario #3 Infection, Risk for: True. Educate pt regarding condition They wanted to know and pressure you for the information. Notify physician Cultural competence Obtain & fill Prepare to initiate cardioversion. -Determine if drainage is increasing Full assessment Scenario #5 5-Request form from medical records for patient release of information Allow family Risk for physical injury: True Pain Level: Increased acuity Have IV ABX Stop the platelets Ensure foley is draining Ms. Gestalt is second day post-op and has requested to get out of bed and to ambulated to bathroom. Scenario 5 Remain w/ pt. He has bilateral lower lobe atelectasis w/ bronchial vesicular wheezing. Imbalanced nutrition Contact Wound Care directly Full assessment Mrs. Stukes's husband is not willing to help assist pt upon d/c w/ her stoma care for failed laparoscopic cholecystectomy. Scenario #2 Teach pt. Ineffective health maintenance: True The problem I am calling about is her blood glucose is high. Evaluate outcome of dietary plan Scenario #5 Sensorium: Normal acuity, Physiological - allow expression of feelings Encourage pt. Ask the pt. You hear a scream coming from Mrs. Horton's room. - Fear Collect supplies Teach pt. Wash hands Scenario 5 Use therapeutic communication/Active listening privacy Scenario 4 Start studying swift river med surg. Failure to thrive. Seek clarification Full assessment Remain w/ pt. Isolation precautions: False -Review of body systems and evaluate pain on a scale of 1-10 Notify PT Pain Level: Increased acuity Ask PCT to secure mask better, and inform her that there is no replacement for her. Impaired gas exchange: True Impaired mobility: True Neurological - normal, Scenario #1 Notify infection control nurse Obtain VS Re-assess BP and pulse. Allow husband to make a quick one-minute visit Remind CODE team to stop CPR and check for pulse Q5 minutes Neurological - increased Ms. Gestalt capillary refilling is now 6 seconds below cast site, extremity is swollen and cold to the touch Ineffective Self-Health Management: False Encourage fluids/fiber/ambulation Leave the break room and not continue in conversation. Verified answer. You are now the Surgical ICU nurse assigned to her. Nutrition Disinfect call light Scenario 3 She was asymptomatic upon arrival. Wash hands Sensorium: Increased acuity, Physiological- Start PCA pump We need to stop the bleeding Scenario #5 The dx tests were completed and Dr. Gray has informed the pt of the dx of HF and tx w/ digoxin. Restart pt's IV Ask the pt. Infection: True. Reinforce need Notify the HCP using SBAR Complete chest x-ray Stop the pt. Give iv morphine 2 mg IVP Recheck VS q 5 min Scenario #5 -Speak slowly in a normal tone of voice Initiate secondary Chronic confusion: False Ensure continuous

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