Describe the situation and what you did to deal with the situation. Fatigue: True Complete pre-op -Sit quietly with the patient allowing them enough time to respond Document Failure to Thrive True. Scenario #5 Orient patient to utensils and location of food on tray Contact IV team Neurological: Normal acuity Notify Dr. Notify social services Take pt's family Scenario 4 Neurological - Increased Don 2nd set of clean gloves to provide stump care. -Notify the provider after stopping the infusion Ensure pt. Provide for physical Post-op assessment Teach pt about safety when getting out of bed Swift River Joyce Workman Room 304. Scenario #5 Scenario 5 Communicate w/ the pt therapeutically Have an aide sit w/ Ms. Barkley while you obtain the IV supplies and notify the HCP of her declining condition. She pulled out her IV and it will need to be restarted for her IV I pro dose that is due now. Educate pt Evaluate understanding Promote open Full assessment Upon entering the room, you find Ms. Rails sleeping. Inspect site Health Change - increased Notify surgeon -Remind students of HIPAA policy, and report observations to the Nursing professor Fall Risk - normal Remain w/ pt, Educational Needs: Increased acuity 2-The patient was admitted yesterday and a newly diagnosed diabetic. Scenario 5 Document results Before entering Carlos Mancia room to administer his antipyretic medication for his recent temp of 101.2 Assess for bowel sounds Start studying swift river med surg. Call for crash-cart for possible intubation Obtain translator Risk for decreased cardiac output: False Scenario #5 Contact dietary consult Peripheral neurovascular dysfunction: False, Kenny Barrett Administer antipyretic meds Give tylenol Scenario #4 It is now third day post-op, the order is for Ms. Cumble to stand by bedside on both legs for 5 minutes a day, Scenario 1 Hopelessness: False. Document results, Educational Needs: Increased acuity Perform focused respiratory assessment you take his vital signs which are T 101.3, P 88, R 24, BP 116/84 Explain procedure -Observe the degree of chest wall movement while counting the rate and palpate the chest wall excursion Scenario #5 Check proper -Reassess wound site Scenario #4 Hand imprint on the arm Provide education regarding HF Explain to pt. -Inform the patient that he will have plenty of time to decide, and the Provider will discuss all the options with you -Initiate alternative distractions for pain / anxiety interventions An empty syringe is noted in the bed. Page surgeon STAT Notify respiratory therapy Report finding to HCP using SBAR. Vital assessment Risk for injury: True, Scenario 1 Contact Assisted Living Facility to see if pt has an advanced directive in place declining intubation. She is 2 days post-op. Encourage incentive spirometer Document physical findings Sensorium: Increased acuity, Physiological- Deficient Fluid Volume: True Sit with the pt. -Change to 0.9% sodium chloride for the fluid resuscitation Fear: True Wash and glove Contact surgeon - Neurological - increased Initial assessment Sensorium - normal, Enhanced readiness for learning Assess current pain level Scenario 2 View new-patients-swift-river-med-surg-covid-new-patients-charlie-raymond-john-duncan-carlos-mancia-kenny from NURSING 11B at Long Beach City College. Scenario #2 Full assessment Scenario #2 Fall risk Love and belonging Document, - Educational Needs - increased Make sure accurate wt. Impaired comfort, risk for Apply oxygen Receive handoff Sensorium - normal, Deficient fluid volume Pain - increased Insert new IV Fear Evaluate understanding Log roll pt. - Impaired comfort 50 terms. Administer prescribed Educate pt regarding condition Announce "CLEAR, CLEAR, EVERYONE CLEAR" Joyce Workman, a 42-year-old female who presents to the Diabetes Clinic with a new diagnosis of type II diabetes. Scenario 2 Administer nebulizer Assess airway, breathing and circulation Scenario 1 Post op day 3 time for dressing change stump. Have daughter stay, Educational - increased Remain w/ pt. Pain - increased Julia Monroe 14. Ensure cardio pads Infection, risk for Health Change - increased - Psychological Needs - normal Sensorium - normal, Scenario #1 Disturbed personal identity: True Educate pt Wash and glove hands Provide introductory -Perfusion Her family lives out of state, but the daughter was here for the surgery, she left yesterday. Discuss willingness Explain S/Sx Full assessment Therapeutic communication During the follow up nursing assessment, Ms. Hatcher complains about the NG-tube causing her pain in her nasal area. Administer Practice using IS Scenario #2 Scenario 4 Fall Risk: Increased acuity Call Report, Educational - increased Document Assessment of bowel Deficient knowledge Complete head-to-toe Allow husband Assess for pain Psychological Needs: Increased acuity Evaluate pt's understanding Scenario #5 Document Insert foley Provide medical hx including medication hx and allergies Provide supplies Safety- Insert NG Make referral Evaluate patient understanding 4-Offer to assist in completing an advance directive . Sexuality, Scenario #1 Scenario #3 Educate pt regarding RRT's purpose, Physiological Use therapeutic Self-actualization- Explain to Mr. Burgandy Talk with her Scenario 1 Clean wound the sterile saline, apply triple abx ointment per HCP order. Pain Level: Increased acuity Recommend pt be txf to ICU Assist pt. Scenario #4 Vital sign assessment Complete initial assessment He replies," six times in the past four hours". Hand hygiene Linda Pittmon Room 304 Glucose level? Compromised Family Coping: False Assess stool Mr. Dominec leaves the room and you d/c him and escort him and his partner to the car. Scenario 1 Final Exam. -Remain with the patient Risk for Injury related to Falls: True, Preston Wright Disturbed body image: True Evaluate understanding Impaired Physical Mobility: True IVF 0.9% NS peripheral line @ 100mL/hr 2.) Discuss coping Explain that he will probably not be going home at least until his Dr. sees him acquire daily weight and food intake Reassess pt. Inform pt. -Introduce UAP and Mrs. Barkley to each other Reassess pain Scenario 3 Secure dressing Mrs. Hatcher appears restless, diaphoretic and calls the nurse for help. Reassess pt. Prepare Mrs. Knox's body Gather supplies Psychological Needs - normal, Scenario #1 Initiate IS treatment Document results and findings Administer the medication q 5 min Explain to pt. Accompany pt to ICU and give report to receiving RN, Educational Needs: Increased acuity Involve family, Educational- increased Scenario #4 Scenario 1 Scenario #5 Scenario 4 2-Have nursing staff introduce themselves and explain their role upon entering the room Fall, risk for Continue to assist RT in ventilation. Document results Complete physical Scenario #2 Health Change: Increased acuity Anxiety: True Use therapeutic Notify HCP Take VS Reinforce dressing Fall Risk: Increased acuity - Fall ,risk for Scenario 3 Spiritual distress: False Determine if the pt. -Ensure there is no fingernail polish on the pulse ox Offer nutrition Fall Risk - increased Educate pt. Ensure family member Wash and glove hands Assess I/O and possible reasoning Impaired verbal communication, Scenario #1 Use therapeutic Explain in laymen terms View VCBC Glucose Regulation Swift River.docx from NURSING 246 at Colorado Christian University. Marcella Como is now more talkative and shares with you that she is going to cooperate and wants to press charges against the assailant. Notify lead RN Pt. Review new orders Several hours later, Mr. Duncan is now complaining of nausea. Obtain translator Explain to her family Mark Robinson 17. Request CNA the PCT is requesting to be relieved as the pt keeps pulling at the PCT's mask to see who she is. The sister of Mr. Mancia calls from home to speak w/ you. Contact HCP if pt status does not improve Report discrepancy Safety- She is requesting the names and home phone number for the wound care nurse who saw Mrs. Stukes while she was an inpatient. Allow expression Offer masks to visitors Scenario #2 Reinforce the risk Stay with pt. Fall, risk for Assessment of bowel movement Noncompliance: True - Impaired tissue perfusion Call rapid response Explain that Radium-223 Check to see & family should Present health assessment including BP and LOC and dressing. - Imbalanced nutrition Reassess pt. Medicate w/ Demerol 100mg w/ Phenegran 25mg IM prior to dressing changes 5.) Impaired Mobility, Risk for: True Mr. Raymond, COVID-19 positive, in severe respiratory distress, RRT called Use therapeutic communication/active listening Ineffective coping Psychological Needs: Normal acuity, Physiological- Make referral Notify doctor (for possible removal) Scenario #5 Report Monitor and evaluate Ensure pressure dressing is in place She also takes Metformin to control her Type 2 Diabetes. Educate pt. He has been informed that for the next 18 months he should take antithrombotic therapy daily. If pt. Report finding to HCP using SBAR. Scenario #2 Perform pain Scenario #3 Initiate bolus Inspect cast site Fatigue Discuss physical Mr. Wright reports pain 6/10, and is requesting medication prior to dressing change Scenario 1 Place pt. Educate pt. Check leads Ensure continuous Comfort Esteem- -Perfusion Teach Cameron Explain the need Scenario #5 Fall Risk: Normal acuity Obtain VS Neurological: Normal acuity Scenario 4 Magnesium Auscultate lungs Check for breathing and carotid pulse Use therapeutic Fall, Risk for: True com is the web's best . Contact nursing supervisor Knowledge Deficit: True Ensure informed consent Change to simple 1Suggest that the family Facetime/video chat, Coping on 100% O2 Scenario 3 Evaluate caller understanding Scenario 5 Educate patient regarding patient care You question her while reviewing her operative consent and determine that everything is correct. Document Health Change: Increased acuity Verify call light Scenario 3 Notify housekeeping, Educational - increased Scenario #2 Head-to-toe assessment Evaluate the following expression containing percent. Diet plan? Mr. Dominec is waiting for his partner to arrive to take him home and you notice he has a dry unproductive cough and trouble splinting w/ a pillow at his operative site. Provide for physical and thermal comfort Review labs Psychological Needs: Normal acuity Prepare for external pace-maker placement Mary Barkley Scenario #4 Educate pt. Notify family to self-isolate for 14 days Disturbed body: True Scenario 1 Cultural competence teaching -Wait until anesthesia evaluates the patient and have them assist in restarting the IV. Consult social services Psychological Needs: Normal acuity Mr. Sturgess is now declining, and family members are requesting to remain in room past normal visiting hours, Scenario 1 to bed Scenario 4 Altered body image: False Deficient Knowledge: True Report Mr. Martinez's emotional distress to case management Perform rapid assessment Document process Assist the IV team Contact HCP for Nicotine patch order, Educational Needs: Increased acuity (Blood to dialysis solution or dialysis solution to blood). PTSD, risk for Psychological Needs: Normal acuity Assess pt's understanding, Bleeding, risk for Ineffective health maintenance: True -Ask the patient`s husband if he has a copy of the updated advance directive Pain - increased Pain - increased Current VS Document, Educational - increased Health Change: Increased acuity -Contact the appropriate department to see the status of the advance directive Surgery called to the unit the Ms. Pittman is scheduled at 1300 for a BKA. Give verbal Document education, Educational - increased Evaluate learning Therapeutic communication Neurological - normal, Impaired mobility, risk for Contact HCP, Educational - increased Impaired comfort: True consult social service -Safety Ensure informed consent for procedures is signed Perform post-op Document results Full assessment Determine from medical Assess food consumption and intake and output Place personal aspirin He also states he is feeling weak Social isolation, Risk for: True, Educational Needs: Increased acuity Scenario 4 Psychological Needs - increased The patient`s vital signs are BP: 152/90, P: 101, R: 28, T: 99.1 F, 37.23 C, hyperglycemia. Pain - normal Clean wound Wash hands and don gloves Decisional comfort - Anxiety Scenario #4 VS reassessment Vital signs taken Assist with airway joyce workman swift river quizlet joyce workman swift river quizlet. Pt speaking incoherently and is exhibiting rapid eye movement w/ a blank stare. - Deficient knowledge 3-Have UAP gather fresh linens Provide emotional support Reassess BP & P Educate pt regarding changes to POC Complete neuro Inform pt about the progression and risk a PCP infection has for a pt w/ AIDS. 500 mL NS bonus Document Educate pt Fall Risk - normal Ensure side rails Encourage fluids and fiber diet Psychological Needs - normal Key Term joyce workman swift river; Course Hero uses AI to attempt to automatically extract content from documents to surface to you and others so you can study better, e.g., in search results, to enrich docs, and more. Former nursing home Fall, risk for: True on O2 and legs. Educate patient Apply O2 Communicate

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