Swift River Assignment 1 Exam
Questions & Answers (Grade A+)
Charlie Raymond, 65-year-old male who was admitted to a negative
pressure room on Med-Surg for COVID precautions.. He has a
history of COPD, hypertension, diabetes type II, and a recent
myocardial infarction. He is a retired postal worker who lives at
home with his wife. He is on Claforan (cefotaxime) 2 g IV q4hr and
sliding scale insulin. Initially this cardiologist was concerned about
congestive heart failure and Mr. Raymond is receiving Furosemide
(Lasix) 20 mg IV twice a day for pulmonary edema. Vital Signs: BP is
145/78, Pulse 89 Respirations 24 and slightly labored, Temperature
100.2 SaO2 94% on 2L nasal cannula. The patient/family is fearing
the worst due to COVID-19 Pandemic.
Scene 2: Select Nursing Concerns:
Scene 3
The next day, he tests positive for COVID 19 and his condition has
deteriorated as he is now in respiratory distress. Mr. Raymond
weighs 260 lbs. Vital Signs: BP is 92/58, Pulse 102, Respiratio -
correct answer ✅Educational need increased
fall risk increased
Health change increased
neuro normal
pain level normal
,Swift River Assignment 1 Exam
Questions & Answers (Grade A+)
patient needs increased
Scene 2: Nursing concerns:
Physiological FALSE
Bleeding False
Death anxiety TRUE
Disturbed Body Image FALSE
Esteem FALSE
Impaired Acute Confusion FALSE
Impaired Gas Exchange TRUE
Ineffective breathing pattern TRUE
Knowledge deficit TRUE
Pain, Acute FALSE
Physical Mobility, Impaired
Skin Integrity FALSE
Scene 3
Don appropriate PPE.
Change to simple O2 face mask per Healthcare provider
,Swift River Assignment 1 Exam
Questions & Answers (Grade A+)
Perform focused respiratory assessment.
Notify respiratory therapist to begin treatment.
Notify family to self-isolate for 14 days
Scene 4
Reorient patient to setting using therapeutic communication.
Obtain a sitter/UAP.
Restart the IV.
Begin strict I&O.
Obtain an order to insert a foley catheter.
Scene 5
Use therapeutic communication to explain necessary procedure.
Position the patient properly.
Create sterile field with foley kit on the bedside table and don
sterile gloves.
Instruct Lucy to assist in maintaining patient position and field
sterility
Insert foley catheter according to hospital recommended
guidelines,to ensure sterility of catheter.
, Swift River Assignment 1 Exam
Questions & Answers (Grade A+)
Scene 6
Make sure O2 mask is secure and free of sputum.
Ensure patient is in fowlers position.
Check the foley catheter to make sure it is not obstructed.
Notify Rapid Response team (RRT).
Provide initial report and assist RRT.
Scene 7
Mr. Raymond, COVID-19 positive, in severe respiratory distress,
rapid response called.
Patient has a history of COPD, hypertension, diabetes type II, and a
recent myocardial infarction. Patient received Furosemide Lasix
20mg, IVP x2, on Claforan Q4, and on sliding scale Insulin.
Intubated by RRT, BP: 88/58, P: 110, T: 101.2, SaO2: 94%, ABG's are
pending. Foley catheter in place.
Recommend patient be transferred to ICU.
Accompany your
Ann Rails
Questions & Answers (Grade A+)
Charlie Raymond, 65-year-old male who was admitted to a negative
pressure room on Med-Surg for COVID precautions.. He has a
history of COPD, hypertension, diabetes type II, and a recent
myocardial infarction. He is a retired postal worker who lives at
home with his wife. He is on Claforan (cefotaxime) 2 g IV q4hr and
sliding scale insulin. Initially this cardiologist was concerned about
congestive heart failure and Mr. Raymond is receiving Furosemide
(Lasix) 20 mg IV twice a day for pulmonary edema. Vital Signs: BP is
145/78, Pulse 89 Respirations 24 and slightly labored, Temperature
100.2 SaO2 94% on 2L nasal cannula. The patient/family is fearing
the worst due to COVID-19 Pandemic.
Scene 2: Select Nursing Concerns:
Scene 3
The next day, he tests positive for COVID 19 and his condition has
deteriorated as he is now in respiratory distress. Mr. Raymond
weighs 260 lbs. Vital Signs: BP is 92/58, Pulse 102, Respiratio -
correct answer ✅Educational need increased
fall risk increased
Health change increased
neuro normal
pain level normal
,Swift River Assignment 1 Exam
Questions & Answers (Grade A+)
patient needs increased
Scene 2: Nursing concerns:
Physiological FALSE
Bleeding False
Death anxiety TRUE
Disturbed Body Image FALSE
Esteem FALSE
Impaired Acute Confusion FALSE
Impaired Gas Exchange TRUE
Ineffective breathing pattern TRUE
Knowledge deficit TRUE
Pain, Acute FALSE
Physical Mobility, Impaired
Skin Integrity FALSE
Scene 3
Don appropriate PPE.
Change to simple O2 face mask per Healthcare provider
,Swift River Assignment 1 Exam
Questions & Answers (Grade A+)
Perform focused respiratory assessment.
Notify respiratory therapist to begin treatment.
Notify family to self-isolate for 14 days
Scene 4
Reorient patient to setting using therapeutic communication.
Obtain a sitter/UAP.
Restart the IV.
Begin strict I&O.
Obtain an order to insert a foley catheter.
Scene 5
Use therapeutic communication to explain necessary procedure.
Position the patient properly.
Create sterile field with foley kit on the bedside table and don
sterile gloves.
Instruct Lucy to assist in maintaining patient position and field
sterility
Insert foley catheter according to hospital recommended
guidelines,to ensure sterility of catheter.
, Swift River Assignment 1 Exam
Questions & Answers (Grade A+)
Scene 6
Make sure O2 mask is secure and free of sputum.
Ensure patient is in fowlers position.
Check the foley catheter to make sure it is not obstructed.
Notify Rapid Response team (RRT).
Provide initial report and assist RRT.
Scene 7
Mr. Raymond, COVID-19 positive, in severe respiratory distress,
rapid response called.
Patient has a history of COPD, hypertension, diabetes type II, and a
recent myocardial infarction. Patient received Furosemide Lasix
20mg, IVP x2, on Claforan Q4, and on sliding scale Insulin.
Intubated by RRT, BP: 88/58, P: 110, T: 101.2, SaO2: 94%, ABG's are
pending. Foley catheter in place.
Recommend patient be transferred to ICU.
Accompany your
Ann Rails
