swift river med surg pt scenarios exam study guide 2024

Ramona Stukes, 69 yr-old, third day post-op cholecystectomy. Non-significant past medical history. No known allergies (NKA). Vital signs -Temp 98.6, BP 114/62, P 100, RR 20, SaO2 94%. Neuro WNL, alert, and cooperative. Skin warm and dry, daily dressing changes, T-tube without drainage. NG tube to low suction possibly D/C'd today after Dr. Levine rounds. Today's incentive spirometry Tidal Volume is 1250ml, improvement over yesterday's 900ml. NPO with small amount of ice chips only. Today's weight 226. IV D5 1/2 NS with 20 KCL @ 125 ml/hr in left forearm. Last pain medicine 2hrs ago at 1300(Demerol 50mg/ Zofran 4mg IV). Ambulates with assistance. Dr. Levine - Educational Needs Increased acuity Fall Risk Increased acuity Health Change Increased acuity Pain Level Increased acuity Psychological Needs Normal acuity Sensorium Normal acuity Ramona Stukes - Physiological Bleeding, Risk for True Constipation False Deficient Fluid Volume, Risk for True Dysfunctional Gastrointestinal Motility False Imbalanced Fluid Volume False Impaired Mobility True Safety Anxiety False Fall, Risk for True Ineffective Self-Health Management False Infection, Risk for True Ramona Stukes Scenario 1 Mrs. Stukes is a failed laparoscopic cholecystectomy that resulted in a bowel resection with a temporary ileostomy in place. Now, third day post-op, Mrs. Stukes appears sad and depressed upon entering the room. Scenario 2 Mrs. Stukes is feeling nauseated. Scenario 3 Mrs. Stukes's appliance is leaking for the fourth time today and has been changed and reapplied each time. She is frustrated and overwhelmed with the new appliance not working properly. Scenario 4 Mrs. Stukes's husband is not willing to help assist patient upon discharge with her stoma care for failed laparoscopic cholecystectomy. Scenario 5 Three days after discharge, you receive a phone call from Mrs. Stukes's neighbor, who is helping take care of her. She is requesting the names and home phone number for the wound care nurse who saw Mrs. Stukes while she was an inpatient. - Scenario 1 Wash and glove Hands Full assessment Allow expression of feelings Educate patient Evaluate understanding Scenario 2 Wash and glove up Full assessment Check Ng tube placement Administer IV antiemetic medication Scenario 3 Full assessment Educate patient Evaluate understanding Notify lead nurse and doctor Consult Wound Care Scenario 4 Discuss with patient identify home health needs Notify lead nurse/doctor of new circumstances Contact Social Services for new consult Update patient on discharge changes Scenario 5 Follow HIPPA Protocol Explain HIPPA Protocol Offer resource assistance to caller Contact Wound Care directly Document Conversation Marcella Como, 38 yr-old, Sexual Trauma Victim (Rape), unknown assailant. Non-significant past medical Hx. No known allergies (NKA). Vital signs -Temp 98.2, BP 94/60, P72, RR 22, SaO2 99%. Multiple abrasions, bruising Head, chest, and inner thigh. Isolative, appears fearful, crying, and refusing to see her husband. SANE nurse to make second visit today. Awaiting diagnostic labs. Taking HIV Meds prophylaxis. Social worker with patient this morning. Diet as tolerated. Dr. Roopes - Educational Needs Increased acuity Fall Risk Normal acuity Health Change Increased acuity Pain Level Increased acuity Psychological Needs Increased acuity Sensorium Normal acuity Marcella Como - Physiological Acute Pain True Impaired Mobility False Impaired Urinary Elimination False Readiness for Enhanced Immunization Status True Safety Chronic Confusion False Fall, Risk for False Fear True Grieving True Infection, Risk for True Sleep Deprivation False Love and belonging Anxiety True Body Image, Disturbed False Chronic Sorrow False Compromised Family Coping True Powerlessness False Social Isolation True Esteem Decisional Conflict False Ineffective Coping True Noncompliance False Rape-Trauma Syndrome True Self-actualization