Swift River Med-Surg Questions and
answers | Updated 2024/25
Carlos Mancia ii
Carlos Mancia, 48yr-old, Spanish speaking migrant worker with no known past medical
ii ii ii ii ii ii ii ii ii ii ii
Hx. r/o Tuberculosis. Vital signs -Temp 99.1, BP 124/62, P 77, RR 20, SaO2 91%.
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Airborne Isolation. Neuro WNL. Skin moist, respiratory bilateral wheezes and rhonchi.
ii ii ii ii ii ii ii ii ii ii ii
Blood-tinged mucous, productive cough. Diet as tolerated. IV maintenance fluids with D5
ii ii ii ii ii ii ii ii ii ii ii ii
1/4 NS @ 150 ml/hr X 3 then reduce rate to 75 ml/hr. Expresses fatigue, fear, concern, and
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
desire for recovery. Need frequent reminder to stay in room and maintain mask
ii ii ii ii ii ii ii ii ii ii ii ii ii
precautions. If family/visitors come, will need education to airborne precautions. Spanish
ii ii ii ii ii ii ii ii ii ii ii
interpreter available at extension 61178. Dr. Rondeau - Educational Needs: Increased
ii ii ii ii ii ii ii ii ii ii ii ii ii
Fall Risk: Increased
ii ii
Health Change: Increased ii ii
Pain Level: Normal
ii ii
Psychological Needs: Increased ii ii
Sensorium: Normal ii
Physiological-
Dysfunctional Gastrointestinal Motility: False ii ii ii
Electrolyte Imbalance: False ii ii
Fatigue: True ii
Impaired Gas Exchange: True ii ii ii
Impaired Mobility: False ii ii
Ineffective Airway Clearance: True ii ii ii
Esteem-
Decisional Conflict: False ii ii
Noncompliance: True ii
Safety-
Anxiety: True ii
Deficient Knowledge: True ii ii
Fall, Risk for: True
ii ii ii
Fear: True ii
Hypothermia: False ii
Impaired Home Maintenance Management: False ii ii ii ii
Self-Actualization-
Readiness for Self-Care Enhancement: True ii ii ii ii
Spiritual Distress: False ii ii
Love and Belonging- ii ii
,Chronic Sorrow: False ii ii
Social Isolation, Risk for: True ii ii ii ii
ii Jody Rush ii
Jody Rush, 20 y/o female, admitted for right femur fracture status post skiing accident. She
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
is in a traction splint, and will be going for surgical repair today. Vital signs are BP 120/62 P
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
88 R 20 T 98.9 F, 37.2 C, PaO2 99. She has been in a lot of pain, and has been receiving 25
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
mcg IVP, q2 hours Fentanyl for pain. She was nauseated after her last Fentanyl dose, and
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
the Dr. Ordered an additional 4mg IVP, Zofran. She has a history of exercise induced
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
asthma, and uses a rescue inhaler, Albuterol. Her parents are on their way; they are flying
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
in today. She was on a ski trip with some of her friends from college; her best friend has
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
been camped out with her. We were able to get her on a bed pan earlier, but it took a lot of
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
work. We just received an order for a foley catheter. There was some concern that she may
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
have sustained a head injury as she has an abrasion to her forehead, but she denies ever
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
losing - Educational Needs: Increased
ii ii ii ii ii ii ii
Fall Risk: Increased ii ii
Health Change: Increased ii ii
Neurological: Increased ii
Pain Level: Normal ii ii
Psychological Needs: Normal ii ii
Physiological-
Acute Pain: True ii ii
Bleeding, Risk for: True ii ii ii
Impaired Mobility, Risk for: True ii ii ii ii
Nausea: True ii
Safety-
Deficient Knowledge: True ii ii
Grieving: False ii
Peripheral Neurovascular Dysfunction: False ii ii ii
ii Mary Barkley ii
Mary Barkley, 74y/o female has been admitted to your floor with a respiratory infection and
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
she has tested positive for COVID19. She resides in an assisted living facility which has
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
seen four deaths related to COVID19. She is exhibiting the same initial signs and
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
symptoms as the other patients and her primary care provider would like to start
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
aggressively treating her. She is running a low-grade fever 99.8 and has a sore scratchy
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
throat which is causing an unproductive cough. She also is complaining of chills, muscle
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
pain and headache. She is an at-risk patient because of her age. She also suffers from
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Lupus and is already taking Hydroxychloroquine, a first-line lupus therapy, but there is no
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
conclusive evidence of its benefits for coronavirus yet. She is very fearful and is requesting
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
to see her family. She states that she does not want to die alone. - Educational Needs:
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Increased
ii
, Fall Risk: Normal
ii ii
Health Change: Increased ii ii
Neurological: Normal ii
Pain Level: Increased ii ii
Psychological Needs: Increased ii ii
Physiological-
Acute Pain: True ii ii
Deficient Knowledge: True ii ii
Grieving: True ii
Impaired Comfort: True ii ii
Safety:
Infection: True ii
ii Wight Goodman ii
Wight Goodman, Patient was admitted to the floor last night from the ER for an orbital
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
fracture. He was hit in the left eye by a softball yesterday. Apparently he was pitching, and
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
the batter hit a line drive hitting him in the right side of the face. They applied some ice to his
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
face, and he decided to go to the post game keg party instead of coming to the ER. The
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
patient stated that there was significant swelling, but his vision was fine, and the pain was
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
controlled with beer and 800mg of Motrin. He was unable to sleep later in the evening as
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
the pain became worse, and his vision became more impaired. The Maxillofacial surgeon
ii ii ii ii ii ii ii ii ii ii ii ii ii
was consulted, and they will see him this morning. They were not concerned as his
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
intraocular pressure was normal in the ER. There is significant edema and discoloration to
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
the left side of his face, and his left eye is almost completely swollen shut. His visual acuity
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
is dimin - Educational Needs: Increased
ii ii ii ii ii ii ii ii
Fall Risk: Increased
ii ii
Health Change: Increased ii ii
Neurological: Normal ii
Pain Level: Increased ii ii
Psychological Needs: Normal ii ii
Physiological-
Acute Pain: True ii ii
Bleeding, Risk for: True ii ii ii
Impaired Comfort: True ii ii
Safety-
Deficient Knowledge: True ii ii
Infection, Risk for: True ii ii ii
ii Jody Rush ii
Scenario 1 ii
answers | Updated 2024/25
Carlos Mancia ii
Carlos Mancia, 48yr-old, Spanish speaking migrant worker with no known past medical
ii ii ii ii ii ii ii ii ii ii ii
Hx. r/o Tuberculosis. Vital signs -Temp 99.1, BP 124/62, P 77, RR 20, SaO2 91%.
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Airborne Isolation. Neuro WNL. Skin moist, respiratory bilateral wheezes and rhonchi.
ii ii ii ii ii ii ii ii ii ii ii
Blood-tinged mucous, productive cough. Diet as tolerated. IV maintenance fluids with D5
ii ii ii ii ii ii ii ii ii ii ii ii
1/4 NS @ 150 ml/hr X 3 then reduce rate to 75 ml/hr. Expresses fatigue, fear, concern, and
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
desire for recovery. Need frequent reminder to stay in room and maintain mask
ii ii ii ii ii ii ii ii ii ii ii ii ii
precautions. If family/visitors come, will need education to airborne precautions. Spanish
ii ii ii ii ii ii ii ii ii ii ii
interpreter available at extension 61178. Dr. Rondeau - Educational Needs: Increased
ii ii ii ii ii ii ii ii ii ii ii ii ii
Fall Risk: Increased
ii ii
Health Change: Increased ii ii
Pain Level: Normal
ii ii
Psychological Needs: Increased ii ii
Sensorium: Normal ii
Physiological-
Dysfunctional Gastrointestinal Motility: False ii ii ii
Electrolyte Imbalance: False ii ii
Fatigue: True ii
Impaired Gas Exchange: True ii ii ii
Impaired Mobility: False ii ii
Ineffective Airway Clearance: True ii ii ii
Esteem-
Decisional Conflict: False ii ii
Noncompliance: True ii
Safety-
Anxiety: True ii
Deficient Knowledge: True ii ii
Fall, Risk for: True
ii ii ii
Fear: True ii
Hypothermia: False ii
Impaired Home Maintenance Management: False ii ii ii ii
Self-Actualization-
Readiness for Self-Care Enhancement: True ii ii ii ii
Spiritual Distress: False ii ii
Love and Belonging- ii ii
,Chronic Sorrow: False ii ii
Social Isolation, Risk for: True ii ii ii ii
ii Jody Rush ii
Jody Rush, 20 y/o female, admitted for right femur fracture status post skiing accident. She
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
is in a traction splint, and will be going for surgical repair today. Vital signs are BP 120/62 P
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
88 R 20 T 98.9 F, 37.2 C, PaO2 99. She has been in a lot of pain, and has been receiving 25
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
mcg IVP, q2 hours Fentanyl for pain. She was nauseated after her last Fentanyl dose, and
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
the Dr. Ordered an additional 4mg IVP, Zofran. She has a history of exercise induced
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
asthma, and uses a rescue inhaler, Albuterol. Her parents are on their way; they are flying
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
in today. She was on a ski trip with some of her friends from college; her best friend has
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
been camped out with her. We were able to get her on a bed pan earlier, but it took a lot of
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
work. We just received an order for a foley catheter. There was some concern that she may
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
have sustained a head injury as she has an abrasion to her forehead, but she denies ever
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
losing - Educational Needs: Increased
ii ii ii ii ii ii ii
Fall Risk: Increased ii ii
Health Change: Increased ii ii
Neurological: Increased ii
Pain Level: Normal ii ii
Psychological Needs: Normal ii ii
Physiological-
Acute Pain: True ii ii
Bleeding, Risk for: True ii ii ii
Impaired Mobility, Risk for: True ii ii ii ii
Nausea: True ii
Safety-
Deficient Knowledge: True ii ii
Grieving: False ii
Peripheral Neurovascular Dysfunction: False ii ii ii
ii Mary Barkley ii
Mary Barkley, 74y/o female has been admitted to your floor with a respiratory infection and
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
she has tested positive for COVID19. She resides in an assisted living facility which has
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
seen four deaths related to COVID19. She is exhibiting the same initial signs and
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
symptoms as the other patients and her primary care provider would like to start
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
aggressively treating her. She is running a low-grade fever 99.8 and has a sore scratchy
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
throat which is causing an unproductive cough. She also is complaining of chills, muscle
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
pain and headache. She is an at-risk patient because of her age. She also suffers from
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Lupus and is already taking Hydroxychloroquine, a first-line lupus therapy, but there is no
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
conclusive evidence of its benefits for coronavirus yet. She is very fearful and is requesting
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
to see her family. She states that she does not want to die alone. - Educational Needs:
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Increased
ii
, Fall Risk: Normal
ii ii
Health Change: Increased ii ii
Neurological: Normal ii
Pain Level: Increased ii ii
Psychological Needs: Increased ii ii
Physiological-
Acute Pain: True ii ii
Deficient Knowledge: True ii ii
Grieving: True ii
Impaired Comfort: True ii ii
Safety:
Infection: True ii
ii Wight Goodman ii
Wight Goodman, Patient was admitted to the floor last night from the ER for an orbital
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
fracture. He was hit in the left eye by a softball yesterday. Apparently he was pitching, and
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
the batter hit a line drive hitting him in the right side of the face. They applied some ice to his
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
face, and he decided to go to the post game keg party instead of coming to the ER. The
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
patient stated that there was significant swelling, but his vision was fine, and the pain was
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
controlled with beer and 800mg of Motrin. He was unable to sleep later in the evening as
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
the pain became worse, and his vision became more impaired. The Maxillofacial surgeon
ii ii ii ii ii ii ii ii ii ii ii ii ii
was consulted, and they will see him this morning. They were not concerned as his
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
intraocular pressure was normal in the ER. There is significant edema and discoloration to
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
the left side of his face, and his left eye is almost completely swollen shut. His visual acuity
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
is dimin - Educational Needs: Increased
ii ii ii ii ii ii ii ii
Fall Risk: Increased
ii ii
Health Change: Increased ii ii
Neurological: Normal ii
Pain Level: Increased ii ii
Psychological Needs: Normal ii ii
Physiological-
Acute Pain: True ii ii
Bleeding, Risk for: True ii ii ii
Impaired Comfort: True ii ii
Safety-
Deficient Knowledge: True ii ii
Infection, Risk for: True ii ii ii
ii Jody Rush ii
Scenario 1 ii
