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