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