Swift River Med Surg Clinical Questions
and answers \ Updated 2024/25
Estelle Hatcher, 31yr-old, r/o appendicitis, 1st day post-op appendectomy; No known
ii ii ii ii ii ii ii ii ii ii
allergies (NKA); Vital signs - Temp 101.2, BP 108/74, P 92, RR 20, SaO2 99%, alert and
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
cooperative. Wound site clean, dry and intact NPO, NG-tube to low continuous suction. IV
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
maintenance fluids with D5 1/2 NS with 20 KCL @ 125ml/hr in left forearm. Ambulates with
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
minimal assistance. Family at beside. Dr. Sangerstien - Educational Needs Increased
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Fall Risk Increased
ii ii ii
Health Change Increased ii ii
Pain Level Increased
ii ii ii
Psychological Needs Normal ii ii ii
Sensorium Normal ii
Ann Rails, 38 years old, c/o back pain, non-significant past medical history. No known
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
allergies (NKA). Vital signs -BP 124/82, Temp 98.2, P 84, RR 22, SaO2 96%. Pain and
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
numbness in legs for one week. Abnormal left leg weakness, gait unsteady, 5/10 on
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
numeric pain scale. Neuro WNL, except leg pain upon movement. Activity as tolerated with
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
assistance. D/C plan- decrease pain and restore normal gait. Regular diet. Dr. Suculo -
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Educational Needs Increased
ii ii ii ii
Fall Risk Increased
ii ii ii
Health Change Increased ii ii
Pain Level Increased
ii ii ii
Psychological Needs Normal ii ii ii
Sensorium Normal ii
Virginia Smith, 57-year-old who has elected to have a total mastectomy based on
ii ii ii ii ii ii ii ii ii ii ii ii ii
consultation with her surgeon, a total mastectomy removes all breast tissue but leaves all
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
or most of axillary lymph nodes and chest muscles intact. She is also to receive radiation,
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
chemotherapy, and hormone therapy post operatively. She is with her physician. She is
ii ii ii ii ii ii ii ii ii ii ii ii ii
also investigating bone marrow transplantation. She has arrived in pre-op and about to
ii ii ii ii ii ii ii ii ii ii ii ii ii
have surgery this morning. Her husband and two grown children are also with her as she is
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
prepared with gown and head cap awaiting transport to the operating room. She has IV
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
access and has received a small dose of Valium to reduce apprehension. Temperature is
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
98.3, HR is 87, RR is16, BP is 121/74, PaO2 is 98%. - Educational Needs Increased
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Health Change Increased ii ii ii
LOC Normal ii ii
Pain Level Normal
ii ii ii
Psychological Needs Normal ii ii ii
Safety Increased ii
Lithia Monson, 93 years old, c/o head injury, r/o subdural hematoma. Hx of dementia, from
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
nursing home, fall one day ago. No known allergies (NKA). Vital signs -Temp 97.2, BP
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
96/74, P 82, RR 20, SaO2 97%. Neuro- confusion to time and place, but oriented to self,
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
, speech clear, poor historian, did not recognize son today which is new for her; Neuro
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
assessment and vital signs q1 hr. Skin warm dry, bruises on forehead with small
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
laceration. Increased fall risk. DSD (dry sterile dressing), forehead laceration clean and
ii ii ii ii ii ii ii ii ii ii ii ii
dry intact. 20ga. Hep-Lock in place left AC. GI WNL. Cardiovascular has pacer with rate of
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
82bpm on demand. Strict I&O, regular diet, intake 50%. Waist belt restraint PRN; family
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
sitter at bedside, assist with bath. Dr. Altace - Educational Needs Increased
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Fall Risk Increased
ii ii ii
Health Change Increased ii ii
Pain Level Increased ii ii ii
Psychological Needs Increased ii ii
Sensorium Increased ii
Linda Pittmon, a 74 -year old female patient who is a noncompliant diabetic, and frequently
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
stays at the local homeless shelter. She has been admitted to the floor with complaints of
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
numbness in her right foot and ankle. Mrs. Pittmon states she has had numbness for years
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
but "now I can't feel it at all, and my toes don't look the right color.". - Educational Needs
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Increased
ii ii
Fall Risk Increased
ii ii ii
Health Change Increased ii ii
Neurological Increased ii ii
Pain Level Normal ii ii ii
Psychological Needs Normal ii ii
Sarah Kathryn Horton, 25 -year old graduate student was brought to the emergency room
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
via ambulance after being shot on the local college campus. Sarah was admitted to Med-
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Surg at 2am. She has two through and through gun-shot wounds. One to her right thigh
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
and one to her right shoulder. She has a 20- gauge peripheral IV to left forearm with 75
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
mL/hr. of 0.9% saline infusing. Vital signs are stable at this time, alert and oriented x3,
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
reports pain 6/10. She remains tearful and has been told that her best friend died on the
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
scene. - Educational Needs Increased
ii ii ii ii ii ii ii ii
Fall Risk Increased
ii ii ii
Health Change Increased ii ii
Pain Level Increased ii ii
Psychological Needs Increased ii ii
Sensorium Normal ii
Lithia Monson
ii ii
93 years old, c/o head injury, r/o subdural hematoma. Hx of dementia, from nursing home,
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
fall one day ago. No known allergies (NKA). Vital signs -Temp 97.2, BP 96/74, P 82, RR 20,
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
SaO2 97%. Neuro- confusion to time and place, but oriented to self, speech clear, poor
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
historian, did not recognize son today which is new for her; Neuro assessment and vital
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
signs q1 hr. Skin warm dry, bruises on forehead with small laceration. Increased fall risk.
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
DSD (dry sterile dressing), forehead laceration clean and dry intact. 20ga. Hep-Lock in
ii ii ii ii ii ii ii ii ii ii ii ii ii
place left AC. GI WNL. Cardiovascular has pacer with rate of 82bpm on demand. Strict
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
I&O, regular diet, intake 50%. Waist belt restraint PRN; family sitter at bedside, assist with
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
bath. Dr. Altace - Bleeding, Risk for
ii ii ii ii ii ii ii ii ii
and answers \ Updated 2024/25
Estelle Hatcher, 31yr-old, r/o appendicitis, 1st day post-op appendectomy; No known
ii ii ii ii ii ii ii ii ii ii
allergies (NKA); Vital signs - Temp 101.2, BP 108/74, P 92, RR 20, SaO2 99%, alert and
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
cooperative. Wound site clean, dry and intact NPO, NG-tube to low continuous suction. IV
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
maintenance fluids with D5 1/2 NS with 20 KCL @ 125ml/hr in left forearm. Ambulates with
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
minimal assistance. Family at beside. Dr. Sangerstien - Educational Needs Increased
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Fall Risk Increased
ii ii ii
Health Change Increased ii ii
Pain Level Increased
ii ii ii
Psychological Needs Normal ii ii ii
Sensorium Normal ii
Ann Rails, 38 years old, c/o back pain, non-significant past medical history. No known
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
allergies (NKA). Vital signs -BP 124/82, Temp 98.2, P 84, RR 22, SaO2 96%. Pain and
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
numbness in legs for one week. Abnormal left leg weakness, gait unsteady, 5/10 on
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
numeric pain scale. Neuro WNL, except leg pain upon movement. Activity as tolerated with
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
assistance. D/C plan- decrease pain and restore normal gait. Regular diet. Dr. Suculo -
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Educational Needs Increased
ii ii ii ii
Fall Risk Increased
ii ii ii
Health Change Increased ii ii
Pain Level Increased
ii ii ii
Psychological Needs Normal ii ii ii
Sensorium Normal ii
Virginia Smith, 57-year-old who has elected to have a total mastectomy based on
ii ii ii ii ii ii ii ii ii ii ii ii ii
consultation with her surgeon, a total mastectomy removes all breast tissue but leaves all
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
or most of axillary lymph nodes and chest muscles intact. She is also to receive radiation,
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
chemotherapy, and hormone therapy post operatively. She is with her physician. She is
ii ii ii ii ii ii ii ii ii ii ii ii ii
also investigating bone marrow transplantation. She has arrived in pre-op and about to
ii ii ii ii ii ii ii ii ii ii ii ii ii
have surgery this morning. Her husband and two grown children are also with her as she is
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
prepared with gown and head cap awaiting transport to the operating room. She has IV
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
access and has received a small dose of Valium to reduce apprehension. Temperature is
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
98.3, HR is 87, RR is16, BP is 121/74, PaO2 is 98%. - Educational Needs Increased
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Health Change Increased ii ii ii
LOC Normal ii ii
Pain Level Normal
ii ii ii
Psychological Needs Normal ii ii ii
Safety Increased ii
Lithia Monson, 93 years old, c/o head injury, r/o subdural hematoma. Hx of dementia, from
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
nursing home, fall one day ago. No known allergies (NKA). Vital signs -Temp 97.2, BP
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
96/74, P 82, RR 20, SaO2 97%. Neuro- confusion to time and place, but oriented to self,
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
, speech clear, poor historian, did not recognize son today which is new for her; Neuro
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
assessment and vital signs q1 hr. Skin warm dry, bruises on forehead with small
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
laceration. Increased fall risk. DSD (dry sterile dressing), forehead laceration clean and
ii ii ii ii ii ii ii ii ii ii ii ii
dry intact. 20ga. Hep-Lock in place left AC. GI WNL. Cardiovascular has pacer with rate of
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
82bpm on demand. Strict I&O, regular diet, intake 50%. Waist belt restraint PRN; family
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
sitter at bedside, assist with bath. Dr. Altace - Educational Needs Increased
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Fall Risk Increased
ii ii ii
Health Change Increased ii ii
Pain Level Increased ii ii ii
Psychological Needs Increased ii ii
Sensorium Increased ii
Linda Pittmon, a 74 -year old female patient who is a noncompliant diabetic, and frequently
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
stays at the local homeless shelter. She has been admitted to the floor with complaints of
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
numbness in her right foot and ankle. Mrs. Pittmon states she has had numbness for years
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
but "now I can't feel it at all, and my toes don't look the right color.". - Educational Needs
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Increased
ii ii
Fall Risk Increased
ii ii ii
Health Change Increased ii ii
Neurological Increased ii ii
Pain Level Normal ii ii ii
Psychological Needs Normal ii ii
Sarah Kathryn Horton, 25 -year old graduate student was brought to the emergency room
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
via ambulance after being shot on the local college campus. Sarah was admitted to Med-
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Surg at 2am. She has two through and through gun-shot wounds. One to her right thigh
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
and one to her right shoulder. She has a 20- gauge peripheral IV to left forearm with 75
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
mL/hr. of 0.9% saline infusing. Vital signs are stable at this time, alert and oriented x3,
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
reports pain 6/10. She remains tearful and has been told that her best friend died on the
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
scene. - Educational Needs Increased
ii ii ii ii ii ii ii ii
Fall Risk Increased
ii ii ii
Health Change Increased ii ii
Pain Level Increased ii ii
Psychological Needs Increased ii ii
Sensorium Normal ii
Lithia Monson
ii ii
93 years old, c/o head injury, r/o subdural hematoma. Hx of dementia, from nursing home,
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
fall one day ago. No known allergies (NKA). Vital signs -Temp 97.2, BP 96/74, P 82, RR 20,
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
SaO2 97%. Neuro- confusion to time and place, but oriented to self, speech clear, poor
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
historian, did not recognize son today which is new for her; Neuro assessment and vital
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
signs q1 hr. Skin warm dry, bruises on forehead with small laceration. Increased fall risk.
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
DSD (dry sterile dressing), forehead laceration clean and dry intact. 20ga. Hep-Lock in
ii ii ii ii ii ii ii ii ii ii ii ii ii
place left AC. GI WNL. Cardiovascular has pacer with rate of 82bpm on demand. Strict
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
I&O, regular diet, intake 50%. Waist belt restraint PRN; family sitter at bedside, assist with
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
bath. Dr. Altace - Bleeding, Risk for
ii ii ii ii ii ii ii ii ii
