Swift River Med Surg Pt Scenarios With
Complete Solutions
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 - ANSWER-
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 - ANSWER-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. - ANSWER-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
Estelle Hatcher, 31yr-old, r/o appendicitis, 1st day post-op appendectomy; No known allergies (NKA);
Vital signs - Temp 101.2, BP 108/74, P 92, RR 20, SaO2 99%, alert and cooperative. Wound site clean,
dry and intact NPO, NG-tube to low continuous suction. IV maintenance fluids with D5 1/2 NS with
20 KCL @ 125ml/hr in left forearm. Ambulates with minimal assistance. Family at beside. Dr.
Sangerstien - ANSWER-Educational Needs Increased acuity
Fall Risk Increased Acuity
Health Change Increased Acuity
Pain Level Increased Acuity
Psychological Needs Normal Acuity
, Sensorium Normal Acuity
Estelle Hatcher - ANSWER-Physiological
Activity Intolerance False
Acute Pain True
Diarrhea False
Electrolyte Imbalance, Risk for True
Impaired Comfort True
Impaired Mobility False
Safety
Deficient Knowledge True
Fall, Risk for True
Fear False
Ineffective Self-Health Management False
Infection, Risk for True
Sleep Deprivation False
Estelle Hatcher
Senario 1
Ms. Hatcher is second day post-op and has a nasogastric tube set to gravity drainage only. She
presses call light with questions about who her nurse will be and her NG-tube.
Senario 2
During the follow up nursing assessment, Ms. Hatcher complains about the nasogastric tube causing
her pain in her nasal area. She has active bowel sounds.
Senario 3
Dr. Brown gives orders to remove nasogastric tube set to gravity and to begin a clear liquid diet.
Complete Solutions
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 - ANSWER-
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 - ANSWER-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. - ANSWER-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
Estelle Hatcher, 31yr-old, r/o appendicitis, 1st day post-op appendectomy; No known allergies (NKA);
Vital signs - Temp 101.2, BP 108/74, P 92, RR 20, SaO2 99%, alert and cooperative. Wound site clean,
dry and intact NPO, NG-tube to low continuous suction. IV maintenance fluids with D5 1/2 NS with
20 KCL @ 125ml/hr in left forearm. Ambulates with minimal assistance. Family at beside. Dr.
Sangerstien - ANSWER-Educational Needs Increased acuity
Fall Risk Increased Acuity
Health Change Increased Acuity
Pain Level Increased Acuity
Psychological Needs Normal Acuity
, Sensorium Normal Acuity
Estelle Hatcher - ANSWER-Physiological
Activity Intolerance False
Acute Pain True
Diarrhea False
Electrolyte Imbalance, Risk for True
Impaired Comfort True
Impaired Mobility False
Safety
Deficient Knowledge True
Fall, Risk for True
Fear False
Ineffective Self-Health Management False
Infection, Risk for True
Sleep Deprivation False
Estelle Hatcher
Senario 1
Ms. Hatcher is second day post-op and has a nasogastric tube set to gravity drainage only. She
presses call light with questions about who her nurse will be and her NG-tube.
Senario 2
During the follow up nursing assessment, Ms. Hatcher complains about the nasogastric tube causing
her pain in her nasal area. She has active bowel sounds.
Senario 3
Dr. Brown gives orders to remove nasogastric tube set to gravity and to begin a clear liquid diet.
