All Swift River Medical-Surgical Room Cases, Solved! Graded!
Updated Spring 2022; Distinction Level Assignment Has everything. -
Swift River Virtual Clinicals
Full file @: https://www.stuvia.com/doc/1643812/all-swift-river-
medical-surgical-room-cases-solved-graded-updated-spring-2022-
distinction-level-assignment-has-everything.
Baby Strickland R03
Baby Strickland, 1-hour-old newborn female, 37-week gestational age born
via C-section, weight 9.9 lbs. Mom has history of diabetes, not well
controlled.
Estelle Hatcher R301
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, NGtube 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
Hayden Clark R302
Hayden Clark, 6-year-old male, weighing 44 lbs., comes to school looking
disheveled, and not wearing a coat with the outside temperature in the low
40’s
Preston Wright R305
Preston Wright, 73-year-old male patient of Dr. Greene, status post CVA 4
weeks ago. He has been readmitted for a red spot on his sacrum of 1 cm and
a 2 cm blister on his right heel. IV fluids of D5 1/2 NS are infusing at 100
mL/hour to his right forearm. Mr. Wright is pleasant and cooperative but
needs to be reminded to avoid pressure on his heel and sacrum. Post CVA, he
has developed some aphasia and is having difficulty with verbal
communication. He has orders for dressing changes q daily and pain
medications before the dressing change
,Jack Hammond R305 SR
Jack Hammond, 10 -year old boy who was admitted last night for cystic
fibrosis exacerbation and possible pneumonia. He has an IV of D5 NS infusing
to his right arm at 75 mL/hour. Oxygen per nasal cannula is in place at 3
L/min, chest x-ray results and sputum culture are pending. He is alert and
oriented, both parents are currently at the bedside. He does complain of
intercostal pain, especially with coughing. Current oxygen saturation is 94%
Calvin Umbyuma R302SR
Calvin Umbyuma Mr. Umbyuma is a 42 y/o male who has been admitted for complaints of
shortness of breath with pleuritic chest pain. He was diagnosed with HIV positive
antibodies
over a year ago. He has recently been traveling back to his home country of Kenya to visit
his
sick mother. He received traditional medical treatment at his village. His temp is 100.9 F,
38.3 C,
R 22, P92, BP 152/89 PaO2 91%. Inflammatory markers – Erythrocyte Sedimentation Rate
(ESR) and C-Reactive Protein (CRP) are elevated at 78.9 mm/h and 67.2 mg/L. He has been
placed in a room at the end of the hall.
Carlos Mancia R301SR
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
Cameron Daniels R 304 SR
Cameron Daniels just turned 18 y/o. She is being admitted from the ER with a diagnosis of
pelvic inflammatory disease (PID). She has heavy vaginal discharge with an unpleasant
odor.
, She is complaining of abdominal pain and looks pale. She was seen by OBGYN in the ER and
a
culture was sent to the lab for Chlamydia and/or Neisseria Gonorrhea. She was a very
difficult
IV start and has a 23g saline lock (SL) in her right hand. They have ordered a liter bolus of
LR,
but it is running very slowly and the IV is positional. VS BP 96/58, P 116, R 18, T 101.2
PaO2
92%.
Dotty Hamilton R304SR
Dotty Hamilton 52 y/o female who has been admitted for bariatric surgery.
She has arrived at 0600 and is scheduled for a laparoscopic Roux-en-Y gastric
bypass (RYGB). She is super morbidly obese with a BMI of 52, Ht, 5'3", Wt,
293lbs. She has well-controlled hypertension with Losartan (Cozaar) 50 mg q
daily. She also takes Metformin to control her Type 2 Diabetes. She has sleep
apnea, and she brought her CPAP machine. She is very excited about the
surgery but is also apprehensive. A friend told her that the complication rate
for this surgery is very high. She believes this surgery is her only hope, as
she says she has tried everything else to lose weight. Her husband is with
her and seems to be very supportive. Body Mass Index (BMI) = kg/m2, where
kg is a person's weight in kilograms and m2 is their height in meters
squared. A BMI of 25.0 or more is overweight, while the healthy range is 18.5
to 24.9. Example: Weight = 133.18 kg, Height = 160.02 cm (1.60 m)
Calculation: 133.18 ÷ (1.60)2 = 52
Arthur Silverstein R SR
Arthur Silverstein, Arthur Silverstein, a 68-year-old homeless Vietnam veteran recently
hospitalized for PTSD resulting from the abuse suffered during imprisonment by Viet Cong.
Arthur lives in a homeless shelter. He has experienced intermittent homelessness and
alcohol
addiction since his wife died 18 years ago. Arthur experiences flashbacks and nightmares.
He is
hyper-vigilant and becomes anxious in crowded spaces or in large groups of people.
Medications: NKDA. Paroxetine (Paxil) 30 mg daily for management of depression,
hypervigilance and PTSD symptoms and zolpidem (Ambien) for sleep as needed. Social
history:
Arthur lives in a homeless shelter. Arthur openly struggles with the day room and the
