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Swift River Med Surg Pt Scenarios With Complete Solutions

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Swift River Med Surg Pt Scenarios With Complete SolutionsSwift River Med Surg Pt Scenarios With Complete SolutionsSwift River Med Surg Pt Scenarios With Complete SolutionsSwift River Med Surg Pt Scenarios With Complete SolutionsSwift River Med Surg Pt Scenarios With Complete SolutionsRamona Stukes,...

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  • 10 augustus 2024
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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.

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