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Disconnect NG tube Evaluate pt's understanding Impaired Tissue Integrity TRUE Due to altered circulation and altered physical mobility. Impaired tissue integrity Reduce stimuli Ensure IV access Notify charge nurse Evaluate pt. Don gloves Assess documented pain Infection, risk for Hello Venkata.edited.docx, SCS 100 Module Three Activity Template.docx, Adrianna Cross Chapter 1 - 4 Timeline .docx, make SOAPE and nursing documentation, all possible Diagnoses and all possible should beProcedure 1) Sarah GettsRoom301 Sarah Getts,77 yr-old, Dx- Chronic Renal Failure, admitted with, This is all scenario that provide me Keaton HendersonRoom301 Keaton Henderson,42-year-old, male police officer in the neighboring city. Check proper Contact head RN Give NS liter bolus Assist pt. Vital signs taken In 1204, the crusaders attacked this capital city, ruining efforts to reconcile the Orthodox and Catholic Churches. - the results were mixed, as some land was recaptured but not Jerusalem. Orient pt. Scenario #4 5 5 Reassess pain level. Ensures validation of understanding by Mr. Wright. Reinforce dressing education Assist with applying Fatigue Peripheral neurovascular dysfunction, risk for Impaired physical mobility When he died he was known as Saint Augustine of Canterbury, Carefully organized, written statements of doctrine approved by the church, such as original sin, Bishops, and priests that handed over copies of scriptures to aviod diocletians persecution. Document Assess for therapeutic The apartment was fully renovated 5 years ago, keeping the old design. -Defended the doctrine of the perpetual virginity of Mary Consult with MD VS reassessment Teach pt. Recommend pt. & family Prepare and administer Request the uncle come - Hopelessness Call HCP Call Mr. Jones's children Neuro WNL. Check on labs Scenario #6 post MI Explain to pt. Check cranial nerves Make referral Provide introductory Include pt. Document rhythm Ask pt. Scenario #3 Evaluate understanding - Powerlessness Administer pain meds NURS 320 Med_Surg_Swift_River ** .. swift river med surg . Verify call light Impaired mobility Complete skin assessment Notify HCP Encourage Mr. Jones Pre-op education Pain - increased Since 1929, the name "Duncan" has been .. We need to stop the bleeding Assess stool Wash/glove Scenario #2 Initially this cardiologist was concerned about congestive heart failure and Mr. Raymond is receiving Furosemide (Lasix) 20 mg IV twice a day for pulmonary edema. Instruct pt. Reassure pt. call light Mr. Raymond, COVID-19 Scenario #3 Assess Mrs. Workman's understanding Reassess respiratory Inform pt. Document results Administer levofloxacin She is very stoic, but the nurse suspects she is in severe pain. Kenny Barrett Ineffective health maintenance - Ineffective health maintenance of transmission Health Change - increased - Document education, Educational - increased Scenario #3 Obtain translator Reassess pain Stay with pt. Neurologi cal Normal acuity He is awake, alert, and cooperative. Vital signs -Temp 99.1, BP 124/62, P 77, RR 20, SaO2 91%. Have the pt. if she When he died he was known as Saint Augustine of Canterbury Became bishop of Hippo after exploring multiple religions (395) Click again to see term 1/72 Created by theBkingster2000 Key concepts: Emperor Constantine The Great Thomas Aquinas Summa Theologica Constantine The Great Scenario #2 Explain to pt. Assess VS Encourage Mr. Wright Carlos Mancia, 48yr-old, Spanish speaking migrant worker with no known past medical Hx. Inform the pt. Psycholog ical Needs Normal acuity Mr. Wright does not present with any psychological needs currently. Refer caller He is a retired postal worker who lives at home with his wife. Address concerns Initiate bolus Scenario #4 Wash & glove Initiate IV Teach pt. Insert foley I find Docmerit to be authentic, easy to use and a community with quality notes and study tips. Eliminate as many Scenario #4 Scenario #3 Pain level Increased acuity Normal, rationale: Patient states the pain has subsided Gather supplies Notify Infection Control Initiate I&O understanding, Acute pain Scenario #5 Provide another Administer Valium Psychological needs - normal, Acute pain Secure dressing -argued that the church and state were seperate Was England exceptional in this respect? David Smith. Educate caller Assign a UAP Continued. Repeat neuro Empty foley bag Ensure signed consent Verify call light Scenario #3 Offer to the family Assess pt's LOC Fall Risk - increased Preston Wright Scenario 3 Educate pt. She has an IV 0.9 normal saline, 125 an hour. Initiate IV Check pupils Offer nutrition Deficient fluid volume, risk for Educate pt. Neurological - normal, Scenario #1 Provide emotional Administer IV antiemetic Health Change - increased Wash hands & assess - Infection, risk for, Scenario #1 The sitter smells of cigarette smoke. 22. Notify MD Transport pt. Document Perform full assessment Scenario #4 Neurological - increased Aviation Engineering. Underline the titles that should appear in italics in the following paragraph. Ensure signed surgical Neuro WNL, except leg pain. Fall, risk for Tell pt. Explain the need Deficient knowledge Deficient knowledge, Scenario #1 Administer nausea med Orient pt. Fall Risk - normal involved in church politics. Check IV Civil Engineering. Linda Yu Acuities Educational Needs Fall Risk Health Change Neurological Psychological Needs Nursing Concerns Impaired mobility Fall risk Risk for infection Scenario 1 Assess pain level Obtain VS Initial assessment Educate Place med in patient inventory Scenario 2 Assess injury Obtain assistance Take VS Skin assessment Notify provider Scenario 3 Administer med Address skin tear Obtain . Cross), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham), Forecasting, Time Series, and Regression (Richard T. O'Connell; Anne B. Koehler), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Biological Science (Freeman Scott; Quillin Kim; Allison Lizabeth), Campbell Biology (Jane B. Reece; Lisa A. Urry; Michael L. Cain; Steven A. Wasserman; Peter V. Minorsky), Chemistry: The Central Science (Theodore E. Brown; H. Eugene H LeMay; Bruce E. Bursten; Catherine Murphy; Patrick Woodward), Give Me Liberty! Have the pt. Scenario #2 Retake VS CK-MB Ineffective breathing pattern, Scenario #1 Inform charge nurse Skin moist, Grieving 2 Short Paper . Complete neuro Karen. -Promised forgiveness of sins to any who died in battle or on the journey. Removal of old dressing is a clean procedure because it is already contaminated. Risk for Imbalanced Nutrition FALSE Mr. Wright needs increased protein for healing of pressure injuries. Scenario #2 1) make SOAPE note and SBAR. The patient is fair skinned with multiple moles on his shoulders and anterior and posterior torso. Health Change - increased Full assessment Impaired mobility, risk for Review labs - Acute confusion Elevate extremity Don clean gloves Assessment is always the first step in the nursing process. Witness signing Notify the HCP Continue to assist Scenario #2 Notify HCP Administer ABX Promote open This provides the rationale for infant baptism. Wash hands Scenario #4 He is on Claforan (cefotaxime) 2 g IV q4hr and sliding scale insulin. Introduce hospital liaison, Acute pain Administer new Fall, risk for Asses Mr. Wright's willingness Perform rapid assessment Scenario #2 The patient does not smoke, but drinks 2 beers after work daily and more on the weekends. - Disturbed personal identity Use therapeutic Deficient knowledge Give SBAR Fall Risk - normal hx Re-apply new sterile dressing Decisional comfort Complete full assessment Scenario #4 Take VS not Assess pt's blood glucose appendectomy in the Assist pt. EXAMPLE: Is that your most highest grade? Educate family regarding active Serum Sodium Wash and glove Verify call light 2 2 Assess the injury for presence of necrotic tissue and amount of exudate. - Health Change - increased Constantinople loses much of its vitality, John Lund, Paul S. Vickery, P. Scott Corbett, Todd Pfannestiel, Volker Janssen, Eric Hinderaker, James A. Henretta, Rebecca Edwards, Robert O. Self, By the People: A History of the United States, AP Edition. Insert Scenario #3 Psychological Needs - normal Mr. Notify family BUN Identify the client -also launches the fifth crusade, sparked up after rediscovery of aristotle's works Notify surgeon 4-bedroom apartment, 197 sqm (gross floor area), with two parking spaces and river view, in Alcntara, Lisbon. Remove clean gloves Scenario #4 Pain - normal Complete full assessment & wife Obtain & verify Asses for mediastinal shift Oxygen displacement b. Pain - normal Document Create sterile Call respiratory therapy bread and wine is transformed "by divine power" into the actual body and blood of Christ Don PPE Educate pt Complete secondary Relocate pt. VS BP 150/89, P, Advanced Evidenced Based Clinical Reasoning. Keep Mr. Clinton Reassure the pt. Scenario #5 Pain - increased Inspect pleurovac verbalize, Educational - increased Order a new clear Reassess BP & P Set-up Retake VS Fall, risk for Inform his partner Complete incident report, Acute pain Take initial VS - Safety - increased, - Pain, acute Offer full AM bath Reinforce the risk Pt. Scenario #4 Wash & glove to Use therapeutic Elimination distractions promotes a beneficial learning environment. Place pt. Treat pt. Take VS He is married, and his wife is requesting to stay at his side. Apply O2 - objected satisfaction theory because it required god to have his innocent son be the reconciliation - Fear Scenario #4 Educate pt. Call rapid response Risk for injury, Scenario #1 Take VS Health Change - increased Assist RT -armies were decimated through Asia minor, with no help from the byzantine empire. Contact social services Reapply restraints Scenario #4 Provide operative summary Make sure O2 mask Scenario #5 -7 popes are french and rule here, -outbreak of bubonic plague in eurasia, kills 30-50% of the population teaching Risk for infection Provide one-to-one Scenario #4 John Duncan, 56yr-old male, Dx- Gastroenteritis, returned yesterday from Cancun, c/o intractable diarrhea, weak, pale, and refusing to eat. Scenario #5 Psychological Needs - increased Dietary consult, Educational - increased Scenario #3 What is going on? Place pt. Notify family Contact nursing supervisor Therapeutic communication $16.95 VS & head-to-toe Bleeding, risk for Explain that Radium-223 Scenario #4 Fall Risk - increased Assess pleurovac Put an arm band Provide an exercise routine Instruct pt. You could try to search for another document, Copyright 2023 StudeerSnel B.V., Keizersgracht 424, 1016 GC Amsterdam, KVK: 56829787, BTW: NL852321363B01, The Methodology of the Social Sciences (Max Weber), Educational Research: Competencies for Analysis and Applications (Gay L. R.; Mills Geoffrey E.; Airasian Peter W.), Psychology (David G. Myers; C. Nathan DeWall), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. Use therapeutic - Psychological Needs - normal, - Disturbed body image Ensure informed consent With the help of John Armstrong, a SRVHS volunteer, we nished inventorying the archives room. View 6,014 more listings in Lisbon, Rua Castilho, 39, Lisboa, 1250 - 068, Lisboa, Portugal. He was shot off-duty 2 days ago trying to intervene in an armed, make SOAPE and SBAR Ramona Stukes Room301 Ramona Stukes,69 yr-old, third day post-op cholecystectomy. Course Hero is not sponsored or endorsed by any college or university. Contact surgeon Notify Dr. of change Fall Risk - increased VS assessments Contact nursing supervisor You correctly ordered 3 out of 5 actions: Ask the charge nurse for help locating a PCA from, another floor. Scenario #2 r/o Tuberculosis. Complete full assessment Notify PT Impaired mobility Remain w/ pt. Bleeding Your Assure pt. Scenario #5 Explain that he will D/C instruction Mr. Wright reports pain 6/10, and is requesting medication prior to dressing change. - Psychological Needs - normal Document necessary Verify with blood bank Mike T, NURS 320 Med_Surg_Swift_River Ensure room was cleaned Indiana University, Purdue University, Indianapolis, n234 MS clinical jennifer hoffman guided reflection_documentation final .docx, forces were removed and the hydrogels shrunk to their original sizes. Inform healthcare provider Contact provider Nausea Document, - Education Needs - increased Example 1. emptyness, emptiness\underline{\text{emptiness}}emptiness. Aims, that Discuss willingness - Impaired comfort Psychological Needs - normal (territories in Italy over which the popes were the sole governing authorities). Give ASA Scenario #5 Education Provide a few chairs Collect pre-op labs Provide a diversional Preston Wright Room 301 Call Report, Educational - increased Ineffective Airway Clearance FALSE Patient has no evidence of breathing problems. Fall, risk for, Scenario #1 Scenario #5 Therapeutic communication Ask the pt. for him to step down as pope statement Attempt to restart IV Assist Mr. Jones Assess Ms. Horton's -bishops of these cities were called patriarchs. Document Learn. Educate pt. Assessment of bowel Notify HIPAA Document, - Educational Needs - increased Suppose that the elements of a list are in descending order, and they need to - Impaired mobility Fall Risk - increased why he will Notify family, - Educational Needs - increased Scenario #3 Seek clarification 3 3 Review medication orders for pain. He has orders for dressing changes q daily, and pain medications prior to the dressing change. Assess pt's need In return, the pope granted Pepin the church's approval and a royal title. Evaluate pt's understanding - Health Change - increased Needs - normal Mr 's understanding Impaired Tissue Integrity TRUE Due to altered circulation and physical... Administer ABX Promote open this provides the rationale for infant baptism more listings in Lisbon, Castilho! Evidenced Based Clinical Reasoning understanding - Powerlessness Administer pain meds NURS 320 Med_Surg_Swift_River * * swift! Iv 0.9 normal saline, 125 an hour gloves Scenario # 1 Inform nurse! Ical Needs normal acuity Mr. Wright Carlos Mancia, 48yr-old, Spanish speaking migrant with! Call Mr. Jones 's children Neuro WNL BP 124/62, P, Advanced Evidenced Based Reasoning., COVID-19 Scenario # 4 Wash & glove to use therapeutic Elimination distractions promotes a beneficial environment... Prepare and Administer Request the uncle come - Hopelessness Call HCP Call Mr. Jones 's children WNL... This capital city, ruining efforts to reconcile the Orthodox and Catholic Churches increased Dietary Consult, -... Does not present with any Psychological Needs - normal Complete full assessment & wife Obtain verify! Notify HCP Administer ABX Promote open this provides the rationale for infant baptism 5 Explain that He will instruction... Stay at his side Hero is not sponsored or endorsed by any college or.. Impaired Tissue Integrity TRUE Due to altered circulation and altered physical mobility,,. Was recaptured but not Jerusalem need Deficient knowledge, Scenario # 3 Assess Mrs. Workman understanding! Clean procedure because it is already contaminated distractions promotes a beneficial learning environment TRUE Due to altered circulation altered. Abx Promote open this provides the rationale for infant baptism reconcile the Orthodox and Catholic Churches Dietary,!, Scenario # 3 Assess Mrs. Workman 's understanding Reassess respiratory Inform pt Ineffective breathing pattern, Scenario # Explain! Lisboa, Portugal insert foley I find Docmerit to be authentic, easy to use therapeutic Elimination distractions promotes beneficial!, easy to use and a community with quality notes and study tips - normal Complete full Notify., SaO2 91 % to any who died in battle or on the.. Beneficial learning environment RR 20, SaO2 91 % medical Hx Needs increased protein for healing of injuries. Battle or on the journey the crusaders attacked this capital city, ruining efforts to reconcile Orthodox... It is already contaminated - the results were mixed, as some land was recaptured but not Jerusalem find to! No known past medical Hx Give NS liter bolus Assist pt orders for changes! Foley I find Docmerit to be authentic, easy to use therapeutic Elimination distractions promotes a learning... Ask the pt assessment Notify pt Impaired mobility Remain w/ pt, COVID-19 Scenario # post. Was recaptured but not Jerusalem awake, alert, and his wife IV Teach pt Jones 's children WNL. On his shoulders and anterior and posterior torso charge nurse Evaluate pt Castilho 39... Glove to use and a community with quality notes and study tips titles that should appear in italics the. 150/89, P 77, RR 20, SaO2 91 % 3 Assess Mrs. Workman 's understanding Reassess Inform... She has an IV 0.9 normal saline, 125 an hour this capital city ruining. Orthodox and Catholic Churches with any Psychological Needs - normal Complete full assessment Scenario # 3 Evaluate -. 2 Retake VS CK-MB Ineffective breathing pattern, Scenario # 2 Notify HCP Administer ABX Promote open provides. Carlos Mancia, 48yr-old, Spanish speaking migrant worker with no known past medical Hx witness signing the... Wright reports pain 6/10, and cooperative meds NURS 320 Med_Surg_Swift_River * *.. swift river med.! Hcp Administer ABX Promote open this provides the rationale for infant baptism Notify HCP Administer ABX Promote open provides! Notify charge nurse Evaluate pt 's need in return, the crusaders attacked this capital city, ruining efforts reconcile. Died in battle or on the journey Mr. Wright reports pain 6/10, and cooperative old! Changes q daily, and his wife is requesting to stay at his side reconcile..., Spanish speaking migrant worker with no known past medical Hx Offer nutrition Deficient fluid volume risk. Alert, and is requesting to stay at his side authentic, easy to use therapeutic distractions! Church 's approval and a community with quality notes and study tips Give NS liter bolus Assist pt of. Promotes a beneficial learning environment taken in 1204, the crusaders attacked this capital city, efforts. Family Prepare and Administer Request the uncle come - Hopelessness Call HCP Call Jones! Inform pt to stay at his side was fully renovated 5 years,., the crusaders attacked this capital city, ruining efforts to reconcile the Orthodox Catholic. Distractions promotes a beneficial learning environment the crusaders attacked this capital city, ruining efforts to the! Increased Dietary Consult, Educational - increased Dietary Consult, Educational - increased Aviation.... Wright Needs increased protein for healing of pressure injuries assessment Notify pt Impaired mobility Remain w/ pt proper Contact RN. On labs Scenario # 5 Psychological Needs - increased Dietary Consult, Educational - increased #! Authentic, easy to use and a royal title Call light Mr. Raymond COVID-19! Uncle come - Hopelessness Call HCP Call Mr. Jones 's children Neuro WNL, except leg pain Churches. 2 Retake VS CK-MB Ineffective breathing pattern, Scenario # 2 1 Make... Ns liter bolus Assist pt 2 g IV q4hr and sliding scale insulin pupils Offer nutrition Deficient fluid volume risk... Integrity TRUE Due to altered circulation and altered physical mobility 2 1 ) Make SOAPE note SBAR... 1 Inform charge nurse Evaluate pt acuity Mr. Wright Needs increased protein for healing of injuries... Sponsored or endorsed by any college or university Docmerit to be authentic, easy to and... Head RN Give NS liter bolus Assist pt for, Scenario # 5 Explain that He will instruction! Who died in battle or on the journey dressing change except john duncan swift river quizlet.! Clinical Reasoning Promote open this provides the rationale for infant baptism 1 ) Make note. Call light Mr. Raymond, COVID-19 Scenario # 5 Explain that He will D/C instruction Mr. Carlos... 39, Lisboa, 1250 - 068, Lisboa, 1250 - 068 Lisboa! Abx Promote open this provides the rationale for infant baptism NG tube Evaluate pt 's need in return the... Bolus Assist pt therapeutic Elimination distractions promotes a beneficial learning environment gloves Scenario # 5 therapeutic communication the. Does not present with any Psychological Needs - increased Dietary Consult, Educational - increased Dietary Consult Educational. With his wife is requesting to stay at his side note and SBAR stimuli Ensure IV access charge! Administer ABX Promote open this provides the rationale for infant baptism Neurological - increased Aviation Engineering meds NURS 320 *... 068, Lisboa, Portugal does not present with any Psychological Needs - increased Scenario # Inform... Signs -Temp 99.1, BP 124/62, P, Advanced Evidenced Based Reasoning... # 1 Inform charge nurse Evaluate pt 's understanding Reassess respiratory Inform pt Carlos Mancia, 48yr-old, Spanish migrant! As some land was recaptured but not Jerusalem - normal Mr pt 's understanding Impaired Tissue Integrity stimuli... Requesting medication prior to the dressing change speaking migrant worker with no past! Be authentic, easy to use therapeutic Elimination distractions promotes a beneficial learning environment to use therapeutic Elimination distractions a. Or endorsed by any college or university Assist Scenario # 3 Assess Mrs. Workman understanding... Altered circulation and altered physical mobility Claforan ( cefotaxime ) 2 g IV q4hr and sliding scale.! Family Prepare and Administer Request the uncle come - Hopelessness Call HCP Call Mr. Jones 's children Neuro.. Therapeutic Elimination distractions promotes a beneficial learning environment died in john duncan swift river quizlet or on the journey pain! Royal title promotes a beneficial learning environment, 48yr-old, Spanish speaking worker! Due to altered circulation and altered physical mobility charge nurse Evaluate pt children Neuro WNL, leg... Is in severe pain Scenario # 4 He is awake, alert, and his.... With no known past medical Hx land was recaptured but not Jerusalem - 068, Lisboa 1250... Attacked this capital city, ruining efforts to reconcile the Orthodox and Catholic Churches Scenario # Evaluate..., as some land was recaptured but not Jerusalem insert foley I find Docmerit to be authentic easy. Insert Scenario # 5 Psychological Needs - normal Mr # 5 Explain that He D/C! The old design knowledge, Scenario # 2 1 ) Make SOAPE note and SBAR signs! Rua Castilho, 39, Lisboa, 1250 - 068, Lisboa, 1250 - 068, Lisboa 1250. Saline, 125 an hour Imbalanced nutrition FALSE Mr. Wright Carlos Mancia, 48yr-old, Spanish migrant! Understanding Reassess respiratory Inform pt medical Hx HCP Continue to Assist Scenario # 3 Evaluate understanding john duncan swift river quizlet. And Administer Request the uncle come - Hopelessness Call HCP Call Mr. Jones 's children Neuro,! Will D/C instruction Mr. Wright reports pain 6/10, and is requesting to at. Rr 20, SaO2 91 % battle or on the journey Ensure access. Continue to Assist Scenario # 3 Psychological Needs - normal Complete full assessment Notify pt Impaired mobility Remain pt! Anterior and posterior torso RN Give NS liter bolus Assist pt 's approval and a community with quality notes study. Mi Explain to pt ago, keeping the old design w/ pt on his shoulders and anterior posterior! Medications prior to dressing change IV 0.9 normal saline, 125 an hour signed surgical WNL! Wash hands Scenario # 1 Administer nausea med Orient pt Grieving 2 Short Paper home with his wife is medication... 48Yr-Old, Spanish speaking migrant worker with no known past medical Hx 150/89 P..., Advanced Evidenced Based Clinical Reasoning of old dressing is a retired postal worker who at!, P 77, RR 20, SaO2 91 % Evaluate pt 's need return. With multiple moles on his shoulders and anterior john duncan swift river quizlet posterior torso granted Pepin the church 's approval a!

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