Exam (elaborations) NURS 267 Med-Surg Mary Richards Feedback Log & Sco

Exam (elaborations) NURS 267 Med-Surg Mary Richards Feedback Log & Sco You arrived at the patient's side. 0:00 You reviewed the patient information. 0:00 You introduced yourself. 0:06 You washed your hands. To maintain patient safety, it is important to wash your hands as soon as you enter the room. 0:10 Patient status - ECG: Sinus bradycardia. Heart rate: 58. Pulse: Present. Blood pressure: 98/58 mm Hg. Respiration: 22. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37.1 C) 1:10 Patient status - ECG: Sinus bradycardia. Heart rate: 58. Pulse: Present. Blood pressure: 98/58 mm Hg. Respiration: 21. Conscious state: Appropriate. SpO2: 98%. Temp: 99 F (37 C) 1:17 You identified the patient. To maintain patient safety, it is important that you quickly identify the patient. 1:26 You asked if the patient was Allergyallergic to anything. She replied: 'No, I am not allergic to anything.' 1:53 You looked for normal breathing. She is breathing at 18 breaths per minute. The chest is moving equally. 2:10 Patient status - ECG: Sinus bradycardia. Heart rate: 58. Pulse: Present. Blood pressure: 96/57 mm Hg. Respiration: 16. Conscious state: Appropriate. SpO2: 98%. Temp: 99 F (37 C) 2:17 You attached the Pulseoximeterpulse oximeter. This was indicated by order. 2:19 The patient developed severe nausea. 2:23 Patient status - ECG: Sinus rhythm. Heart rate: 60. Pulse: Present. Blood pressure: 96/57 mm Hg. Respiration: 16. Conscious state: Appropriate. SpO2: 98%. Temp: 99 F (37 C) 2:28 You checked the radial pulse. The pulse is strong, 60 per minute, and regular. It is       This study source was downloaded by from CourseH on :14:30 GMT -05:00 This study resource was shared via CourseH 5/21/2020 Feedback Log & Score — Mary Richards Oct 02, 2019 08:10 AM correct to assess the patient's vital signs. 2:52 You attached the automatic noninvasive blood pressure (NIBP) measurement cuff. This will allow you to reassess the patient continuously. 3:03 You measured the Temperaturetemperature in the ear. The temperature was 99 F (37 C). 3:23 Patient status - ECG: Sinus rhythm. Heart rate: 62. Pulse: Present. Blood pressure: 99/59 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C) 3:53 You listened to the heart of the patient. This is reasonable. There were regular heart sounds without murmurs. 4:16 You listened to the lungs of the patient. The breath sounds are clear and equal bilaterally. 4:23 Patient status - ECG: Sinus rhythm. Heart rate: 63. Pulse: Present. Blood pressure: 100/60 mm Hg. Respiration: 11. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C) 4:33 You assessed the patient's neurological status. 5:23 Patient status - ECG: Sinus rhythm. Heart rate: 63. Pulse: Present. Blood pressure: 101/60 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C) 5:52 You assessed the patient's consciousness. The patient scores 15 on the Glasgow Coma Scale (GCS). 6:11 You assessed the patient's sedation level using the Pasero Sedation Scale. The patient was awake and alert. On the Pasero Opioid-Induced Sedation Scale, the patient was graded to 1. 6:23 Patient status - ECG: Sinus rhythm. Heart rate: 64. Pulse: Present. Blood pressure: 102/61 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C) 6:33 You asked the patient if she could describe her pain. She replied: 'There is nothing to describe' 6:38 You asked: How would you rate your pain? She replied: 'There is no pain.' 7:03 You reviewed the orders.        This study source was downloaded by from CourseH on :14:30 GMT -05:00 This study resource was shared via CourseH 5/21/2020 Feedback Log & Score — Mary Richards Oct 02, 2019 08:10 AM 7:16 You phoned the provider in order to discuss the patient. 7:23 Patient status - ECG: Sinus rhythm. Heart rate: 64. Pulse: Present. Blood pressure: 100/60 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C) 8:23 Patient status - ECG: Sinus rhythm. Heart rate: 64. Pulse: Present. Blood pressure: 100/60 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C) 8:45 You reviewed the MAR. 8:48 You assessed the patient's IV. The site had no redness, swelling, infiltration, bleeding, or drainage. The dressing was dry and intact. This is correct. Assessing any IVs the patient has is always important. 9:23 Patient status - ECG: Sinus rhythm. Heart rate: 65. Pulse: Present. Blood pressure: 102/61 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C) 9:38 You verified the potassium chloride 10 mEq in 100 mL dilution dose with another nurse. This was reasonable. The dose was correct. 10:23 Patient status - ECG: Sinus rhythm. Heart rate: 65. Pulse: Present. Blood pressure: 99/59 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C) 10:42 You compared the medication label with MAR. This was reasonable. 10:57 You started infusing potassium chloride 10 mEq in 100 mL dilution at 65 mL/hr. It is important to use the basic rights of medication administration to ensure proper drug therapy. This was indicated by order. 10:57 You reviewed the diagnostics. 11:23 Patient status - ECG: Sinus rhythm. Heart rate: 65. Pulse: Present. Blood pressure: 99/59 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C) 11:30 You educated the patient about the drug potassium. 12:09 You listened to the heart of the patient. There were regular heart sounds without murmurs. 12:23 Patient status - ECG: Sinus rhythm. Heart rate: 65. Pulse: Present. Blood pressure: 101/60 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)        This study source was downloaded by from CourseH on :14:30 GMT -05:00 This study resource was shared via CourseH 5/21/2020 Feedback Log & Score — Mary Richards Oct 02, 2019 08:10 AM 12:33 You listened to the lungs of the patient. The breath sounds are clear and equal bilaterally. 12:38 You looked for normal breathing. She is breathing at 12 breaths per minute. The chest is moving equally. 12:58 You checked the radial pulse. The pulse is strong, 65 per minute, and regular. 13:20 You measured the Temperaturetemperature in the ear. The temperature was 99 F (37 C). 13:23 Patient status - ECG: Sinus rhythm. Heart rate: 65. Pulse: Present. Blood pressure: 102/61 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 96%. Temp: 99 F (37 C) 13:36 You assessed the patient's neurological status. 14:23 Patient status - ECG: Sinus rhythm. Heart rate: 65. Pulse: Present. Blood pressure: 100/59 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 96%. Temp: 99 F (37 C) 14:54 You assessed the patient's consciousness. The patient scores 15 on the Glasgow Coma Scale (GCS). 15:06 You reviewed the patient log. 15:09 You asked the patient if she had any pain. She replied: 'No, I don't have any pain.' 15:14 You asked: How would you rate your pain? She replied: 'There is no pain.' 15:23 Patient status - ECG: Sinus rhythm. Heart rate: 65. Pulse: Present. Blood pressure: 101/60 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 96%. Temp: 99 F (37 C) 15:29 You phoned the provider in order to discuss the patient. 16:23 Patient status - ECG: Sinus rhythm. Heart rate: 66. Pulse: Present. Blood pressure: 102/61 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 96%. Temp: 99 F (37 C) 17:04 You asked the patient how she felt. She replied: 'I feel really bad. The nausea became worse.' 17:23 Patient status - ECG: Sinus rhythm. Heart rate: 66. Pulse: Present. Blood pressure: 102/61 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 96%. Temp: 99 F (37 C)      This study source was downloaded by from CourseH on :14:30 GMT -05:00 This study resource was shared via CourseH 5/21/2020 Feedback Log & Score — Mary Richards Oct 02, 2019 08:10 AM 17:27 You compared the medication label with MAR. This was reasonable. 17:39 You administered 4 mg of ondansetron IV. This was indicated by order. 17:46 You flushed the cannula. 18:03 You educated the patient about the drug ondansetron. 18:23 Patient status - ECG: Sinus rhythm. Heart rate: 62. Pulse: Present. Blood pressure: 95/57 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 96%. Temp: 99 F (37 C) 18:37 You educat