Swiftriver Med surg(questions with complete answers)2022

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 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 98%. Fall Risk- Increased Health Change- Increased Pain- Increased Psychological- Normal Education- Increased Neurologic- Normal Chanthavy Chhet Chanthavy Chhet, 46 y/o female admitted for dehydration and gastritis. She is accompanied by her uncle who speaks fluent English, but patient speaks little to no English and is a Cambodian native. The uncle suggests that nursing staff address the patient by CC. Family is concerned that she has not been eating or drinking. Her non-verbal communication indicates abdominal discomfort. Vital signs are: T: 99.4 F, 37.4 C, P:92, R:18, PaO2: 98%, BP: 102/82 sitting, BP: 90/64 standing Educational Needs- Increased Fall Risk- Increased Health Change- Increased Pain level- Increased Psychological- Increased Neurological- Normal 00:06 01:15 Clement Hall was admitted from ED with a diagnosis of acute Pancreatitis. He is C/O severe left upper quadrant abdominal pain 10/10 radiating to his back with nausea and vomiting. He stated that the abdominal pain started a week ago, but he thought it was his ulcer. The pain has intensified over the last eight hours. He said the pain became unbearable after he ate a burger and fries. He said the coke usually calms down his stomach, but instead, he vomited, and there was no relief of pain. VS: BP 102/74, HR 102, R 22, T 99.8F, SpO2 98. Labs: Na 152, K 5.6, Ca 9, Ma 2.1, BG 262, BUN 22, Creatinine 0.7, Serum Amylase 220 (0-130), Serum Lipase 188 (0-160) Educational- Increased Fall Risk- Increased Health Change- Increased Pain Acute- Increased Psychological Needs- Normal Neurological - Normal Don Johnson There was a warehouse fire that quickly spread to an adjoining neighborhood. Multiple burn injuries have overwhelmed the local hospitals. The ICU and burn unit are full of the most severe patients, so some of the patients have been admitted to the stepdown unit on the med-surg floor. Don Johnson 23 y/o male was injured when trying to rescue a coworker. He has sustained burns over part of his back, to include his right arm and right side of his face. Most of the burns are superficial and partial thickness with a few small areas that may be full thickness. The patients beard caught on fire causing burns on the right of face including his right ear. The patient is very apprehensive over the event and concerned for his friend. He has an 18-gauge IV to left AC and the Parkland fluid resuscitation is ordered. The patients weighs 90 KG. 4ml x 90 x 20. He is on simple face mask and has a dry cough. Vital signs are BP: 140/82, P: 92, R: 24, T: 99.2 F, 37.3 C, PaO2: 98% Educational Needs- Increased Falls- Increased Health change- Increased Pain- Increased Psychological needs- Increased Neurological- Normal Donald Lyles 52-year old male, was admitted yesterday evening for stabilization of his uncontrolled type II diabetes. He is married, and his wife is requesting to stay at his side. His HbgA1c is 10.6%. He has a history of a Myocardial Infarction, MI, one year ago, and has refused all cardiac rehab, and has not had another cardiac event. He refuses to comply with dietary recommendations. His BMI is 37. Vital signs are: BP: 146/94, P: 88, R: 22, T: 99.2, PaO2: 94% Blood glucose upon admission is 340 mg/dl Educational Needs- Increased acuity Fall Risk- Normal acuity Health change- Increased acuity Neurological- Normal acuity Pain level-Normal acuity Psychological-Normal acuity Dotty Hamilton 48 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. She was told by a friend 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 metres 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 Educational Needs- Increased Acuity Fall Risk- Normal Acuity Health Change-Normal Acuity Pain level- Normal Psych Needs- Increased Neuro- Normal Julia Monroe 74-year-old, widowed, female arrived to floor alone last night. She was admitted from the ER complaining of swelling in her legs as well as having gained 5 lbs over the past two days. Chest x-ray and EKG were unremarkable. She stated that her legs were hurting most of the night. She has a medical history of hypertension and hypothyroidism. She was admitted to Dr. Gray for full diagnostic work up to determine the cause of her symptoms. Educational Needs- Increased Acuity Fall Risk- Increased Acuity Health Change-Increased Acuity Pain level- Increased Psych Needs- Normal Neuro- Normal Karen Cole 56 year old female, Karen Cole, a school principal at White House High School. Admitted directly from the Dr.'s office to the IMCU after initial complaint for tightness in her chest, denies pain, and slight shortness of breath. Vital signs are BP: 168/92, P: 90, R: 24, T: 98.6. Her husband insisted that she come. She is insisting that she will only stay 12 hours, because she has to be back to school in the morning and does not see this as a serious cardiac event. Educational Needs- Increased Fall Risk- Normal Health- Increased Pain- Normal Psychological- Normal Sensorium- Normal Sarah Getts 77 yr-old, Dx- Chronic Renal Failure, admitted with hyperkalemia (5.9, Eq/L)/hyponatremia (128mEq/L). No known allergies (NKA). Vital signs -Temp 98.8, BP 102/76, P 102- irregular, RR 22, SaO2 90%, cardiovascular on telemetry with Sinus irregular rhythm. Disoriented to time and place, speech slurred. Pupils PERRLA, eyes clear. 20 ga. Hep-Lock in right forearm, skin warm and dry, generalized weakness with recent weight loss. 50% intake. High fall risk. Renal diet. Family in room with patient very concerned. Dr. Brown Education- Increased Falls- Increased Health-Increased Pain- Normal Psychological-Increased Sensorium- Increased Chanthavy Chhet- Select appropriate nursing concerns below based upon patient report above: Physiological: Acute pain- TRUE Bleeding risk for- False Impaired mobility, risk for- True Nausea- True Safety: Cultural Competence- True Deficient knowledge- True Grieving- False Impaired Verbal Communication- True Peripheral Neurovascular dysfunction- False Cameron Daniels Select appropriate nursing concerns below based upon patient report above: Acute Pain- True Impaired Mobility- True Nausea- False Deficient Knowledge- True Falls, risk for- True Infection, risk for- True Dotty Hamilton Select appropriate nursing concerns below based upon patient report above: Risk for bleeding- True Impaired comfort- True Nausea- False Deficient knowledge- True Risk for infection- True Peripheral Neurovascular disfunction- False