Swift River Stephanie Gold: 19-year-old
Caucasian female|2025 Update with
complete solution.
Arthur Thomason56-year-old MVA victim, fourth day post op with a
splenectomy and femur repair. He is experiencing new onset of shortness of
breath and has a nasal cannula with 2L of Oxygen in place. He is restless with
slight confusion but is easily orientated with attempts from nurse.
Temperature spiked during the night to 102.4, BP now 146/94 which is slightly
elevated, respirations at 30 bpm and slightly labored, heart rate 102 versus 84
from last night shift. Skin cool to touch and appears pale. His coughing, to clear
his airway, appears ineffective. Recent chest X-ray shows diffuse bilateral
interstitial infiltrates in all lobes. Recent blood gases demonstrate falling PaO2
(hypoxemia) and increasing CO2 (Hypercapnia). Mr. Thomason is anxious and
is obviously worsened from the shift before in overall condition. - answer-
Education- increased
Fall risk- increased
Health change- increased
Neurological- increased
Pain- increased
Psychological- increased
PHYSIOLOGICAL
alteration in comfort- TRUE
alteration in gas exchange-TRUE
,ineffectual airway clearance-TRUE
potential for shock-TRUE
LOVE AND BELONGING
anxiey/fear-TRUE
potnetial for failure to thrive-FALSE
SAFETY
prolonged confusion- TRUE
Scenario 1
-Assess
-Replace O2 nasal cannula
-Use therapeutic
-Notify Doctor
Scenario 2
-Remind Physician
-Explain to physician
-Assist physician
-Obtain recent
-Reassure patient
,Scenario 3
-Tap patient
-Elevate head
-Call rapid response
-Start secondary
-Remain with patient
Scenario 4
-Provide verbal report
-Emergency intubation
-Assume role
-Obtain patient record
-Provide information
Scenario 5
-You Explain that his condition
-You explain that he is receiving
-You have them remain with you
-You escort them with you
-You call his doctor
Clement Hallwas admitted from ED with a diagnosis of acute Pancreatitis. He
reports 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 soda 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) - answer-Education- increased
Fall risk- increased
Health change- increased
Neurological-normal
Pain- increased
Psychological- normal
PHYSIOLOGICAL
-acute discomfort TRUE
-bleeding FALSE
-potential for alteration in mobility TRUE
SAFETY
-infection TRUE
-potential for alteration in electrolyte balance TRUE
Scenerio 1
-initiate contact isolation
-administer pain medication as ordered
-initiate IV bolus
Caucasian female|2025 Update with
complete solution.
Arthur Thomason56-year-old MVA victim, fourth day post op with a
splenectomy and femur repair. He is experiencing new onset of shortness of
breath and has a nasal cannula with 2L of Oxygen in place. He is restless with
slight confusion but is easily orientated with attempts from nurse.
Temperature spiked during the night to 102.4, BP now 146/94 which is slightly
elevated, respirations at 30 bpm and slightly labored, heart rate 102 versus 84
from last night shift. Skin cool to touch and appears pale. His coughing, to clear
his airway, appears ineffective. Recent chest X-ray shows diffuse bilateral
interstitial infiltrates in all lobes. Recent blood gases demonstrate falling PaO2
(hypoxemia) and increasing CO2 (Hypercapnia). Mr. Thomason is anxious and
is obviously worsened from the shift before in overall condition. - answer-
Education- increased
Fall risk- increased
Health change- increased
Neurological- increased
Pain- increased
Psychological- increased
PHYSIOLOGICAL
alteration in comfort- TRUE
alteration in gas exchange-TRUE
,ineffectual airway clearance-TRUE
potential for shock-TRUE
LOVE AND BELONGING
anxiey/fear-TRUE
potnetial for failure to thrive-FALSE
SAFETY
prolonged confusion- TRUE
Scenario 1
-Assess
-Replace O2 nasal cannula
-Use therapeutic
-Notify Doctor
Scenario 2
-Remind Physician
-Explain to physician
-Assist physician
-Obtain recent
-Reassure patient
,Scenario 3
-Tap patient
-Elevate head
-Call rapid response
-Start secondary
-Remain with patient
Scenario 4
-Provide verbal report
-Emergency intubation
-Assume role
-Obtain patient record
-Provide information
Scenario 5
-You Explain that his condition
-You explain that he is receiving
-You have them remain with you
-You escort them with you
-You call his doctor
Clement Hallwas admitted from ED with a diagnosis of acute Pancreatitis. He
reports 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 soda 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) - answer-Education- increased
Fall risk- increased
Health change- increased
Neurological-normal
Pain- increased
Psychological- normal
PHYSIOLOGICAL
-acute discomfort TRUE
-bleeding FALSE
-potential for alteration in mobility TRUE
SAFETY
-infection TRUE
-potential for alteration in electrolyte balance TRUE
Scenerio 1
-initiate contact isolation
-administer pain medication as ordered
-initiate IV bolus
