Swiftriver Med surg(questions with complete answers)2022
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Swiftriver Med surg
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Swiftriver Med Surg
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 la...
swiftriver med surgquestions with complete answers2022
cameron daniels just turned 18 yo she is being admitted from the er with a diagnosis of pelvic inflammatory disease pid she has heavy vagi
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Swiftriver Med surg
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%. - Answer 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 -
Answer Educational Needs- Increased
Fall Risk- Increased
Health Change- Increased
Pain level- Increased
Psychological- Increased
Neurological- Normal
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) - Answer
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% - Answer 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 -
Answer 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 -
Answer 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. - Answer 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. - Answer 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 - Answer Education- Increased
Falls- Increased
Health-Increased
Pain- Normal
Psychological-Increased
Sensorium- Increased
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