Swift River: Medical -Surgical Complete Exam Guide Graded A 2024 With Solutions Wight Goodman | Room 301 Patient Overview wight_goodman.jpgWight GoodmanPatient was admitted to the floor last night from the ER for an orbital fracture. He was hit in the left eye by a softball yesterday. Apparently, he was pitching, and the batter hit a line drive hitting him in the right side o f the face. They applied some ice to his face, and he decided to go to the post game keg party instead of coming to the ER. The patient stated that there was significant swelling, but his vision was fine, and the p ain was controlled with beer and 800mg of Motrin. He was unable to sleep later in the evening as the pain became worse, and his vision became more impaired. Patient states, "I'm afraid I will be permanently scarred"! The Maxillofacial surgeon was consulted , and they will see him this morning. They were not concerned as his intraocular pressure was normal in the ER. There is significant edema and discoloration to the left side of his face, and his left eye is almost completely swollen shut. His visual acuity is diminished, and the whites of his eyes are hemorrhaged. His pain has been well controlled with IV morphine 4 mg, q3 hours. He has a 20g SL to his right hand, that was started in the ER. He has no other health concerns. He's being admitted for pain cont rol, close observation of his intralocular pressure, and head injury. Educational Needs - Increased Fall Risk - Increased Health Change - Increased Neurological - Increased Pain Level - Increased Psychological Needs - Increased Wight Goodman Wight Goodman Patient was admitted to the floor last night from the ER for an orbital fracture. He was hit in the left eye by a softball yesterday. Apparently, he was pitching, and the batter hit a line drive hitting him in the right side of the face. They applied some ice to his face, and he decided to go to the post game keg party instead of coming to the ER. The patient stated that there was significant swelling, but his vision was fine, and the pain was controlled with beer and 800mg of Mo trin. He was unable to sleep later in the evening as the pain became worse, and his vision became more impaired. Patient states, "I'm afraid I will be permanently scarred"! The Maxillofacial surgeon was consulted, and they will see him this morning. They w ere not concerned as his intraocular pressure was normal in the ER. There is significant edema and discoloration to the left side of his face, and his left eye is almost completely swollen shut. His visual acuity is diminished, and the whites of his eyes a re hemorrhaged. His pain has been well controlled with IV morphine 4 mg, q3 hours. He has a 20g SL to his right hand, that was started in the ER. He has no other health concerns. He's being admitted for pain control, close observation of his intralocular pressure, and head injury. Acute discomfort Alteration in comfort Potential for bleeding Knowledge deficit Potential for infection Wight Goodman Scenario 1 Wight GoodmanMr. Goodman has been scheduled for surgery to repair a supraorbital rim fracture, but he is very concerned about any scaring that may affect his appearance. He is alert and oriented and has signed the surgical consent. The nurse notices a smal l amount of blood coming from the patient's nose. He does not remember his nose bleeding initially or in the ER. VS BP140/82 P74 R 20 T 98.7 F, 37.1 C. 1- Wash hands and assess 2- Complete Neurological assessment 3- Check the blood from his nose for CSF 4- Pre-op education 5- Ask Surgeon to discuss with patient the potential facial scarring Wight Goodman Scenario 2 Wight GoodmanThe blood from the nose was positive for CSF. An MRI is ordered, and reveals a small Orbital roof fracture. The neurosurgeon is consulted. The maxillofacial surgeon will repair the suborbital rim fracture first, and the neurosurgeon will monit or the patient postoperatively as well as be available to assist if the orbital roof fracture becomes unstable. IV antibiotics are ordered to be administered ASAP . The patient will need to sign another surgical consent for potential neurosurgery. The surge on also orders Neuro checks q2 hours, his Glasgow Coma Score is 15. 1- Complete Neurological assessment 2- Educate patient of plan of care 3- Evaluate patients understanding of care 4- Administer IV antibiotics 5- Sign additional surgical consent Wight Goodman Scenario 3 Mr. Goodman is first day post -op from his suborbital rim fracture repair, and his orbital edema has been greatly reduced. His CSF with rhinorrhea has subsided. The neurosurgeon has decided to continue to observe his recovery, instead of surgical interventi on to repair the orbital roof fracture. The patients VS are stable, and he is afebrile. Patient does not have medical insurance, so he is wanting to leave today. The patient is emotionally distraught, and angry as face appears to h ave drooping of his eyelid and his visual acuities have not improved. While the swelling has decreased there is still periorbital edema (Ptosis). 1- Complete Neurological Assessment 2- Educate patient and family of necessity for q2 hour neuro checks and visual acuities 3- Inform Healthcare Provider that patient is medically indigent, and wanting to go home today 4- Contact social services to discuss options for payment 5- Extensive discharge planning and education Wight Goodman Scenario 4 Wight GoodmanThe resident has been rounding on Mr. Goodman and is preparing his discharge. Mr. Goodman is still very upset about his appearance. He is also complaining of nasal congestion and insists on trying to blow his nose. The nurse informs the reside nt that his visual acuities are worse, patient's eyelid is drooping, and his left -eye (OS) pain is increasing . The resident tells the nurse that is a common complication with this type of injury, and they will see him in the clini c for a follow -up. 1- Repeat Neurological assessment and contrast your latest findings 2- Reemphasize to patient that he cannot blow his nose 3- Approach Resident again, and explain that you feel his condition is worsening 4- Contact Nursing Supervisor of disagreement of patients readiness for discharge 5- Document Wight Goodman Scenario 5 Wight GoodmanThe attending maxillofacial surgeon comes to see the patient before his discharge at the nurse's insistence. He agrees that the visual acuity is a concern and consults an ophthalmologist. It is discovered that Mr. Goodman has increased intraoc ular pressure, and it may be a result of suborbital edema which will require STAT surgical decompression to preserve his sight. Mr. Goodman is irate, starts yelling at the nurse, and accidentally pulls out his IV. He believes they have caused him permanent disfigurement and now blindness. The nurse must restart his IV and obtain another surgical consent. 1- Assure patient that surgery is necessary to preserve his sight, and that this should not be permanent 2- Take vital signs and position patient 30 degrees upright 3- Restart patients IV 4- Obtain surgical consent 5- Remain with patient John Davis | Room 304 Patient Overview John_Davis.jpgJohn Davisis a 54 y/o male admitted for surgical resection and biopsy of multiple lesions on his back and shoulders. The patient is fair skinned with multiple moles on his shoulders and anterior and posterior torso. The patient is high risk f or basal cell carcinoma and has had mole - mapping. Mr. Davis is very thin and reports an 8 lbs. weight loss over the last four months. He owns a landscape business, works outside, he also enjoys being out on his boat . He had a basil cell carcinoma removed from his forehead four years ago (Mohs micrographic surgery) which has left a large scar. Mr. Davis is concerned about potential scars from these lesions. He denies any other health issues. The patient does not smoke , but drinks 2 beers after work daily and more on the weekends. VS BP 150/89, P 62, R 14, T 98.2. Educational Needs - Increased Fall Risk - Normal Health Change - Increased Neurological - Normal
