NAME: Carol Reece

AGE:     77 years old

DOB:     July 11, 1942

WEIGHT:   160 pounds (73kg)

HEIGHT: 61 inches (155cm)

Past Medical History: HTN, DM II, sore on the right heel that had progressed to a Grade 4 decubitus ulcer

She lives in a high rise public housing complex for elderly residents. The housing complex has a reputation for poor sanitation. Ms. Reece has a home health aide who visits once a week and a wound nurse who visits once weekly as well.

Home health aide called 9-1-1 when she arrived to find Ms. Reece in bed covered in vomit and a weak thready pulse.

She arrives via basic life support (emergency medical technician) ambulance with only oxygen in place.

1. From the provided information, what are your concerns?

2. What orders do you anticipate for this client?

3. What supplies do you anticipate you will need to care for this client?

Carol Reece

DOB: July 11, 1942

MR: 45928412 - CR

• Aspirin 81mg PO per day
• Metformin XR 2000mg PO once per day in morning
• Metoprolol 20mg PO per day
• HCTZ 25 mg PO per day in the morning
• Lisinopril 20 mg PO once per day in the evening
• Normal Saline 1000ml IV bolus now
• Normal Saline 250ml/hr IV after bolus

Order Set

• 2 Large bore peripheral IVs (Both already started)
• Assess breath sounds every 10 minutes
• Vital signs every 5 minutes
• 12 Lead EKG STAT
• Continuous EKG monitoring
• Oxygen at level to maintain SpO2 of >95%
• LABS: CBC with diff, CMP, lactic acid, Blood Culture x2, troponin, CRP (Already drawn and sent to lab)

Simulation #1 Information and Questions:

The client is severely confused and does not answer questions appropriately.

1. What ESI Level would you triage this patient as? Why?

2. What is your priority assessment?

3. What are your priority interventions?

4. What labs do you anticipate the physician will order?

Simulation #1   Post-Simulation Questions:

Lab Values: Lactic Acid 5.6, WBC 34

1. What are the phases of shock? What phase do you think this patient is in? Why?

2. What are the signs/symptoms of sepsis?

3. What does the elevated lactic acid level indicate?

4. You assess the patient’s urine output and measure 10ml/hr. How would you define this level of urine output? What would be your priority action?

5. During your assessment you also note that your patient is experiencing hypovolemic shock. What interventions would be appropriate?

NAME: Carol Reece

AGE:     77 years old

DOB:     July 11, 1942

WEIGHT:   160 pounds (73kg)

HEIGHT: 61 inches (155cm)

Past Medical History: HTN, DM II, sore on the right heel that had progressed to a Grade 4 decubitus ulcer

She lives in a high rise public housing complex for elderly residents. The housing complex has a reputation for poor sanitation. Ms. Reece has a home health aide who visits once a week and a wound nurse who visits once weekly as well.

Home health aide called 9-1-1 when she arrived to find Ms. Reece in bed covered in vomit and a weak thready pulse.

She arrives via basic life support (emergency medical technician) ambulance with only oxygen in place.

1. From the provided information, what are your concerns?

2. What orders do you anticipate for this client?

3. What supplies do you anticipate you will need to care for this client?

Carol Reece

DOB: July 11, 1942

MR: 45928412 - CR

• Aspirin 81mg PO per day
• Metformin XR 2000mg PO once per day in morning
• Metoprolol 20mg PO per day
• HCTZ 25 mg PO per day in the morning
• Lisinopril 20 mg PO once per day in the evening
• Normal Saline 1000ml IV bolus now
• Normal Saline 250ml/hr IV after bolus

Order Set

• 2 Large bore peripheral IVs (Both already started)
• Assess breath sounds every 10 minutes
• Vital signs every 5 minutes
• 12 Lead EKG STAT
• Continuous EKG monitoring
• Oxygen at level to maintain SpO2 of >95%
• LABS: CBC with diff, CMP, lactic acid, Blood Culture x2, troponin, CRP (Already drawn and sent to lab)

Simulation #1 Information and Questions:

The client is severely confused and does not answer questions appropriately.

1. What ESI Level would you triage this patient as? Why?

2. What is your priority assessment?

3. What are your priority interventions?

4. What labs do you anticipate the physician will order?

Simulation #1   Post-Simulation Questions:

Lab Values: Lactic Acid 5.6, WBC 34

1. What are the phases of shock? What phase do you think this patient is in? Why?

2. What are the signs/symptoms of sepsis?

3. What does the elevated lactic acid level indicate?

4. You assess the patient’s urine output and measure 10ml/hr. How would you define this level of urine output? What would be your priority action?

5. During your assessment you also note that your patient is experiencing hypovolemic shock. What interventions would be appropriate?

Scenario #2 Pre-Simulation Information:

NAME: John Tram

AGE:     49 years old

DOB:     December 2, 1970

WEIGHT:   235 pounds (107 kg)

HEIGHT: 72 inches (183 cm)

PMH: HTN, Herpes Zoster

John Tram is a 49 yo male that has been diagnosed with Herpes Zoster that was prescribed Acyclovir 800mg po five times daily. John took 2 doses and after the 2^nd dose noticed facial and oral swelling, increased difficulty breathing, and difficulty swallowing. These symptoms started about 1 hour ago and have been getting progressively worse.

He arrives in the emergency department for treatment.

1. From the provided information, what are your concerns?

2. What orders do you anticipate for this client?

3. What supplies do you anticipate you will need to care for this client?

John Tram

DOB:     December 2, 1970

MR: 4328469 - JT

MEDICATIONS

• Epinephrine 0.3mg IM of 1:1000 concentration STAT; repeat in 10 min prn
• Solumedrol 125mg IVP now
• Diphenhydramine 50mg IVP now
• Ranitidine 50mg IVP now
• IV NS fluid bolus of 1000mL now

ORDER SET

• 2 Large bore peripheral IV (Both already started)
• 12 Lead EKG
• Assess breath sounds every 10 minutes
• Vital signs every 10 minutes
• Continuous EKG monitoring
• Oxygen at level to maintain SpO2 of >95%

Scenario #2 Simulation Information and Questions:

The nurse assesses the client and notes wheezing, severe hypotension, tachycardia, edema of the tongue and throat.

1. What ESI Level would you triage this patient as?

2. What are your priority assessments?

3. What are your priority interventions?

Scenario #2   Post-Simulation Questions:

1. What route(s) can epinephrine be administered? What is the concentration for epinephrine for the treatment of anaphylaxis?

2. Describe the mechanism of action for the medications ordered for the treatment of anaphylaxis.

3. What are signs/symptoms of anaphylactic shock?

4. What education will you provide to this patient prior to discharge?

Apply the nursing Process to the following

Hypothetical situation

Mrs. Rojas, 30 years old, came to the emergency room with a cold two weeks ago, she presented dyspnea (difficulty breathing). It indicates that you have a fever, headache for several days, chest pain, and you have to sit up to breathe well. Also, complaints of chills have decreased fluid intake 2 days ago. On physical examination temp. 39.5C, pulse 92 reg., Strong, Resp. 22 / min. Superficial. B / P 122/80., Dry mouth mucosa, pale, hot skin, reddened cheeks. Decreased vesicular and crackling sounds on inspiration in the right upper and lower lobe. Its thoracic expansion is 3 cm., Scant cough, dense sputum of light pink color. Lethargic, weak, and fatigued appearance. The doctor suspects that this may have the diagnosis Influenza A H1N1.
After reading the situation, answer the following questions;
1.After reading and analyzing the situation, identify the estimated data, and classify them as subjective and objective.

2. Mention the problems that you infer in this situation?

3. According to the NANDA category, which nursing diagnosis applies in this situation. (It must include Problem, etiology and symptoms).

4. Develop the expected result for this Situation

5.Develop nursing interventions such as coordinating and managing
Care of this patient, include the nursing orders and justification for each intervention. (Complete the table).

                   Nursing orders                                    Justification                              

6. Mention what legal ethical implications should be considered in this condition.

7. List and define the six nursing steps and define them.

outcome

Care providers to individuals in different settings, understanding cultural variations, effective communication based on their learning style.
 Coordinator and care manager in situations that require problem-solving and uses principles of delegation when warranted.
Practice the profession according to the legal framework of the profession's standards.
Uses the nursing process as a framework to develop, implement, and evaluate the care plan for the healthy individual or with a minimum of alterations.
 Information management.

What are your thoughts about how you would provide care for the family members after the death of the child?

Give a brief description of how you can identify these anomalies:

a. A First Degree AV block __________________________________________________

b. A second Degree AV block Type I __________________________________________

c. A second degree AV block Type II ___________________________________________

electrode placement:

V5 is placed where? ____________________________________________________________

Midclavicular(vertical) line and 5th intercostal space is lead _____________________

How do you find lead V3? __________________________________________________________

Perform a mini literature review on a barrier that needs to be addressed in the improvement of health care. Provide an overview of one article related to the health care issue that supports the need for improvement.

You have a hypovolemic person (due to dehydration) in Metabolic Acidosis with a history of Hypertension and Chronic Kidney Disease.

Draw or write about what is happening before and during the Pre-Renal and Intra-Renal phases related to their state.

Question 1: In at least 150 words, in what ways if any, do the value of spirituality demonstrate your commitment to helping others grow and building community at your school? Be specific (at least 150 words)

1.Your patient, Jessie Baer, is a member of the Native American community. It is of critical importance that nurses develop cultural competence. Discuss the key components of cultural competence.

2.The diet of the pregnant woman with diabetes is individualized to account for increased fetal and metabolic requirements. Discuss the factors that should be considered when formulating Jessie Baer's plan of care.

3.A glucose reflectance meter or biosensor monitor is the commonly accepted method for monitoring blood glucose levels at home. Describe the procedure for self-care blood glucose testing.

1.Describe in detail the pathophysiology for anemia and hypothyroidism.
2.Findout if any,Relationship between anemia and hypothyroidism when pateint have lung cancer in detail.

• He sought consult at the ER Department due to 2^nd degree burns on the anterior head and neck, anterior thorax, abdomen, and groin area.
• His weight is 70 kgs.Male ,34,Male
• Lactated Ringer's Solution was ordered for fluid resuscitation for a specific amount of time.
• Pain relievers were given to relieve pain. Silver sulfadiazine was also ordered for wound care.
• VS: BP – 130/80, PR – 102 BPM, RR – 24 CPM, T^o – 37.6 ^OC, SPO2 – 96%.

Case Scenario:

NOI: 2^nd Degree Burns

DOI: October 25, 2020

TOI: 5:00 pm

POI: At the University's Chemical Laboratory

Physical Assessment and Review of System

Case study

• Explain the relationship between fluid and electrolyte balance and chronic kidney disease

• Explain the pathophysiology of the disease and discuss common clinical manifestations for chronic renal failure