John Davis - Concepts of Nursing III PDF

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Concepts of Nursing III...

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John Davis Room 301 John Davis is 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 for 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.

You responded correctly to 6 out of 6 evaluations: Category Fall Risk Health Change Pain Level Psychological Needs Educational Neurological Status

Your response Normal Increased acuity Normal Normal

Explanation No indication of impairment Patient has recently lost weight and has several lesions No indication of pain No indication of increased need

Increased acuity Normal

Patient needs teaching on risks of sun exposure No indication of increased need

John Davis John Davis is 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 for 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.

You correctly diagnosed 6 out of 6 options: Physiological Description Acute Pain Chronic pain Impaired Confort Nausea Safety

Description Deficient knowledge grieving

Your Response False False False False

Explanation No indication No indication No indication No indication

Your Response Explanation True Patient has recently lost weight and has several lesions False No indication

John Davis Scenario 1 The surgery went well, he had one partial thickness lesion on his shoulder and one of the lesions on his back are full thickness that will require staged closure or a possible skin graft. He has a 4x4 dressing on his right shoulder, two large dressings, and two smaller dressings on his back. His vital signs are stable. He has an IV NS to his left hand @ TKO. He received 2 liters intraoperatively. He was given Fentanyl 100 mg and Zofran 4mg in the PACU. The patient asks if he can go to the bathroom because he needs to void immediately.

You correctly ordered 5 out of 5 actions: Is this order correct Your Correc orde t r order Step Explanation 1 1 Offer patient a Patient has asked to void urinal and assist to immediately. Mitigates risk bedside, if needed to ambulate to the bathroom. Reduces anxiety to complete assessment and possible hypertension Post-operative head-to-toe 2 2 Perform post-op assessment is necessary assessment to after surgery include visual inspection of dressings, vital signs, pain 3 3 Assist patient to a To encourage patient comfort, reduce anxiety and comfortable pain position in bed 4 4 Tell patient not to Educate patient to prevent fall post-anesthesia get out of bed without assistance 5 5 Ensure side rails Ensures patient safety and are up and call light reinforces the need to call for assistance is within reach

John Davis Scenario 2 The patient has been made aware that he has advanced basal cell carcinoma and has a poor prognosis. The largest dressing is saturated with serous sanguineous fluid. The patient is complaining of 8/10 pain from two of the partial thickness incisions on his back (he will need skin graft soon). Patient states the larger dressings on his back that are full thickness do not hurt at all. The patient has an order for dressing changes PRN. The patient is awaiting orders for chemotherapy. VS BP 162/90, P 99, R 20, T 98.9.

You correctly ordered 5 out of 5 actions: Is this order correct Your Correc orde t r order Step 1 1 Assess the large dressing site (full thickness)

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Explanation Assessment should always be priority when caring for the patient. There is a significant amount of drainage and absence of pain indicates nerve endings are removed Administer pain Once assessment is medication as complete, patient comfort is ordered necessary prior to dressing change and to alleviate pain Assess dressing Obtaining supplies can be supply needs and completed once needs are obtain understood after assessment. Reducing the number of times entering/leaving the room reduces infection. Assess patient’s As a result of new diagnosis. need for emotional Administration of pain support and medication requires a followevaluate up assessment effectiveness of pain medication Document color Baseline drainage and amount of assessment will help with wound drainage on future evaluation dressing

John Davis Scenario 3

The nurse’s aide reports that the Mr. J did not eat any of his lunch or dinner. The surgeon and oncologist had visited with the patient that morning. When the patient is asked about his appetite the patient states that he is nauseated. The SL is occluded. The orders came to initiate Chemotherapy: vismodegib (Erivedge) is 150mg orally daily. The sonidegib (Odomzo) dose is 200 mg orally daily taken on an empty stomach, at least 1 hour before or 2 hours after a meal. Zofran 4mg IV PRN

You correctly ordered 5 out of 5 actions: Is this order correct Your Correc orde t r order Step 1 1 Restart new IV 2

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Explanation IV must be replaced to administer nausea medication Administer nausea Patient is complaining of medicine nausea and prior to administering chemotherapeutic agents Assess for Determine if patient has contraindications allergies, review CBC/WBC to Chemotherapy and other labs to include electrolytes and liver function studies. Must be completed prior to administering chemotherapeutic agents. Weigh the patient Most chemotherapeutic and verify dosage agents are weight based and must be verified prior to administration VS must be taken Take VS and immediately prior to provide patient administering teaching on chemotherapeutic agents and chemotherapy 15 minutes post prior to infusion. administration. Patient

Your Correc orde t r order

Step

Explanation education must be done so the patient can alert the nurse is they are having side effects.

John Davis Scenario 4 The nurse is still concerned about the patient’s appetite the next day, 3 days post-op. The patient will be seeing an oncologist before his discharge and the surgeon has stated that he will need to have several more lesions removed ASAP. The patient has learned that his cancer is stage 4 basal cell and has metastasized. He has not been ambulating and has been laying on his back most of the time. When changing the dressings, the nurse notices that the one of wounds on his back appears inflamed and reddened as well. VS BP 150/80, P 82, R 14, T 100.8

You correctly ordered 5 out of 5 actions: Is this order correct Your Correct order order Step 1 1 Complete full assessment and inspect patient’s wounds 2 2 Apply clean dressing to all wounds 3

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Encourage patient to change body position and not lie on wounds Continue to encourage nutrition and fluids

Explanation Patient’s physical change necessitates a new assessment Assess breakdown of skin integrity and possible infection Promotes wound healing by removing pressure on skin Nutrition and hydration are necessary for healing

Your Correct order order Step Explanation 5 5 Document and inform The HCP needs to be HCP of wound changes aware of possible wound infection

John Davis Scenario 5 The doctor has chosen to pursue a more aggressive chemotherapy agent related to metastasizing cancer and side effects (muscle cramps and gastrointestinal discomfort). The patient will continue chemotherapy after discharge and is being counseled for the placement of a peripherally inserted central catheter (PICC) and why he needs it. The patient will be receiving his chemotherapy from an outpatient infusion clinic. The patient is still not eating and seems complacent in his care. When inquiring about his support system the patient states that running a business does not allow much time for friends or family.

You correctly ordered 5 out of 5 actions: Is this order correct Your Correc orde t r order Step 1 1 Assess patients concerns and understanding plan of care and current treatment 2 2 Teach patient about the benefits of a picc line with chemotherapeutic agents 3 3 Make referral to the infusion clinic to verify

Explanation To increase compliance with patient teaching plan

To prevent infection and avoid other complications

To ensure the patient has contact

Your Correc orde t r order

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Step appointments

Explanation information/schedule for the infusion clinic Discuss with patient if Patient may lacks social he has any support and the inability transportation to drive themselves. Have patient verbalize To determine if patient understanding of understands the plan of treatment and future care and support needs and services services...