Vernon Watkins (week 9 worksheet) PDF

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CONCEPT MAP WORKSHEET DESCRIBE DISEASE PROCESS AFFECTING PATIENT (INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS) Thepa t i e nt , Mr . Wa t ki nsi sa6 9ye a r ol dma l ewhounde r we ntahe mi c ol e c t omy . Hehasami dl i neabdomi na li nc i s i on wi t houtr e dne s s , s we l l i ng, ordr ai na ge . Hehasr e f us e dt oambul a t ebe c aus eoff a t i guea ndas or el e g .Asapos t ope r a t i ve pa t i e nt ,hei sa tr i s kf orc ompl i c a t i onss uc ha sa t e l e c t a s i s ,pne umoni a ,de e pv e i nt hr ombos i s ,pul mona r ye mbol i s m, c ons t i pa t i on,pa r al yt i ci l e us , andwoundi nf e c t i on. Hi spul monar ye mbol i s m( PE)i smos tl i ke l yt her e s ul tofde e pve i n t hr ombos i sr e l a t e dt os ur ge r ya ndde c r e a s e dmobi l i t y . Pul mona r yEmbol i s m( PE)i st hebl oc ka geof1ormor epul mona r yar t e r i e sb yat hr ombus ,f a tora i re mbol us ,o rt umor t i s s ue .A PEc ons i s t sofma t e r i a lt ha tgai nsa c c e s st ot heve nouss ys t e ma ndt he nt ot hepul mona r yc i r c ul a t i on.Thee mbol us t r a ve l swi t hbl oodflow t hr oughe ve r s ma l l e rbl oodve s s e l sunt i li tl odge sandobs t r uc t spe r f us i onoft hea l ve ol i .Thel owe r l obe soft hel unga r emos tof t e na ffe c t e d.Mos tPEsa r i s ef r om de e pve i nt hr ombos i s( DVT)i nt hede e pve i nsoft hel e gs . Le wi sMe dSur gpg .5 3 2

DIAGNOSTIC TESTS PATIENT INFORMATION (REASON FOR TEST AND RESULTS) At er i a lBl oodGa s : t e s tme as ur e st he a mount sofa r t e r i a lga s e s ,s uc ha soxyge n a ndc a r bondi oxi de . oduc e si ma ge soft he Che s tXRa y:pr he a r t , l ungs , a i r wa ys ,bl oodve s s e l sa nd t hebone soft hes pi neandc he s t . Spi r alCTSc a n:wi l lhe l pfindpr obl e ms s uc ha si nf e c t i on,l ungc a nc e r ,bl oc ke d bl oodflow i nt hel ung( pul mona r y

ANTICIPATED PHYSICAL

NAME: Ve r nonWa t ki ns DOB:0 4 /0 9 /1 9 51 GENDER: Mal e WEI GHT:8 0 kg HEI GHT:1 8 2 c m ALLERGI ES: Pe ni c i l l i n Admi nDX: Pos t ope r a t i ve He mi c ol e c t omy Pr ovi de r :n/a

e mbol i s m) ,a ndot he rl ungpr obl e ms . Ve nousBl oodAna l ys i s :us e dt oa s s e s s a c i dbas es t a t usal ongwi t hade qua c yof ve nt i l a t i onandoxyge na t i on

FINDINGS -

Dys pne a Hypo x e mi a Ta c hypne a Cough Che s tpai n He mopt ys i s Cr a c kl e s Whe e z i ng Fe ve r Ac c e nt ua t i onofpul moni che ar t s ound Ta c hyc a r di a S ync ope Sudde nc ha ngei nme nt a ls t a t us Hypot e ns i on Fe e l i ngsofi mpe ndi ngdoom.

ANTICIPATED NURSING INTERVENTIONS 1 . 2 . 3 . 4 . 5 . 6 . 7 . 8 .

Pr ovi dea de qua t et i s s uepe r f us i ona ndr e s pi r a t or yf unc t i ondur i ngs hi f t . Pr e ve ntf ur t hergr owt hore xt e ns i onoft hr ombii nt hel owere xt r e mi t i e sdur i ngs hi f t . Pr e ve nte mbol i z a t i onf r om t heupperorl owe re xt r e mi t i e st ot hepul mona r yvas c ul ars ys t e m. Pr e ve ntf ur t herr e c ur r e nc eofPEdur i ngs hi f t . Foc us e da s s e s s me ntofpa t i ent ’ sc ar di opul monar ys t a t us Oxygenadmi ni s t r a t i onbymas korc annul a( whe nhypox e mi ai spr e s e nt )a sor der e d. Re que s tABG a nal ys i s . Tur npa t i ent , e nc our a gec oughi ng, dee pbr e a t hi ng, andi nc e nt i ves pi r ome t r yt ohe l ppr e ve ntort r e a t a t e l ec t as i s . 9 . Admi ni s t e rpai nmedi c a t i on 10. Teachpat i entaboutc ondi t i on.

vSim ISBAR ACTIVITY INTRODUCTION

STUDENT WORKSHEET SHARON TEBI, RN, Surgical Unit

Your name, positon (RN), unit you are working on

SITUATION Patent’s name, age, specific reason for visit

BACKGROUND Patent’s primary diagnosis, date of admission, current orders for patent

ASSESSMENT Current pertnent assessment data using head to toe approach, pertnent diagnostcs, vital signs

Thepa t i e nt ,Ve r nonWa t ki nsi sa6 9 ye ar ol dmal ewhopr e s e nt e dt ot he Eme r ge nc yDe pa r t me nt4da ysa gowi t hc ompl a i nt sofna us e a , vomi t i ng, and s e ve r eabdomi nalpa i nandwa sa dmi t t e df ore me r ge nts ur ge r yf orbowe l pe r f or a t i on.Heunde r we ntahe mi c ol e c t omy.Hehasr e f us e dt oambul a t et hi s mor ni ngbe c aus eoff a t i guea ndas or el e g,a ndi se x hi bi t i ngs i gnsofPE

ThePa t i e ntpr e s e nt e dt ot heEme r ge nc yDe pa r t me nt4da ysa gowi t h c ompl a i nt sofna us e a ,v omi t i ng, ands e ve r eabdomi na lpa i nandwasadmi t t e d f ore me r ge nts ur ge r yf orbo we lpe r f or a t i on.Heunde r we ntahe mi c ol e c t omy . Hehasami dl i nea bdomi na li nc i s i onwi t houtr e dne s s ,s we l l i ng, ordr ai na ge . Hei st ol e r a t i ngas of tdi e twi t houtnaus e aorvomi t i ng.Bowe ls oundsar e pr e s e nti na l lf ourabdomi na lqua dr a nt s .Hehadabowe lmove me nty e s t e r da y . Hei sr e l uc t a ntt ous et hei nc e nt i v es pi r ome t e r , buthi swi f ee nc our a ge shi mt o dohi sde e pbr e a t hi ng. Abdomi na lpa i nhasbe e nc ont r ol l e dwi t hmor phi ne . He ha sr e f us e dt oambul a t et hi smor ni ngbe c aus eoff a t i guea ndas or el e g .The HCPor de r e d: - Re gul a rdi e t - Cont i nue sECG, SpO2moni t or i nga ndvi t a ls i gnse v e r y4hr s - Oxyge nt oma i nt a i nS pO2>9 2% - Che s tXr a y - Spi r alCTSc anwi t hc ont r a s t - Pr ot hr ombi nTi me ,a c t i va t e dpa r t i a lt hr ombopl a s t i nt i meandDdi me ri n6 hr s - I Vhe pa r i nPr ot oc ol - Re que s tABGs t a t /l a bs - Me di c a t i ona dmi ni s t r a t i on 1 . Mor phi nes ul pha t e4–6mgI Vpus he ve r y4 hr sPRN pa i n 2 . He pa r i n80 U/kgBol us ,t he1 8U/kgpe rhrI V( He pa r i n 2 5 , 00 0uni t si n25 0mLde xt r os e5 %i nwa t e r )

1 . 2 . 3 . 4 .

Mi dl i neabdomi na li nc i s i oni swi t houtr e dne s s ,s we l l i ng,ordr a i na ge Hei st ol e r a t i ngas of tdi e twi t houtnaus e aorvomi t i ng Bowe ls oundsa r epr e s e nti na l lf oura bdomi nalqua dr ant s Pa t i e nti sr e l uc t a ntt ous et hei nc e nt i v es pi r ome t e r , butdoe sde e p br e a t hi ng 5 . Pa t i e ntr e f us e dt oambul a t eduet of a t i guea ndas or el e g. 6 . Thebr e a t hs oundsa r enor mal . 7 . The r ea r enor ma lhe a r ts ounds 8 . He ’ sbr e a t hi nga t2 4br e a t hspe rmi nut e , wi t ht hec he s tmo vi ng nor mal l yonbot hs i de s . 9 . Bl oodpr e s s ur ei sa t1 54 /9 2mm Hg 1 0 .Ra di a lpul s ei ss t r ong, 11 0pe rmi nut ea ndr e gul a r . 1 1 .Di ffic ul t ybr e a t hi ng,pa i ni nc he s ta ndl e ga ta bouta3 . 1 2 .Pa t i e nts t a t us-ECG: Si nust a c hyc a r di awi t hs i gnsofpul mona r y hype r t e ns i on.He ar tr a t e : 1 1 0. Pul s e : Pr e s e nt . Bl oodpr e s s ur e :1 5 5 /9 3 mm Hg .Re s pi r a t i on: 2 4. Cons c i ouss t a t e :Appr opr i a t e .SpO2 :9 0 %. Te mp: 99F( 3 7C) 1 3 .I Vs i t ea nddr e s s i ngha dnor e dne s s ,s we l l i ng,i nfil t r a t i on, bl e e di ng,or dr ai na ge . Thedr e s s i ngwa sdr ya ndi nt a c t . 1 4 .Pa t i e nti sal l e r gi ct ope ni c i l l i n. 1 5 .Re que s t e df ora na r t e r i a lbl oods a mpl e , c he s tx r a ya nds pi r alCTs c an oft hec he s t 1 6 .Pe da lpul s ei ss t r ong,1 1 0pe rmi nut ea ndr e gul a r .

1 7 .Pa t i e nt ' sr i ghtl e gs e e mss wol l e n,t he r ei snor mals ki nt ur gor , hi ss ki n i sc ool , a ndhei sve r ys we a t y . 1 8 .Gl a s gow ComaSc a l e( GCS)a s s e s s me ntpr ove dpa t i e ntt obea t1 5 .

RECOMMENDATION Any orders or recommendatons you may have for this patent

- Cont i nue sECG, SpO2moni t or i nga ndvi t a ls i gns - Admi ni s t e rme di c a t i onsa sor de r e dandl ookoutf ora nys i dee ffe c t s . - Ens ur epa t i e nte duc a t i oni se ffe c t i vea nddot e a c hba c k

PATIENT EDUCATION WORKSHEET NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE MEDICATION: Heparin Sodium

CLASSIFICATION: Anticoagulant

PROTOTYPE: Heparin SAFE DOSE OR DOSE RANGE, SAFE ROUTE 

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Ful l dos ec ont i nuousI Vi nf us i ont he r a pyf orDVTorPE: Adul t s : I ni t i a l l y , 5 , 0 0 0uni t s( or8 0uni t s /kg)byI Vbol us ; t he n 2 0 , 00 0t o4 0 , 0 0 0uni t s /da y( or1 8uni t s /kg/hour )byI Vi nf us i onwi t hpump. Ti t r a t ehour l yr a t ebas e donaPTTr e s ul t s ( e ve r y4t o6hour si nt hee a r l ys t a ge soft r e a t me nt ) . Ful l dos es ubc utt he r a pyf orDVTorPE Ad ul t s : I ni t i al l y ,5 , 0 00uni t sI Vbol usa nd10 , 00 0t o2 0 , 0 0 0uni t si nac onc e nt r a t e ds ol ut i ons ubc ut ; t he n8 , 0 0 0t o10 , 0 00 uni t ss ubc ute ve r y8hour sor15 , 0 0 0t o20 , 0 00uni t si nac onc e nt r a t e ds ol ut i ons ubc ute ve r y1 2hour s . Ful l dos ei nt e r mi t t enta nt i c oa gul a t i onI Vt her a pyf orDVTorPE Ad ul t s : I ni t i al l y ,1 0 , 00 0uni t sbyI Vbol us ; t he n5 , 0 0 0t o1 0, 0 00uni t s( or5 0t o70uni t s /kg)I Ve ve r y4t o6hour st i t r a t e d a c c or di ngt oaPTT. Fi x e dl owdos et he r a pyf orpr e ve nt i onofve noust hr ombos i s ,PE, e mbol i s ma s s oc i a t e dwi t ha t r i a lfibr i l l a t i on,a nd pos t ope r a t i veDVT Ad ul t s : 5, 0 00uni t ss ubc ute ve r y1 2hour s . I ns ur gi c a lpa t i e nt s , gi v efir s tdos e2hour sbe f or epr oc e dur e ; t he n5 , 0 0 0uni t s s ubc ute ve r y8t o1 2hour sf or5t o7da ysorunt i lpa t i e ntc anwa l k.

PURPOSE FOR TAKING THIS MEDICATION Dr ugt he r a pyf orDVTorPE. I ta c c e l e r a t e sf or ma t i onofant i t hr ombi nI I I – t hr ombi nc ompl e xa ndde ac t i va t e st hr ombi n,pr e ve nt i ng c onve r s i onoffibr i noge nt ofibr i n.

PATIENT EDUCATION WHILE TAKING THIS MEDICATION    

I ns t r uc tpa t i e nta ndf a mi l yt or e por ta l la dve r s er e ac t i ons . Advi s epa t i e ntandf ami l yt owa t c hf ors i gnsa nds ympt omsofbl e e di ngorbr ui s i ngandt onot i f ypr e s c r i be r i mme di a t e l yi fanyoc c ur . Te l lpa t i e ntt oa voi dOTCdr ugsc ont ai ni nga s pi r i n,ot he rs al i c yl a t e s ,ordr ugst ha tma yi nt e r ac twi t hhe par i n unl e s sor de r e dbypr e s c r i be r . Advi s epa t i e ntt oc ons ul tpr e s c r i be rbe f or es t ar t i nghe r balt he r a py;ma nyhe r bsha vea nt i c oa gul ant , a nt i pl a t e l e t ,orfibr i nol yt i cpr oper t i e s .

PATIENT EDUCATION WORKSHEET NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE MEDICATION: Morphine Sulphate

CLASSIFICATION: Opioid Analgesic

PROTOTYPE: Morphin SAFE DOSE OR DOSE RANGE, SAFE ROUTE I ni t i a l :10mge ve r y4hour sa sne e de d;i fpai ni snotr e l i e ve d,ma yi nc r e as edos ea st ol e r a t e d.Ma ygi veupt o30mg e ve r y4hour sasne e de df ors e ve r e ,ac ut epai ni nhos pi t al i z edpa t i e nt sa tl ow r i s kf orr e s pi r a t or yde pr e s s i on

PURPOSE FOR TAKING THIS MEDICATION Mor phi nei si ndi c a t e df ort her e l i e fofs e ve r eac ut ea nds e ve r ec hr oni cpai n.Forc ont r olofs e ve r e ,c hr oni cpa i ni n pa t i e nt swi t hc e r t ai nt e r mi naldi s e as e s ,t hi sdr ugs houl dbeadmi ni s t e r e donar e gul a r l ys c he dul e dba s i s ,e ve r y4 hour s ,a tt hel owe s tdos a gel e ve lt ha twi l lac hi e vea de qua t ea na l ge s i a .

PATIENT EDUCATION WHILE TAKING THIS MEDICATION 

t e l lyourdoc t ora ndphar ma c i s ti fyoua r ea l l e r gi ct omor phi ne ,a nyot he rme di c a t i ons , ora nyoft hei na c t i ve i ngr e di e nt si nt het ypeofmor phi nepr oduc tyoupl a nt ot a ke .

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t e l lyourdoc t ora ndphar ma c i s twha tpr e s c r i pt i ona ndnonpr e s c r i pt i onme di c a t i ons , vi t a mi ns ,nut r i t i onal s uppl e me nt s , a ndhe r ba lpr oduc t syoua r et a ki ngorpl a nt ot a ke . t e l lyourdoc t orwha the r ba lpr oduc t syoua r et a ki ng,e s pe c i a l l ySt .J ohn' swor ta ndt r ypt ophan.

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t e l lyourdoc t ori fyouha veorha vee ve rhada nyoft hec ondi t i onsme nt i one di nt heI MPORTANTWARNI NGs e c t i on orpar a l yt i ci l e us( c ondi t i oni nwhi c hdi ge s t e df ooddoe snotmovet hr ought hei nt e s t i ne s ) .

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t e l lyourdoc t ori fyouha veorha vee ve rhadabl oc ka gei ny ours t oma c hori nt e s t i ne s ;s e i z ur e s ; di ffic ul t ys wal l owi ng; pr os t a t i chype r t r ophyorl i v e r , ki dne y ,pa nc r e a s , t hyr oi d, orgal l bl a dde rdi s e as e .

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t e l lyourdoc t ori fyoua r ebr e a s t f e e di ng.

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yous houl dknow t ha tt hi sme di c a t i onma yde c r e a s ef e r t i l i t yi nme na ndwome n. Ta l kt oyourdoc t ora boutt her i s ks oft a ki ngmor phi ne .

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i fy oua r eha vi ngs ur ge r y ,i nc l udi ngde nt a ls ur ge r y , t e l lt hedoc t ororde nt i s tt ha tyoua r et a ki ngmor phi ne .

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yous houl dknow t ha tt hi sme di c a t i onma yma keyoudr ows y . Donotdr i veac a rorope r a t ema c hi ne r yunt i lyou know how t hi sme di c a t i onaffe c t syou.

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yous houl dknow t ha tmor phi nema yc a us edi z z i ne s s , l i ght he a de dne s s , a ndf a i nt i ngwhe nyouge tupt ooqui c kl y f r om al yi ngpos i t i on.T oa voi dt hi spr obl e m, ge toutofbe ds l owl y ,r e s t i ngyourf e e tont hefloorf oraf e w mi nut e s be f or es t a ndi ngup.

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yous houl dknow t ha tmor phi nema yc a us ec ons t i pa t i on. Ta l kt oyourdoc t ora boutc hangi ngyourdi e torus i ngot he r me di c a t i onst opr e v e ntort r e a tc ons t i pa t i onwhi l eyoua r et a ki ngmor phi ne .

Clinical Worksheet Date: 10-29-2020

Student Name: SHARON TEBI

Initials: VW

Diagnosis: PE

Age: 59y

Length of Stay: n/a

M/F: M

Allergies: Penicillin

HCP: n/a

Consults: n/a

Assigned vSim:VERNON WATKINS

Isolation: n/a

IV Type: Heparin

Fall Risk: Yes

Location: Right arm

Transfer: n/a

Code Status: n/a

Fluid/Rate: 80U/kg STAT and 18U/Kg/hr

Other Services: Critical Labs: - Spiral CT scan pH (7.34-7.46) 7.49 - Chest X-ray HCO3- (22-26mEq/L) 21.1 PCO2 (33-46 mmHg) 26 PO2 (75-100 mmHg) 56 Consults Needed: n/a SaO2 (>95%) 88 Cl- (60-100 mEq/L) 102 D-dimer (...