Virtual Clinical-wk4 - nursing PDF

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Virtual Clinical- Swift River Week 4 What was the priority nursing assessment (s)? -

Russel Montgomery- Spinal Injury: assess neuro, musculoskeletal, respiratory

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Thomas Bechman- Gout & Dementia: assess integumentary, neuro, musculoskeletal, endocrine (for levothyroxine) Louis Hutchinson- Amyotrophic lateral sclerosis (ALS): musculoskeletal, neurological, integumentary

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Nora Gentry- Dimentia, HTN- cardiac, nurologic

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Ottis Williams- Alzheimer’s- neurologic, musculoskeletal,

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Thomas Koenig- Bilateral Amputee, Pacemaker- cardiac, integumentary, musculoskeletal

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Ronald Burgundy- News Reporter-Explosion- integumentary, respiratory, cardiac, neurological, musculoskeletal

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Richard Dominec- emergent appendectomy- abdominal, cardiac,

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Janene Whitmore- cardiac, abdominal, reproductive,

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Mary Barkley- respiratory infection, COVID-19+, lupus- respiratory,

Did you obtain the pertinent data? 3 pt. Identifiers Pt. allergies before medication administration Give two examples of communication components that were necessary to take care of the client (s)? How did these components help you (rationale)? -

The phone rings, indicating that there is a new patient to admit.- RN "I need something for sleep."- LPN "Mrs. Blakemore has a fever of 102.5 again."- LPN Several call lights are on at once and you are not available to answer them.- CNA "I am not eating this fish please get me something else."- LPN Housekeeping tells you there is a call light on, but no answer from patient.- CNA "My bed is wet. Can I be changed now?"- RN (only person available) Housekeeping tells you patient on other hall states they can't catch their breath and need help.- RN Family tells you another patient just threw up everywhere.- CNA

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"My IV site is burning me now."- RN RN comes and tells you Mrs. Smith just fell from chair to floor and needs help picking her up.- CAN "I need help getting to the bathroom."- CAN "My chest is hurting again, and I need pain meds."- LPN There is no one at the desk and the phone keeps ringing.- CAN The patient to whom you just passed medication has just vomited.- RN CNA comes to you and says, "Come quick and tape this skin tear on Mr. Jones."- LPN A doctor is on the phone wanting assessment information on a patient he saw earlier in the day.- RN As you are passing medication, you hear a patient say, "My dressing bandage is oozing blood."- LPN Patient tells secretary, "Can you find my nurse?"- LPN

What was the priority issues with the client (s)? -

Russel Montgomery- Spinal Injury

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Thomas Bechman- Gout & Dementia Louis Hutchinson: Amyotrophic lateral sclerosis (ALS)

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Nora Gentry- Dimentia, HTN

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Ottis Williams- Alzheimer’s

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Thomas Koenig- Bilateral Amputee, Pacemaker

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Ron Burgundy- emotionally distraught, partial thickness burns, fractured humerus, metal fragments in L arm and torso, difficulty hearing/tinnitus, pain in L arm and L chest upon inhalation

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Richard Dominec- emergent appendectomy, recent AIDS diagnosis/HIV+

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Mary Barkley- respiratory infection, COVID-19+, lupus

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Joyce Workman- new diagnosis T2D, new onset HTN

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Dotty Hamilton- pre-op assessment, consent

Did you prioritize appropriately and what would you do differently? What patient safety issues did you encounter? How did you navigate these? Thomas Bechman:

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Pain 0/10- held hydrocodone (0900)…… Pain was 5/10 at 1800 (moderate), so hydrocodone was given, and he doesn’t have opioid allergies Patient Birth dates did not match so I did not enter the room and I marked it as an error Hold if potassium is greater than 5.0 mEq/L. (Thomas’ potassium level was 4.9 so potassium was given) Patients with anuria should not take furosemide. (Thomas does not have anuria, so furosemide was given)

Nora Gentry: -

Amlodipine should not be given to patients with a systolic bp less than 100.- Nora’s BP was 126/89 so amlodipine was given Patients with bradycardia should not take carvedilol. (Nora’s HR was 94 so carvedilol was given) Hydrocodone: Administer when pain level is Moderate to Severe….Patients allergic to opioids should NEVER take hydrocodone. (Nora is allergic to opioids so medication was held due to pt. allergy)

Ottis Williams: -

Patients with a systolic bp less than 110 should not be given enalapril. (Ottis’ BP was 92/54 so enalapril was held) Patients with aspirin or NSAID allergy should not take etodolac. (Ottis’ allergies are gabapentin and Novocain, so etodolac was given) Patients under 2yo, or with anemia, liver dx, or renal dx should not take trimethoprim… Patients with sulfa allergies should not take trimethoprim. (Ottis does not meet those precautions, nor does he have any sulfa allergies so trimethoprim was given)

Russel Montgomery: -

Patients with aspirin or NSAID allergy should not take etodolac.(Russell is allergic to iodine and penicillin, so etodolac was given)

Thomas Koenig: -

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Patients allergic to NSAIDs or aspirin should not take aspirin. (Thomas has NKDA so aspirin was given) Patients with a systolic bp less than 110 should not take metoprolol. (Thomas’ BP was 107/63 so metropolol was held at 1800)… (Thomas’ BP was 90/50 so metropolol was held at 2100) Patients allergic to statins should avoid taking pravastatin. (Thomas has NKDA so pravastatin was given)

Louis Hutchinson: -

Albuterol can raise heart rate. (Louis’ heart rate was 66 so the medication was given) Hold if Depakote level greater than 100. (Louis’ Depakote level was 65, so divalproex was administered)...