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Advanced Medical Surgical Nursing New Patients

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John Marsh
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Advanced Medical-Surgical Nursing New Patients Swift River

Charlie Raymond , John Duncan, Carlos Mancia, kenny barrett, Tim Jones, Julia Monroe, Donald Lyles, John Wiggins, Richard Dominec, Preston Wright, Tom Richardson, Joyce Workman, Karen Cole, Jose Martinez, Mary Barkley Charlie Raymond (for older swift river patients see other pdf files loaded at the bottom of this file)

John Wiggins

Educational Needs Increased acuity Safety concerns from riding his ATV w/o helmet. Symptoms of worsening head-injury. Danger of ETOH dependence, and use when operating motor vehicles.

Kenny Barrett Room 303

Kenny Barrett, 64 years old, was admitted for observation of initial administering of BP his treatment with blood pressure of 220/124 after visiting his doctor for a routine physical. ECG was unremarkable. No past history of HTN. Past medical history includes hyperlipidemia and a history of 1 pack a day smoker for the past 20 years. Vital signs are Temp 98.9F, BP 178/90, P 88, RR 18 SaO2 95% on Room air. IV with NS @ 125 mL/ hr.

Preston Wright Room 301

Preston Wright, 73- year old male, patient of Dr. Greene, status post CVA 4 weeks ago. He has been readmitted for a red spot on his sacrum of 1 cm and a 2 cm blister on his right heel. IV fluids of D5 1/2 NS are infusing at 100 mL/hour to his right forearm. Mr. Wright is pleasant and cooperative, but needs to be reminded to avoid pressure on his heel and sacrum. He has orders for dressing changes q daily, and pain medications prior to the
dressing change.

Tom Richardson Room 302

Tom Richardson, 46yr-old. Dx- urinary stones with 3 episodes/ 5yrs. Allergic to sulfa drugs. Vital signs -Temp 98.4,BP 178/105, P 112, RR 28, SaO2 94%; Neuro- WNL’s. Skin warm and pale. Generalized weakness, blood tinged urine and severe pain upon urination, GI- n/v. Clear liquid diet. Strict I&O and strain all urine, filters in bathroom. Patient demonstrates urine strain procedure. Severe pain (10/10) medicated q 30 minutes x4 with IV Morphine 2mg with little relief. IV D5 1/2 NS @150ml/hr. Dr. Small at bedside with

Joyce Workman Room 303

Joyce Workman, Joyce Workman, 42- year old female who presents to the Diabetes Clinic with a new diagnosis of type II diabetes. She has been documented as being obese, new onset hypertension, polyuria, and a rash on her abdomen. She was asymptomatic upon arrival. She was admitted yesterday for stabilization of her glucose levels, and assist her with lifestyle modification. She states she leads a sedentary lifestyle as a bank officer.

Joyce Workman Scenario 1

Mrs. Workman presented to the diabetes clinic and provided a 24- hour food recall. She was then sent to the lab for ordered lab tests. She is to notify the nurse upon return to the clinic from the lab. Patient has requested more information on her diabetes and states she does not understand why she “should be concerned” with blood glucose control in both the short and long term.

3 months later, Mrs. Workman has returned to the Diabetes Clinic having lost 20 pounds and is requesting to stop taking the Metformin (Glucophage). HbA1C is 7.5 %. She is also complaining of new onset diarrhea.

Karen Cole Room 304

Karen Cole, 56 year old female, Karen Cole, a school principal at White House High School. Admitted directly from the Dr.’s office to the IMCU after initial complaint for tightness in her chest, denies pain, and slight shortness of breath. Vital signs are BP: 168/92, P: 90, R: 24, T: 98.6. Her husband insisted that she come. She is insisting that she will only stay 12 hours, because she has to be back to school in the morning.

Jose Martinez Room 305

Jose Martinez, Jose Martinez, 43- year old male experiencing chest pain while watching a state rival football game earlier in the evening. Chest pain became progressively worse, so he called for an ambulance to bring him to the Emergency Department. Once the ambulance arrived, he reported his pain as 10/10.

The 12-lead EKG showed ST elevation. Vital signs were HR 160, BP 145/102, Respirations 23, and Pulse Ox 89%. He was given nitroglycerin during transport to the hospital with little relief. He complained of feeling “light- headed”. He has been admitted to the unit, and the pain has subsided. He does have a 10-year history of hypertension.

Mary Barkley Room 307

Mary Barkley, 74y/o female has been admitted to your floor with a respiratory infection and she has tested positive for COVID19. She resides in an assisted living facility which has seen four deaths related to COVID19. She is exhibiting the same initial signs and symptoms as the other patients and her primary care provider would like to start aggressively treating her. She is running a low-grade fever 99.8 and has a sore scratchy throat which is causing an unproductive cough. She also is complaining of chills, muscle pain and headache.

Charlie Raymond Room 302

65-year-old male who was admitted to a negative pressure room on Med-Surg for COVID precautions.. He has a history of COPD, hypertension, diabetes type II, and a recent myocardial infarction. He is a retired postal worker who lives at home with his wife. He is on Claforan (cefotaxime) 2 g IV q4hr and sliding scale insulin. Initially this cardiologist was concerned about congestive heart failure and Mr. Raymond is receiving Furosemide (Lasix) 20 mg IV twice a day for pulmonary edema. Vital Signs: BP is 145/78, Pulse 89 Respirations 24 and slightly labored, Temperature 100.2 SaO2 94% on 2L nasal cannula. The patient/family is fearing

Richard Dominec

Donald Lyles

Tim Jones Room 304

Tim Jones, 82 -year old male patient of Dr. Diggs just arrived this morning from the local nursing home. He was confused upon arrival. During the initial assessment, fresh and various stages of bruise healing were noted to his shoulders, lower back, ribs, and thighs. Admitted to Med-Surg for new onset confusion. Mr. Jones is guarded and has facial grimacing anytime someone reaches toward him or touches him. He does moan when rolled.

Julia Monroe Room 305

Julia Monroe, 74-year-old, widowed, female arrived to floor alone last night. She was admitted from the ER complaining of swelling in her legs as well as having gained 5 lbs over the past two days. Chest x-ray and EKG were unremarkable. She stated that her legs were hurting most of the night. She has a medical history of hypertension and hypothyroidism. She was admitted to Dr. Gray for full diagnostic work up to determine the cause of her symptoms.

 

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Advanced Medical Surgical Nursing (Nurs 211) New Patients Swift River Med Surg Covid New Patients Charlie Raymond John Duncan Carlos Mancia Kenny Barrett Tim Jones Julia Monroe

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