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Swift River Med Surg Scenarios Answers

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John Marsh
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Swift River Scenarios

Edu:
Fall risk:
Health change:
Pain:
Psycho:
Neuro:

Acute Pain:
Risk Bleeding:
Imp. Mobility:
Nauea:
Knowledge:
Grieving:
Periph. Nerve:

Scene1:
Scene 2:
Scene 3:
Scene 4:
Scene 5:

Jody Rush

20 y/o female, admitted for right femur fracture status post skiing accident. She is in a traction splint, and will be going for surgical repair today. Vital signs are BP 120/62 P 88 R 20 T 98.9 F, 37.2 C, PaO2 99. She has been in a lot of pain, and has been receiving 25 mcg IVP, q2 hours Fentanyl for pain. She was nauseated after her last Fentanyl dose, and the Dr. Ordered an additional 4mg IVP, Zofran. She has a history of exercise induced asthma, and uses a rescue inhaler, Albuterol. Her parents are on their way; they are flying in today. She was on a ski trip with some of her friends from college; her best friend hasbeen camped out with her. We were able to get her on a bed pan earlier, but it took a lot of work. Wejust received an order for a foley catheter. There was some concern that she may have sustained a head injury as she has an abrasion to her forehead, but she denies ever losing consciousness. Patients
affected extremity has normal pulses, and the capillary refill is less than 3 seconds.

Kate Bradley
Kate Bradley 88 y/o female, patient fell and broke her hip two days ago. Sheis coming to us from the Shady-Rest nursing home. She is a little confused asto person and place. She does have a sitter in place, and has a bed alarm forfall risks. She has a 22g IV to her left forearm that was very difficult toobtain; she had multiple IV stick last night. Her skin is very friable, and weare using paper tape. She has several skin tears on her arms. She is inconsiderable pain, and screams when we try to move her. She receivedFentanyl 25 mcg IVP this morning at 0600, and is resting quietly now. Theyplan to take her to the OR later this afternoon.

Dotty Hamilton, 52 y/o female who has been admitted for bariatric Surgery. She has arrived at 0600, and is scheduled for a laparoscopic Roux-en-Y gastric bypass (RYGB). She is super morbidly obese with a BMI of 52, Ht, 5’3”, Wt, 293lbs. She has well controlled hypertension with Losartan (Cozaar) 50 mg q daily. She also takes Metformin to control her Type 2 Diabetes. She has sleep apnea, and she brought her CPAP machine. She is very excited about the surgery but is also apprehensive. She was told by a friend that the complication rate for this surgery is very high. She believes this surgery is her only hope, as she says she has tried everything else to lose weight. Her husband is with her and seems to be very supportive. Body Mass Index (BMI) = kg/m2 where kg is a person’s weight in kilograms and m2 is their height in meters squared. A BMI of 25.0 or more is overweight, while the healthy range is 18.5 to 24.9. Example: Weight = 133.18 kg, Height = 160.02 cm (1.60 m) Calculation: 133.18 ÷ (1.60)2 = 52

Linda Yu was admitted to your unit after surgery on her left hip due to a fall. She is 2 days post-op. She
is 85 years old and has a history of osteoarthritis and cataracts. PT has been getting the patient up with a
walker and she is able to take a few steps. She is aware of self and situation, but not time or day. Her
family lives out of state, but the daughter was here for the surgery, she left yesterday. The plan is to
discharge Ms. Glover back to her assisted living facility. Her daily medications at home include:
Prednisone 5 mg, Furosemide 20 mg, and ASA 81 mg daily. The surgeon added oxycodone 5mg q 4-6
hours prn pain. NKDA

Charlie Raymond, 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.

Wight Goodman, Patient was admitted to the floor last night from the ER for an orbital fracture. He
was hit in the left eye by a softball yesterday. Apparently he was pitching, and the batter hit a line drive
hitting him in the right side of the face. They applied some ice to his face, and he decided to go to the
post game keg party instead of coming to the ER. The patient stated that there was significant swelling,
but his vision was fine, and the pain was controlled with beer and 800mg of Motrin.

 

Roger Clinton, 57-year-old male construction worker arrives at 0600 to be prepared for a partial
thyroidectomy to determine if he has cancer. His past symptoms for three months have been that he
noticed a slight hoarseness in speaking, a slight dry cough not related to a cold, and upon examination
had a “pea-size lump on the center of his neck”. His Endocrinologist had a radioiodine scan performed
that showed a suspicious area.

Ramona Stukes, 69 yr-old, third day post-op cholecystectomy. Non-significant past medical history. No
known allergies (NKA). Vital signs -Temp 98.6, BP 114/62, P 100, RR 20, SaO2 94%. Neuro WNL, alert,
and cooperative. Skin warm and dry, daily dressing changes, T-tube without drainage.

Marcella Como, 38 yr-old, Sexual Trauma Victim (Rape), unknown assailant. Non-significant past
medical Hx. No known allergies (NKA). Vital signs -Temp 98.2, BP 94/60, P72, RR 22, SaO2 99%. Multiple
abrasions, bruising Head, chest, and inner thigh. Isolative, appears fearful, crying, and refusing to see her
husband. SANE nurse to make second visit today.

Estelle Hatcher, 31yr-old, r/o appendicitis, 1st day post-op appendectomy; No known allergies (NKA);
Vital signs – Temp 101.2, BP 108/74, P 92, RR 20, SaO2 99%, alert and cooperative. Wound site clean, dry
and intact NPO, NG-tube to low continuous suction. IV maintenance fluids with D5 1/2 NS with 20 KCL @
125ml/hr in left forearm. Ambulates with minimal assistance.

Viola Cumble, 92yr-old, second day post-op hip repair, Allergic to Penicillin. Vital sign Temp 98.4, BP
136/78, P 72, RR 20, SaO2 97%. Normal Sinus Rhythm on telemetry. Alert and cooperative. No weight
bearing today. Skin warm and dry, may sit up on edge of bed today.

Carlos Mancia, 48yr-old, Spanish speaking migrant worker with no known past medical Hx. r/o
Tuberculosis. Vital signs -Temp 99.1, BP 124/62, P 77, RR 20, SaO2 91%. Airborne Isolation. Neuro WNL.
Skin moist, respiratory bilateral wheezes and rhonchi. Blood-tinged mucous, productive cough. Diet as
tolerated. IV maintenance fluids with D5 1/4 NS @ 150 ml/hr X 3 then reduce rate to 75 ml/hr.

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.

Ann Rails, 38 years old, c/o back pain, non-significant past medical history. No known allergies (NKA).
Vital signs -BP 124/82, Temp 98.2, P 84, RR 22, SaO2 96%. Pain and numbness in legs for one week.
Abnormal left leg weakness, gait unsteady, 5/10 on numeric pain scale. Neuro WNL, except leg pain
upon movement.

Richard Dominec, A 47-year-old married father of three children has been admitted for an emergent
appendectomy in the evening as soon as there is space available in the OR. He is currently febrile with
temperature 100.8, HR 99, BP 135/96, RR 20, PaO2 96%, nauseated with no vomiting, rebound

Kathy Gestalt, 33yr-old, Dx- second day post-op open right Tibia/Fibula fracture, plaster cast in place
on right lower leg. No known allergies. Vital signs -Temp 98.4, BP 116/76, P 96, RR 20, SaO2 99%. Neuro
WNL, alert, and cooperative but worried about scarring and is reluctance regarding walking on leg.

Robert Sturgess, 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. Palliative care. No Known
allergies (NKA). Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. Neuro WNL alert and
cooperative. Skin warm and dry, all vital signs in WNL except 115 pulse, which is normal for him. Blood
Glucose 185, 4 units of insulin sliding scale for coverage

Arthur Thomason, 56-year-old MVA victim, fourth day post op with a splenectomy and femur repair.
He is experiencing new onset of shortness of breath and has a nasal cannula with 2L of Oxygen in place.
He is restless with slight confusion but is easily orientated with attempts from nurse.

Virginia Smith, 57-year-old who has elected to have a total mastectomy based on consultation with
her surgeon, a total mastectomy removes all breast tissue but leaves all or most of axillary lymph nodes
and chest muscles intact. She is also to receive radiation, chemotherapy, and hormone therapy post
operatively. She is with her physician.

Lithia Monson, 93 years old, c/o head injury, r/o subdural hematoma. Hx of dementia, from nursing
home, fall one day ago. No known allergies (NKA). Vital signs -Temp 97.2, BP 96/74, P 82, RR 20, SaO2
97%. Neuro- confusion to time and place, but oriented to self, speech clear, poor historian, did not
recognize son today which is new for her; Neuro assessment and vital signs q1 hr. Skin warm dry, bruises
on forehead with small laceration.

Sarah Getts, 77 yr-old, Dx- Chronic Renal Failure, admitted with hyperkalemia (5.9, Eq/L)/hyponatremia
(128mEq/L). No known allergies (NKA). Vital signs -Temp 98.8, BP 102/76, P 102- irregular, RR 22, SaO2
90%, cardiovascular on telemetry with Sinus irregular rhythm. Disoriented to time and place, speech
slurred. Pupils PERRLA, eyes clear.

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