neuro check: A/O x2, left pupil is larger than his right and is +5 to react to light, their is no evidence of any drainage, cranial checks are all normal and pt is less cooperative for extremity strength assessment. You check his VS and they are: BP 185/75, P 58, R 28 and irregular, T 99.1, PaO2 98. NPO Scenario 4 You accompany transport of Mr. Contact radiology for a stat CT scan of the head. Scenario 3 After sharing findings w/ the provider, he orders the following: 1. Scenario 2 Your neurological assessment concludes the following: A/O x4 appears normal, left pupil is slightly larger than his right and is +3 to react to light, there is no evidence of any drainage, cranial checks are WNL, and extremity strength is slightly diminished. You tell the pt that you must do a assessment before you can give him any medication. He is complaining that his headache is worsening. John Wiggins Scenario 1 You respond to Mr. Notify the social worker of need for a new nursing home placement option. Jones if he would like for a chaplain or minister to be called. Jones to cough and take deep breaths hourly Document findings from repeat assessment Scenario 5 Talk w/ Mr. Scenario 4 Notify HCP for change in respiratory assessment Administer nebulizer to per HCP order Reassess respiratory status Encourage Mr. Jones to seek assistance before getting out of bed Obtain a sitter to stay w/ pt. Jones back to bed Provide personal hygiene Remind Mr. Jones that he will be safe during his hospital stay Administer prescribed anxiolytics medication prior to transfer to CT area Offer UAP to accompany Mr. Jones on why he does not want to leave the room. Scenario 1 Wash hands Reassure pt that he is in a safe environment Interviewing pt regarding need for hospitalization Complete physical assessment Notify charge nurse and social services Scenario 2 Use therapeutic communication Seek clarification from Mr. He requests no visitors at this time, but later asks for his family to be called to discuss a plan of care. He insists that he is not hungry and refuses assistance with his meal. He does not want to return to the nursing home, and does not wish to burden or live with his children. Jones is now more alert and states he does not see the point in living anymore and wishes he would just die quietly. Based on assessment, nebulizer tx administered per MD orders. Jones was noted to have bilateral wheezing, R 24, some use of accessory muscles w/ respiration's, dullness to percussion in the left lower lobe, an an unproductive cough. Jones is resting quietly in the bed, R 22, slightly labored, color pink. Jones falls on his way to the bathroom Scenario 4 Mr. Jones does not want to be alone and is afraid of being hurt Scenario 3 Later in the evening Mr. Jones stated to the nurse that he "was scared to leave the room." Further questioning and clarification revealed Mr. Jones is scheduled for a full body CT scan. He has no other health concerns.Tim Jones Scenario 1 You begin your shift assessment w/ Mr. He has a 20ga saline lock to his right hand, that was started in the ER. His pain has been well controlled with IV morphine 4 mg, written every 3 hours. His visual acuity is diminished, and the whites of his eyes are hemorrhaged. There is significant edema and discoloration to the left side of his face, and his left eye is almost completely swollen shut. They were not concerned as his intraocular pressure was normal in the ER. The maxillofacial surgeon was consulted, and they will see him this morning. He was unable to sleep later in the evening as the pain became worse, and his vision became more impaired. The patient stated that there was significant swelling, but his vision was fine, and the pain was controlled with beer and 800mg of ibuprofen. They applied some ice to his face, and he decided to go to the post game keg party instead of coming to the ER. Apparently, he was pitching, and the batter hit a line drive hitting him in the right side of the face. He was hit in the left eye by a softball yesterday. Wight Goodman, Patient was admitted to the floor last night from the ER for an orbital fracture.
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