University:
College
Course:
College Nursing
Academic year:

2023
Views:

146

Pages:

3
Author:

desgolhayp9a

Estelle Hatcher Educational Needs: Increased acuity Fall Risk: Increased acuity Health Change: Increased acuity Pain Level: Increased acuity Psychological Needs: Normal acuity Sensorium: Normal acuity Physiological- Activity intolerance: False Acute pain: True Diarrhea: False Electrolyte imbalance, risk for: True Impaired comfort: True Impaired mobility: False Safety- Deficient knowledge: True Fall, Risk for: True Fear: False Ineffective self-health management: False Infection, Risk for: True Sleep deprivation: False Scenario 1 Ms. Hatcher is second day post-op and has a NG tube set to gravity drainage only. She presses the call light w/ questions about who her RN will be and her NG-tube. Introduce yourself/identify pt Full assessment Educate pt Evaluate understanding Provide comfort Scenario 2 During the follow up nursing assessment, Ms. Hatcher complains about the NG-tube causing her pain in her nasal area. She has active bowel sounds Wash/glove hands Inspect pain location Check proper positioning Verify call light/bed safety precautions Notify doctor (for possible removal) Scenario 3 Dr. Brown gives orders to remove NG-tube set to gravity and to begin a clear liquid diet Educate pt Evaluate understanding Remove NG-tube Order a new clear liquid diet Document results Scenario 4 Mrs. Hatcher appears restless, diaphoretic and calls the nurse for help. Upon entering the room, what is the appropriate order of events for the RN to take? Wash/glove hands Full assessment Encourage incentive spirometer Verify call light/bed safety precautions Document results Scenario 5 Several hours later, Mrs. Hatcher is feeling much better. She puts her call light and asks to see a RN. Upon enter the room, she asks you if she will be able to drive when she gets home tomorrow. Use therapeutic communication/active listening Educate pt Evaluate understanding Verify call light/bed safety precautions Document results