![]() ![]() Question: Acute painImpaired mobility, risk forFluid & electrolyte imbalance, risk forInfection Question: Educational - increasedFall Risk - increasedHealth Change - increasedNeurological - normalPain - increasedPsychological needs - normal Question: Scenario #1Obtain translatorInitiate IVBegin fluid and electrolyteAdminister IV ABXConsult with MDScenario #2What is going on?We need to stop the bleedingTell me where you areWho were you talking to?What were the voices telling you?Scenario #3Attempt to establish rapportNotify HCP of findingsAttempt to restart IVContact dietaryObtain a sitterRemove potential harmful objectsScenario #4Delay insertion of IVContact HCPContact CC's uncleRequest the uncle comeRequest the uncle participatesScenario #5Provide one-to-oneInitiate anti-psychotic medsEnsure family memberReassess environmentInitiate continuous observation Question: Acute painImpaired mobility, risk forNauseaCultural competenceDeficient knowledgeImpaired verbal communication ![]() Question: Educational - increasedFall Risk - increasedHealth Change - increasedPain - increasedPsychological Needs - increasedNeurological - normal Scenario #4Make sure accurate wt.Explain reason for medicationTell the mother that you understandTell the mother that visitors are welcomeBe honest with CameronScenario #5Assess pt.Perform rapid assessmentAsk pt.Inform charge nurseCall local law enforcement Explain to pt.Stress importanceInform pt. Question: Scenario #1Give tylenolStart another IVInitiate bolusRequest additional pain medReasses temp in 1 hourScenario #2Sit at an eye levelTeach CameronEvaluate understandingContact charge nurseDocument pt's statementsScenario #3Provide emotional supportAssure pt. Question: Acute painImpaired mobilityDeficient knowledgeFall, risk forInfection, risk for Question: Educational - increasedFall Risk - increasedHealth Change - increasedPain - increasedPsychological Needs - normalNeurological - normal teachingContact respiratory therapåhest x-rayWestern blotBronchoscopyScenario #5Elevate HOBInitiate O2 at 4LReassess VSReevaluate amount of blood lostContact HCP what his mother's Educate pt.Evaluate effectivenessReport findingsScenario #4Pt. UObtain blood culturesStart IVCollect sputum cultureScenario#2Wash hand, don PPEExplain to the visitorRespiratory assessmentExplain to Mr. Question: Scenario #1Place on respiratory isolationAsk Mr. Question: Educational - increasedFall Risk - normalHealth Change - increasedPain - increasedPsychological needs - normalNeurological - normal recordProvide informationScenario #5You explain that his conditionYou explain that he is receivingYou have them remain with youYou escort them with youYou call his doctor Elevate HOBCall rapid responseStart secondaryRemain with pt.Scenario #4Provide verbal reportEmergency intubationAssume roleObtain pt. and charge nurseScenario #2Remind physicianExplain to physicianAssist physicianObtain recentReassure pt.Scenario #3Tap pt. Question: Scenario #1AssessReplace O2Use therapeuticNotify Dr. Question: Impaired confortImpaired gas exchangeIneffective airway clearanceShock, risk forAnxiety/fearFailure to thrive, risk for Question: Educational - increasedHealth change - increasedLOC - increasedPain - increasedPsychological needs - increasedSafety - increased understandingAttain fluids/fiber dietDocument of optionsNotify lead nurse/doctorContact Social ServicesDocumentScenario #4Wash and glove handsVisual assessmentDo not disturbVerify Call LightDocumentScenario #5Assess for bowel soundsEncourage fluids/fiber/ambulationEvaluate pt. learningPlace call lightDocumentScenario #2Wash and glove handsAssessProvide comfort measuresNotify doctorDocumentScenario #3Listen to pt. Question: Scenario #1Use therapeutic Educate pt.Evaluate pt. Question: Acute painImpaired comfortImpaired mobilityDisturbed sensory perceptionFall, risk forPeripheral neurovascular dysfunction Question: Educational - Increased Fall Risk - Increased Health Change - Increased Pain - Increased Psychological Needs - Normal Sensorium - Normal
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