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www.ATLclinicalworkshop.com Sheri Taylor: [email protected] © 2014 ATL Clinical Workshop. All rights reserved. Greg Edwards: [email protected]

Rules&to&Careplanning










1 Angela((Lubbock)(53(yo(female,(post(menopausal(pelvic(mass,(on(3/4/10(had(total(abdominal(hysterectomy(with(salpingectomy.(On(PCA(and(has(Lortab(for(breakthrough(pain((had(twice(on(the(previous(day)(raGng(pain(a(5.(PaGent(has(a(foleySafety:(siderails(up(x(2,(NKAVital(signs:(apical(HR,(RR,(axillary(temp,(manual(BPFluid(management(with(I&Os.(Ad(lib(fluids,(regular(dietMobility(is(to(assist(with(ambulaGon(x1Pain(management(with(pain(relief(measures(and(0W10(pain(scale(Po(meds:(Lisinopril,(hctz(at(0900(and(lovenox(sub(QFYI...paGent(is(using(peripads(for(the(nurse(to(monitor(for(bleeding(

2 Brian((Gwinne])(61(year(old(male(history(of(smoking,(PVD,(DM.(Admi]ed(with(a(right(leg(arterial(occlusion(and(had(an(arterial(aorcadifemoral(bypass(gra`(a(month(ago(as(well(as(a(right(great(toe(amputaGon.(PaGent(is(also(hypertensive.Safety:(siderails(up(x(2,(NKA(Vital(signs(apical(HR,(RR,(manual(BP,(oral(temp,(with(pain(assessment(using(0W10(scale(Fluid(management(with(I&Os.(PaGent(has(hyperal(at(85(ml/hr.(NPO(except(for(ice(chips(and(hard(candy;(uses(urinalMobility:(Ambulate(with(assistance(x(1Abdominal(assessmentPeripheral(vascular(assessment(to(the(lower(extremiGes(0900(meds:(aspirin,(plavix,(fragmin(sub(qRespiratory(management(with(incenGve(spirometer(x(5(repeGGons(and(O2(sats(

3 John((UGca)(80(yo(male(with(uncontrolled(diabetes.(Has(a(10(year(old(foot(ulcer,(osteomyeliGs,(diabeGc(

neuropathy,(amputaGon(of(a(few(toes(on(the(le`,(le`(foot(ulcers(with(no(necrosis(around(the(4th(and(

5th(metatarsals.(Lateral(feet(cool(and(warm.(Pulses(palpable(but(weak.(PaGent(has(a(pacemaker(that(rates(around(60W61Safety:(Siderails(up(x2,(NKA(I&Os:(ad(lib(fluids,(1800(calorie(ADA(Vital(signs:(pain(scale(0W10(with(vital(signs:(HR(apical,(RR,(temp(axillary,(manual(BP(Mobility:(oob(and(ambulate((mandatory)(and(paGent(wears(a(support(boot(when(ambulaGng;(change(bed((mandatory)neuro(assessment((paGent(had(a(stroke(22(years(ago(but(no(residual(with(it)PVA(lowerMeds(at(0900:(Coumadin,(Lantus(and(humulog(SQ(Last(BPs(102/60(and(151/68.



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4 Haley((Grady)(12(yo(female(admi]ed(3(days(ago(with(sickle(cell(crisis,(pain(in(chest(area,(constantly(raGng(a(6W7Safety:(siderails(up(x(2,(NKAMobility:(bedrest(with(reposiGon(x(1(Vital(signs(apical(HR,(RR,(blood(pressure,(axillary(temp(with(pain(assessment(using(a(0W10(scale.((paGent(raGng(pain(an(8(or(9(in(the(legs(all(of(the(Gme)O2(management(and(paGent(is(on(NC(2lpm((you(are(not(assigned(to(check(O2(sats)(Respiratory(management(with(I/S(x10(Fluid(management:(Intake(only(IV(fluids(D5(1⁄2(NS(with(20(mEq(of(KCl(@(75(ml/hr,(regular(diet,(encourage(fluids0900(meds:(folic(acid(poFYI:(paGent(has(shallow(respiraGons(and(nonWproducGve(to(no(cough.(

5 Simba((UGca)(14(year(old(pregnant(with(twins,(ruptured(appendix(and(had(an(appendectomy(yesterdaySafety:(siderails(up(x(2,(NKAFluid(Management:(I&Os(D5(1⁄2(NS(with(20(mEq(of(Kcl(@(100(ml/hr,(encourage(fluids,(full(liquid(diet,(paGent(is(complaining(of(nausea(Mobility:(reposiGon(x(1Vital(signs(apical(HR,(RR,(manual(BP,(oral(temp,(with(pain(assessment(using(a(0W10(scale(Peripheral(vascular(assessment(of(lower(extremiGes(Respiratory(management(with(cough(and(deep(breathing(exercises(FYI:(Breath(sounds(diminished,(weak(cough,(pain(is(a(4.(

6 Robin((St.Mary’s(Madison)(76(yo(female(admi]ed(2(days(ago(with(GI(bleed(secondary(to(diverGculosis.(Safety:(Side(rails(up(x(2,(NKA,(wears(glassesMobility:(ambulate(with(standby(assistance(x1Fluid(Management:(I&O,(no(IV,(fluids(ad(lib,(clear(liquid(diet(Vitals:(apical(HR,(oral(temp,(RR,(manual(BP(with(pain(assessment(0W10(scale(and(O2(sats((noGfy(primary(nurse(if(sats(<92%)(Respiratory(assessmentAbdominal(assessmentpo(meds(@(0900:(vasotec,(lexepro,(hctz,(MVI,(flaxseed(oilPaGent(is(not(complaining(of(any(pain(but(c/o(weakness.(H&H(on(admission(was(13(and(37,(today(it(is(9.2(and(28.(She(also(becomes(tachycardic(when(ambulaGng.(










[email protected]

7 Luis((Lubbock,(Tx)(peds(subsGtute...admi]ed(with(pneumonia,(hx(of(COPD(Safety:(Siderails(up(x2(Mobility:(ReposiGon(x(1Vitals:(Oral(temp,(apical(HR,(RR,(manual(BP,(O2(sats(and(noGfy(primary(nurse(if(<(92%,(pain(assessment(using(a(0W10(pain(scale(Respiratory(assessmentO2(management(and(the(paGent(is(on(O2(via(2lpm/NC,Fluid(Management:(I&O,(paGent(has(a(heplock(to(flush(with(5(ml(of(normal(saline,(fluids(ad(lib,(2gm(Na+(diet,(paGent(wears(depends0900(meds:(levothyroxine,(K+,(hydrocorGsone(cream,(and(moisture(barrier(cream(

8 Stephen((Madison)(DiabeGc(male(admi]ed(for(shortness(of(breath(and(ineffecGve(cough.(PaGent(also(has(a(history(of(COPD,(HTN,(hyponatremia,(and(tracheal(esophageal(fistula(Safety:(Siderails(up(x(2;(NKA,(wears(glasses(for(reading(Vital(signs:(Oral(temp,(apical(HR,(RR,(manual(BP(with(O2(sats,(noGfy(primary(nurse(if(<92%(Mobility:(Ambulate(from(bed(to(chair(x1Respiratory(assessmentPVA(of(lower(Fluid(Management:(I&O,(PaGent(has(an(intermi]ent(IV(that(you(flush(with(3(mls(of(normal(saline,(1800(cal(diabeGc(diet,(fluids(ad(lib(0900(meds:(digoxin,(levofloxacin,(topazol(FYI:(paGent(is(on(2(lpm(NC

9 Nancy((Madison)(male(with(malignant(hypertension,(and(DVT(in(le`(arm(with(celluliGs,(poorly(controlled(diabetes,(obstrucGve(sleep(apnea((paGent(weighs(164(kg),(renal(failure(that(is(occurring(rapidlySafety:(Siderails(up(x2;(NKA,(wears(glasses(Mobility:(Ambulate(paGent(with(standby(assistance,(Keep(le`(arm(elevated(at(all(Gmes(Vital(signs(apical(HR,(RR,(manual(BP,(oral(temp,(with(pain(assessment(0W10(scaleFluid(management:(fluids(ad(lib,(Na+(restricted(diet;(intake(onlyPVA(of(the(upper(Oxygen(management:(O2(via(nasal(cannula(between(2(and(3(liters,(with(O2(sats(and(noGfy(primary(nurse(if(<92%0900(meds:(tetracycline,(lovenox(sq,(glipizide,(and(metoprolol(








10 William(((Lubbock)(47(yo(with(breast(CA,(mastectomy,(total(skin(flap(on(the(right((yesterday),(paGent(is(raGng(pain(a(0(to(3,(paGent(has(a(picc(line(on(right(arm(Safety:(Siderails(up(x(2,(NKA(Mobility:(Ambulate(with(assistance(x1Vital(signs:(oral(temp,(apical(HR,(RR,(manual(BP,(O2(sats(report(if(<92%(Fluid(mgmt:(ad(lib(fluids,(regular(diet,(I&OsPain(management(0W10(scale,(with(pain(relief(measuresPeripheral(vascular(assessment(to(upper(extremiGesFYI:(Primary(nurse(medicates(for(pain(

11 Kim((Grady)(12(yo(sickle(cell(in(vasoWocclusive(crisis(Safety:(side(rails(up(x2,(NKAMobility:(Independent(with(ambulaGon((standby(assist)Fluid(management:(D5(1⁄4(NS(with(20(mEq(of(Kcl(@(85(ml/hr(on(pump,(fluids(ad(lib,(regular(diet;(intake(onlyVital(signs(apical(HR,(RR,(blood(pressure(on(machine,(oral(temp,(with(pain(assessment(0W(10(scale((paGent(is(on(a(dilaudid(pump(and(raGng(pain(an(8(in(chest(and(lower(back(mostly),(check(O2(sats(and(noGfy(if(<92%Neurological(assessmentRespiratory(management(with(I/S(x30900(po(meds:(colace(and(folic(acidFYI:(pain(is(a(7(at(all(Gmes((currently(an(8)(primarily(in(the(chest(and(lower(back

12 Christy((Lubbock,(Tx)(peds(subsGtute(77(yo(female(shortness(of(breath(and(bronchiGs,(history(of(COPD(and(asthma,(has(a(heplock(in(the(right(upper(extremity,(O2(via(NC(at(4(lpm((you(don’t(touch),(side(rails (up(x2,(allergic(to(erythromycin(and(codeineSafety:(siderails(up(x(2,(NKA(Mobility:(Bedrest(with(bathroom(privileges((bedside(commode),(ReposiGon(paGentFluid(Management:(I&O(fluids(ad(lib,(regular(dietVital(signs(apical(HR,(RR,(manual(BP,(oral(temp,(with(pain(assess.(0W10(and(O2(sats,(report(if(<90%0900(meds:(aldactone,(celexa,(plavix,(cipro,(lovenox(subqComfort(managementRespiratory(management(with(deep(breathing(and(coughing(



[email protected]









[email protected]


13 Steve((Grady)(male(with(a(closed(head(injury(and(facial(fractures.(Side(rails(up(x(2,(allergic(to(PCN(Mobility:(Bedrest(reposiGon(x(1Vital(signs:(Axillary(temp,(apical(HR,(RR,(BP(manualFluid(mgmt:(Normal(Saline(0.9%(@(125ml/hr(on(pump,(1800(calorie(ADA(diet,(fluids(ad(lib;(intake(onlyPain(management(with(pain(relief(measures(using(a(0W10(pain(scaleNeurological(assessmentSkin(assessment(with(occiput,(sacrum/coccygeal(assigned0900(heparin(sub(qFYI:(paGent(currently(raGng(pain(a(4(on(top(of(head(and(behind(eyes(

14 Barberita((3/26(Grady)(62(yo(female(frequent(flyer.(Obese(with(a(gluteal(abscess.(Hx(of(HTN,(DM,(allergic(to(penicillin(and(neomycinSafety:(siderails(up(x(2,(NKAMobility:(Bedrest(with(bathroom(privileges;(reposiGon(at(least(once(Fluid(mgmt:(fluids(ad(lib,(diabeGc(diet,(IV(Normal(Saline(at(125(ml/hr;(I&OVital(signs:(oral(temp,(apical(HR,(RR,(manual(BP,(with(pain(assessment(using(a(0W10(scale(Neurological(assessment(Wound(management(–(clean(gluteal(area(with(a(normal(saline(4x4(and(do(a(clean(dressing(change0900(medicaGons:(asa,(heparin(subq,(Imdur,(toprol,(and(colaceFYI(paGent(has(had(hypotension(and(BP(meds(have(been(on(hold.(The(doctor(wants(the(BP(to(be(below(130/90(but(has(been(running(80/50(so(the(assigned(meds(may(not(be(given(during(the(pcs(just(depending(on(the(BP.

15 Myrlande((3/26(Gwinne])(80(yo(male(with(urosepsis(and(history(of(prostate(problems(and(cataracts.Safety:(Siderails(up(x2;(NKAMobility:(Transfer(from(bed(to(chair(with(assistance,(fyi:(confused(at(Gmes,(fall(precauGonsFluid(management:(ad(lib(fluids;(low(fat(diet,(IV(of(normal(saline(@(100(ml/hr,(in(charge(of(intake(onlyVital(signs(with(pain(assessment(using(a(0W10(scale(and(check(O2(sats.(PaGent(is(on(room(air(but(noGfy(the(primary(nurse(if(O2(sats(are(<92%Neurological(assessment0900(meds:(pepcid,(crestor,(flomaxRespiratory(management(with(cough(and(deep(breathing(2W3(reps









[email protected]


16 Christy((3/20(Plainview(Tx)(70(yo(CHF(and(pneumonia,Safety:(Siderails(up(x(2,(NKAMobility:(Bedrest(with(reposiGoning(x(1Vital(signs(apical(HR,(RR,(manual(BP,(oral(temp,(with(O2(sats(and(noGfy(if(<92%(O2(management:(O2(via(2lpm(NCRespiratory(assessment(PVA(to(upperSkin(assessmentNo(meds(to(be(given,(no(IV(to(mess(with

17 Barberita(#3((3/28(Grady)(49(yo(female(gunshot(wound(to(the(chest(in(June(of(2009(but(the(wound(never(healed.(The(paGent(had(been(seeing(the(wound(clinic(for(treatments(and(the(wound(dehisced.(Admi]ed(to(the(hospital(for(wound(debridement(and(wound(vac(therapy.(Complains(of(pain(9/10,Safety:(Siderails(up(x(2;(NKAVital(signs:(Oral(temp,(apical(HR,(RR,(manual(BP,(O2(satsPain(management(with(pain(relief(measures(and(primary(nurse(is(to(medicate,(0W10(pain(scaleSkin(assessment(to(the(chest(around(the(wound(vac(which(is(edematous,(pink,(and(warmO2(management(with(O2(via(2lpm(NC(and(O2(sats(checked(with(vital(signsFYI:(The(paGent(appears(“slow”,(“anxious”...quesGonable(mental(issues(but(nothing(in(the(chart.Mobility:(The(paGent(is(assigned(bedrest(but(keeps(climbing(out(of(bedMeds(@(0900(is(nexium,(colace(and(lovenox(sub(q(with(the(paGent(only(wanGng(it(injected(in(the(back(of(the(arm.

18 Bill((4/9(Southern(Regional)(Post(surgical(male(who(had(a(laparoscopic(cholecystectomy(Safety:(siderails(up(x2,(NKAMobility:(reposiGon(paGent(Vital(signs(apical(HR,(RR,(manual(BP,(oral(temp,(with(0W10(pain(scale(and(O2(sats(Fluid(management:(clear(liquid(diet,(IV(is(heplocked,(offer(fluids,(intake(only(Respiratory(management(with(cough(and(deep(breathingAbdominal(assessment((fyi(ABD(pad(to(the(lower(pelvic(region)(Meds:(levoquin(given(on(pump(at(0900,(primary(nurse(is(to(medicate(with(Percocet(for(pain(










[email protected]

19 Lori((4/9(Grady)(59(yo(male(who(has(not(been(to(the(doctor(in(20(years.(Has(been(in(the(hospital(for(10(days(and(chief(complaint(was(a(wt(loss(of(50#(in(2(months.(On(4/1(paGent(had(a(thorocotomy(because(of(a(lung(mass(and(sepsis.Side(rails(up(x(2(Bedrest(and(reposiGon(x1Pain(management(with(0W10(scale,(enteral(feeds(are(ad(lib(with(regular(diet(and(assigned(I&Os:(paGent(is(on(full(liquid(diet,(offer(fluids(Vital(signs,(apical(HR,(RR,(oral(temp,(manual(BP,(weigh(paGent,(O2(sats((pt.(is(on(2(liters(NC(O2(that(the(primary(nurse(manages)Respiratory(management(with(deep(breathing(and(cough((paGent(has(had(a(non(producGve(cough(and(breath(sounds(are(clear,(respiraGons(are(shallow)(PaGent(has(staples(to(the(le`(chest,0900(meds(are(:(norvasc,(colace,(lisinopril,(ms(conGn,(senna,(and(heparin(sub(q.There(is(a(new(order(on(the(chart(for(Tylenol(with(codeine(as(well.(PaGent(also(has(a(hep(lock(to(the(right(arm.(

20 BJ((4/9(Grady)(Female(2(days(post(op(laminectomy(of(the(C3WC7(Safety:(side(rails(up(x(2;(NKA(Mobility:(OOB(x1(with(assistFluid(management:(I&Os,(regular(diet,(IV(d/c’d,(fluids(ad(lib(Vital(signs(with(pain(0W10(scaleNeurological(assessmentPVA(of(lower(extremiGesmeds(at(0900:(elavil,(flexeril,(colace,(lisinopril,(neuronGn.FYI:(paGent(has(an(unsteady(gait,(has(asked(to(speak(to(a(chaplain(because(she(has(lost(her(job(and(her(boyfriend(le`(her(when(she(was(admi]ed(into(the(hospital(and(she(is(raGng(pain(a(6.

21 Lisa((4/9(Madison(Wi)(Female(with(a(hx(of(spinal(stenosis,(total(bilat.(Knee(replacement(and(total(hip(replacement.(In(the(hospital(now(with(a(dx(of(GERD(and(had(a(lap(Nissen(FundiplicaGon.Safety:(siderails(up(x(2,(NKA(Vital(signs(manual(BP,(apical(HR,(RR,(oral(temp,(with(a(0W10(pain(scale,(PCA((narcoGc(dependent)(and(on(methadone(3x(a(dayMobility:(OOB(to(chair(x1Abdominal(assessment(Respiratory(assessmentI&Os,(fluids(ad(lib,(JP(drain,(diabeGc(on(clear(liquidsAlso(a(history(of(breast(CA(on(le`,Comfort(management(is(assigned(with(mouth(care(specified,(FYI:(paGent(gets(Novalog(3x(a(day.(O2(sats(are(assigned(with(vital(signs(and(noGfy(primary(nurse(if(sats(are(less(than(90%((they(have(been(91W92%),(paGent(is(on(3liters(O2(NC(at(night(because(of(sleep(apnea,(pain(is(currently(a(3(










[email protected]

22 Brian((4/9(Milwaukee)(70(year(old(male(with(a(history(of(atrial(fib,(HTN,(CHF,(sleep(apnea,(diabetes,(and(GI(bleed.(Post(op(hernia(repair.(Has(an(NG(to(low(intermi]ent(sucGon(Safety:(siderails(up(x(2,(NKA,(wears(glassesMobility:(ambulate(with(assistance(x1(Vital(signs(apical(HR,(RR,(manual(BP,(oral(temp,(with(pain(scale(0W10Fluid(Management:(PCA(pump(and(IV(running(at(150(ml/hr.(NPO(except(for(ice(chips(Abdominal(assessmentRespiratory(assessments(as(well(as(check(O2(sat(and(noGfy(primary(nurse(if(sats(are(less(than(92%.((on(room(air(currently)FYI:(Pain(is(currently(a(2W30900(meds(are(:(digoxin,(amiodarone,(kcl,(lasix,(valsartan,(tamsulosin(

23 Leah((4/9(Gwinne]e)(58(yo(male(with(a(right(leg(wound(and(DVT.(Had(a(splitWthickness(skin(gra`(Safety:(siderails(up(x(2,(NKAVital(signs(apical(HR,(RR,(manual(BP,(oral(temp,(with(a(0W10(pain(scale(and(O2(sats((noGfy(if(<92%)Mobility:(ReposiGon(paGent(x(1(PVA(lower(extremiGesComfort(management(with(comfort(measures(Fluid(management:(encourage(fluids(and(I&O,(0900(meds:(MulGvitaminFYI:(currently(raGng(pain(a(3(

24 Charlene((4/9(Mansfield)(92(yo(female(with(transient(ischemia,(HTN(Safety:(siderails(up(x2Mobility:(bathroom(priviledges((offer(x1)(Vital(signs(apical(HR,(RR,(manual(BP,(oral(temp,(with(0W10(pain(scale(and(02sats((noGfy(primary(nurse(if(less(than(92%)Neurological(assessment((paGent(A&O(x3(but(says(face(feels(funny(and(no(weakness),(Fluid(management:(cardiac(diet,(encourage(fluids,(I(&(Os,(heplock((you(are(not(assigned(to(flush)(Comfort(measures0900(meds:(vit.C,(vit(B12,(diGazem,(and(metoprolol(










[email protected]

25 Dewayne((4/9(Grady)(male(with(a(history(of(colon(ca(and(had(a(cholectomy(1(day(ago(Safety:(siderails(up(x(2,(NKAVital(signs:(apical(HR,(RR,(manual(BP,(oral(temp,(with(pain(0W10(scale((currently(a(5)Respiratory(management(with(I/S(x(5(and(deep(breathing(and(coughing(Mobility:(ambulate(with(assistance(x1Abdominal(assessment0900(meds:(heparin(subq,(protonix(po(and(dilaudid(given(by(primary(nurse

26 Rise((4/9(Mansfield(Ohio)(83(yo(with(COPD,(syncope,(fall(risk,(hx(of(lung(CASafety:(Siderails(up(x(2,(NKAVital(signs:(apical(HR,(RR,(manual(BP,(oral(temp,(with(0W10(pain(scale(and(O2(sats((noGfyprimary(nurse(if(less(than(92%)Neurological(assessmentO2(management(on(2(lpm(NCMobility:(bedrest(with(reposiGoning(x1,(HOB(90(degrees(with(mealsFluid(management:(thickened(liquids,(and(on(aspiraGon(precauGons,(I&O(0900(meds:(levoquin(IV(on(pump

27 Heather((4/9(Grady)(37(yo(female(1(week(postpartum((had(a(cesarean(1(week(ago(and(developed(a(DVT),(on(dilaudid(given(by(primary(nurse(as(well(as(CoumadinSafety:(side(rails(up(x(2Mobility:(bathroom(privileges,(reposiGon(x(1(Fluid(management:(I&Os,(Encourage(fluids,(low(vitamin(K(dietVital(signs(apical(HR,(manual(BP,(RR,(oral(temp,(with(O2(sats(and(noGfy(primary(nurse(if(less(than(90%Pain(management(0W10(scale((currently(a(3(and(describes(it(as(a(stabbing,(throbbing(pain(in(legs),(PVA(of(lower(extremiGes,(keep(legs(elevated(on(pillows((paGent(keeps(crossing(legs)Skin(assessment(to(bilateral(legs(from(knee(to(mid(thigh(and(coccyx0900(meds:(atacand,(colace(and(prenatal(vitaminshistory(of(HTN(with(current(BP(140/80,(low(grade(temp(of(100.4(










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28 Crystal((4/16(Madison(Wi)(63(yo(empyema(with(lung(abscess(that(was(aspirated(2(days(ago.(PaGent(has(a(PICC(lineSafety:(siderails(up(x(2,(NKAVital(signs(oral(temp,(apical(HR,(RR,(manual(BP,(with(pain(assessment(using(a(0W10(scale(and(O2(sats.Mobility:(Ambulate(paGent(with(standby(assistance(x1Fluid(management:(regular(diet,(encourage(fluids,(I(&(ORespiratory(assessmentComfort(managementMedicaGons(@(0900:(heparin(sub(q,(1gram(Vancomycin(via(PICC(line(in(100(ml/NS(over(1(hour(on(pump.(FYI(paGent(is(denying(any(pain,(has(a(producGve(cough(with(yellow(sputum(produced,(O2(sats(are(99%(on(room(air(and(history(of(smoking(

29 Gwine]a((4/23(Madison)(Female(rehab(paGent(with(DVT(in(right(leg(and(le`(hemiparesis(and(right(leg(edema(and(le`(pulmonary(embolism.Safety:(siderails(up(x(2,(NKAVital(signs:(apical(HR,(RR,(manual(BP,(oral(temp(with(0W10(pain(assessment(and(O2(sats((noGfy(primary(nurse(of(sats(<92%)Fluid(management:(I&Os,(regular(diet,(ad(lib(fluidsNeuro(assessmentPVA(of(lower0900(meds:(pepcid,(lopressor,(dilanGn,(spironolactone,(zestril.(Mobility:(OOB(to(chair(or(to(wheelchair(x(1FYI(paGent(is(complaining(of(right(leg(pain(raGng(a(5(on(0W10(scale(

30 Victoria((4/23(Milwaukee)(male(admi]ed(with(vomiGng(and(dehydraGon,(tachycardia,(renal(insufficiency(and(elevated(liver(funcGon(tests,(alcoholic,(GERD,(small(bowel(obstrucGon((resecGon(in(1999),Safety:(siderails(up(x(2,(NKA(Fluid(management:(clear(liquid(diet,(fluids(ad(lib,(strict(I&O,(D5(1⁄2(NS(with(20(mEq(of(K(@125/hrVital(signs((report(temp(>100,(and(O2(sat(of(92%)(0W10(pain(scaleMobility:(independent(with(ambulaGon((supervise(only)x1(Abdominal(assessment0900(meds:(folic,(MVI,(pantoprazole,(nexium.Comfort(management(with(mouth(care(as(one(comfort(measure(










[email protected]

31 Todd((4/23(Syracuse)(52(yo(female(with(hx(of(mulGple(hip(surgeries.(Had(another(le`(hip(surgery(yesterday.Safety:(siderails(up(x(2,(NKAVital(signs(apical(HR,(RR,(manual(BP,(oral(temp,(with(0W10(pain(assessment(0900(meds:(estrogen,(medroxyprogesterone,(singulair,(MVI,(omeprazole,(saline(lock((not(assigned(to(flush)Mobility:(OOB(to(chair(with(weight(bearing(as(tolerated(x1Fluid(management:(I&Os(regular(diet,(encourage(fluids(PVA(of(lowerComfort(management(

32 Keith((4/23(Grady)(Peds(5yo(sickle(cell/(aplasGc(crisis,(in(hospital(for(a(week(and(was(admi]ed(with(an(opportunisGc(infecGon.(Spiked(a(temp(of(102+(at(school(and(on(admission(was(100.Safety:(siderails(up(x(2,(NKAFluid(management:(Reg(diet,(fluids(ad(lib,(D5(1⁄4(NS(with(20(mEq(of(potassium(at(40(ml/hr(on(ICDMobility:(bedrest(with(bathroom(privileges,(reposiGon(x(1Pain(management(using(faces(scale((paGent(is(currently(a(2(and(states(“all(over(my(arms”)(0900(meds:(mirilax(and(zantacPVA(of(upper(extremityFYI:(MSO4(PCA(was(d/c’d,(droplet(precauGonsWisolaGon.(

33 Jessica((Madison(4/30)(64(yo(female(with(MS(and(pneumonia.(Right(BKA(and(Le`(upper(extremity(amputaGon(a`er(contracGng(a(nosocomial(infecGon(while(in(the(hospital.(History(of(HTN,(Diabetes,(and(cardiomyopathy.Safety:(Siderails(up(x2Mobility:(transfer(out(of(bed(with(assistance(of(2(using(a(sling(from(bed(to(chairFluid(Management:(peg(tube(with(nothing(going(in(at(present,(thickened(liquids(po,(intake(onlyComfort(management(with(oral(care(Vital(signs(with(O2(sats(and(noGfy(primary(nurse(if(<92%(and(pain(assessment(using(a(0W(10(scale.0900(meds:(Epogen(SQ,(anaxoprim,(B12(injecGon,(cyclobenzaprine,(folic(acid,(and(guiafenasin.(Respiratory(Management(with(cough(and(deep(breathing;(FYI(there(are(rales(in(the(le`(base(and(diminished(breath(sounds.(










[email protected]

34 Claribel((Meriter(4/30)(Male(admi]ed(on(4/27(with(right(total(knee(replacement(surgery.(History(of(DVT,(Safety:(siderails(up(x2Mobility:(ambulate(OOB(to(chair(with(walker(and(1(assistVital(signs(with(O2(sat(check,(0W10(pain(scale,(no(IV,(PCA(was(d/c’d(today,(PVA(of(lower(extremiGesComfort(management,Fluid(management:(regular(diet,(encourage(fluids,(I&Os0900(meds:(docusate,(prednisone,(and(lovenox(sq(

35 Felicia((4/30(Milwaukee)(paGent(admi]ed(on(3/21(for(a(thyroid(goiter(and(thyroidectomy(who(had(difficulty(swallowing.(PaGent(ended(up(having(laryngeal(edema(and(was(trached.(The(trach(was(d/c’d(4(days(ago.Safety:(Siderails(up(x2(Vital(signs(apical(HR,(RR,(manual(BP,(oral(temp,(with(O2(sats,(assess(pain(using(a(0W10(scale(Respiratory(assessmentWound(management(change(the(4x4(to(the(trach(siteMobility:(reposiGon(x1(0900(meds:(norvasc,(aspirin,(synthroid,(detemir((insulin),(I&Os(Fluid(Management:(Diet(is(so`,(fluids(are(encouragedFYI:(Keep(HOB(at(least(30(degrees(when(eaGng(

36 Pam((4/30(Gwinne])(65(yo(pulmonary(fibrosis,(NIDDM,(Cardiac(problems((history(of(heart(a]ack)(Safety:(Siderails(up(x2Vital(signs(apical(HR,(RR,(manual(BP,(oral(temp,(with(O2(satsWnoGfy(primary(nurse(if(<92%,(pain(assessment(0W10(scale,Intake(only(:(Heart(healthy(diet,(fluids(ad(libMobility:(ReposiGon(x(1PVA(lowerOxygen(management:(O2(via(2(liters(NC,(I&O,(with(teaching(FYI...there(are(crackles(in(bases(and(paGent(raGng(pain(a(0.(

37 Rona((4/30(Grady)(62(yo(female(with(HTN,(Hypoglycemia,(DemenGa(Safety:(Side(rails(up(x(2(Fluid(management:(Intake(only:(Fluids(ad(lib,(regular(dietVital(signs(apical(HR,(RR,(manual(BP,(oral(temp,(0W10(pain(assessmentMobility:(Stand(by(assistance(x(1Respiratory(assessmentComfort(management0900(meds:(norvasc,(heparin(sub(q((paGent(has(a(PIV(but(student(is(not(to(mess(with)(Fyi:(paGent(is(raGng(pain(a(0.(










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38 Tammy((4/30(Grady)(15(yo(African(American(Female(with(nonketonic(hyperosmolar(hyperglycemia,(and(a(family(history(of(diabetes(and(paGent(is(obese.Safety:(siderails(up(x(2,(NKA(Vital(signs(apical(HR,(manual(BP,(RR,(oral(temp(with(0W10(pain(assessment(Fluids:(I&O(1800(cal(ADA(diet,(encourage(fluidsMobility:(Ambulate(with(standby((paGent(may(refuse);(if(refuses,(reposiGon(x(1(Neurological(assessmentPVA0900(meds:(lisinoprilFYI:(paGent(complains(of(feet(“burning”(all(the(Gme

39 Nancy((4/30(Gwinne])(Male(with(colon(cancer(that(had(a(colon(resecGon(2(days(agoMobility:(keep(HOB(30(degrees,(ambulate(as(toleratedFluid(Management:(NGT(to(LIS,(#18(angiocath(for(an(IV(in(the(right(hand,(PCA(of(Dilaudid,(NPO(except(ice(chipsSafety:(siderails(up(x2Abdominal(assessmentPVA(of(lowerRespiratory(assessment0900(meds:(fragmin(subqVital(signs:(oral(temp,(apical(pulse,(resp.(rate,(manual(BP,(0W10(pain(assessment,(O2(sats(and(noGfy(primary(nurse(if(<92%FYI(paGent(is(breathing(shallow(and(O2(sats(are(97%(on(room(air

40 Andy,(a(50(year(old(male(who(had(a(colostomy(placed(3(months(ago(and(1(week(ago(had(an(abdominal/perineal(resecGonSafety:(siderails(up(x(2Mobility:(independent(with(standby(assistanceFluid(Management:(full(liquid(diet(and(encourage(fluids((may(go(to(so`(diet(in(the(morning)Vital(Signs:(apical(HR,(RR,(oral(temp(pain(using(a(0W10(pain(scaleIV(of(D5(0.45%(NS(with(20(mEq(of(kcl(@(50(ml/hrAbdominal(assessmentDrainage(and(specimen(W(paGent(has(a(colostomy;(you(are(to(empty(colostomyPaGent(teaching(with(drainage(and(specimen(collecGonoff(MSO4(pump(last(night(and(went(to(Percocet((raGng(pain(a(4(to(7)NGTube(came(out(today







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