Clinical Replacement Packet.docx 3 copy.docx - vSim ISBAR...

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vSim ISBAR Activity Student WorksheetIntroduction(Your name, position (RN), unit you are working on)Mary Frometa (RN)Emergency Department SituationPatient’s name, age, specific reason for visitStan Checketts , 52 years old male,Reason for visit : Rule out preoperative bowel obstruction BackgroundPatient’s primary diagnosis, date of admission, current orders of patientAdm DX: Rule out preoperative Bowel Obstruction Adm on 4/14/2020Current Orders:Start IV and give normal saline fluid bolus 500 mL over 30 minutes. Oxygen to maintain SpO2 greater than 92%ECG monitoring Diet NPOInsert nasogastric tube to low intermittent suction Labs: CBC , Chemistry profile , Abdominal X-ray Meds Buprenorphine 0.3 mg slow IV push every 6-hour PRN pain Ondansetron 4-8 mg IV push every 6 hours PRN nausea AssessmentCurrent pertinent assessment data using head to toe approach, pertinent diagnostics, vital signsVital Signs Heart rate: 129 Blood pressure: 108/78 mm Hg. Respiration: 29. SpO2: 90%. Temp: 99 F (37 C)There is decreased skin turgor. His skin is quite cold. Patient is breathing at 28 breaths per minute. The chest is moving normally on both sides. The breath sounds are normal. There were only normal heart sounds noted. Hyperactive sounds from the abdomen noted. The IV site had no redness, swelling, infiltration, bleeding, or drainage. The dressing was dry and intact. Patientstated a pain level of 4 that has been present for a few days.
RecommendationAny orders or recommendations you may have for this patient Encourage increased fluid intake, if not contraindicated, promote bedrest, provide bedside commode. Observe for fever, tachycardia, lethargy, leukocytosis, decreased serum protein, anxiety,Patient Education WorksheetName of medication, classificationMedication: BuprenorphineClassification: opioid analgesics, Pharmacologic: opioid agonists/antagonistsSafe dose or dose range, safe routeAnalgesia IM, IV (Adults): 0.3 mg q 4– 6 hr as needed. May repeat initial dose after 30 min (up to 0.3 mg q 4 hr or 0.6 mg q 6 hr); 0.6-mg doses should be given only IM.Transdermal (Adults): Opioid-naive-Transdermal system delivering 5– 20 mcg/ hr applied every 7 days. Initiate with 5 mcg/hr system; each dose titration may occur after 72 hr; do not exceed dose of 20 mcg/hr (due to high risk of QT interval prolongation); Previously taking 30 mg/day of morphine or equivalent-Initiate with 5 mcg/hr system; each dose titration may occur

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