Kate Bradley 88 y/o female, patient fell and broke her hip two days ago. She is coming to us from the ShadyRest nursing home. She is a little...
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Kate Bradley Scenario 5 The surgeon is adamant that the patient come to the OR. He is not concerned about the patients temperature. The nurse has contacted Anesthesia, and they have said they will start the IV in the pre—op holding area if the IV team is unsuccessful. The surgeon persists and asks you to have the daughter sign. You correctly ordered 6 out of 6 actions: Your Correct order order V1 1 V2 2 V3 3 V4 4 V5 5 V6 6 Continue Step Witness daughter signing consent Call report to pre-op holding 88 y/o female, fractured right hip, confused. Daughter has signed the surgical consent. Former nursing home patient, and injured 2 days ago at Shady-Rest Patient has a Foley catheter that is draining cloudy urine, and is febrile. Her vital signs are: T:'lDi.5 £3216 C, P: 92, BP: 10452, R: 18, Pa02 92% Have the daughter stay with the patient as she is more compliant with her present. Remind PACU staff to position patient to stay off the decubitus. Inform the staff that the daughter has been belligerent, and smells of alcohol. Explanation Witnessing the consent is not determining competency of daughter to sign; the surgery is necessary, and the surgeon is aware of daughter's condition So pre-op holding is ready to receive the patient SeSituation B—Background A—Assessment ReRecommendation

Kate Bradley Scenario 4 The nurse attempts to communicate to the patient that she needs surgery to repair her hip, and they will need to start her IV again to treat her UTl. The N team is here to restart the N Ms. Bradley now screams she does not want another IV, wants to go back home, and is hurting. You correctly ordered 5 out of 5 actions: Your Correct order order Step Explanation V 'l 1 Provide therapeutic communication In order to support patient V 2 2 Assess her last medication for pain To determine if an intramuscular route is preferred as there is no IV access at this time V 3 3 Assist the IV team to restart the IV Patient may be uncooperativelcombative, and is a difficult stick V4 4 Explain to the daughter what is going on, and allow her to The daughter needs to understand the patient's condition upon arrival remain with her mother and the plan of care V 5 5 Contact social services while daughter is present Allow them to evaluate family dynamics, daughter, and plans for discharge back to nursing home Continue

Kate Bradley Scenario 3 The nurse receives an angry call from the surgeon asking why the patient is not in the preeop holding area, and why her morning labs were not drawn. The daughter arrives and is very belligerent, blaming the hospital statf tor her mothers' condition. The daughter smells of alcohol. You correctly ordered 5 out of 5 actions: Your Correct order order Step Explanation V 'l 1 Explain to the surgeon that she was told that patient was told to go Deescalate surgeon and reassure him that the patient will be to preeop in the aflernoon in preeop ASAP V 2 2 Check on labs to determine if they were drawn To make ready for surgery V 3 3 Contact Charge nurse and nursing supervisor To clarity pre—op orders V4 4 Meet with daughter and explain events: determine her competency A family member under the influence of drugsfalcohol cannot to sign surgery consent sign surgery consent V 5 5 Msess patient and make ready to transport to preeop Assess for any contraindications of patient going to surgery Continue

Kate Bradley Scenario 2 Mrs. Bradley has received her bed bath, and the wound nurse has assessed and started treatment on her decubitus ulcer. During her bed bath, her IV is accidentally pulled out and a new IV must be started as she is receiving IV Ciprofloxacin (Cipro), 400mg BID and PRN pain medication. The nurse is also concerned as no family members have visited, nor have they been available to sign a surgical consent. The technician reports that Mrs. Bradley is running a 101.3 F, 38.5 C temperature; P 94, BP 100/48, R 16. The nurse checks the vital signs from the previous shift and discovers they were close to identical, and her temp was recorded as 98.4 for the last 24 hours. You correctly ordered 0 out of 5 actions: Your Correct order order Step Explanation X 4 1 Reassess Vital signs To determine hemodynamic status X 5 2 Report discrepancy in vital signs to Charge nurse In order to determine if nursing staff neglect has taken place X1 3 Notify I—ICP that patient is nowfebrile,101.5 F, 38.6 C A fever may indicate an acute infection, and postpone surgery I 3 4 Contact IV team to restart the IV IV is necessary for antibiotic treatment and pain; patient has a history of di'l'ficult IV catheterization X 2 5 Document a" finding. and attempt to contact family Legal requirements to investigate potential neglect; patient mental status again for surgical consent prevents hertrom signing surgery consent Continue

Kate Bradley Scenario 1 Upon entering the room, the nurse does not see the sitter. While the nurse is doing the initial assessment, the sitter returns and says she ran to get something to eat. The sitter smells of cigarette smoke. The patient is awake. She is confused to time and place, but answers to her name. The nurse was able to slightly turn the patient, and while the patient does yell in pain she notes that she has had a BMPatient states she also has a stage three decubitus ulcer that was not reported along with dry feces. She also has a Foley catheter that was not reported; it is draining cloudy urine. The patient is laying on a bottom sheet from the nursing home. You correctly ordered 5 out of 5 actions: Your Correct order order Step Explanation V 1 1 Complete full assessment To determine hemodynamic status V 2 2 Secure help for bed bath To minimize pain and stabilize fracture while turning patient 5' 3 3 Medicate for pain To minimize pain during patient bed bath V 4 4 Contact Nursing To document initial findings of this patient upon arrival, and to have patient inspection from nursing Supervisor supervisor V 5 5 Complete bed bath To prevent infection, and further skin breakdown Continue

Kate Bradley 88 y/o female, patient fell and broke her hip two days ago. She is coming to us from the Shady—Rest nursing home. She is a little confused as to person and place. She does have a sitter in place, and has a bed alarm for fall risks. She has a 22g IV to her left forearm that was very difficult to obtain: she had multiple IV stick last night. Her skin is very friable, and we are using paper tape. She has several skin tears on her arms. She is in considerable pain, and screams when we try to move her. She received Fentanyl 25 mcg IVP this morning at 0600, and is resting quietly now. They plan to take her to the OR later this afternoon. You correctly diagnosed 8 out of 8 options: Physiological Description Your Response Explanation Acute pain V True Patient verbalizes pain Bleeding, risk for V True Patient has a fractured hip Impaired comfort V True Patient has a fractured hip Impaired mobility V True Patient has a present fractured hip, and diminished mental status Safety Description Your Response Explanation Deficient knowledge V True Patient is confused, and does not understand her surroundings. Fall, risk for V True Patient has a present fractured hip, and diminished mental status Grieving V False No indication at this time Infection, risk for V True Patient has a Foley catheter, and will be undergoing surgery Continue...

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