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Wendy Johnson Wendy is a female who is a post operative day three from a cholecystectomy. She has an intravenous of 0.9% normal saline infusing @...

Wendy Johnson
Wendy is a female who is a post operative day three from a cholecystectomy. She has an intravenous of 0.9% normal saline infusing @ 100ml/hr in her right hand. She has been complaining of pain in her abdomen for eight hours. On assessment she has no bowel sounds, a distended abdomen, and is not passing flatus. An x-ray has confirmed a small bowel obstruction. Currently she has a catheter insitu and since yesterday she’s been up walking around the unit with one-person assist. She had Percocet 2 tabs po ½ hour ago for pain.
The time is now 1000hrs.

Doctor’s Orders:
Admitting Diagnosis: Cholecystectomy
Goals of care designation: R1, Client is expected to benefit from and is accepting of
any appropriate investigations/interventions that can be offered including the
option of ICU care and resuscitation.
NPO
Ambulate
Insert Nasogastric Tube STAT
IV 0.9% Normal Saline @ 100ml/ hour
Cefazolin 1 gm IVPB q8hr
Percocet 2 tablets PO Q4H PRN
Discontinue catheter
I&O catheter q4 hr PRN














Maria Schwartz
Ms. Schwartz had a chest tube inserted two days ago after a partial lobectomy related to cancer of the lung. The chest tube dressing was changed earlier today. She also has a Jackson-Pratt drain in her abdomen for collection of fluid caused by peritonitis. She has been given morphine via IV, but her veins are very fragile and go interstitial frequently. She has many bruises and broken skin areas related to poor skin turgor and many different old IV sites. She indicates that her pain is 8 out of 10. She has been assessed and an insertion of an HDC line has been ordered for her pain medication.
It is now 1600 hrs.

DOCTOR’S ORDERS:
Admitting Diagnosis: Lung Cancer
Goals of care designation: C1: Goals of care and interventions are for maximal
symptom control and maintenance of function without cure or control of
underlying condition. Transfer maybe undertaken in order to better understand
or control symptoms. Surgery may be undertaken in special circumstances to
better understand or control symptoms.
Insert HDC line.
Haldol 5 mg via HDC line TID
Morphine 5-10 mg via HDC q2-4hr PRN
Discontinue Jackson Pratt drain.
NPO
Consult ET nurse
Social work referral















Michael Towers

Michael was working in construction and while on the job tripped and fell onto a cement block sustaining an injury to his trachea resulting in a tracheostomy needing to be inserted. He has a productive cough producing tenacious yellow phlegm, he is not always able to expectorate this mucous and requires PRN suctioning through the trach. He is not able to verbalize at this time, but writes to communicate; Michael has a lot of anxiety related to his injuries that he sustained and has been receiving Ativan on regular basis since his arrival to your unit 4 days ago. His pain is under control and vital signs are stable on room air. His IV is infusing at 125 mL/hr.
It is now 0900 hrs.
Dr’s Orders:
Admitting Diagnosis: Trauma to the Trachea
Goals of Care designation: R1, client is expected to benefit from and is accepting
of any appropriate investigations/interventions that can be offered including the
option of ICU are and resuscitation.
NPO
Trach suctioning PRN as needed
Change trach dressing daily
Combivent 125 mEq via nebulizer Q4h
Lorazepam 4 mg IVPB q 6-8 hr PRN
MorphINE inj 5-10 mg IVPB q4h PRN
Flush Saline Loc per protocol
Ringer`s Lactate IV continuous at 125 mL/hr
Keep oxygen saturation above 90%
Ambulate as tolerated













Annabelle Watts

Annabelle is a paraplegic that presented to you in the emergency department while you are working a night shift. She has a history of frequent UTI`s and has just completed a round of Macrodantin 1 week ago and presents to you with a burning sensation around her urethra and expresses severe flank pain bilaterally that is poorly managed with morphine. Her oral intake today consisted of 3 glasses of milk 2 cans of cranberry juice and a 1L bottle of water. While at home she performs her own self catheterization multiple times throughout the day. Her temperature is currently elevated to 39.2 C and her urinalysis result shows a specific gravity of 1.30, a large number of leukocytes and is positive for nitrates. Her current weight as of this evening was 125 lbs and has a height of 5 foot 3 inches.
Time is currently 0300 hr
Dr. Order:

Admitting Diagnosis: Urinary Tract Infection

Goals of care designation: R1, client is expected to benefit from and is accepting
of any appropriate investigations/interventions that can be offered including the
option of ICU are and resuscitation.

Insert foley catheter
Monitor I+O
Paracetamol 1 g PO q 4hr PRN
Gentamicin IVPB give once as per parenteral drug monograph protocol
Discharge home after IV antibiotics
Send home with IV saline loc
Book appointment with urology
Book appointment with HPTP (Home Parenteral Therapy Program) in am












Jeremy Winters

Jeremy Winters has been admitted to your general surgery unit from emergency with a diagnosis of an upper GI bleed of undetermined origin. He has a previous history of alcohol abuse and states that his last drink was 10 hours ago. He has had frequent bouts ‘heartburn’ that has been relieved with TUMS until two days. His vital signs remain stable. He had approximately 400 mL of dark brown coloured emesis 30 min ago. His admission assessment sheet has been completed. His blood work from emergency was: Hgb 101 g/L Platelet count was 203 10E9/L PTT 32 sec and INR 0.9 . His pain is now under control with morphine IVPB that was administered 15 min ago. His CIWA score on admission was 2.
Current time is 0800 hr

Dr. Order:

Admitting diagnosis: Upper GI bleed of undetermined origin with a query of H. Pylori

Goals of care designation: R1, client is expected to benefit from and is accepting
of any appropriate investigations/interventions that can be offered including the
option of ICU are and resuscitation.
NPO
Insert NG tube
PENICILLIN G Sodium 1.5 Million units IVPB q 6 hours
PANTO 40 mg IVPB once daily
ONDANSATRON 8 mg IVPB q 3-4 hours PRN
DimenhyDRINATE 50 mg IVPB q 4 hours PRN
Maxeran 10 mg IVPB q 4 hours PRN
Morphine 5-10 mg IVPB q 2-3hr PRN
KCL 0.9% Sodium Chloride 75 mL/hr
Blood work in am: CBC, Lytes, Liver panel, INR
CIWA Protocol











Mangieol Ryu
Ms. Ryu is currently being treated for pneumonia and is coughing up green/yellow phlegm. Her temperature was 39.2 C at 0630 hours and the night nurse gave her Tylenol. She has an IV of normal saline infusing in her right forearm that is almost empty and needs to be changed immediately. IV tubing was changed yesterday. There are no IV pumps available at present, so her IV is running via gravity.
The time is now 0800hrs.

Dr’s Orders:
Admitting Diagnosis: Pneumonia
Goals of care designation: R1, client is expected to benefit from and is accepting
of any appropriate investigations/interventions that can be offered including the
option of ICU are and resuscitation.
IV 0.9% Sodium Chloride @ 100mls/hour
Cefuroxime 750mg IVPB Q8H
Tylenol 500-1000 mg PO Q4hr PRN
Blood cultures STAT X2 if temp >39.0
Encourage ambulation
Physiotherapy to assess
Wellness diet







Please find below scenerios i need answers
1. medication research for each scenerio, including client teaching
2. DARP charting for each scenerio
3. Care plan/ Nursing Diagnosis for each scenerio
showing 1.three nursing diagnosis using NANDA
2.one goal for each nursing diagnosis
3.three interventions for each nursing diagnosis
Please note, i am to perform nursing skill for each scenerio, hence, what will be my client teaching
Thank you.
2.

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