PRIORITY Patient Activity
Part I: Who does the nurse see first?
Part I-Patient Care Scenarios
You are the RN on a busy medical-surgical/telemetry floor at Anytown General
Hospital. Each nurse on your unit typically c
...
PRIORITY Patient Activity
Part I: Who does the nurse see first?
Part I-Patient Care Scenarios
You are the RN on a busy medical-surgical/telemetry floor at Anytown General
Hospital. Each nurse on your unit typically cares for 3-5 patients.
You have just arrived for your day shift and are receiving nurse-to-nurse reports
from three different night shift nurses. After you receive reports, you will have an
opportunity to review the current orders for each of your patients.
>>Herbie Saunders is a 62-year-old male who came in last
night for a CHF exacerbation. His doctor is Dr. Davis and
he’s a full code. He’s alert and oriented and can make his
needs known. He’s on tele, normal sinus rhythm with
occasional PVCs. His pressures are fine, heart rate is in
the 70s. Lungs are clear in the uppers with crackles in the
bases.
He’s coughing up a small amount of white frothy
secretions. He’s been on room air since he arrived,
oxygen sats are in the low-mid 90s. He got 40 mg IV
Lasix last night in the ED; I think you might have
something scheduled during your shift but I haven’t given
anything overnight. He has a 20 gauge in his right
forearm. I’m not sure how he gets around since he’s been
in bed since he got here.”
>>>>David Mueller is 72 years old, here for a right
BKA. He is Dr. Snyder’s patient. Vitals are fine,
he’s not on telemetry. Lungs are clear, he’s on room
air. I think he still has an 18 gauge in his left a/c but
I didn’t get a chance to flush it because he was
sleeping most of the night.
His finger sticks have been in the high 200s and he
gets a sliding scale. That’s really all I have for him.
I was so busy last night with a new admission and
another patient who was on the call light all night
long.”
>>>>Gladys Parker is a sweet little 92-year-old lady. She’s
here because she had a fall at her nursing home that
they think was due to dehydration and weakness. She
was admitted by the night float but Dr. Howard will
probably be her attending. She’s DNR/DNI. Alert to
self and place, but definitely disoriented to time and
situation. She’s really forgetful and doesn’t seem to
want to bother anyone so she hasn’t used her call light
all night. I’d guess she’s at least an assist of one for
transfers.
She’s on telemetry because her electrolytes were off
when she arrived. EKG showed Afib with a heart rate
in the 90s. Blood pressures are pretty soft, her systolic
blood pressures were in the low 90s for me. Lungs are
clear, she’s on room air. They put her on a mechanical
soft diet. She takes her pills whole in pudding or
applesauce. The nursing home said her last bowel
movement was 3 days ago and that she’s incontinent of
both bowel and bladder.
Her urine seems really concentrated and has a strong
odor. I noticed that there is still an outstanding order to
collect a UA but I couldn’t get one since she was
incontinent all night. Maybe you can address that with
the doctor today if they still want it. She’s got a 22
gauge in her left wrist with LR running at 100 mls/hr
for a total of one liter. I started that at 0200.”
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