NURSING PROCESS: THE PATIENT WITH PNEUMONIA. The lack of energy causes an increased level of hunger. Read the patient scenario below and then match each numbered and {bracketed} nursing activity with the correct step of the nursing process.Annie seeks your help in the student health clinic because she suspects that her roommate Angela suffered date r@pe. Stroller, Pens, Churchman, Doherty ; Make don’ appear in the body of your assignment. Negative feedback loop controls thyroid levels by increasing thyroid hormones above a particular threshold, thus making the TRH-secreting neurons in the hypothalamus to be inhibited and stopped from secretion. How to Answer Scenario-Based Nursing Interview Questions By: Lisa Fields. Planned nursing care to meet these goal include monitoring Mr.. Smith’s vital signs and cardiac rhythm. Stress hormones, such as adrenaline and cortisol, can raise blood sugar. Smith with high protein, high-energy nutritious knacks and drinks that contain adequate energy and protein, and that require minimal effort to consume. Close monitoring is essential to prevent unsafe increases in the patient’s Papa, as apneas may occur. This suggests that Mr.. Smith is oxygen sensitive, and was retaining CO as a result of the TO. At the end of 72 hours Mr. Smith’s condition was stable and he was discharged and referred to home health services for urging care and oxygen management for further education and COOP rehabilitation. A respiratory assessment will further identify the clinical manifestations of pneumonia: pleuritic … Although Lines and Kelly explain that it is important to realize that individuals will respond to TO differently. could not have come at a better time. The nurse simulation scenarios, documents, and videos contained in the Montgomery College Nursing Simulation Scenario Library (the “Content”) are reviewed and updated periodically for accuracy and current best practices. Myxedema coma often occurs as a result of long-standing, undiagnosed or untreated hypothyroidism and is often precipitated by a systemic disease. The planning and implementation of these nursing interventions was deemed a success due to all goals being achieved. Notably, the individuals with Polydipsia urinate frequently and pass large volumes of urine- more than 3 liters daily compared to the normal urine output in adults of approximately 1 to 2 liters a day. Designate one student to act as a patient. Polydipsia is the increase in thirst as a result of high blood glucose that raises the osmolarity of the blood, thus making it more concentrated. Intermediate: Mr. . Stay focused only on the information provided in the scenarios. The patient then begins to show the symptoms of polyuria, polyphagia, polydipsia, and weight loss, as in the case of the patient in this scenario. Observe color and consistency of sputum and note on the Fluid Balance Chart. Monitor Abs and note any changes, signs of respiratory failure are increasing Apace and decreasing Papa. Critical thinking is an essential part of a nurse’s professional growth because it determines the quality of decisions made in the course of practice. In addition, please provide a clear indication of who did what to fulfill the need to address the importance of teamwork and I will be happy to ass this section of your assignment. Signs of advanced hyperemia include darkness Ana central cyanogens. She is visibly upset because the patient informed her that she is to be discharged that morning. Moore agrees, explaining that a COOP patient at risk of RAFF should only be administrated oxygen via a Ventura mask, which helps to ensure the correct dose of oxygen is administered and prevents the patient rebating CO, reducing the risk of RAFF. The common cause of hypothyroidism is an unregulated autoimmune response, which happens when the body confuses the normal, healthy cells for living cells. She is a female and has arthritis while also suffering from advanced liver failure. Planned nursing care to meet these goal include monitoring Mr.. Smith’s vital signs and cardiac rhythm. At NURSING.com, our case studies are written by practicing nurses with advanced degrees who have direct patient care experience taking care of those with the specific disease process. State what the cause of the above problem is (related to factor) (R/T). With the explosion of the use and incorporation of simulations in nursing education today, this book, Simulation Scenarios for Nurse Educators: Making It REAL! Water follows the glucose concentration passively, resulting in abnormally high urine output. Coping skills reduced caused by anxiety, lack of solicitation, depression, low activity levels and an inability to work. Implementation Phase: Please put the information in these sections under the ‘planning’ title where they belong and write a small paragraph indicating that the planned care was actually carried out for Mr. Smith. Social workers are passing water pitchers and afternoon snacks. As a result, the glucose from the blood cannot enter the cells due to either a lack of insulin or insulin resistance- so the body cannot convert the food eaten into energy. SCENARIO 1: This is your first day at Adventure Nursing Home! Part 5 - Clinical Scenarios Your RN practice will depend on your client’s situation and the setting where you offer nursing care. & Erb, G. (2008). Prevent fluid volume insufficiency and electrolyte imbalance. Indications of cyanogens can be observed peripherally or centrally. Advises he often feels anxious due to threat of death, purposes that are not being met. b. the main road to and from the nursing home, preventing anyone from leaving or coming to work. However they emphasis its limitations, including that false readings can occur due to poor perfusion or patient movement and its inability to detect CO in the blood. Whether you are handling a patient with schizophrenia, pneumonia, diabetes, appendicitis, hypertension, COPD, etc, you will need to follow specific steps to ensure that you are executing the critical nursing process. Planning Phase: Goals: Mr. Smith is at high risk of developing acute hyperplasia respiratory failure. Welcome to the world of case studies that can bring you high grades! Describe a clinical scenario in which you were faced with a patient problem (This should be brief, no more than 100 words). The implementation phase usually has a focus on side effects of medication provided and your extensive considerations related to administration of oxygen certainly achieves that. Nursing Advocacy in Action boxes present a patient scenario along with implications for nursing advocacy, especially advocating for vulnerable patient populations. Spends a lot of time in bed with no solicitation with nursing staff or other patients. Karen will give feedback on Rob’s performance Let’s test your knowledge about the nursing process with this 25-item questionnaire. The second priority is to enhance his nutritional intake to encourage increased energy levels needed for function and to restore energy levels diminished by factors relating to his COOP. Environmental factors such as deficiency in vitamin-D, exposure to enteroviruses, unhealthy diet, polluted air, and damage to immune cells trigger an autoimmune response. Activity: Nursing Process Role-play. In the scenario, the gets tired quickly, an indication of uncontrolled lack of energy as a result of polyphagia. Obesity due to a lack of exercise is accompanied by a decrease in muscle mass and induces insulin resistance. Nursing Process Scenarios: Complete the steps below for scenarios 1 - 6. Acasestudy.com © 2007-2019 All rights reserved. Hypoactive or diminished bowel sounds may indicate a decrease in gastric motility and constipation related to reduced fluid intake, decreased activity, poor food choices, and hyperemia. Scenario Number 2. Provide Mr. . Read each of the scenarios below to test your knowledge and clinical judgement. The 26-chapter book provides step-by-step guidelines for nursing faculty to design, develop, and implement clinical simulation scenarios in diverse settings, with diverse patients, and for … Smith enjoys a daily walk around the lake close to his home and helps his wife around the house. Nursing process records were utilized to assess the evolution of clinical reasoning prior to and following exposure to a high-fidelity post-operative simulation experience. The nursing process is a patient-centered, outcome-oriented method that directs the nurse and patient to accomplish the following: assess the patient, determine the diagnosis, identify expected outcomes and plan of care, implement the care, and evaluate the results. In the scenario, the blood glucose is higher than normal. Provision of such clarity ensures that no aspect of patient care gets overlooked which really improves efficiency and the effectiveness of care provision. In the scenario, the patient complained of frequently visiting the bathroom and feels very weak. When this incidence happens, the body begins to burn fat and muscle for energy, thus leading to a reduction in the overall body weight. When he is called back from the … Mr. Smith will be weighed each day to assess nutritional status and determine caloric needs, set weight goal, and evaluate an adequate nutritional plan. NICE clinical case scenarios . Noxious tastes, slants, Ana smells are major deterrents to appetite and can provide a stimulus for nausea and vomiting causing respiratory exertion. Hypothyroidism occurs when the body fails to produce enough thyroid hormones, which help the body to regulate and utilize energy. Thirdly a plan for post discharge care and support is required for Mr.Smith and his family, to enhance his quality of life and reduce the risk of COOP exacerbation and re-admission to hospital. If either of these conditions progress in severity, BP might drop, a rapid heart rate with arrhythmias endures and respiratory failure may result in Mr. Administer medications as ordered and provide mouth care after inhalers. As a result, the individual will often experience fatigue, as noted in the patient in this scenario. Smith maintains optimal gas exchange as evidenced by normal Abs, appears alert and responsive with no reduction in mental status. Scheduled rest periods and paced activities following treatments and procedures will prevent fatigue. Mr.. Smith’s response to oxygen therapy will be monitored closely oxygen including saturation, sputum consistency, and respiratory rate. However, before the surgery, one is given specific blood pressure medications that block the actions of the high-adrenaline hormones to reduce the risk of developing severe high blood pressure during surgery. Below is an example of the process from start to finish in a story like fashion: Assessment John visits his general physician on Monday because he was feeling sick over the weekend. Further, cortisol promotes gluconeogenesis, which contributes to hyperglycemia noticed in KDA. You patiently sorted through hundreds of nursing job postings, found one that matches your skills and interests, and submitted an application. The treatment goals for managing pheochromocytoma include the removal of the tumor and control of blood pressure. 1296-1298). These measurements will also be used to determine the success of these interventions in meeting the nursing goal. Consume a high-energy diet and encourage regular eating and rest tatters. Mr. Smith will be encouraged to rest for a period of 1 hour before and after meals to reduce fatigue during mealtime, and create an opportunity to increase his total calorie intake. • Nursing Skills show both actions and rationales and highlight special considerations. Designed to simulate real nursing scenarios and to develop clinical decision-making skills, competence, and confidence in nursing students, vSim for Nursing includes: Online interactive virtual simulations with integrated curriculum resources pre- and post-simulation quizzes; Guided reflection questions. The nursing assessment (Assessing) is the systematic and continuous collection, organization, validation, and documentation of data (information). Carbonated beverages and gas-producing foods should be avoided; abdominal distension may result, which hinders abdominal breathing and diaphragmatic movement increasing the risk of dyspepsia. The nursing process is a problem-solving process that addresses community health problems at all aggregate levels and aims to prevent illness. Diabetes insipidus is caused by problems with a chemical known as vasopressin (AVP), which is also referred to as antidiuretic hormone (ADH). The hormone epinephrine participates in the development of KDA aiding the liver to convert stored glycogen to glucose and release it, thus raising blood sugar levels leading to KDA. 6 Effective Content Marketing Strategies You May Have Overlooked, Market Analysis Definition (With Explanation and Examples). The patient factors that lead to the development of thyroid include manifestations of symptoms such as racing heartbeat, perspiration, hyperactivity, and severe palpitation, and heat intolerance. Kozier & Erb’s fundamentals of nursing: Concepts, process, and practice (8th ed., p. 905 & pp. Facial expressions are often observed being sad. These clinical scenarios describe three different practice settings to help you understand how different RN practices can be from one setting to another. Mr.. Smith’s will be monitored closely for signs hyperplasia and hyperemia. This way, the concentration of the hormone in the blood is maintained. Eating requires energy and more oxygen will be consumed than at rest. Write a paper on grant proposals and processes using the scenario in appendix BPaper requirements: Describe the steps to writing a grant proposal for the Mr.. Smith will be assisted with ambulation, to promote lung expansion, stimulate deep breathing and assist with clearance of mucus and secretions. The imbalance causes the body to hold too much water, increasing the blood volume and blood pressure. Hyperplasia is caused by low oxygen saturation, symptoms of this include confusion and anxiety and decreased respiratory rate. The pathophysiology of polyphagia can be explained by the onset of uncontrolled Type 1 diabetes, which causes blood glucose levels to remain extremely high. NURSING AND MIDWIFERY SUPERGUIDE SCENARIOS The results of the assessment will be documented and conveyed to the Nursing Unit Manager (NUM). Critical Thinking Scenario – Nursing Essay. Over the next day he appeared to remain alert and responsive which indicated optimal gas exchange via oxygen therapy. Explaining … The primary treatment is surgery to remove the tumor. Helen, the nurse coordinator, identifies an open room for the following day and moves Mr. Smith’s case from 1230 to 0730 but does not check with the … Scenario 8. Administer supplemental oxygen during meals as indicated. Abed and Hunks found that oxygen saturation levels need to be maintained between 88-92% to reduce the risk of oxygen induced hyperplasia and to avoid hyperemia. Besides, the patient stated that he could not afford the insulin, meaning that he had insufficient insulin, meaning he had Type 2 diabetes. Rehabilitation incorporating exercise programs, education and psychosocial support can provide the greatest benefits firstly by improving cardiovascular fitness, muscle strength Ana exercise endurance leaning to Improved Tunnel Ana reach symptoms of COOP; enhancing Mr.Smith’s self-confidence and coping strategies, and improving medication adherence and use of respiratory treatment devices; and lastly by enlightening mood by controlling anxiety and panic, diminishing depression, and reducing social barriers. TeamSTEPPS 2.0 Specialty Scenarios - 85 Specialty Scenarios OR Scenario 68 Appropriate for: All Specialties Setting: Hospital Mr. Smith, a 65-year-old male, is scheduled for a major surgical procedure at 1230 the next day. He become confused, agitated, was saturating at 84% via a Hudson marks and his arterial blood gases showed respiratory acidosis and hyperplasia, all of which are signs of RAFF. The maternal uncle had some sugar diabetes problems. In case the autoimmune is not regulated, the body’s immune system can attack healthy tissues, causing severe health issues like hyperactivity, as witnessed by the patient bursting into tears without any reason, decreased appetite, sleep problems, and depression. Imbalanced Nutrition – less than body requirements. 1. On the other hand, Cushing’s disease is a specific form of Cushing’s syndrome that can be differentiated from Cushing’s syndrome when a pituitary tumor secretes excessive ACTH. The nursing process is a deliberate intellectual activity whereby the practice of nursing is approached in a dynamic, systematic manner to patient care in a dynamic, continuous method to assist the patient to achieve and … In the scenario, the patient lost weight despite eating more, an indication that there is insufficient insulin that prevents the body from absorbing the necessary glucose that can be broken down into energy. Evaluate Body Mass Index to assess dietary habits and monitor amount of fluid and food ingested to determine efficiency of intake. It is a fine line between optimal and excessive TO, therefore risk management should always be a nursing priority. Over a period of 24 hrs Mr. Smith’s oxygen saturation levels were measured and recorded every 30 minutes at a level of 88-92%. February 15, 2019. [email protected] 804-506-0782 350 5th Ave, New York, NY 10118, USA. In this scenario, the patient has hyperthyroidism, and she did not take the prescribed antithyroid medication and also refused thyroidectomy. Impaired insulin secretion leads to a reduction in glucose responsiveness. I en respiratory status Ana level AT consciousness AT Mr.. Smith will be assessed every 1 to 2 hours until stable, then at least every 4 hours. Think of this as your chance … These strategies have been administered upon discharge to enhance Mr. Smith’s quality of life and reduce the risk of any further complications resulting from COOP and future hospital admissions. c. State the signs and … Initial signs of hypoxia and hyperplasia indicate an increase in Blood Pressure, respiratory and heart rate. By continuing we’ll assume you board with our, Sample Nursing Case Study About Pneumonia, Clinical Pathologically Nursing Case Study, How to secure financing as a small business owner, How to Make a Business Plan for Any Business, 7 Crucial Macro Environment Factors to Include in Your Analysis, Macro Environment Examples in the Real World. His COOP may cause inadequate gas exchange, resulting in hyperemia and hyperplasia. One area identified to reduce this risk is health promotion and education through access to comprehensive pulmonary rehabilitation. Mr. Smith denies being involved in any religious beliefs but attends Church with his wife on Christmas Eve as a tradition. If either of these conditions progress in severity, BP might drop, a rapid heart rate with arrhythmias endures and respiratory failure may result in Mr. . Her husband, of American Indian descent, has his ideas about what needs to be done as Ella comes to […] The following scenarios will help you start developing the thought process of critical thinking. A nursing assistant is leading an impromptu sing-a-long with a group of residents. In most cases, it is often an early symptom of Type 1 diabetes. Besides, glucagon has its significant physiological action at the liver to break down glycogen, which contributes to increased ketones and acidosis present in KDA. In this case scenario, the patient was diagnosed with hypothyroidism, which had not been treated, thus leading to myxedema coma. The condition occurs the adrenal gland secretes excessive aldosterone hormone that results in the increases in sodium reabsorption and loss of potassium and hydrogen ions. Lastly, growth hormone participates in the development of KDA by enhancing the breakdown of triglyceride into free fatty acids and gluconeogenesis, which is the primary cause for the elevation in serum glucose levels in KDA. The risk of rebound hypothermia is also present, where due to the sudden cessation of TO, the remaining oxygen is absorbed into the bloodstream resulting in tattletales. Answer each question to … Nevertheless, these scenarios, documents, and videos, including but not limited to text, graphics, images, and other material are for informational and … Smith requires close monitoring and risk management while on the respiratory ward, especially while receiving TO to avoid hyperemia and hyperplasia leading to RAFF. According to the International Nursing Association for Clinical Simulation and Learning the first step in scenario development is the completion of a needs assessment.The INACSL simulation design standard provides a sequential plan for scenario development which can be adapted for … (Could you do the scenario that I am a nurse working with the patient who has a pressure ulcer at the nursing … Clinical case scenarios: Common mental health disorders in primary care (May 2012) Page 4 of 85 . Activity Intolerance related to imbalance between oxygen supply with demand. Thyroid storm develops in patients with hyperthyroidism but are not receiving recommended treatment. Early indications of hypoxia include restlessness and anxiety, worsening Arterial Blood Gases accompanied by confusion are signs of cerebral dysfunction. The nurse tells you that she was unaware of this plan as the doctor made rounds and left without discussing his orders. Does not want to eat at meal times as states he has no appetite. Their declaration hat this is particularly important for those patients over 70 is especially relevant considering Mr.. Smith’s age of 74. HHNKS or HHNS is an emergency that is caused by extremely high blood sugar, often over 600 mg/gL. I explain the Nursing Process step-by-step so you can understand it. Long- term: Rater Mr. Smelt to none Neal services Tort nursing care, oxygen management and COOP rehabilitation. If uncontrolled high concentration of oxygen is given inappropriately in COOP patients, some may retain CO, which puts them at risk of hyperplasia and respiratory acidosis. Smith being incapable of sustaining the rapid respiratory rate. Steps on Nursing Process. Calculate Mr. Smith for bowel sounds. Maintain Mr.. Smith’s airway potency by teaching “huff” coughing techniques to effectively loosen mucus and secretions, reducing fatigue and conserving energy. An evaluation of the goals set out should involve observations of Mr.. Smith’s ability to cough and deep breathe effectively. His oxygen saturation levels will be measured and recorded every 30 minutes using a pulse geometry device to ensure they stay teen 88-92% over the 24-hour period. . Guided questioning will be used throughout the process, to assess Rob’s understanding and critical thinking skills. Any damage to the pituitary gland or hypothalamus from surgery, tumor, head injury, or even any other disease leads to diabetes insipidus by the impact the normal production, storage, and release of ADH as noted in this scenario. Divide your students into groups of 3 -4 for this activity. Cushing’s syndrome is caused by any condition that causes the adrenal gland to produce excess cortisol regardless of the cause. Pheochromocytoma causes the classic symptoms the patient presented through the overproduction of the epinephrine and norepinephrine hormones that increase the blood pressure, which causes severe headache and palpitation. Smith is at risk of RAFF, as evidenced by his is mildly hypersonic state with compensated respiratory acidosis and 82% oxygen saturation levels on Room Air. Has no appetite and states he does not feel hungry. Immediately after eels the original oxygen delivery system should be resumed. Pulmonary rehabilitation is one of the most successful interventions in COOP, enhancing health-related quality of life and self-efficacy, and reducing depression and anxiety, dispensed and the possibility of future hospitalizing. The five stages of the nursing process are assessment, diagnosing, planning, implementation, and evaluation. Write the scenario describing how you (or the RN) followed the steps of the nursing process, labeling each step of the nursing process within the scenario.
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