Final Scenarios: Scenario I: Mr. Smith is your patient today.

He was admitted after suffering a knife stabbing which resulted in a hemo-pneumothorax. Upon admission to the ER two chest tubes were placed into the right pleura. Mr. Smith also has been prescribed IV antibiotics for an infection resulting from the stabbing. You need to assess Mr. Smith¶s chest tube site and system for any complications. Additionally, Mr. Smith¶s IV site shows signs of phlebitis. You will need to start a new IV (be sure to know what phlebitis is and what you would document). Orders: Ancef 1 gram IV every 12 hours. Chest tube suction to 20 cm. Water seal 2cm Be prepared to trouble shoot and address any problems.

Orders: Tracheosotmy care every 6 hours and as needed. Jones has been in a long term care facility after suffering an extensive stroke which has left her with bilateral upper and lower extremity paralysis and severe dysphasia. Jones has returned to the hospital with signs and symptoms of pneumonia. She had to have a tracheostomy placed due to continued need for artificial ventilation. Obtain a sterile sputum specimen Suction as needed. Ms. Upon admission she had a central line placed.Scenario II: Ms. .

You must respond to the reaction appropriately. A CBC done revealed a hgb of 7. . He has been directly admitted to your floor and needs an IV access. Type and cross and blood transfusion. Orders: Start IV run with 0.Scenario III: Your patient has recently been seen by his primary care giver for fatigue and tachycardia. He was subsequently admitted to the hospital for diagnostic studies and a blood transfusion. Your patient will have a reaction to the transfusion.4. Type and cross and administer 2 units of packed red blood cells.9 normal saline at Keep vein open rate.

who suffered a pneumothorax after sustaining a motor vehicle accident.Scenario IV: Your patient is a 28 year old Caucasian male. Orders: Switch current IV to a PCA: Morphine 1 mg/ml No loading dose PCA and Continuous PCA dose: 1.0 mg every 10 minutes Continuous rate 5 mg/hr 4 hour lockout 20 mg Change suction on chest tube to 20 cm Perform central line dressing change every 12 hours. He had a chest tube and central line placed prior to being transferred to your unit. .

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