All Virtual clinical scenarios, Med-Surg & Room, all Evaluated, Latest 2021

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All Virtual clinical scenarios, Med-Surg & Room, all Evaluated Linda Yu Jose Martinez Room 304 Jose Martinez, Jose Martinez, 43- year old male experiencing chest pain whilewatching a state rival f... ootball game earlier in the evening. Chest pain became progressively worse, so he called for an ambulance to bring him to the Emergency Department. Once the ambulance arrived, he reported his pain as 10/10. The 12-lead EKG showed ST elevation. Vital signs were HR 160, BP 145/102, Respirations 23, and Pulse Ox 89%. He was given nitroglycerin during transport to the hospital with little relief. He complained of feeling “light- headed”. He has been admitted to the unit, and the pain has subsided. He does have a 10-year history of hypertension. He was transferred here to the cardiac stepdown unit from the ER, because no beds were open in cardiac ICU. Ambulance report: Nitroglycerin SL x 3, 12-lead EKG, Blood drawn for cardiac enzymes, Peripheral IV started to left forearm. Karen Cole 56 year old female, Karen Cole, a school principal at White House High School. Admitted directly from the Dr.’s office to the IMCU after initial complaint for tightness in her chest, denies pain, and slight shortness of breath. Vital signs are BP: 168/92, P: 90, R: 24, T: 98.6 F, 37 C. Her husband insisted that she come. She is insisting that she will only stay 12 hours, because she has to be back to school in the morning JOHN WIGGINS LINDA PITTMON TIM Jones SARAH KATHY HORTON Estelle hatcher: Ana rails Arthur Thomason Room 301 Richard Dominec, A 47-year-old married father of three children has been admitted for an emergent appendectomy in the evening as soon as there is space available in the OR. He is currently febrile with temperature 100.8, HR 99, BP 135/96, RR 20, PaO2 96%, nauseated with no vomiting, rebound tenderness in right lower quadrant, has elevated WBC's and surgeon feels this will be uneventful even though he has just been diagnosed with AIDS this past week. His overall health is good, and he has known he has been HIVpositive for the past five years. He has been taking his HIV medication daily. Recently he manifested an unusual black lesion on his thigh and developed an opportunistic fungal mouth infection which was treated successfully. The lesion was identified as Kaposi's Sarcoma. Now, meeting the CDC definition, he has full blown AIDS but is asymptomatic at this time. Mr. Dominec has a male partner and has been married for the past ten years and share their three children to the marriage. Kathy Gestalt, 33yr-old, Dx- second day post-op open right Tibia/Fibula fracture, plaster cast in place on right lower leg. No known allergies. Vital signs -Temp 98.4, BP 116/76, P 96, RR 20, SaO2 99%. Neuro WNL, alert, and cooperative but worried about scarring and is reluctance regarding walking on leg. Diet as tolerated, up ad lib after gait training. Crutches at bedside adjusted for height. Dr. Anderson Virginia Smith, 57-year-old who has elected to have a total mastectomy based on consultation with her surgeon, a total mastectomy removes all breast tissue but leaves all or most of axillary lymph nodes and chest muscles intact. She is also to receive radiation, chemotherapy, and hormone therapy post operatively. She is with her physician. She is also investigating bone marrow transplantation. She has arrived in pre-op and about to have surgery this morning. Her husband and two grown children are also with her as she is prepared with gown and head cap awaiting transport to the operating room. She has IV access and has received a small dose of Valium to reduce apprehension. Temperature is 98.3, HR is 87, RR is16, BP is 121/74,PaO2 is 98%. Robert Sturgess, 81 years old, Dx- Metastatic CA of Colon, Hx of diabetes. Palliative care. No Known allergies (NKA). Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. Neuro WNL alert and cooperative. Skin warm and dry, all vital signs in WNL except 115 pulse, which is normal for him. Blood Glucose 185, 4 units of insulin sliding scale for coverage. ADA diet, intake 25%. Demerol 25mg SIVP for pain, patient reports 7/10 on pain scale. Patientand family upset regarding dx. Dr. Donofrio Marcella Como, 38 yr-old, Sexual Trauma Victim (Rape), unknown assailant. Non-significant past medical Hx. No known allergies (NKA). Vital signs -Temp98.2, BP 94/60, P72, RR 22, SaO2 99%. Multiple abrasions, bruising Head, chest, and inner thigh. Isolative, appears fearful, crying, and refusing to see her husband. SANE nurse to make second visit today. Awaiting diagnostic labs. Taking HIV Meds prophylaxis. Social worker with patient this morning.Diet as tolerated. Dr. Roopes Ramona Stukes, 69 yr-old, third day post-op cholecystectomy. Non-significant past medical history. No known allergies (NKA). Vital signs -Temp 98.6, BP 114/62, P 100, RR 20, SaO2 94%. Neuro WNL, alert, and cooperative. Skin warm and dry, daily dressing changes, T-tube without drainage. NG tube to low suction possibly D/C'd today after Dr. Levine rounds. Today's incentive spirometry Tidal Volume is 1250ml, improvement over yesterday's 900ml. NPO with small amount of ice chips only. Today's weight 226. IV D5 1/2 NS with 20 KCL @ 125 ml/hr in left forearm. Last pain medicine 2hrs ago at 1300(Demerol 50mg/ Zofran 4mg IV). Ambulates with assistance. Dr. Levine Bleeding, Risk for Fals Status assessment reports surgical It Lithia Monson, 93 years old, c/o head injury, r/o subdural hematoma. Hx of dementia, from nursing home, fall one day ago. No known allergies (NKA). Vital signs -Temp 97.2, BP 96/74, P 82, RR 20, SaO2 97%. Neuro- confusion totime and place, but oriented to self, speech clear, poor historian, did not recognize son today which is new for her; Neuro assessment and vital signs q1 hr. Skin warm dry, bruises on forehead with small laceration. Increased fall risk. DSD (dry sterile dressing), forehead laceration clean and dry intact. 20ga. Hep-Lock in place left AC. GI WNL. Cardiovascular has pacer with rate of 82bpm on demand. Strict I&O, regular diet, intake 50%. Waist belt restraint PRN; family sitter at bedside, assist with bath. Dr. Altace Tom mrdson, 46yr-old. Dx- urinary stones with 3 episodes/5yrs. Allergic to sulfa drugs. Vital signs -Temp 98.4,BP 178/105, P 112, RR 28, SaO2 94%; Neuro- WNL's. Skin warm and pale. Generalized weakness, blood tinged urine and severe pain upon urination, GI- n/v. Clear liquid diet. Strict I&O and strain all urine, filters in bathroom. Patient demonstrates urine strain procedure. Severe pain (10/10) medicated q 30 minutes x4 with IV Morphine 2mg with little relief. IV D5 1/2 NS @150ml/hr. Dr. Small at bedside with patient and family. Stat lithotripsy treatment ordered. Awaiting transport. CARLOS 48yr-old, Spanish speaking migrant worker with no known past medical Hx. Rule out Tuberculosis. Vital signs -Temp 99.1, BP 124/62, P 77, RR20, SaO2 91%. Airborne Isolation. Neuro WNL. Skin moist, respiratory bilateral wheezes and rhonchi. Blood-tinged mucous, productive cough. Dietas tolerated. IV maintenance fluids with D5 1/4 NS @ 150 ml/hr X 3 then reduce rate to 75 ml/hr. Expresses fatigue, fear, concern, and desire for recovery. Need frequent reminder to stay in room and maintain mask precautions. If family/visitors come, will need education to airborne precautions. Spanish interpreter available at extension 61178. Dr. Rondeau [Show More]

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