All Swift River Medical-Surgical Room Cases, Solved! Graded! Updated Spring 2022; Distinction Level Assignment Has everything.

Hannah Johnson Room 302

Hannah Johnson, 10-year-old female presented to the ED 45 minutes ago

with dehydration, dysuria, and significant weight loss of 18 pounds over the

last 2 months. Both parents are with the child, the father is insisting that he

be notified of all interventions before they are initiated.  Initial assessment

reveals: Skin dry and warm to touch, B/P 90/58, T 99.2, HR 110, RR 30. Child

appears thin. Breathing is fast and deep. Noted fruity odor to breath. Initial

labs: CBC WNL, K+ 2.89, BG 459, Urinalysis: Positive for ketones, glucose,

and bacteria. Orders: IV 0.9% normal Saline at 150 ml/hour, Add 20 mEq K+

after first liter, Ampicillin 250 mg PO q 6 hours, finger stick blood glucose

(FSBG) q 1 hour.

You responded correctly to 6 out of 6 evaluations:

Category

Your

response Explanation

Educational

Needs

Increased

acuity

Status assessment reports abnormal and possible

newly diagnosis of type 1 diabetes.

Health Increased

acuity

Status assessment reports abnormal labs and

weight loss.

LOC Normal

acuity

Status assessment reports no indication of

increased LOC

Pain Increased

acuity

Status assessment reports dysuria.

Psych Normal

acuity

Status assessment reports no indication of

Psychiatric deficits

Safety Increased

acuity

Status assessment reports IV's and High Blood

Glucose.

Physiological

Description

Your

Respons

e Explanation

Breathing

pattern,

ineffective

True Status assessment reports altered

breathing pattern

This study source was downloaded by 100000840858457 from CourseHero.com on 03-28-2022 21:15:19 GMT -05:00

https://www.coursehero.com/file/127431685/Hannah-Johnsondocx/

Description

Your

Respons

e Explanation

Dehydration True Status assessment reports medical

dx of dehydration related to

abnormal labs and weight loss.

Tissue

integrity,

impaired

False Status assessment reports no

indication of Tissue integrity,

impaired

Safety

Description

Your

Response Explanation

Anxiety False Status assessment reports no

indication of Anxiety. Patient would be

"at Risk for"

Infection True Status assessment reports dysuria

with presence of bacteria in urine

Knowledge

deficit

True Status assessment reports new

medical diagnoses and weight loss

Risk for

injury

True Status assessment reports IV's and

High Blood Glucose.

Esteem

Description

Your

Response Explanation

Growth and

development

True Need for adolescence education

for new diagnosis.

Scenario 1

Hannah is fearful of administering insulin. You must attempt to help her gain

confidence.

This study source was downloaded by 100000840858457 from CourseHero.com on 03-28-2022 21:15:19 GMT -05:00

https://www.coursehero.com/file/127431685/Hannah-Johnsondocx/

You correctly ordered 5 out of 5 actions:

Your

order

Correc

t order Step Explanation

1 1 Apply Therapeutic

Communication/

Active Listening

Need to establish

therapeutic relationship

and trust

2 2 Educate Hannah

regarding insulin

Education is provided prior

to practicing on a doll to

increase knowledge and

decrease anxiety

3 3 Allow Hannah to

practice with doll

Less invasive, gives the

child the chance to

practice before learning to

inject self

4 4 Allow Hannah to

return

demonstration

Ensure patient/family

understands correct

technique

5 5 Evaluate teaching Determine effectiveness

and areas that may need

reeducation

Scenario 2

Upon entering room, you notice patient eating fast food hamburger, fries,

and a milkshake.

You correctly ordered 5 out of 5 actions:

Your

orde

r

Correc

t order Step Explanation

1 1 Provide

carbohydrate

education (CHO)

for patient and

Educate parents and child

on need for proper diet and

effects of CHO

This study source was downloaded by 100000840858457 from CourseHero.com on 03-28-2022 21:15:19 GMT -05:00

https://www.coursehero.com/file/127431685/Hannah-Johnsondocx/

Your

orde

r

Correc

t order Step Explanation

parents

2 2 Provide quick

reference tool for

CHO

Parents and child need

quick guide reference, so

they are not overwhelmed

with learning how to count

CHO.

3 3 You demonstrate

using reference

tool

Helps decrease anxiety

related to the reference,

increases chance for

learning to occur

4 4 Patient and parents

identify appropriate

substitution

Demonstrates

understanding of the

intervention of the CHO

education

5 5 Document

Education

Must always document

education provided and

what patient/family

understands

Scenario 3

Patient is observed as lethargic. Patient states she “hasn’t eaten much

today”.

You correctly ordered 5 out of 5 actions:

Your

order

Correc

t order Step Explanation

1 1 Assess patient Always assess situation

before coming up with goal

or intervention

2 2 Perform bedside BG performed based on