Please answer both scenarios with short answers.

Please answer both scenarios with short answers. Thank you. Scenario #1-Kelly Francis Kelly Francis is a 58-year-old female who had a complete mastectomy of her R breast after a diagnosis of stage 4 carcinoma. Her surgery was yesterday, and you have been told she had a restful night with sedation. Her nursing assessment shows a history of high cholesterol and hypertension both managed by medications. She is supported by her husband of 35 years and her 2 grown children. Post-operatively she has a Jackson Pratt drain in place and an occlusive dressing on her R side where the breast was removed. She has an IV infusing. She has not been up to ambulate post-operatively and her care plan shows that she is to attempt ambulation today. After reviewing the chart, you come in to assess Kelly Francis she is in semi-fowler’s position and her eyes are closed. She appears to be resting quietly. 1. What are your first steps when meeting Kelly Francis? Once you are able to speak with Kelly Francis, you find her to be very soft-spoken and tearful. 2. What types of communication techniques would you use/what would you say to Kelly Francis? 3. What are some of the issues you feel could be causing Kelly Francis to be tearful and upset? 4. Upon physical examination of Kelly Francis, you assess her vital signs to be BP 128/82 P-100, R- 19, T-37.9 °C. What is your assessment of these vital signs? 5. What other physical observations would you make? Assess Kelly Francis. 6. Note any unusual findings from assessing Kelly Francis, what would be your response to each of the findings? 2 hours into your shift you go in to check on Kelly Francis and get her up into a chair. You find her complaining of a headache and pain from her surgical site. She also states that she is having difficulty focusing on her eyes. 7. What are your first steps to getting Kelly Francis up and into a chair? 8. What are some reasons Kelly Francis could be complaining of a headache and difficulty focusing? 9. What are your assessments and nursing interventions for Kelly Francis at this time? Additional Questions 10. Your patient is wearing TED stockings, what are the indications for wearing TED stockings? 11. Your orders have a choice of IV or IM…what are the indications and benefits for one method over another? Scenario # 2- Jafar Singh Jafar Singh is a 55-year-old male admitted pre-operatively for a total knee replacement of his R knee. He has had a history of Type 1 diabetes for the past 40 years. He lives alone in a 1-bedroom apt. His diabetes is not well controlled and as a result, has been completely blind for the past 5 years. Jafar Singh weighs approx. 300 lbs and has difficulty moving around. You notice him straining to stand from sitting in a chair. After transferring from the chair to the bed his breathing is laboured, and it takes him about 5-10 minutes to recover from the transfer. His initial nursing assessment showed the following vital signs BP 144/89 T-36.7*C P-110 R-24. His blood sugar on admission was 9 mmol at dinner. He takes insulin BID. The physician has entered the following orders pre-op: NPO Hold regular medications Give Ativan 1 mg SL1 hour pre-operatively IV 2/3 & 1/3 infusing at 100 cc/hr 1. What other information would you like to know about Jafar Singh? 2. What are some issues that could interfere with Jafar Singh’s surgery and recovery? 3. . Since Jafar is blind, what are some communication and other issues you can expect/anticipate related to his inability to see? 4. What are some nursing diagnoses you can formulate for Jafar Singh with the information you know at this point? Scenario continued: Jafar is set to go to the OR in just over 1 hour. It is 09:00 and he has been NPO since midnight. His glucometer reading 5 minutes ago showed his blood sugar at 7.1 mmol. He is getting concerned because he is feeling hungry and would like to eat. He is also expressing his concerns about the stress of surgery and how he will manage post-operatively. 5. What should you be doing to get this patient ready pre-operatively? 6.. Why is he NPO and how do you explain this to him? 7. What bloodwork would you expect to draw and why? Scenario continued: It is now 16:00 and Jafar has just returned from the recovery room. He is drowsy and complaining of pain in his leg, pain scale of 5/10. You get him settled back into his bed and somewhat comfortable. 8. What assessments do you need to make at this time? 9. What additional information would you like to know? Scenario continued: You have just assessed Jafar and have found the following information, BP 125/80, P 96, R 15. His blood sugar is 4.2 mmol. He is due for his insulin now. 10. Looking at the post-operative orders and your assessment of Jafar what medications will you be administering? 11. The order has Jafar on clear fluids- DAT, why is he not on solid food immediately? During your next assessment of Jafar, you find him pale in appearance and he is shaking in his bed. He is complaining of feeling anxious and ‘unwell’. 12. What are your first thoughts about Jafar’s condition? 13. What further assessments would you like to make? 14. What nursing interventions would you perform for Jafar at this point? SCIENCE HEALTH SCIENCE NURSING NURS 24998

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