Medical Surgical Unit

Directions: There are three scenarios that will be used in this discussion posting. You are all responsible for the initial discussion posting and then responding to one posting in the remaining scenarios. For example, my last name is Combs, therefore my initial discussion posting will occur from scenario #1. I will then be responsible for responding to one post from scenario #2 and one post from scenario #3.Initial Discussion scenario #1: Students that have last names beginning with A thru I will post your initial discussion to this scenario.Mrs. Parker is a 56-year-old woman who was diagnosed with heart failure 4 years ago. She has been admitted to the hospital for shortness of breath (SOB). She states, “I was taking a diuretic at home but ran out 1 week ago. I have not been able to refill my prescription”. She complains of difficulty breathing and has noticed some swelling in her feel that seemed worse than usual. On physical examination, you observe that she is alert and oriented to person, place, and time; SOB on exertion; oxygen saturation is 89% o room air; fine crackles bilateral in the lower lobes; fine 2+ edema bilaterally; and vital signs are T – 37.0, BO – 130/85, P – 120, and R – 35/min. You feel that it is best to notify the physician. Prepare and post your ISBAR using the attached form.Initial Discussion scenario #2: Students that have last names beginning with J thru Q will post your initial discussion to this scenario.Mr. Edwards is an 80-year-old male with a left cerebrovascular accident (CVA) who has been in a long-term care facility for the past 2 years. He is immobile and has to be transferred with the mechanical lift. His nutritional needs are met with 6 cans of Prosource via g-tube @ 50mL/hr. You are assigned to Mr. Edwards on the evening shift and you provided hygiene care and repositioned him. Mr. Edward’s routine medications were administered at 1800 hours. His G feed is also in progress. At 2000 hours when you approach Mr. Edward’s bed, you hear him coughing, respirations are noisy and his face is flushed. His vital signs are T – 39, HR – 110 bpm, R – 32, BP – 150.90, and SpO2 is 86% on room air. You feel that it is best to notify the physician. Prepare and post your ISBAR using the attached form.Initial Discussion scenario #3: Students that have last names beginning with R thru Z will post your initial discussion to this scenario.Miss Thompson, a 28-year-old female was admitted to your Medical-Surgical unit on the previous night shift for abdominal pain not yet diagnosed. The shift report stated that vitals were stable on admission. Upon shift change, you enter her room and she was moaning loudly and complaining of severe abdominal pain. She has just returned to bed after going to the bathroom. When you looked in the toilet, you noticed that she had a large, bloody stool. She states that she has had “at least one like that each day for the past week.” She states, “I feel so tired and weak. I have never felt this bad before. I can hardly stand long enough to brush my teeth”! Her color is pale, skin cool and diaphoretic. She is alert, knows her name, the date, and where she is but she is very fatigued. Vital signs at 0800 are T – 36.5, HR – 55bpm, R – 18, BP – 105/55, and SpO2 is 97% on room air. The change in the patient’s condition warrants a call to the physician. Prepare and post your ISBAR using the attached form.

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