- MUSCULOSKELETAL
SCENARIO 1 (RHEUMATHOID ARTHRITIS)
Mrs X is admitted to the orthopedic ward. She has fallen at home and has sustained an intracapsular fracture of the hip at the femoral neck. The following history is obtained from her: She is a 75-year-old widow with three children living nearby. Her father died of cancer at age 62; mother died of heart failure at age 79. Her height is 5 feet 3 inches; weight is 118 pounds. She has a 50-pack-year smoking history and denies alcohol use. She has severe rheumatoid arthritis (RA), had an upper gastrointestinal bleed in 1993, and had coronary artery disease with a coronary artery bypass graft 9 months ago. Since that time she has engaged in “very mild exercises at home.” Vital signs (VS) are 128/60, 98, 14, 99° F (37.2° C), Sa o2 94% on 2 L oxygen by nasal cannula. Her oral medications are rabeprazole (Aciphex) 20 mg/day, prednisone (Deltasone) 5 mg/day, and methotrexate (Amethopterin) 2.5 mg/wk. Mrs X is taken to surgery for an Internal fixation.
SCENARIO 2 (ORIF)
Mr K is a 26-year-old man who tried to light a cigarette while driving and lost control of his truck. The truck flipped and landed on the passenger side. Mr K was transported to the emergency department with a deformed, edematous right lower leg and a deep puncture wound approximately 5cm long over the deformity. Blood continues to ooze from the wound. Mr K is taken to surgery for open reduction and internal fixation (ORIF) of the tibia and fibula fractures. He returns with a full-leg fiberglass cast with windows over the areas of surgery.
SCENARIO 3 (SKELETAL TRACTION)
Ms J is a 67-year-old woman, was involved in an auto accident and is flown by emergency helicopter to your facility. She sustained a ruptured spleen, fractured pelvis, and compound fractures of the left femur. On admission (5 days ago) she underwent a splenectomy. Her pelvis was stabilized with an external fixation device 3 days ago, and, yesterday, her left femur was stabilized using balanced suspension with skeletal traction. She has a Thomas splint with a Pearson attachment on her left leg. She has 20 pounds of skeletal traction and 5 pounds applied to the balanced suspension. Her left femur is elevated off of the bed at approximately 45 degrees. The lower leg is parallel to the bed and lies in a sling that the nurse adjusts on the frame, and the foot hangs freely. This morning, Ms J was transferred to your orthopedic unit for specialized care. You are the nurse assigned to care for her on the night shift. - SKIN AND BURN
SCENARIO 1 (BURN AND SCALD)
A 9 year old boy weighing 48 kgs and Ht. 135 cms, sustained burns today while playing with matches in a garage. Unknown accelerant and his pants caught on fire, which he attempted to put out using his hands. He sustained burns on both lower extremities. The burns are circumferential on the right lower extremity extending from the ankle to the midthigh and anteriorly on the left thigh. He also has burns to both hands, palmer surfaces.
SCENARIO 2 (BURN AND SKIN GRAFTING)
You are admitting a 20 years old man with partial thickness scald burn. The burns are on the anterior torso and neck, right upper extremity and the right side of the face. There are large blisters on the torso and upper extremity. In addition, there are splash marks on the left lower and upper extremities without blisters and have intact skin. There is a 22G IV in the left arm and Normal Saline 0.9% is infusing at 70 mls / hour. The transport team placed wet saline dressings prior to transport. Wt. 54kg Ht. 196cms
SCENARIO 3 (PSORIASIS)
A 45 year old male is referred from outpatient clinic to a hospital dermatology department with well dermacated erythematous scaly annular plaques, scattered on his trunk, face and scalp, which is not responding to conventional psoriasis treatment. - PERIOPERATIVE NURSING
SCENARIO 1
A 45-year-old male with history of cigarette smoking is scheduled at 7:00 a.m. for a lung resection to remove a malignant tumor under general anesthesia. leads a sedentary lifestyle. His past medical history includes type 1 diabetes mellitus and chronic renal insufficiency. When he arrives in the preoperative unit two hours in advance, he states that his weight has remained constant over the last five years, and that he has been NPO since 10 p.m. last night. Baseline vital signs are assessed and his blood pressure is 148/90 mmHg. The patient is taken to the OR as per the scheduled time.
SCENARIO 2
A 75-year-old male patient is admitted to the hospital for a low anterior bowel resection for an adenocarcinoma of the sigmoid colon. His past medical history includes type 2 diabetes and inflammatory bowel disease with associated chronic diarrhea. He has been bed-ridden for the last year and presents with a Stage III pressure ulcer on his sacrum. He has not eaten in the last two days due to abdominal pain. His weight was ten pounds higher thirty days ago. He arrives in the preoperative unit one hour before the scheduled surgery time and waits an additional 1.5 hours due to an unexpected delay. His baseline blood pressure was 120/80 mmHg. - MUSCULOSKELETAL, HEMEOPOITIC AND ONCOLOGY
SCENARIO 1 (PALLIATIVE TREATMENT)
You are a home health nurse who has been seeing Mdm A, who was diagnosed with small-cell lung cancer approximately 1 year ago. She has been treated with radiation and chemotherapy; however, her cancer is no longer treatable because it has spread to her bones and liver and that the focus of her treatment will change from curative measures to symptom relief. She is confused of the term palliative treatment.
SCENARIO 2 (RADIOTHERAPHY)
Mr J, a well-known 62-year-old homeless alcoholic, is admitted for a total laryngectomy and a permanent tracheostomy was placed. He has a long history of tobacco use, poor diet, and no dental care. Over the past several months, he has experienced increasing shortness of breath, hoarseness, and odynophagia. A piriform sinus mass was found on bronchoscopy. The large mass extends to and is fixed to the left true vocal cord. His chest x-ray is normal with the exception of changes related to chronic tobacco use. Past medical history includes reactive airway disease and hypertension. On examination, you find two palpable left-sided cervical nodes, which are firm and fixed. After being hospitalized for 6 weeks, he was scheduled for radio therapy for the next 8 weeks. You are concerned about the effects of radiation therapy, particularly the development of mucositis which is common in those receiving radiation to the head and neck.
SCENARIO 3 (SICKLE CELL ANEMIA)
Mr K is a 39-year-old man who has sickle cell disease (SCD), sometimes called sickle cell anemia, marked by frequent episodes of severe pain. His anemia has been managed with multiple transfusions, and he started showing signs of chronic renal failure 6 months ago. His regular medications are pentoxifylline (Trental), oxycodone-acetaminophen (Percocet), hydroxyurea (Droxia), and folic acid. In the hematology clinic this morning, Mr K’s hemoglobin measured 6.7g/dL. He received 2 units packed RBCs over 3 hours and then went home. He developed dyspnea and shortness of breath approximately 1 later. The emergency medical system crew initiated oxygen and transported him to the emergency department (ED).
SCENARIO 4 (SKELETAL TRACTION)
Ms J is a 67-year-old woman, was involved in an auto accident and is flown by emergency helicopter to your facility. She sustained a ruptured spleen, fractured pelvis, and compound fractures of the left femur. On admission (5 days ago) she underwent a splenectomy. Her pelvis was stabilized with an external fixation device 3 days ago, and, yesterday, her left femur was stabilized using balanced suspension with skeletal traction. She has a Thomas splint with a Pearson attachment on her left leg. She has 20 pounds of skeletal traction and 5 pounds applied to the balanced suspension. Her left femur is elevated off of the bed at approximately 45 degrees. The lower leg is parallel to the bed and lies in a sling that the nurse adjusts on the frame, and the foot hangs freely. This morning, Ms J was transferred to your orthopedic unit for specialized care. You are the nurse assigned to care for her on the night shift.