Patient Diagnosis and Treatment Overview

Simulation Patients Overview

• Focus on patient diagnosis, history and assessment (priority/focused).
• Understand the link between illness and symptoms.
• Treatment includes vital signs, head-to-toe assessment, blood work, medications, and nursing interventions.
• Medications are important including therapeutic use and contradictions for the patient.

Patient 1

• Admitted with nausea, vomiting, and diarrhea for 3 days.
• History of adenocarcinoma of the colon and scheduled for surgical excision next month.
• Started chemotherapy and radiation three and a half weeks ago.
• Medications include dexamethasone, tylenol, ondansetron, dilaudid, dimenhydrinate, and Imodium.

Patient 2

• Presented with difficulty swallowing.
• Admitted with esophageal candidiasis secondary to HIV contracted 15 years ago.
• Non-compliant with ART, HIV has progressed to AIDS.
• Unable to work and disabled for 2 years after a series of infections.
• Has a stage 3 pressure injury for 3 weeks on the right heel with yellow purulent drainage.
• Medications include vancomycin, fluconazole, tylenol, dilaudid, lidocaine, and nystatin.

Patient 3

• Presented with worsening shortness of breath for 3 days and rumbly lung sounds.
• Febrile with elevated WBC and productive cough with yellow-green sputum.
• Admitted with pneumonia.
• History of COPD, HTN, and smokes cigarettes.
• Has a tracheostomy from a previous respiratory event.
• Medications include amlodipine, azithromycin, prednisone, tylenol, ventolin, and atrovent.

Patient 4

• Admitted with a diagnosis of type 1 diabetes mellitus 12 months ago.
• Experienced vomiting and anorexia over 5 days, stopped taking insulin 2 days ago due to inability to eat.
• Wife brought him in due to confusion and agitation.
• Medications include trurapi insulin and hypoglycemia protocol (D50 IV, glucose tabs, glucagon SC).

Patient 5

• Admitted with hypoglycemia due to increased lethargy and occasional confusion.
• Blood glucose was 2.3 in ED, given D50.
• Started on trurapi according to sliding scale QID and hypoglycemia protocol on standby.
• Medications include amlodipine, crestor, metoprolol, trurapi, januvia, jardiance and hypoglycemia protocol.

Patient 6

• Admitted with anemia secondary to GI bleed.
• History of peptic ulcers for 5 years.
• Noticed change in stool color (melena) in the past week.
• Hematocrit 25%, hemoglobin 74 mmol/L, BUN 11.5 mmol/L.
• Anemia secondary to upper GIB.
• Medications include pantoloc, 2 units PRBC's IV, furosemide, tylenol, and benadryl.

Patient 7

• Admitted to the burn unit with 3rd-degree burns to the left anterior leg.
• Developed necrotizing fasciitis and Clostridium difficile.
• Requires significant pain management and wound care BID.
• Medications include tylenol, dilaudid, flagyl, florastor, and imodium.

Patient 8

• Diagnosed with breast cancer, underwent chemo & radiation with 40% success.
• Scheduled for a right mastectomy, has no medical history.
• Medications include dilaudid, hydromorph contin, and pip-taz.

Patient 9

• Admitted with undiagnosed hematuria.
• Seen at student health center with swelling around eyes and rusty-colored urine.
• History of sore throat several weeks ago that resolved.
• History of type 1 diabetes mellitus since age 7, with excellent glucose control via intensive insulin therapy.
• Urine output was 150 mL over the previous 8 hours.
• Medications include tylenol, lasix, and apidra pen.

Patient 10

• Admitted with hemopneumothorax post motor vehicle collision and chest trauma.
• Has a left chest tube draining serosanguineous fluid.
• Last PRN Dilaudid was at 0100 but is now NPO and transitioning to clear fluids.
• Medications include centrum, lovenox, and dilaudid.

Patient 11

• 6-year-old male with a history of epilepsy for 2 years on phenytoin & tegretol.
• Admitted after experiencing a tonic-clonic seizure at school for 2 minutes.
• Medications include ativan, dilantin, and tegretol.

Patient 12

• Presented with indigestion and jaw pain since 2100.
• History of type II diabetes (non-compliant), BP 188/104, HR 116, and slight ST depression.
• Suspected atypical presentation of NSTEMI.
• Provided ASA 160mg, plavix 300mg, nitro spray 0.4 mg x 3, maxeran 10mg, and morphine 1mg IV push.
• Admitted to the cardiac floor for monitoring.
• Medications include nitro spray, morphine, metoprolol, metformin, glyburide, ASA, and ramipril.

Theory Topics

• Mental health (signs and symptoms, medications for bipolar disorder, depression, schizophrenia
• Priority nursing care and assessments based on vital signs
• Pediatric nursing (vital signs and interventions)
• Medical-surgical topics: pre- and post-operative care management, musculoskeletal assessments, cardiovascular and neurological assessments, endocrine and respiratory assessment and management, intravenous therapy, and central vascular access device management.