Directions: Read the following scenario.It is about a typical patient load in a hospital.

Directions: Read the following scenario. It is about a typical patient load in a hospital. You will need to define all the medical diagnosis, and evaluate all data describing it as normal or abnormal and implications of that information. Every piece of information must be evaluated. The second challenge is to prioritize your day. Look at each person and figure out what is going on with him/her and then prioritize your day: who you will see first and why? There is also a nursing assistant working with you. What can you delegate? How would you go about doing this delegation? (You need to be specific to your steps). Remember all of your responsibilities when working in a hospital setting. In summary: there are two parts to this assignment; 1) the evaluation of the data and 2) the prioritization of your entire 8 hour day day. 

Room 811: S.L. is a 67 year old female admitted with Diabetes Mellitus. She has a long history of diabetes but is well controlled at home on glyburide 10 mg PO BID and metformin 500 mg PO BID. She was admitted yesterday because she has developed a sinus infection and an ear infection and has had quite elevated blood sugars since that time. She has QID blood glucose monitoring ordered, which were 191 at 1700, 184 at 2100 last night. The lab from this morning shows a fasting blood sugar of 259. She has sliding scale insulin for any blood sugar over 180.  Her 0600 VS were 160/88, HR-90, RR-16,   T-98.1.  She has an IV of D5NS with 20 meq KCL at 125 ml/hr. She is receiving cefazolin 1.0 Gram IVPB every six hours. Other labs this morning are sodium-145, potassium- 4.5, Chloride-101, BUN-29 mg/dl, and creatinine 1.6 mg/dl . Hemoglobin A1C was 8.9. She is scheduled for a CT scan with contrast of her sinuses later today.

Room 812: J. P. is a 76 year old female with hypertension. Despite being on lisinopril 40 mg daily, and hydrochlorothiazide 25 mg daily, her blood pressure has continued to rise. Her blood pressure on the previous shift was checked every two hours because it had been elevated. The blood pressures were: 2400- 196/108; 0200- 214/126. At this time the night nurse called the physician and received an order to give Hydralazine 10 mg IV once. This was given at 0220. Further blood pressures were 0300- 188/94; 0400- 182/90; 0600- 196/102. Her other VS at 0600 are 84, 20, 98.4. She is on a regular diet. Labs this morning are: sodium- 138, potassium- 3.1, chloride- 101, BUN- 17, creatinine- 1.0, Glucose- 124, total cholesterol- 213. There is a saline lock in her right hand which was last flushed at 1600 yesterday.  The nursing assistant just came to tell you that the patient put her light on with complaints of a severe frontal headache.  

Room 813: R.M. is a 62 year old male with Chronic Obstructive Pulmonary (COPD). He is chronically disabled due to his lung disease. He uses home O2 but is able to live independently with his wife. A home care nurse and a respiratory therapist visit twice a week. R.M. has been in the hospital for the past 8 days with an upper respiratory infection. He is on oxygen at 2 liters per nasal cannula, and the night nurse reported more dyspnea, coughing and wheezing. He had a rough time around 0500 with cyanosis but was improved with an albuterol nebulized treatment from respiratory therapy. After the treatment his oxygen saturation improved from 82% to 92%, and he has rested the remainder of the night. However, this morning his labs are ABG's;  

pH - 7.29, PCO2 - 61, PO2 - 54, HCO3 - 23 and an oxygen saturation of 86%. At 0600 his VS were 156/88, HR- 112, RR- 32, T- 99.1. Cap refill is five seconds on all extremities. 

Room 814: C.L. is an 85 year old male with a left sided cerebral vascular accident (CVA). He had his stroke two weeks ago. He has only gross motor movement of his right leg and his right arm is flaccid. His left arm and leg are not affected. He is oriented and nods appropriately. He has some expressive aphasia, but this has been slowly improving with the assistance of the speech therapist. The therapist is also working with him because he has some dysphagia. He is on tube feedings at night only, for nutritional support. He receives full strength Enrich at 60 ml/hr from 8:00 PM to 8:00 AM. Then during the day he is assisted to re-learn swallowing. His VS at 0600 were 160/88, HR - 76, RR - 24, T - 98.8. His morning labs are sodium - 148, potassium - 5.0, chloride - 105, BUN - 32, creatinine - 2.1, hemoglobin - 15.2, hematocrit - 47%, albumin - 3.0 , total protein - 4.7. His home meds include: atorvastatin 20 mg, clopidogrel 75 mg, and metoprolol 12.5 mg. He takes all his meds in the morning.