Lab Assignment SCENARIO #1: Bill Jones, 57 years old, was admitted 3 days
ago with a diagnosis of congestive heart failure. Yesterday he was transferred from CICU
to a hospital floor. This is your first day working with the patient and is the second day on
the unit. The patient mentions to you how much better he is feeling since he had his
breakfast (bacon) and his meal last night that was so tasty. He said that the bland food
he had in CICU was awful. You notice that his AM weight is up 2 pounds from his weight
when he was in CICU. His dietary order says “regular diet”. He has increased edema in
his feet and his blood pressure is slightly elevated this AM (164/102) from last night’s
pressure of 152/98. Exercise: You are the nurse calling the physician or the medical
student discussing this with the nurse to avert any complications. You also feel that some
Lasix is indicated because his blood pressure is rising, his weight is up, edema is
occurring and there have been no diet or fluid restrictions. Use SBAR to convey this
information. SCENARIO #2: Mary Smith, 34 years old, a healthy female gravida 1 para 0
patient has been admitted to the delivery room in active labor. She is at 39 weeks
gestation. She has had excellent prenatal care and no complications. She is currently
dilated to 6 cm, but her contractions have lessened in intensity and frequency. There are
no signs of fetal distress. Her membranes ruptured 12 hours ago, so there is some
urgency to keep her labor progressing in order to avoid a c-section. Exercise: You are the
physician for Ms. Smith, and you need to communicate with her nurse to report her
current status and your treatment and monitoring plan. You plan to start her on an
oxytocin (Pitocin) drip to enhance her labor. This will require closer monitoring of the
patient and fetus to ensure that labor is progressing well and that there are no fetal or
maternal complications. You are particularly concerned about the risk of fetal arrhythmias
or uterine hypertoncity. Use SBAR to convey this information to Ms. Smith’s nurse.
SCENARIO #3: Ms. Brown, 63 years old, was admitted to the hospital from a retirement
community where she has resided for the last 2 years. She apparently fell and sustained
a right hip fracture. She had a right ORIF (Open Reduction Internal Fixation) surgery
three days ago and has not been very compliant with deep breathing and coughing nor is
she using the incentive spirometer except for when you ask her to. She was your patient
yesterday and again today. This AM you noticed she appears paler than yesterday, her
breath sounds are diminished in her left lower lung fields. Her temperature is 100.2 and a
spot check of her oxygen saturations show 90%. Exercise: You are Ms. Brown’s nurse
and want to call the physician about the subtle but apparent change in her condition. She
is scheduled to be transferred to a SNF tomorrow and you think perhaps a respiratory
complication may be developing. Use SBAR to convey this information to the physician.
Academic Level : Bachelor
SCENARIO #1:
Bill Jones, 57 years old, was admitted 3 days ago with a diagnosis of congestive heart failure. Yesterday he
was transferred from CICU to a hospital floor. This is your first day working with the patient and is the second
day on the unit. The patient mentions to you how much better he is feeling since he had his breakfast (bacon)
and his meal last night that was so tasty. He said that the bland food he had in CICU was awful. You notice that
his AM weight is up 2 pounds from his weight when he was in CICU. His dietary order says “regular diet”. He
has increased edema in his feet and his blood pressure is slightly elevated this AM (164/102) from last night’s
pressure of 152/98.
Exercise: You are the nurse calling the physician or the medical student discussing this with the nurse to avert
any complications. You also feel that some Lasix is indicated because his blood pressure is rising, his weight is
up, edema is occurring and there have been no diet or fluid restrictions. Use SBAR to convey this information.
SCENARIO #2:
Mary Smith, 34 years old, a healthy female gravida 1 para 0 patient has been admitted to the delivery room in
active labor. She is at 39 weeks gestation. She has had excellent prenatal care and no complications. She is
currently dilated to 6 cm, but her contractions have lessened in intensity and frequency. There are no signs of
fetal distress. Her membranes ruptured 12 hours ago, so there is some urgency to keep her labor progressing
in order to avoid a c-section.
Exercise: You are the physician for Ms. Smith, and you need to communicate with her nurse to report her
current status and your treatment and monitoring plan. You plan to start her on an oxytocin (Pitocin) drip to
enhance her labor. This will require closer monitoring of the patient and fetus to ensure that labor is
progressing well and that there are no fetal or maternal complications. You are particularly concerned about the
risk of fetal arrhythmias or uterine hypertoncity. Use SBAR to convey this information to Ms. Smith’s nurse.
SCENARIO #3:
Ms. Brown, 63 years old, was admitted to the hospital from a retirement community where she has resided for
the last 2 years. She apparently fell and sustained a right hip fracture. She had a right ORIF (Open Reduction
Internal Fixation) surgery three days ago and has not been very compliant with deep breathing and coughing
nor is she using the incentive spirometer except for when you ask her to. She was your patient yesterday and
again today. This AM you noticed she appears paler than yesterday, her breath sounds are diminished in her
left lower lung fields. Her temperature is 100.2 and a spot check of her oxygen saturations show 90%.
Exercise: You are Ms. Brown’s nurse and want to call the physician about the subtle but apparent change in
her condition. She is scheduled to be transferred to a SNF tomorrow and you think perhaps a respiratory
complication may be developing. Use SBAR to convey this information to the physician.
Sample Solution
