11/10/23, 10:26 AM Melanie Baker 38-years-old: Attempt review

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11/10/23, 10:26 AM Melanie Baker 38-years-old: Attempt review

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Started on Friday, 10 November 2023, 9:10 AM

State Finished

Completed on Friday, 10 November 2023, 9:26 AM

Time taken 16 mins 10 secs

Grade 90.00 out of 100.00

Question Complete Mark 33.34 out of 33.34

Name: Melanie Baker Age: 38 years Provider: J. Kline MD

Code Status: Full Code Admit Wt: 125 lbs (56.7 kg) BMI: 19

Allergies: codeine

Before answering this question, review the client’s health information in the EHR. Identify the assessment findings that currently concern the nurse.
Select one option in each row.

1

Nursing Flowsheets Provider Other

NURSING ASSESSMENT & NOTES

4/10
1000

Nursing Note: Client with a 1-year history of right-hand tingling, weakness, and patchy numbness. Denies fall or known injury to hand.
Describes her job as repetitive hand, wrist, and arm movements. Numbness increases during the night, sometimes waking her. Current
discomfort is 2/10. Describes it as a numbness type of discomfort, not real pain. Capillary refill less than 3 seconds, fingers and hand
warm to touch, skin color appropriate, and matches left hand.

4/10
1015

Neuro/Cognitive: Gait steady with ambulation. Grips equal and strong. Alert and oriented x 3. Pupils 4 mm PERRLA. Client says that
she has slight numbness and tingling in right hand, denies pain. Discerns sharp from dull sensations in right hand.

Cardiovascular: S1 S2, rate regular.

Respiratory: Lungs clear, denies cough, none noted, speaking in full sentences.

Gastrointestinal: Abdomen soft with active bowel sounds x 4 quads. Last bowel movement was this morning.

Musculoskeletal: Ambulates without assistance, no weakness, some pain, and numbness when asked to flex and bend R wrist.

Integumentary: Visible skin intact, denies open areas or hematomas.

Concerning Not concerning

Capillary refill

Pain with flexion

Vital signs

Skin temperature

Occupation

Tingling

Medical history

Numbness

Financial status

Consider:

1. What medical assistance may be available for the client?

2. What are the financial implications should the client need surgery?

3. What are the implications if the neurovascular assessment determines a lack of circulation or innervation to the hand?

11/10/23, 10:26 AM Melanie Baker 38-years-old: Attempt review

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Question Complete Mark 23.33 out of 33.33

Name: Melanie Baker Age: 38 years Provider: J. Kline MD

Code Status: Full Code Admit Wt: 125 lbs (56.7 kg) BMI: 19

Allergies: codeine

4/10
1000

Nursing Note: Client with a 1-year history of right-hand tingling, weakness, and patchy numbness. Denies fall or
known injury to hand. Describes her job as repetitive hand, wrist, and arm movements. Numbness increases
during the night, sometimes waking her. Current discomfort is 2/10. Describes it as a numbness type of
discomfort, not real pain. Capillary refill less than 3 seconds, fingers and hand warm to touch, skin color
appropriate, and matches left hand.

4/10
1015

Neuro/Cognitive: Gait steady with ambulation. Grips equal and strong. Alert and oriented x 3. Pupils 4 mm
PERRLA. Client says that she has slight numbness and tingling in right hand, denies pain. Discerns sharp from
dull sensations in right hand.

Cardiovascular: S1 S2, rate regular.

Respiratory: Lungs clear, denies cough, none noted, speaking in full sentences.

Gastrointestinal: Abdomen soft with active bowel sounds x 4 quads. Last bowel movement was this morning.

Musculoskeletal: Ambulates without assistance, no weakness, some pain, and numbness when asked to flex
and bend R wrist.

Integumentary: Visible skin intact, denies open areas or hematomas.

4/30
1215

PACU Discharge Nurse’s Note: Dressing to right hand/wrist dry and intact. Fingers warm, capillary refill less
than 3 seconds. Discharge instructions provided to client and her mother, both verbalize understanding of
instructions, dressing care, medication use, and when to contact provider for complications. Client aware of
follow-up appointment and no driving for 24 hours after surgery or after prescription pain medication. Client’s
mother will be staying with client to help with young daughter and will be driving for appointments.

Before answering this question, review the client’s health information in the EHR. Indicate the events, should they occur, that
would warrant the client calling the health care provider. Select four (4) that apply.

2

Nursing Flowsheets Provider Other

NURSING ASSESSMENT & NOTES

The client’s daughter is upset seeing her mom’s dressing.

The client’s right-hand fingers are light blue.

The dressing becomes saturated with blood. 

The client feels mild pain in the right hand. 

The nerve block begins to subside.

The pain is rated 8/10, 45-minutes after oxycodone. 

The client needs to rest after walking into home.

The right-hand fingers become numb and throbbing. 

Consider:

11/10/23, 10:26 AM Melanie Baker 38-years-old: Attempt review

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Question Complete Mark 33.33 out of 33.33

Name: Melanie Baker Age: 38 years Provider: J. Kline MD

Code Status: Full Code Admit Wt: 125 lbs (56.7 kg) BMI: 19

Allergies: codeine

4/10
1000

Nursing Note: Client with a 1-year history of right-hand tingling, weakness, and patchy numbness. Denies fall or
known injury to hand. Describes her job as repetitive hand, wrist, and arm movements. Numbness increases
during the night, sometimes waking her. Current discomfort is 2/10. Describes it as a numbness type of
discomfort, not real pain. Capillary refill less than 3 seconds, fingers and hand warm to touch, skin color
appropriate, and matches left hand.

4/10
1015

Neuro/Cognitive: Gait steady with ambulation. Grips equal and strong. Alert and oriented x 3. Pupils 4 mm
PERRLA. Client says that she has slight numbness and tingling in right hand, denies pain. Discerns sharp from
dull sensations in right hand.

Cardiovascular: S1 S2, rate regular.

Respiratory: Lungs clear, denies cough, none noted, speaking in full sentences.

Gastrointestinal: Abdomen soft with active bowel sounds x 4 quads. Last bowel movement was this morning.

Musculoskeletal: Ambulates without assistance, no weakness, some pain, and numbness when asked to flex
and bend R wrist.

Integumentary: Visible skin intact, denies open areas or hematomas.

4/30
1215

PACU Discharge Nurse’s Note: Dressing to right hand/wrist dry and intact. Fingers warm, capillary refill less than 3 seconds.

Discharge instructions provided to client and her mother, both verbalize understanding of instructions, dressing care, medication use, and

when to contact provider for complications. Client aware of follow-up appointment and no driving for 24 hours after surgery or after

prescription pain medication. Client’s mother will be staying with client to help with young daughter and will be driving for appointments.

5/3
1030

Nursing Note: Client reports increased pain and discomfort in right hand. Client had removed dressing from
hand on 5/1 and went into the hot tub with friends. Incision red and tender to touch, partial wound dehiscence
noted at distal aspect of incision.

5/3
1110

Nursing Note: Wound care demonstrated to client, and client able to return demonstration without concerns.
Instructed on use of prescribed antibiotics. Instructed on complications to report to provider. Client verbalizes
understanding of discharge instructions.

Before answering this question, review the client’s health information in the EHR. Identify the areas of the provider’s note that
concern the nurse. Select to highlight.

Provider Prescriptions – 05/03 1042:

Client with 2 cm wound dehiscence at distal aspect of surgical incision.
Wound with moderate purulent drainage, slight odor noted, 2 cm of erythema.
Client afebrile, pain is 4/10. Taking oxycodone once per day and acetaminophen every 6 hours since 4/30/2022 for
discomfort.

1. What are reasons for the development of neurovascular compromise?

2. What is the difference between opioid-naïve and opioid-tolerant?

3. What strategies should the nurse suggest in preparing the client’s daughter for the client’s post-operative course?

3

Nursing Flowsheets Provider Other

NURSING ASSESSMENT & NOTES

11/10/23, 10:26 AM Melanie Baker 38-years-old: Attempt review

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Instructions to client to avoid bodies of water, including hot tubs, pool, bathtubs.
Client instructed to take antibiotics and begin dressing changes, nurse to instruct.
Client to return to office in 7 days for evaluation of infection.
Client to contact provider before scheduled visit if increased wound dehiscence, increased pain, change in hand sensation,
numbness, edema, color change, or temperature change.

Consider:

1. What additional cues of infection should the nurse assess for?

2. Describe the pathophysiology of the client’s wound infection.

3. What complications could occur if this were untreated?

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