Case study 8 Brittany long PDF

Preview

Summary

guided reflection questions...

Description

Pediatric Case 8: Brittany Long (Complex) Guided Reflection Questions

Opening Questions How did the simulated experience of Brittany Long’s case make you feel? 

This case study was kind of harder than the ones before, I had to repeat it 3 times to get a passing grade. I felt anxious at first attempt because of the patient critical situation and vital signs I didn’t know if I need to continue with my regular assessment or call the provider so I had problem with prioritizing actions.

Describe the actions you felt went well in this scenario. 

At my second and third attempt, I felt that I did well with assessment, monitoring, teaching the kid and the mom, and intervening quickly.

Scenario Analysis Questions* EBP How did the findings from Brittany Long’s physical assessment and diagnostic studies affect decisions you made about the administration of intravenous (IV) fluid and blood products? 

EBP

What complications might Brittany Long face if her symptoms are not recognized and treated in a timely manner? 

PCC

Upon assessment ECG showed Sinus tachycardia. Her Heart rate was 165. her Blood pressure: 89/70 mmHg. With Respiration of 34. Her temp was 100F. skin was cold and tenting, patient had pain in the abdomen rated 3 out of 5. Urine output was less than 1 ml. all of these findings are critical and needed quickly intervention to call the provider to get an order for fluids and blood infusion to fix hypovolemia.

Hypovolemic shock and multi-system organ failure. Reflecting on the care you provided Brittany Long, identify how the anxiety of Brittany’s mother would impact your nursing interventions and actions and Brittany’s responses.

*

The Scenario Analysis Questions are correlated to the Quality and Safety Education for Nurses (QSEN) competencies: Patient-Centered Care (PCC), Teamwork and Collaboration (T&C), Evidence-Based Practice (EBP), Quality Improvement (QI), Safety (S), and Informatics (I). Find more information at: http://qsen.org/

From vSim for Nursing | Pediatric. © Wolters Kluwer Health.



PCC

Parents can be source of anxiety and stress and may interfere with care if they didn’t control themselves, if this happened in real life, the mom would be screaming, crying, or mad and this could lead to delayed interventions and compromised care. What nursing considerations would be appropriate in the crisis situation to decrease the anxiety of Brittany Long and her mother and improve coping?



S/QI



Incorporating the mother and the child in the care, teaching about the situation and keeping the mother informed about her girl’s situation, all medications taken, provider’s orders, signs to report, and how to help in taking care of the patient will help a lot. Reflect on ways to improve safety and quality of care based on your experience with Brittany Long’s case. being able to actually see the blood product given and compare with patient blood type, being able to have more detailed assessment, not just the limited options that we have.

T&C/I What key elements would you include in the handoff report for this patient? Consider the situation-background-assessment-recommendation (SBAR) format. 

 



S: Brittany Long is a 5-year-old African American female with a history of sickle cell anemia (HbSS) treated with regular folic acid supplement who came in yesterday with an acute vasoocclusive pain crisis. had a sudden increase in left upper quadrant abdominal pain and tenderness. Her spleen is palpated 3 cm below the left costal margin. She rated her abdominal pain a 5 on the FACES Scale and received morphine sulfate. She continues to receive intravenous maintenance fluids at 52 mL/hr and is on a nasal cannula with oxygen 2 L/min. She is pale and weak and just wants to sleep. Her mother is concerned about her increasing fatigue. Her urinary output is decreased. Her vital signs have been taken every 2 hours, and she had labs drawn twice. Her last hemoglobin was decreased by 1.3 g/dL, and is now 7.5 g/dL; platelets are also decreasing and are 200; her reticulocyte count is increasing and is 7.5. Legal consent to give blood products has been obtained from the mother. B: primary problem: sickle cell crisis. Past medical history: sickle cell disease. A: Heart rate was 165. her Blood pressure: 89/70 mmHg. With Respiration of 34. Her temp was 100F. skin was cold and tenting, patient had pain in the abdomen rated 3 out of 5. Urine output was less than 1 ml. R: teach the mom to recognize the signs and symptoms of acute splenic sequestration complication (ASSC), how to palpate the spleen, and the importance of seeking medical attention promptly.

From vSim for Nursing | Pediatric. © Wolters Kluwer Health.

Concluding Questions Reflecting on Brittany Long’s case, were there any actions you would do differently? If so, what were these actions, and why would you do them differently? None. Describe how you would apply the knowledge and skills that you obtained in Brittany Long’s case to an actual patient care situation. 

I learned a lot from this case study, I learned about acute splenic sequestration complication (ASSC) which happens as a complication with sickle cell crisis, I learned how to treat it which is by correcting hypovolemia and giving blood transfusion. And how to assess for it. I think I will be able to apply what I have learned from this case study if I see a patient with same condition.

From vSim for Nursing | Pediatric. © Wolters Kluwer Health....