Eve Madison vSim-Pediatrics PDF

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Assignment for Eve Madison vSim-pediatrics/maternity full description...

Description

CONCEPT MAP WORKSHEET DESCRIBE DISEASE PROCESS AFFECTING PATIENT (INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS) Dehydration: Occurs more common in children and infants than in adults. The risk of dehydration increases in children and infants because they have increase extracellular fluid percentage. Risk factors to dehydration for children/infants include increased BMR, increased insensible fluid loss, immature renal function, and increased ratio of BSA to body mass. If dehydration is left untreated it can lead to complications such as shock and warrants immediate treatment to prevent the development of hypovolemic shock.

DIAGNOSTIC TESTS (REASON FOR TEST AND RESULTS) There really is not a specific diagnostic tool used to diagnose dehydration. However, obtaining labs to assess electrolytes are important as it can indicate fluid loss and show signs of electrolyte loss as well. Electrolytes such as K or NA can indicate signs of dehydration. The nurse should also obtain a health historry such as diarrhea, vomiting, decreased oral intake, burns, or DKA that can also lead to dehydration.

PATIENT INFORMATION Eva Madison is a 5 year old patient who came in with a h3 day history of vomiting and diarrhea, inability to keep fluids down, and no urination as of 8 pm yesterday. She arrived at 7 am with a weight change from 21.2 kg to 20.5 kg. Upon assessment, she looks pale and listless with dry mucous membranes. While in the ER prior to being transfered to the PEDS unit, she received an IV saline bolus of 400 mL which is now finished. Maintance fluid is going to follow.

ANTICIPATED PHYSICAL FINDINGS Increased HR Dry, pale skin/mucous membrane Decrease blood pressure Increase capillary refill

ANTICIPATED NURSING INTERVENTIONS Nursing interventions include restoring the patient's fluid volume to maintain normal electrolyte levels and prevent progression to hypovolemia. If a child has moderate dehydration, oral fluids can be given, but if severe IV fluids such as 20 mL/kg of normal saline or lactated ringers can be administered. After administering fluids, it is important to reassess hydration status to determine if patient is responding well. The nurse should also educate the patient and family on foods not to consume such as soup, broth, or milk for oral rehydration. Instruct that once oral rehydration has been well achieved, regular diet can resume. Instruct the patient and family if symtoms do not get better to get medical attention.

vSim ISBAR ACTIVITY INTRODUCTION

STUDENT WORKSHEET Hello this is Laura, RN, calling from the pediatric unit.

Your name, position (RN), unit you are working on

SITUATION Patient’s name, age, specific reason for visit

BACKGROUND Patient’s primary diagnosis, date of admission, current orders for patient

ASSESSMENT Current pertinent assessment data using head to toe approach, pertinent diagnostics, vital signs

Eva Madison is a 5 year-old patient who arrived to the pediatric unit from the ER with 3 day history of vomiting and diarrhea, no urination, and inability to keep fluids down.

My patient arrived this morning at around 7 am with a 3 day history of not being able to keep fluids down, vomiting and diarrhea, and no urination since 8 pm yesterday. A few months ago she had her check up, her weight was 21.2 kg and is now currently 20.5 kg.

Upon assessment Eva looks pale and listless with dry mucous membranes. An IV saline bolus of 400 mL was started while she was in the ER which is now finished, followed by maintance fluid. Vitals are: (obtained from scenario) RR: 30 breaths per minute SPO2: 96% on room air HR: 10 bpm BP: 82/65 mmHg T: 99*F

RECOMMENDATION

Assess vital signs such as HR for tachycardia, BP for hypotension, and increased capillary refill.

Any orders or recommendations you may have for this patient

Assess and record intake and output to determine fluid amount Obtain labs to determine abnormalities Assess mucous and skin for signs such as decreased skin turgor, paleness, and dry

PHARM -4- FUN PATIENT EDUCATION WORKSHEET NAME OF MEDICATION and CLASSIFICATION

MEDICATION: Dextrose

CLASSIFICATION: Nutritional supplement

SAFE DOSE OR DOSE RANGE, SAFE ROUTE IV: 2.5, 5 or 10% depending on fluid and caloric needs

PURPOSE FOR TAKING THIS MEDICATION The purpose of this medication is to replace fluid that were lost from the patient's body. It is a simple water-slobule sugar that promotes anabolism in patient where oral caloric intake is limited.

PATIENT EDUCATION WHILE TAKING THIS MEDICATION The nurse should explain to both the parent and the patient on the purpose of the medication to allow medication adherence. Instruct the patient to report any signs of severe dizziness or syncope. This medication is given intravenously, therefore it is important that the nurse educates the parent and the patient to report any symptoms such as pain at the site as it can indicate infiltration or a possible infection.

PHARM-4-FUN PATIENT EDUCATION WORKSHEET NAME OF MEDICATION and CLASSIFICATION

MEDICATION: Sodium chloride

CLASSIFICATION: Electrolyte replacement

SAFE DOSE OR DOSE RANGE, SAFE ROUTE IV: 1-2 mEq/kg/day

PURPOSE FOR TAKING THIS MEDICATION The purpose of this medication is to replace sodium and chloride loss and be able to maintain the levels at a normal level.

PATIENT EDUCATION WHILE TAKING THIS MEDICATION The patient education the nurse must do with this medication is to instruct the patient and family to report any adverse reactions for a prompt treatment such as pulmonary edema or local skin tenderness. The nurse should also educate on the purpose and administration of the medication prior to administering any medications. The patient should always know why they are taking a certain medication because it will allow for patient adherence and prevent medication errors.

Instructor Feedback:

PHARM-4-FUN PATIENT EDUCATION WORKSHEET NAME OF MEDICATION and CLASSIFICATION

MEDICATION:

CLASSIFICATION:

SAFE DOSE OR DOSE RANGE, SAFE ROUTE

PURPOSE FOR TAKING THIS MEDICATION

PATIENT EDUCATION WHILE TAKING THIS MEDICATION

Instructor Feedback:

PHARM-4-FUN PATIENT EDUCATION WORKSHEET NAME OF MEDICATION and CLASSIFICATION

MEDICATION:

CLASSIFICATION:

SAFE DOSE OR DOSE RANGE, SAFE ROUTE

PURPOSE FOR TAKING THIS MEDICATION

PATIENT EDUCATION WHILE TAKING THIS MEDICATION

Instructor Feedback:

PHARM-4-FUN PATIENT EDUCATION WORKSHEET NAME OF MEDICATION and CLASSIFICATION

MEDICATION:

CLASSIFICATION:

SAFE DOSE OR DOSE RANGE, SAFE ROUTE

PURPOSE FOR TAKING THIS MEDICATION

PATIENT EDUCATION WHILE TAKING THIS MEDICATION

Instructor Feedback:

PHARM-4-FUN PATIENT EDUCATION WORKSHEET NAME OF MEDICATION and CLASSIFICATION

MEDICATION:

CLASSIFICATION:

SAFE DOSE OR DOSE RANGE, SAFE ROUTE

PURPOSE FOR TAKING THIS MEDICATION

PATIENT EDUCATION WHILE TAKING THIS MEDICATION

Instructor Feedback:

Clinical Worksheet Date:3/25/2021 Initials: E.M Age: 5 M/F: FEMALE

Student Name: Laura Bautista-Gomez Diagnosis: HCP: N/A Gastroenteritis/dehydr ation Length of Stay: Admitted 3/25/2021

Code Status:

FULL CODE

Allergies: NKA

Consults: N/A

Assigned vSim: Eva Madison

Isolation: IV Type: Peripheral NO PRECAUTIONS Location: CONTACT PRECAUT Left arm Fall Risk: Fluid/Rate: D5 in 0.45% normal saline at 62 mL/hr Transfer: From ER to PEDS unit

Critical Labs: K= 4.7 Na= 145

Other Services:

N/A Consults Needed: N/A

Why is your patient in the hospital (Answer in your own words and include the History of present Illness): My patient is on the hospital because she was complaining of a 3 day history of vomiting and diarrhea, inability to keep fluids down and no urination since 8 pm yesterday.

Health History/Comorbidities (that relate to this hospitalization): My patient arrived at 7 am with signs of weight lose. At her previous visit with the physician she weighed 21.2 kg and now currently weighs 20.5 kg.

Shift Goals/ Patient Education Needs: 1. Administer proper medication to prevent or minimize dehydration and shock 2.

Obtain a baseline set of vital signs that are useful to compare and determine if treatment is working or if a modication needs to be done.

3. Prodive patient education regarding the situation, what is being done for treatment, and the outcome that are to be expected. 4. Provide atraumatic care to the patient to decrease fear and anxiety and increase comfort. Path to Discharge: For a successful discharge the nurse must assess and administer proper medications according to provider's orders.. This will enhance the treatment process and allow for a full recovery. Patient education is also important to provide in between treatment time to allow the patient and family to be aware of how to prevent or minimize another reoccurence.

Path to Death or Injury: The patient can be at risk for hypovolemia which can lead to shock and ultimately death. Therefore, prompt treatment is crucial to prevent shock.

Clinical Worksheet Alerts: What are you on alert for with this patient? (Signs & Symptoms) Tachyardia that will not improve 1.

Management of Care: What needs to be done for this Patient Today? Administer proper medication according to provider orders and patient condition 1.

2. Hypotension due to too much fluid loss

2. Educate patient regarding course of treatment and condition.

Increase capillary refill, pale and dry mucous membrane 3.

3. Obtain a set of vital signs for comparison to determine effective treatment 4.

What Assessments will focus on for this patient? (How will I identify the above signs &Symptoms?) Assess heart rate and implement measures to decrease it 1. 2. Assess and monitor blood pressure frequently as hypotension is a late sign of dehydration. Assess fluid intake as not enough fluid can lead to pale or dry mucous. 3.

5.

Auscultate lung and heart sounds Provider comfort measures such as offering stuffed bear Assess skin, mucous membrane, and capillary refill, as well as pain

6. Priorities for Managing the Patient’s Care Today 1. Obtain a set of vital signs for comparison to determine effective treatment 2. Auscultate lung and heart sounds, assess skin, mucous membrane, and capillary refill, as well as pain 3.

List Complications that may occur related to dx, procedure, comorbidities: 1.

Hypovolemic shock

Administer proper medication according to provider orders and patient condition and educat patient 4. Provider comfort measures such as offering stuffed bear

2. Seizures 3. Death

What nursing or medical interventions may prevent the above Alert or complications?

Asssess and monitor blood pressure. A decrease in blood pressure will also cause a drop in oxygen which is important for the body to function well 1.

If fluid or electrolytes are not replaced, too much loss can eventually lead to 2. seizure. Thefore, labs are important to be monitored and obtained. 3. The most severe thing that can occur if no treatment is given is death. Too much fluid loss can lead to shock, seizures and ultimately death. Monitoring is 4. extremely important In general, the nurse must monitor the patient carefully and make sure that

What aspects of the patient care can be Delegated and who can do it? The aspect of care that can be delegated to a UAP would be to obtain a set of patient vitals and provide comfort measures such as offering drink or stuffed animal to distract the patient. The rest of the care plan must be done by the RN.

Reflection Questions Paste your reflection questions in the box below Opening Questions How did the simulated experience of Eva Madison's case make you feel? This scenario was not as difficult; however, it still makes me nervous when it comes to treating a child who is pain. Describe the actions you felt went well in this scenario. The actions I feel that went well in this scenario is obtaining vital signs, assessing skin and mucous membrane, auscultating lungs and heart, and assessing pain level. Scenario Analysis Questions* EBP List in order of priority your initial nursing actions identified for Eva Madison based on physical findings and family interaction. The priorities that taken first was obtaining a set of vital signs that can be used if provider was to be contacted for further orders. It also serves to see if there are signs for dehydration such as tachycardia and hypotension. The nurse than administered the medication such as the D5 in 0.45% normal saline to help the patient and monitored for outcome. EBP When initiating a fluid bolus for a dehydrated child, what type of fluid should be given and why? The type of fluid that should be given to a dehydrated child would be isotonic normal saline or lactated ringers as it will provide rapid volume expansion. EBP What complications might Eva Madison face if her symptoms are not recognized and treated in a timely manner? The biggest complications that Eva might experience if her symptoms are not treated in a timely manner include hypovolemic shock. PCC What measures should be initiated to decrease anxiety in Eva Madison's mother while simultaneously caring for Eva? Measures to include to decrease Eva’ s mother’ s anxiety is to educate her along the course of Eva’ s treatment. Knowing what is going on and what the nurse is doing to make Eva better will ease her anxiety. The nurse could also include Eva’ s mother in her treatment such as helping her eat, assisting her to the bathroom, and other aspects which will allow both Eva and her mother’ s anxiety to ease. S/QI Reflect on ways to improve safety and quality of care based on your experience with Eva Madison's case. Some ways to improve safety and quality of care is to have the appropriate medical equipment available in case it is needed. Offer the call light for which Eva can call the nurse for assistant and monitor Eva frequently to determine if treatment is working. S/QI What infection control measures should be taken in this case and why? Infection controls that should be taken include washing hands. This will prevent any contamination to other people and prevent further infection. T&C/I What key elements would you include in the handoff report for this patient? Consider the situation-background-assessment-recommendation (SBAR) format. The elements that should be included in the hand off report for this patient includes vital signs, the reason why the patient is in the hospital, and interventions. This will allow the next nurse to know what happened, what was done, and how the patient responded to the treatment for evaluation for the next course of treatment plan.

Reflection Questions Paste your reflection questions in the box below Concluding Questions Reflecting on Eva Madison's case, were there any actions you would do differently? If so, what were these actions, and why would you do them differently? The only action that I would have done differently is to make sure that orders are read carefully prior to administering. This is crucial, otherwise it can lead to patient injury. Describe how you would apply the knowledge and skills that you obtained in Eva Madison's case to an actual patient care situation. I would apply the knowledge I obtained from this scenario by now having more information on how to treat a patient with dehydration. Fluid is important to administer as well as other interventions to make sure the outcome is positive.

Rubric for Grading vSim Clinical Worksheet 5 Patient Information:

3

1

0

All documented areas 100% complete and provide thorough information.

Three listed areas completed OR documented areas 75% complete.

Less than three listed areas completed OR documented areas less than 50% completed.

Patient information area blank.

100% of HPI, Past Medical/Surgical History and Comorbidity Factors completed with thorough, relevant information.

75% of HPI, Past Medical/Surgical History and Comorbidity Factors completed. Information relevant to scenario.

50% of HPI, Past Medical/Surgical History and Comorbidity Factors completed. Information basic and lacks relevancy.

25% of HPI, Past Medical/Surgical History and Comorbidity Factors completed. Information not relevant, or content areas left blank,

Thorough and detailed patient education. Patient shift. goals are SMART, relevant, and detailed goals. 100% of worksheet area is complete.

Provides patient education but lacks thoroughness or details. Patient shift goals missing 1-2 components of SMART goals. 75% of information needed for worksheet area present.

Patient education lacks thoroughness and details. Patient shift goals missing 3 – 4 components of SMART goals. 50% of the information needed for worksheet area present.

Pathway to death and health is identified with detail. Information is concise, relevant, accurate and portraits appropriate timeframe for occurrence. 100% of the information needed for worksheet present.

Pathway to death and health is identified. Information is relevant and accurate. Missing timeframe for occurrence. 75% of information needed for worksheet area present.

Missing over 50% of needed information for worksheet area present. Pathway to death and health identified but content either not relevant or accurate for situation present in scenario.

Missing patient education and/or patient shift goals. Patient shift goals lack all components of SMART goals. 25% of the information needed for worksheet area present. Pathway to death and health contains information not relevant or accurate to the scenario or section left blank.

Alerts, Assessments, Complications and Interventions/Preventions identified thoroughly. Answers relevant to scenario. 100% of the information needed is present.

Alerts, Assessments, Complications and Interventions/Preventions identified. Most answers relevant to scenario. 75% of the information needed for worksheet area present.

Missing 2 – 3 areas on worksheet. Answers not relevant to scenario. 50% of the information needed is present.

Missing 4 or more areas on worksheet. Answers not relevant to scenario. 25% of the information needed for worksheet area is present.

Management of Care relevant to case scenario and detailed. Priorities for scenario identified. Identifies all aspects of care that can be delegated and identifies appropriate personnel to delegate activities to. Answers detailed, Critical thinking evident.

Management of Care, Priorities or delegation sections relevant to scenario. Answers generic to situation. Some evidence of critical thinking present.

Missing relevant data in one or more categories (management of care, prioritization, delegation). Answers basic without detail. Little to no evidence of critical thinking present.

Information provided not relevant to scenario. Answers are basic without detail. No evidence of critical thinking. Missing answers in one or more area.

Demographics, Diagnosis, Allergies, Provider, Consults, Isolation, Fall Risk, Intravenous Therapy, Critical Labs, Services and Needed Consults

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Medical History: Why patient is in the hospital, History of p...