Sim Ticket Spring 2021 Amira Youssef PDF

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Summary

Pediatric simulation online zoom ticket using the Saunders textbook. For colorado college of nursing. Erickson's and Paiget's....

Description

Patient Name: Amira Youssef Scenario: peds sim staff

Adolescent Age: 14 yrs

DOB 3/24 Weight: 105 lbs. 9oz Height: 5’ 4”

Setting: Primary care NKDA

Goals:     

Apply the developmentally appropriate psychosocial principles needed to care for the adolescent and the family experiencing illness (APPLYING) [COs: 1, 4, 5] Explain the appropriate nursing interventions and teaching principles for an adolescent with symptoms of pharyngitis and dysphagia (ANALYZING) [COs 2,3,7,9 ] Identify the early signs and symptoms of potential causes of pharyngitis in adolescents (APPLYING) [COs 2,3,6] Incorporate the concepts of family-centered care in planning and implementing care of the adolescent patient (APPLYING) [COs 4,5,7,8] Formulate a nursing care plan for the adolescent patient experiencing severe pharyngitis (CREATING) [4,5,7]

Review:  Conducts basic environmental safety assessment and maintains safety measures  Calculates and administers medications safely according to the Six Rights

  

Performs focused respiratory assessment/respiratory resuscitation Reviews IV administration Creates an ethical environment and culture of civi

Complete the Following Prior to Simulation day: 1. Watch required videos (see back of page). 2. Name and describe the Erikson and Piaget stages for a 14 year old. How would those developmental concepts be used when developing a plan of care for this patient? a. Erikson- Identity vs role confusion is the stage the 14 year old is at. He is most likely experiencing puberty and the increased amount of hormones and body changes can be embarrassing for children at this age. They begin to heavily weigh importance on how peers perceive them and yearn for social acceptance. As well as, they begin to struggle with who they are, what are their values? Are they similar to their family or friends? They want to be seen as adults but cognitively their brain is still developing and they can resort back to young child like behavior when confronted in challenging situations. Knowing this stage of development, the nurse understands that the adolescent wants to be treated as an adult and usually does not want parents in the room so it should always be asked of the teen. The nurse should explain care and give reassurance of the body developing normal (unless contraindicated). Also, the nurse needs to build trust with the adolescent and should listen attentively and express no judgement, it should be a safe place for the adolescent to communicate (Hockenberry, M., et al., 2017). b. Piaget- Formal operations is where the 14 year old is and can now think in abstract terms. They are able to think in past, present, and future and analyze information that is presented in front of them and come up with a solution that is logical. They can visualize theoretic, philosophical matters mentally and explain their rationale. The nurse can explain procedures to the child usually in 8 th grade comprehension as well as being honest with the procedure. Adolescents can detect if an adult is lying and

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can lose trust immediately. For example, if an adolescent is asking how an IV placement, the nurse should give explain there is a range of tolerance, i.e., some people don’t even notice it and others find it very painful/uncomfortable. Then, the nurse should explain the procedure and give therapeutic strategies to help cope with it. Using the IV example, have the adolescent look away, breathing in and out counting by 3’s, imagery, etc. (Hockenberry, M., et al., 2017).

3. The week prior to this simulation, each student will be given one of the following disease processes to research and present in prebrief. Prepare a power point, 5-8

slides, describing pathophys/causative organism, incubation, key S/S, appropriate treatment, and stand-out points in addition to your ticket, med sheet, and clinical prep worksheet due prior to sim. o o o o o o

Influenza – Oseltamivir 75 mg. P.O. twice daily for 5 days Mononucleosis – Can antibiotics be given? If they are, specifically what happens? Epiglottitis – Cefotaxime - 2 Gm. IV intermittent infusion q 4 hrs (Life threatening infections) Covid-19 – Cover the disease process AND report on current available vaccines https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines.html MIS-C – https://www.cdc.gov/mis-c. Number of cases in Colorado; go to Healthcare Professionals, then go to MIS-C for Healthcare Providers. Group A Streptococcal bacteria – Amoxicillin P.O. 2 Gm. q 12 hrs X 10 days ( children > 3 months )

o

Vaping/huffing – Dexamethasone 15 mg. IV q 6 hrs. (adult – airway edema or extubation) can get info at

o

o 4.

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cdc.gov website; on main page is list of Outbreaks; EVALI is on that list. Allergic reaction/anaphylaxis - Epinephrine - subQ, IM (adults and children > 30 kg) - 0.3 -0.5 mg single dose not to exceed 0.5 mg; may repeat every 10 – 15 minutes as needed (severe anaphylaxis) RSV

Describe your focused assessment; give a stepwise approach. a. My first focused assessment would be the cardiac system because the worst case scenario of MIS-C is shock so, I want to see if my patient is experiencing any signs or symptoms. Inspection would be immediate, looking for the patient’s color, breathing and behavior. If the patient were to be pale, lethargic and short of breath these would be compelling signs of shock. If patient was having a difficult time breathing I would assess the respiratory system getting an oxygen saturation, respiratory count and auscultation of the lungs. The lungs may have bubbling or crackling sounds due to the alveoli having mucus from the epithelial damage and macrophages along with possible damage from the hyper-inflammatory response. The patient may be breathing rapidly, 20< breaths per minute to compensate. Then, I would be getting a blood pressure as this would be a probable sign because if the patient’s blood pressure was >90/>60 this is a sign of hypotension and inadequate perfusion. Next, I would assess capillary refill in all extremities looking for adequate perfusion and any possible blood clots (if ¾ extremities capillary refill 3 seconds< occurred this is an

5.

indication for a blood clot). Along with the capillary refill I would be checking for edema, poking bony prominences assessing for any pitting. The next system would be GI asking the patient if they are experiencing any abdominal pain and/or nausea and vomiting. I would also assess the oral mucous membranes to assess if they were dry as children with MIS-C were reported to be dehydrated most likely due to the high inflammatory response affecting the circulatory system and throat which if the throat is swollen can make swallowing difficult and painful. I would then move into assessing for inflammation such as looking for any rashes on the body and taking the temperature to assess for a fever (Flavia Ribeiro dos Santos Miggiolaro, A., et al., 2020). Nursing Care Plan for the patient ( use sore throat/impaired swallowing)  

2 Priority Nursing Diagnoses (No Psych/Social or Knowledge Deficit NDX) 3 Potential Interventions for each Diagnosis- total of 6 (“the nurse will . . .”) (Assessments are NOT interventions.) Patient/Family Education

A. Impaired swallowing r/t rash of oropharynx AEB patient complains 5/10 pain after swallowing meals. a. Nurse will request PO medications to liquid, if can’t be done then, crush PO medicines in applesauce for administration b. Keep patient in high fowlers during and after feeding. c. Administer mucosal anesthetics such as dibucaine to reduce irritation of throat. d. Education-Educate family and patient to choose soft foods that are nutritious to maintain healthy weight and decrease difficulty of swallowing. Educate family how to monitor patient to prevent and detect aspiration during eating. Work with dysphagia team for methods of swallowing effectively (Ackley, B., et al., 2019). B. Impaired oral mucous membranes r/t dehydration AEB patient’s urine specific gravity is 1.029. a. Nurse will encourage oral fluid intake and let patient choose favorite juice to increase encouragement. b. Nurse will provide oral care to keep mouth moist and reduce the risk of bacteria accumulation. c. Nurse will insert IV and begin fluid resuscitation by 0.9% NS to decrease specific gravity number. d. Education- nurse will educate family and patient to use a soft toothbrush until patient is adequately hydrated and to reduce risk of bleeding of gums. Educate patient and family how to inspect oral cavity and monitor for s/s of infection or complications and to call HCP. Educate family and patient

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methods to keep mouth moist through use of hard candies or synthetic saliva (Ackley, B., et al., 2019). Medication: Anakinra

Weight of patient: 105 lbs. 9 oz / 47.9

Dose ordered: dependent on physician orders but should be based on 1-2mg/kg/day

Frequency/Schedule: dependent on physician orders

Route: Subcutaneous

kg

1.

Calculate safe dose range (mg/kg/dose or day) : 1-2 mg/kg/day given in 1-2 divided doses. Can be increased 0.5-1 mg/kg/day but cannot exceed 8mg/kg/day. 1mg*47.9kg*day= 47.9 mg/day OR 23.95mg/dose. 2mg*47.9*day= 95.8mg/day OR 47.9mg/dose MAX dose for this child: 383.2 mg/day Is the dose SAFE: YES NO

2. If IV Medication: Not provided in IV form A. What is the safe concentration to administer? B. Based on the dose and safe concentration , calculate the minimal safe volume to be infused. 3. Based on the recommended administration time for infusion, how fast can you infuse this med? Vials come in prefilled syringes of 100mg/0.67mL

4: Why is the patient receiving this medication related to the diagnosis: Reduces signs and symptoms of multisystem inflammatory disease blocking the destructive effects of interleukin 1 (Vallerand, A. H., et al., 2019). 5: What are some common side effects and nursing implications of this medication. infections, injection site reactions, headache, diarrhea, nausea, neutropenia. Subcutaneous injection. Rotate SC sites and do not inject in areas that are red or swollen. Assess for hypersensitivity; utricaria, dyspnea, hypotension (Vallerand, A. H., et al., 2019). 

It is indicated on Davis Drug Guide safety is not established in Peds however since MIS-C is so new, providers are prescribing in hopes of reducing systemic inflammation.

6: Identify some teaching needs for patient and family concerning this drug. Inform family and patient about s/s of hypersensitivity and the injection site for pain, rednss, swelling, warmth and to contact HCP and nurse. Advise that patient to no receive live vaccines during therapy and to consult with HCP (Vallerand, A. H., et al., 2019). Medication: Weight of Dose ordered: Frequency/Schedule: Route: PO Aspirin

patient:

80-100mg/kg/day

47.9 kg 1. Calculate safe dose range (mg/kg/dose or day)

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daily

80-100mg/kg/day in 4 divided doses. Can be 3-5mg/kg/day as single dose for 8 weeks for maintenance. 80*47.9/day= 3,832mg/day /6 h= 638. 7mg/dose OR 100mg*47.9/day= 4790mg/day/6h= 798.3 mg/dose Is the dose SAFE: YES NO

2. If IV Medication: PO med A. What is the safe concentration to administer? B. Based on the dose and safe concentration , calculate the minimal safe volume to be infused. 3. Based on the recommended administration time for infusion, how fast can you infuse this med?

PO medication 4: Why is the patient receiving this medication related to the diagnosis: MIS-C and COVID-19 may cause blood clots and fever from studies of CDC. It is determined aspirin is used for comfort treatment (Centers for Disease Control and Prevention, 2021). It is also used in adjunctive treatment of Kawasaki disease which is similar to MIS-C (Vallerand, A. H., et al., 2019).

5: What are some common side effects and nursing implications of this medication s/s- GI bleeding, rash, urticarial, vomiting, anemia, hypersensitivity reactions nausea, epigastric distress. Administer with meals. Monitor for GI bleeds, tarry stool. Bleeding precautions such as soft tooth brushes, no flossing or hard nose blowing. Monitor for toxicity- tinnitus, headache, hyperventilation, agitation, diarrhea. Give sodium bicarbonate(Vallerand, A. H., et al., 2019). 6: Identify some teaching needs for patient and family concerning this drug. Take with a full glass of water and stay in upright position 15-30 min. Be cautious for Reye’s syndrome. Educate family and patient about prolonged bleeding times and contact HCP if unusual bleeding of gums occur, bruises lasting more than 3 days and black, tarry stool (Vallerand, A. H., et al., 2019). Medication: Prednisone

Weight of

Dose ordered:

patient:

Frequency/Schedule: dependent on physician order

Route: PO

dependent on physician 47.9 kg order 1. Calculate safe dose range (mg/kg/dose or day) 1mg/kg q 6 h for 48 h then 1-2 mg/kg/day in two divided doses max: 60mg/day 1mg/kg * 47.9kg= 47.9mg/day (since this is a one-time dose per physician order, it is below the 60 mg/day) = put range in this; 47.9- 95.8mg/day. Can NOT give 2mg/kg/day as this exceeds the max dose of 60mg/day. Recommendation: 1mg/kg/day dosing.

(Vallerand, A. H., et al., 2019). Is the dose SAFE: YES NO – if given as 1mg/kg/day

2. If IV Medication: PO route. A. What is the safe concentration to administer? Do not exceed 60 mg/day for PO. B. Based on the dose and safe concentration, calculate the minimal safe volume to be infused.

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3. Based on the recommended administration time for infusion, how fast can you infuse this med? This is a PO drug.

4: Why is the patient receiving this medication related to the diagnosis: Used to reduce inflammatory and autoimmune response (Vallerand, A. H., et al., 2019). 5: What are some common side effects and nursing implications of this medication peptic ulceration, increased intracranial pressure, HTN, adrenal suppression, thromboembolism, fragility, anorexia. Administer with meals to decrease GI irritation. Monitor for any peripheral edema, crackles or dyspnea and notify HCP if any occur (Vallerand, A. H., et al., 2019). 6: Identify some teaching needs for patient and family concerning this drug. Educate on s/s of severe abdominal pain and black stools as well as behavior changes, tiredness, unusual swelling and to report. Educate to avoid vaccinations if continuing to use drug. Educate if condition worsens and to call nurse or HCP (Vallerand, A. H., et al., 2019). If continued use, explain the need for labs and periodic checkups as this drug can stop growth (Vallerand, A. H., et al., 2019).

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CLINICAL PREPARATION WORKSHEET Patient’s Name: Amira Youseff Child’s Age:

Student’s Name: Jasmine Mihovilovic Gender: F

14 yr old

Diagnosis: MIS-C

Allergies: NKDA

Vital signs: norms for age Pulse 60-120 Resp. 12-18 BP:100-130/60-80

Child’s Weight & Height Wt: 105 lbs 9 oz/47.9 kg Ht: 5’4’’/162.56 cm

% on growth curve Wt: 25-50% Ht: 50%

Intake and output calculations Intake – normal maintenance fluids Calculation: (4ml*10 kg) + (2 mL *20kg) + (1mL * 17.9kg)=40+40+17.9=97.9mL/hr First 0 to 10 kgs: 4 ml/kg/hr 10 to 20 kgs: 2 ml/kg/hr >20 kgs: 1 ml/kg/hr Hourly fluid intake: Daily (24 hr) intake:

97.9 mL/hr 2349.6mL/day

Output – normal urine output Calculation:1ml*47.9kg*hr=47.9mL/hr 2ml*47.9kg*hr=95.8 ml/hr Urine output should be 1 to 2 ml/kg/hr

Hourly output: 47.9-95.8 ml/hr Daily (24 hr) output: 1149.6-2299.2 ml/day

Labs and Diagnostics: Which labs and diagnostic tests would you expect to see ordered to confirm this diagnosis? Choose the top 3.If there is a “gold standard”, place that test or lab at the top of your list. Name of test or lab Normal value Expected findings COVID 19 serological negative S & N proteins *if vaccinated S proteins will only show testing- ELISA (Centers for Disease Control and Prevention,

2021). BNP...