(answered) Pediatric Case Study: Endocrine System Simulation #4; Zoe is a 6 year old female
Pediatric Case Study: Endocrine System Simulation #4 Patient Presentation/Behavior: Presenting in non-pediatric specialty ED: Zoe is a 6 year old female, 2 week history of fever and worsening tiredness, In the last 24 hours: she has become lethargic and very drowsy- has not moved off of couch today per mom report, having labored breathing, started complaining of stomach pains, started vomiting this morning. Patient weight: 20 kg 1) As the ED triage nurse: What other questions would you want to ask the parents and/or child? 2) Assuming this child is previously healthy with no chronic illness, is up to date on vaccines, has met all developmental milestones a. What would be your next step? b. List what you would include in your physical assessment of this patient: c. What would you expect to be abnormal assessment findings? Vital Signs: Time V/S Pulse Blood Pressure Respiratory Rate Pulse Ox Temperature Skin Assessment Other: 3) Base on the GSC score: What would your neurological assessment be (Describe your patient assessment findings)? 4) What are Kussmaul respirations? (Describe your patient assessment findings) a. What nursing intervention would you do to help improve breathing? b. How could you protect an airway of a pediatric patient as the bedside nurse? 5) The heart rate above- is this normal or abnormal? a. If abnormal what is it and what would you do next? 6) How would you assess hydration status? a. What orders might be appropriate to request from attending provider? 7) What would be your SBAR to the attending provider? i. S: ii. B: iii. A: iv. R: 8) Calculate drip rate for above NS bolus 9) Of the above lab values: What is abnormal? Would this patient be in acidosis or alkalosis? Respiratory or Metabolic? Why? 10) Why are there peaked T waves on the EKG? 11) What is a normal range for A1C? 12) As the primary nurse, how would explain to the parents what is going on? 13) As the primary nurse, how would prepare the patient for the IV, lab draw, and urine catheter placement? a. What collaborative staff member would be important part of this process if the hospital has them available? Vital Signs: Time V/S Pulse Blood Pressure Respiratory Rate Pulse Ox Temperature Skin Assessment Other: 14) With the change in GSC: What would your neurological assessment be? 15) What is Cushing Triad? 16) What is Posturing? What are the 2 types? What is worst form and why? Vital Signs: Time V/S Pulse Blood Pressure Respiratory Rate Pulse Ox Temperature Skin Assessment Other: 17) Why would you think we would set up an IV bag with dextrose in it for a patient that has high blood glucose levels? a. What could happen to the brain if glucose decreases too much? 18) Aside from the blood glucose elevation, what on the above repeat labs/assessment is concerning? 19) Based on the assessment: what do you think is most likely elevating? 20) What would you do next? 21) Why would we give mannitol? How does it work within the body in this circumstance? a. When would you expect to see changes in patient? 22) Calculate the drip rate to give mannitol (use macrodrip tubing) 23) As the primary nurse, how would you explain to the parents what is happening? a. What support would you offer/give? Vital Signs: Time V/S 1030 Pulse 75/min Blood Pressure 128/84 mm Hg Respiratory Rate 18/min- intubated Pulse Ox 100%- intubated Temperature 100.3 F, axillary Skin Assessment Very flushed cheeks, + tears Other: GCS unchanged, pulse is weak 24) Based on the updated GCS: What would your neurological assessment be? 25) As the primary nurse, how would you explain to the parents why intubation is needed and what is happening to their child? 26) Why is the large decrease in Blood glucose a concern? a. What is the possible reason for this? b. Could this have been prevented? If so, how? Time V/S Pulse Blood Pressure Respiratory Rate Pulse Ox Temperature Skin Assessment Other: 27) What is your SBAR to the flight nurse? 28) IV Mannitol is completed- would you remove line or clamp it and leave in place? 29) What is your SBAR to the primary nurse at the accepting hospital? Debriefing: Guided Reflection Glasgow Coma Scale Eye Opening Response Vocal Response Motor Response
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- October 22, 2021
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pediatric case study endocrine system simulation 4
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1 as the ed triage nurse what other questions would you want to ask the parents andor child
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patient presentationbehavior presenting in non ped
