PediatricCase - Sabina Vasquez.WITH VERIFIED ANSWERS GRADED A.

Opening Questions How did the simulated experience of Sabina Vasquez’s case make you feel? I felt confident going into this simulation. I am now more familiar with what priority assessment to perform based on the client’s current symptoms. Describe the actions you felt went well in this scenario. I recognized that Sabina was in distress, and she needed another dose of albuterol. I contacted the doctor to deal with the problem at hand, and I had no problem picking what mediation was the priority. Albuterol took the first place, to alleviate girls bronchospasm, then I proceeded with medication to treat the fever and antibiotics. Even though this is not available in this simulation, one of my first thoughts was a need for an interpreter. I knew that we should provide them with appropriate language services in case they weren’t comfortable with English. Scenario Analysis Questions1 EBP List in order of priority your initial nursing actions for Sabina Vasquez based on physical findings and family interaction. Based on the initial physical assessment my priority nursing actions for Sabina Vasquez included hand hygiene, 3 identifiers of the patient and identifying the patient’s mother, verifying any allergies, and getting vitals on her, including pain. Next, I did a full respiratory assessment, looking at each breath (depth and rate) as well as making sure they were bilateral, noting any adventitious breath sounds. Following the assessment, I went ahead with the physician’s interventions as ordered, giving her medications, oxygen therapy, and continuous monitoring. After poking and prodding the patient, I offered her favorite teddy bear to her to provide her with some comfort. With Sabina’s mother at the bedside, I took the time to educate her on Sabina’s condition, as well as let her know our plan of action. After the intervention, Sabina’s vitals were not within the range in which the physician ordered, so I phoned him to let him know her current status and see what he wanted to do next. EBP What complications might Sabina Vasquez face if her symptoms are not recognized and if care is not initiated in a timely manner? The patient was prone to have an increased number of asthma episodes. If the event went unnoticed, Sabina's bronchospasm could progress and become severe, leading to status asthmaticus. Sabina’s lungs are not fully functional since we know that the x-ray showed right lower lobe pneumonia effusions. Additionally, Bronchospasm, mucus plugging, and edema in the peripheral airways from hyperreactiveness can result in increased airway resistance and obstruction. This all points to hypoxemia that will make Sabina hyperventilate and possibly lead to respiratory alkalosis. Sabina could experience respiratory distress, respiratory arrest, and death. PCC What actions should be taken to ensure the delivery of appropriate information to Sabina Vasquez’s mother? The use of a translator because it seems that Sabina’s mother has limited English skills. This could lead to her mother having misconceptions and false information. English is not her primary language, but Spanish. I would ensure that she receives information, both verbal and written, in both English and Spanish. PCC Recognizing the acuity of the situation, how would you include Sabina Vasquez and her mother in the decision-making process? The mother can be included in making Sabina more relaxed by comforting her and helping her with the nebulizer treatment. Having a mask on can be claustrophobic for an adult so that a preschooler can have some anxiety related to the medication delivery. Sabina could help in decision making when taking the medication. The nurse could ask if Sabina wants to drink the medicine cup herself, or maybe she would like her mom to give it to her. S/QI Reflect on ways to improve safety and quality of care based on your experience with Sabina Vasquez’s case. The nurse should educate the mom about what to look for when a child is having respiratory distress and having her call the nurse if the symptoms get worse. This way Sabina's mother will be continuously assessing her child. This is helpful because a mother/caregiver can recognize one of the earliest symptoms of hypoxia before it progresses and shows more evidently on the vital signs. T&C/I What key elements would you include in the handoff report for this patient? Consider the situation-background-assessment-recommendation (SBAR) format. Situation: Sabina Vasquez, 5-year-old, Hispanic girl came in with her mother to the ER with pneumonia. She has a history of asthma and has had several episodes requiring use of an albuterol inhaler at home. Background: Sabina’s mother reports her daughter had an upper airway infection for a couple of days, and today she developed 39 C fever; therefore, she brought her in. She is now on 4 L/min humidified nasal canula. She got a 380 mL bolus of NS and albuterol at 1700. When I saw her at 1900, she had: difficulty breathing, unproductive cough, and some wheezing, along with reduced breath sounds at the right lung base, SpO2 92%, respiration rate 29/min, and temperature 39.1C; We got an extra dose of 2.5 mg albuterol nebulizer to ease the bronchospasm from the provider; 240 mL of acetaminophen for the fever; piggyback infusion of 475 mg of cefuroxime IV for pneumonia; also a 190-mg oral dose of azithromycin for pneumonia. An intravenous injection of D5 ½NS is infusing at 61 mL/hr. Assessment: I believe Sabina’s airway is hyperactive during illness due to increased inflammation caused by pneumonia. Recommendation: Sabina's airway should be monitored carefully, and the mother should be encouraged to call for help if she sees and hears any complaint of dyspnea so that we can manage asthma and pneumonia efficiently. Monitor for signs and symptoms of antibiotic hypersensitivity. There are two antibiotics ordered for treatment of pneumonia, that should be discussed and reinforced with Sabina's mother, so that she will receive a full treatment after she is discharged home. Educate both Sabinas mother and Sabina on Asthma triggers and home care. QI As you begin to think about discharge planning for Sabina Vasquez and her family, what teaching needs to be provided? Mrs. Vasquez should review asthma and asthma action plan. She should be aware that because Sabina has this chronic condition, her developing another respiratory illness like pneumonia, or flu, will cause asthma exacerbation even if it was well-controlled before. Mrs. Vasquez should be educated about immunizations like a pneumococcal vaccine or annual flu vaccine. Most importantly, education about antibiotics should be provided. Sabina should receive the full treatment, even if she feels better. No saving of the medication for later sickness is allowed or sharing it with the siblings. Concluding Questions Reflecting on Sabina Vasquez’s case, were there any actions you would do differently? If so, what were these actions, and why would you do them differently? Yes, I would add a lot more education for Sabina's mother. After Sabina gets her albuterol and we monitor her for improvement I think it’s a good timing to begin talking about asthma action plan, and explain why is she having this difficulty breathing because of the pneumonia as well. This way we can lower Sabinas mother stress, therefore indirectly Sabina will feel more comfortable with mom that is less anxious. As a practicing nurse we should be talking to the patient in simple terms on actions done. For example, in the vSim, medication administration is quiet, and the nurse does not give any information about what she is giving to Sabina. This is again a good time for teaching, and keeping the mother involved and informed. Describe how you would apply the knowledge and skills obtained in Sabina Vasquez’s case to an actual patient care situation. As a nurse it is important to have an asthma action plan in case a child needs an inhaler. The review of the medication and inhalers will help the nurse look for proper use of them in the nurse's office to ensure adequate administration. Sabina's case made me think about the cultural aspect of nursing, that use of bilingual pamphlets can increase compliance with new medication. Concepts of cultural differences in the nursing care