Paul Windsor Room 301
Paul Windsor, 4-year-old male admitted yesterday from the clinic with a
diagnosis of Nephrotic Syndrome. Vital signs: Temperature 99.0, HR 88, BP
104/76, RR 22, PaO2 95%. He presented yesterday with his parents reporting
a gradual increase in pain and “swelling” around his eyes and ankles, and
now his stomach is getting “bigger". Paul has little to no appetite. Current
weight is 56 pounds compared to a usual weight of 43 pounds. Urinalysis:
Thick, frothy appearance. Specific gravity: 1.025. Protein 3+. Blood 2+. Other
labs: Triglycerides 180 mg/dl. Cholesterol 190 mg/dl. Group B strep culture
negative in office.
You responded correctly to 6 out of 6 evaluations:
Your
Category response Explanation
Educational Increased Mother and patient need renal diet and fluid
Needs acuity restriction education.
Health Increased Status assessment reports weight gain and recent
acuity abnormal labs.
LOC Normal Status assessment reports no indication of
acuity increased LOC acuity
Pain Increased Status assessment reports gradual increase pain
acuity and “swelling” around his eyes and ankles
Psych Normal Status assessment reports no indication of
acuity increased Psychiatric acuity
Safety Increased Status assessment reports pain around ankle
acuity making patient a fall risk.
Physiological
Your
Description Response Explanation
Fluid volume True Patient is at risk for Fluid
deficit volume deficit.
Impaired skin True Status assessment reports would
integrity, risk for be at risk for impaired skin
, Your
Description Response Explanation
integrity
Risk for True Status assessment reports high
Thrombus triglycerides and cholesterol.
formation
Safety
Your
Description Response Explanation
Deficient True Status assessment reports new
Knowledge diagnosis of Nephrotic
Infection, risk Syndrome.
for True Patient is at risk for Infection
Scenario 1
CBC from last night shows the following: Hgb -18g/dl, and Hct 43%. Paul’s
skin is dry to touch.
You correctly ordered 5 out of 5 actions:
Your Correct
order order Step Explanation
1 1 Obtain order and Treat dehydration
initiate IV fluids of D5
½ NS at 75 ml/hour
2 2 Request low sodium Support nutrition
diet
3 3 Explain to parents Education needed for
and Paul the need for child and parents related
sodium restriction to diagnosis
4 4 Encourage Paul to Further prevent
drink appropriate dehydration
Paul Windsor, 4-year-old male admitted yesterday from the clinic with a
diagnosis of Nephrotic Syndrome. Vital signs: Temperature 99.0, HR 88, BP
104/76, RR 22, PaO2 95%. He presented yesterday with his parents reporting
a gradual increase in pain and “swelling” around his eyes and ankles, and
now his stomach is getting “bigger". Paul has little to no appetite. Current
weight is 56 pounds compared to a usual weight of 43 pounds. Urinalysis:
Thick, frothy appearance. Specific gravity: 1.025. Protein 3+. Blood 2+. Other
labs: Triglycerides 180 mg/dl. Cholesterol 190 mg/dl. Group B strep culture
negative in office.
You responded correctly to 6 out of 6 evaluations:
Your
Category response Explanation
Educational Increased Mother and patient need renal diet and fluid
Needs acuity restriction education.
Health Increased Status assessment reports weight gain and recent
acuity abnormal labs.
LOC Normal Status assessment reports no indication of
acuity increased LOC acuity
Pain Increased Status assessment reports gradual increase pain
acuity and “swelling” around his eyes and ankles
Psych Normal Status assessment reports no indication of
acuity increased Psychiatric acuity
Safety Increased Status assessment reports pain around ankle
acuity making patient a fall risk.
Physiological
Your
Description Response Explanation
Fluid volume True Patient is at risk for Fluid
deficit volume deficit.
Impaired skin True Status assessment reports would
integrity, risk for be at risk for impaired skin
, Your
Description Response Explanation
integrity
Risk for True Status assessment reports high
Thrombus triglycerides and cholesterol.
formation
Safety
Your
Description Response Explanation
Deficient True Status assessment reports new
Knowledge diagnosis of Nephrotic
Infection, risk Syndrome.
for True Patient is at risk for Infection
Scenario 1
CBC from last night shows the following: Hgb -18g/dl, and Hct 43%. Paul’s
skin is dry to touch.
You correctly ordered 5 out of 5 actions:
Your Correct
order order Step Explanation
1 1 Obtain order and Treat dehydration
initiate IV fluids of D5
½ NS at 75 ml/hour
2 2 Request low sodium Support nutrition
diet
3 3 Explain to parents Education needed for
and Paul the need for child and parents related
sodium restriction to diagnosis
4 4 Encourage Paul to Further prevent
drink appropriate dehydration
