Pediatric Case Study: Endocrine System Simulation #4; Zoe is a 6 year old female ALL ANSWERS 100% CORRECT FALL – 2021 GUARANTEED GRADE A

This case study is in replacement of onsite simulation #4. Please review this document and answer the questions throughout appropriate. There may be questions that ask you to play different nursing roles, please make sure that you answer each question appropriately and in its entirety. I understand this does not replace the loss of experience at the bedside or in the simulation lab, however I have tried to adapt these case study simulations the best way possible to still help you think about the next steps. Questions to be answered are in red type, there are 29 imbedded within the case study plus 4 guided reflection questions. **Remember to complete your reflection question (1 per simulation case study) and turn into Professor Manero at the end of the semester. If you have any questions please email me- Please remember though that I may not be able to respond for a few hours as I am still working in my clinic. 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 1000 Pulse 160/min Blood Pressure 90/50 mm Hg Respiratory Rate 30/min Pulse Ox 98% on room air Temperature 99.3 F, oral Skin Assessment Very flushed cheeks Other: Sleepy, pupils normal, capillary refill 3sec, pulse weak, Kussmaul respirations, lung fields are clear, mouth/lips- dry/cracked, crying few tears, mild diffuse tenderness of abdomen, fruity breath smell, GSC: 13 1000: Complete Head to Toe assessment including but not limited to the following: V/S, Neurological and GSC (Glasgow Coma Scale (GCS): Motor- 6, Vocal- 4, Eye-3), Respiratory, Circulation (no murmurs), GI, Urinary (GU), Skin 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? 1005: History taken from parents: excessive drinking, bedwetting, increasing tiredness, mom reports patient not gaining weight, last 1.5 days- worsening fatigue, complaining of stomachache (+polyuria, polydipsia, enuresis, 5 kg weight loss in last 1 month), vomiting x2 started this morning, medical history: unremarkable Psych/Social: 1st grade at public school, parents work FT, has 1 younger brother- Dx with strep throat 1 week ago; Allergies: NKDA, environmental, food 7) What would be your SBAR to the attending provider? i. S: ii. B: iii. A: iv. R: 1010: Orders given from attending provider include: Move patient to ED trauma bay, Placement of IV catheter, draw labs, IV infusion of NS placed (bolus 10 mL/kg), calculate drip rate 200 mL to be given over 15 minutes with a macrodrip tubing=15gtt/mL, place Urine Catheter, apply 2 L O2 via NC, recheck VS Labs: CBC w/ diff, CMP, renal function, capillary gas (ABG), accucheck, serum osmolality, urine dip ABG results: (serum: pH 7.00, HCO3 10, CO2 5, Na 132, K 5.4, BUN 24 mg/dL, Cr 1.9 mg/dL, glucose 915), HgB A1C: 13% Bedside BS: critical high (500), urine ketones 4+, glu