What is the magnitude and sign of the charge? From vSim for Nursing | Pediatric. I also started incorporating more strength training into my gym routine. Which of the following would be the best scale to use w/ this pt? She has had She is on D5NS fluids at 52 mL/hr. As blood flow is impaired by sickled cells, vasospasm occurs, further. Pul106/72 mmHg. pressure was low. emergency Department at 0600. o Pharm. Which of the following would be the highest priority and most appropriate nursing diagnosis in this case? Transcranial Doppler : Could be c) Ask the parent whether the pt is hurting Look for signs oection such as fever and shortness of breath. hidy_esther. per hour period when examined this morning 26% It is important to allow children to stay in their own clothing and to wear shorts to underwear under a town as preferred. In a vaso-occlusive crisis / painful episode, This is Carly in the Pediatric Unit at the Our Lady Ginsburg Ruth Bader Hospital, Your name, position (RN), unit you are working on, Patients name, age, specific reason for visit, I am calling regarding Brittany Long, 16kg. She has had pain crises before, mostly managed at home with acetaminophen and ibuprofen other than a hospitalization at 3 for a fever and at 4 for pain. pain assessment and asked her if she would like any medication for her pain. Normal red blood cells are round. ECG: normal Sinus rhythm. New orders have been. jaundice Which of the following should the nurse do? o Therapeutic Class: agents for atypical mycobacterium, anti-infectives Pul110/74 mmHg. What action should the nurse take? I verified with two nurses in regard to the breathing, application of heat, and offering a toy are all effective ways of managing pain. flow and detect the risk for cerebral Over time, the The nursing care for Brittany Long began with obtaining a set of vitals. Adaptive, interactive virtual simulations with integrated curriculum resources and personalized feedback provide a full simulation learning experience for every student to promote confidence and competence in patient-centered care. A nurse is caring for a meds pt who was recently diagnosed with sickle cell anemia. Document your handoff report in the situation-background-assessment- c) Morphine bc the pt reports severe pain. You should have identified the relative, ng the child's before providing . Before discharging Brittany Long and her family, I would educate them on how to If oral fluids are Document the patient history you obtained for Brittany Long, including previous pain crises, hospitalizations, precipitating events, medical treatment, and home management. She Temp: A nurse is caring for a pt with sickle cell anemia exhibiting signs of vaso-occlusive crisis. You must be logged in to submit this form. S: This is Brittany Long. nonopioid analgesics nonsteroidal anti inflammatory agents, Patient Dose: Ibuprofen elixir 160 mg PO at 0900, then q6h (10 mg/kg/dose), Critical Labs Hgb 9.8 (13.5-17.5) Hct: 29 (40-45%) Reticulocytes 5.5, Location at left axillary. 8:13 You provided patient education. 18 terms. The FACES pain rating scale is a self-report tool that is acceptable for use w/ a developmentally appropriate 5 y/o. e) Precipitating events. IV (Children 6 mo12 yr): Analgesic and antipyretic 10 mg/kg (not to exceed 400 mg) every 46 hr as needed (not to exceed 40 mg/kg/day or 15:2 6 You started a bolus of 250 mL of normal saline IV, giThis was indicated by order. management so it does not turn into a crisis. every 34 hr, maximum: 15 mg/dose. VBVA=45.0V. Pages 15 Course Hero uses AI to attempt to automatically extract content from documents to surface to you and others so you can study better, e.g., in search results, to enrich docs, and more. Student exploration Graphing Skills SE Key Gizmos Explore Learning. A step-by-step guide to craft a winning sales presentation . Document the patient teaching that you would provide for Brittbefore discharge, including disease process, nutrition, signs and sany Long and her family ymptoms of crises, d) Anemia and hypotension. o Therapeutic: opioid analgesics Document the patient history you obtained for Brittany Long, including previous pain crises, hospitalizations, precipitating events, medical treatment, and home management. Hematuria Document your initial focused assessment of Brittany Long. Instruct patient how and when to ask for pain medication. Acute: (related to dehydration vSim - Brittany Long. line infusion rate to 52. She was brought into the emergency department during the night by her mother, who stated that the patient has been complaining of right lower leg pain over the last 2 days. Patients who are immobile are at greater (16kg * 0 ) = 0 / (16kg * 0) = 3 = SAFE DOSE I/O can be calculated by UAP. 19 terms. Brittany Long had tenting of the skin , her skin felt cold to touch , and her mucous membrane was dry . and the abdomen is generally tender. A 5 y/o come to the ER with a hx of sickle cell anemia and acute leg pain. $16.49 Add to cart . Vital signs q4h Continuous Pulse Oximetry: Monitor O2 saturation levels Labs; daily complete blood count and basic metabolic panel, Blood analysis (notable): Hgb 9.8 (13.5-17.5) Hct: 29 (40-45%) Reticulocytes 5.5 (0.5-1.5%) Electrolytes Creatinine: 0.4 (0.8-1.4). sickle cell disease. 0 mg/kg every 12 hr. Pain severe enough to require daily, around-the-clock long-term opioid treatment and for which alternative treatment options proceeded to ask where her pain was and she responded, my tummy. She rated her pain a 3/ 13:3 9 You phoned the provider in order to discuss the patient. awakened. The provider has increased the morphine dose, but her mother voices concerns that Brittany is addicted to the medication. Designed to simulate real nursing scenarios, vSim for Nursing, co-developed by Laerdal Medical and Wolters Kluwer, allows students to interact with patients in a safe, realistic online environment. Take missed doses as soon as remembered but not if almost time for next dose. Instruct patients with cardiac disease to avoid straining during bowel movements (Valsalva maneuver). Recommendation: Educate the patient and family about the importance of hydration And Hct. She ha, pain crises before, mostly managed at home with acetaminophen and ibuprofen. Blood, Current pertinent assessment data using headto toe approach, pertinent diagnostics, vital signs. SAFE DOSAGE: 16kg*4mg/10mg = 64mg to 160mg, PO (Children 6 mo12 yr): Anti-inflammatory 3050 mg/kg/day in 34 divided doses (maximum dose: 2 g/day). With each pregnancy, there is a 25% chance the child will have sickle cell anemia, a 50% chance the child will be a carrier of the trait and 25% chance the child will be unaffected. Background: Brittany Long has a history of sickle cell anemia being treated with a folic Jackson Weber Complex Pre/Post Quiz. Download these free nursing education guides for best practices on integrating virtual simulations into your nursing program. Leadership class , week 3 executive summary, I am doing my essay on the Ted Talk titaled How One Photo Captured a Humanitie Crisis https, School-Plan - School Plan of San Juan Integrated School, SEC-502-RS-Dispositions Self-Assessment Survey T3 (1), Techniques DE Separation ET Analyse EN Biochimi 1, Infant, Child And Adolescent Nursing (NSG 441). for a fever. DramaQueen66. Find all solutions of the following equation. Leadership and Management in Nursing (NUR 4773), Advanced Concepts in Applied Behavior Analysis (PSY7709), Intermediate Medical Surgical Nursing (NRSG 250), Professional Application in Service Learning I (LDR-461), Advanced Anatomy & Physiology for Health Professions (NUR 4904), Principles Of Environmental Science (ENV 100), Operating Systems 2 (proctored course) (CS 3307), Comparative Programming Languages (CS 4402), Business Core Capstone: An Integrated Application (D083), Ch. Fluid and Electrolyte levels stabilized and maintained. Note that the wording of the dictionary definition may vary from the wording below. of oral fluids and continues to receive e child with a favorite drink, 9:48 You changed the dextrose 5% in 0% normal samL/hr. Respiration: 15. Protein dipstick is +4, negative ketones, negative glucose, +2 dependent edema, and facial . Britta, not had an appetite in the last 24 hours but has taken small amounts of oral fluids. (In pain) She replied: 6:49 You asked the parent: When the problems starte'A few days ago.' d. The parent replied: 6:54 You asked the parent: Has she had fever? Place the steps of an abdominal assessment in order. Advise patient that morphine is a drug with known abuse potential. Respiration: 24. 15:1 0 Child status - ECG: Sinus rhythm. afety it is important that, You should have identified the relatives as one of yoassure patient safety. D5 in 1/2NS IV at 52 mL per hour, codeine elixir 8 milligrams orally every four hours (06-10-14-18-22-02) , acetaminophen Alexa are 240 mg orally every six hours (6-12-18-24), ibuprofen elixir 160 mg orally at 0900 and then q6h , Docusate sodium 100 mg orally once daily at 2000, morphine sulfate 2 mg IV one time dose. A family hx of blood transfusion wouldn't be relevant, as it wouldn't affect the pt. 37 C PO Infants: 5 mg/kg/day in 14 divided doses. VSim Brittany Long Pre/Post test. Acute Pain Her pain was a 3/, in her right lower legs. Pediatric Case 7: Brittany Long (Core) Documentation Assignments. The padon't think so.' rent replied: 'No. prescribed was given for her pain. There is tenting sign of the skin. He ordered, normal saline and PRBC infusion to help with the hypovolemia. Referring to your feedback log, document the nursing care you presponse. I then preformed an assessment on her abdomen. Management of Care: What needs to be done for this Patient Today? a) Choose the face that looks like how you feel inside. Which of the following explanations by the nurse correctly describes how to use the scale? Conscious state: Appropse: Present. I worked my way up to an hour of cardio per workout session. Advise patients that laxatives should be used only for short-term therapy. slurred speech, What Assessments will focus on for this patient? PDA Closure temperature <102F (39C) or 10 mg/kg for higher temperatures (not to exceed 40 mg/kg/day); may be repeated every 46 hr. She also didn't have any energy to eat anything by mouth. treat it. Britney long Jesse has sickle cell disease and was brought to the Emergency Department for an acute vaso occlusive crisis. I recommend close monitoring of pain levels, strict I/Os to asses dehydration status with a possible increase in fluids needed. In a vaso-occlusive crisis / painful Conscious state: Appropriate. She has had pain crises before, mostly This new feature enables different reading modes for our document viewer.By default we've enabled the "Distraction-Free" mode, but you can change it back to "Regular", using this dropdown. 2) Inspect abdomen for size and shape. Temp: This new feature enables different reading modes for our document viewer. 37 C scale and did not want anyone to touch her I have given her morphine 2 mg IV Push and have also bolused She now rates her pain as a 3. Britney rated her pain as a 5 on the faces over the last 2 days. 19 terms. Blood pressure:riate. regular heart sounds without murmurs. CLASSIFICATION: kuuleinani1102. c) FACES scale Do not stop taking without discussing with health care professional; Course Hero is not sponsored or endorsed by any college or university. On inspection, the pt's skin is flat & w/o erythema. nonsteroidal anti inflammatory agents Vital Document the patient history you obtained for Brittany Long, including previous pain cri, hospitalizations, precipitating events, medical treatment, and hom, diagnosed at 6 months old, and has been prescribed regular folic acid supplement. I gave her the stuffed animal as a comfort tool to have while I preformed my assessments. VSim Sabina Vasquez Pre/Post test. A:Her spleen is currently enlarged, and she reported a 3/5 on the FACES Scale. hands and feet cool to touch. If you are logged in and still cannot post, make sure "Do not track" in your browser settings is disabled. SpO2: 98%. has been taking small amounts of oral fluids and continues to receive intravenous Neutrophils and bans are bacterial. Document the patient history you obtained for Brittany Long, including previous pain crises, hospitalizations, precipitating events, medical treatment, and home management. normal saline and PRBC infusion to help with the hypovolemia. She has pain a 6/10 on the faces scale and is receiving morphine to In people with sickle cell anemia, hemoglobin a substance in red blood cells becomes defective and causes the red blood cells to change shape. female with a history of sickle cell disease, Brought into the ED by her mother last night. 34 hr initially. Children with mild-to-moderate sickle cell crisis usually receive oral opioid medication and She has been, hospitalized twice, once at age 4 years for a vaso-occlusive crisis episode and once at age 3 yea, She is asleep but is responsive when awakened. IV (Children 1217 yr): Analgesic and antipyretic 400 mg every 46 hr as needed (not to exceed 2400 mg/day). a) Sickle cells cause increased blood flow throughout the body. Store out of sight and reach of children, and in a location not accessible by others. Normal bowel habits are variable and may vary from 3 syndrome can develop in children with sickle cell crisis. Pul108/73 mmHg. managed at home with acetaminophen and also on 2L nasal cannula. After the nurse has given discharge instructions regarding prevention of vaso-occlusive pain crisis, which response b Brittany's mother indicates that further teaching is needed? Initial focus assessment was the patients pain and location. Her right lower leg pain is stable, but Brittany has had a sudden increase in left upper quadrant abdominal pain and tenderness. 13 terms. Identify and document key nursing diagnoses for Brittany Long: Brittany Long needs the following diagnosis:. arcoca. once at age 4 years for vaso-occlusive crisis 13:2 3 You examined the child's legs. Create three research questions that would be appropriate for a historical analysis essay, keeping in mind the characteristics of a critical r, Conversation Concept Lab Transcript Shadow Health. both her and her mother. Heart rate: 126. Brittany Long is a 5-year-old African American female with a history of sickle cell disease, diagnosed at 6 months old, and has been prescribed regular folic acid supplement. She was admitted to the Pediatric unit this morning 02/02/2020 at 0700 for an acute vaso-occlusive crisis. Ineffective Tissue Perfusion The increased blood flow through the blood vessels causes tour child to have severe pain 7:11 You asked the parent: Has she been travelling recently? Pul106/73 mmHg. Which of the following should be included in the plan of care for this patient? May cause drowsiness or dizziness. bacterial. Document your initial focused assessment of Brittany Long. a) immunization hx 2. Temp: of hydration with patients who have sickle cell anemia. Verify your answer in a medical dictionary. Current orders are, Vital signs q4h, continuous pulse ox and oxygen to keep SpO2 greater than 94%, to encourage PO fluids, daily CBC and BMP. The nurse is assessing for which of the following complications of vast-occlusive crisis? 7:03 You asked the parent: Has there been vomiting,The parent replied: 'No.' diarrhea or constipation? Respiration: 25. Assess patient and caregiver knowledge of how to avoid crisis. Sets found in the same folder. Monitor and note changes in level of consciousness, reports of headache, dizziness, diagnosed at six months old and has been 11:1 0 Child status - ECG: Sinus rhythm. 19 terms. Circulating sickle cells are hemolysized by the. M IV SC (Adults and Children <50 kg): Usual starting dose for moderate to severe pain in opioid-naive patients 00 mg/kg shortness of breath, fatigue leg is warm to the mg Brittany Long was diagnosed with sickle cell disease at 6 months old. This was not part of your orders here. Conscious state: Appropse: Present. She has been hospitalized twice, Course Hero is not sponsored or endorsed by any college or university. Document your initial focused assessment of Brittany Long. b. JpxJ p xJpx, Give the word derived from Greek elements that matches given of the following. PATIENT EDUCATION WHILE TAKING THIS MEDICATION In people with sickle cell lymphocytes monocytes increase is In addition to pharmacologic pain management, what nonpharmacologic pain management strategies can the nurse use for their pt? a) I want to listen to you breathe. She has been hospitalized twice, once at age 4 years Making a purchase. hospitalizations, precipitating events, medical treatment, and home management. episode and once at age 3 years for a fever. maintenance fluids at 52 mL/hr. critical, particularly in young children, whose fluid stores are rapidly depleted. Document your . Protect it from theft, and never give to anyone other than the precipitating factor in sickle cell crises. a) acute leg pain and dactylitis vSim for Nursing allows each student to have a different experience with the patient. Hgb 9 (13.5-17) Situation: Brittany long is a 5-year-old African American female who has a history of sickle cell anemia, she came into the hospital yesterday suffering from a sickle . Blood pressure:te. respiratory depression. Her pulse measured 160bpm, her respirations were 34, and her blood SpO2: 99%. vascular accident (CVA). Reduction of fever. vSim - Brittany Long. Thus, the maximum safe dose is 240 mg. A 5 y/o pt with sickle cell anemia has an order for oral codeine elixir 8 mg Q4H around the clock for pain. temperature was 37 Celsius she now rates 2. Brittany Long vSim Concept Map Meghan Simons NUR 411L Date 1 Patient Diagnosis and Pathophysiology Dx & Patho Diagnosis Dx Sickle cell disease/anemia Pathophysiology Patho Brittany Long is a 5 year old female with a history of sickle cell anemia, who presented to the ED with right . (Signs & Symptoms), awakened. Your name, posi t on (RN), unit you are working on SITUATION The patient is Brittany Long, a 5-year-old African American female with a history of sickle cell disease whom was diagnosed at 6 months old. 3. CBC due Q 4 hours. before discharge. Acute manifestations of sickle cell anemia in a vaso-occlusive crisis include pain crisis and swelling of the fingers and toes (dactylitis). her pain as a three. Heart rate: 128. Blood pressure:riate. therapies are essential for children and offer them comfort and security. A 5 y/o is old enough to accurately report his or her own pain level and may be lying still as a coping strategy of bc the movement is painful. ur first actions to, 3:00 You asked the parent: Does she have any known areplied: 'No. I monitored her respiratory rate for any Which of the following methods is appropriate for the nurse to employ to administer the medication? Neutrophils and bans are Naltrexone: -opioid receptor antagonist that reduces the. 1. Document the patient history you obtained for Brittany Long. This was, 2:10 Child status - ECG: Sinus rhythm. She was brought into the emergency department during the night by her mother, who stated that the patient has been complaining of right lower leg pain over the last 2 days. vSim ISBAR ACTIVITY STUDENT WORKSHEET INTRODUCTION Hello my name is Cheina, I am an RN on the Pediatric Care Unit. Cross), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham), Psychology (David G. Myers; C. Nathan DeWall), The Methodology of the Social Sciences (Max Weber), Give Me Liberty! o Emphasize the importance of aggressive prevention of constipation with the use of morphine, MEDICATION: Docusate sodium 100 mg PO daily (liquid per home dose). Communication Interact with the patient through questions that result in text and audio responses. Hypovolemia by evidence of pale extremities I monitored her respiratory rate for any, respiratory depression. Assessments Conduct specific physical assessments, Interventions Take action with the patient to improve their health status, Drugs and IV Management Administer medication according to provider orders, Tests and Diagnostics Perform lab or diagnostic tests to support clinical decisions, Search - Find available interactions to take with the patient, Electronic Health Record - Reference provider orders and patient information to influence decision making, Call Provider - Request additional information during the scenario, Patient Handoff - End the scenario at any time, vSim Score Immediate feedback calculated based on severity of errors, Main Opportunity for Improvement Identify key focus areas, Basic View - Review a timeline of student actions with feedback and remediation, Detailed View - View patient status at the time of student actions. She also did n't have any energy to eat anything by mouth . prescribed regular folic acid supplement. development of sensory and motor deficits (hemiparesis or paralysis), and seizure activity. I I educated the patient. PO (Infants 611 mo/1217 lb): 50 mg every 68 hr. Timely pain management. Take note of This was part of your order. early recognition are critical in preventing respiratory complications and failure. (SBAR) format to communicate what further care Brittany Long needs. A. Somatization disorder - manifests as a pain syndrome with a significant loss of or alteration in physical function that mimics a physical, Of the axons involved in the transmission of pain, which one is thinly myelinated and conducts that first feeling of pain that is often felt as coming on as a sharp, rapid feeling? Over time, the red blood cells become rigid and shaped like crescent moons or sickles. administer blood products, usually packed RBCS an exchange transfusions per facility protocol. Advise patients to take ibuprofen with a full glass of water and to remain in an upright position for 1530 min after administration. (Clinical slides 02.02) When examined this morning, her blood pressure was 101/ Provide intense hydration therapy while maintaining fluid and electrolyte balance: monitor I/ O, give oral fluids administer Tolerance is not addiction. Pennsylvania College of Technology. Heart rate: 127. How did the simulated experience of Brittany Long's case make you feel? VS can be monitored and reported by the UAP. Summary - Fatime sanogo vsim steps. fatime sanogo age:&tab;23 years diagnosis:&tab;induction . for a vaso-occlusive crisis episode and once at age 3 years for a fever. I don't thhat you think we should ink so.' 7:47 You offered the child a toy. c) Use a dropper to place med in back of the pt's throat She has not had an appetite in the last 24 hours but has taken small amounts of oral fluids. a) Acute leg pain and dactylitis. PO (Children 910 yr/6071 lb): 250 mg every 68 hr. Your other child definitely carries the trait Pulmonary edema. Advise patient not to take docusate within 2 hr of other laxatives. To maintain patient syou quickly identify the child. The nurse enters the room to check on Brittany and finds her sitting gin bed playing video games with her sister. Temp: ood or had a reaction to a. Heart rate: 126. Which lab findings would indicate the pt is experiencing a vast-occlusive crisis? 37 C c) Enuresis and proteinuria. Identify and document key nursing diagnoses for Brittany Long. She was brought into the emergency A nurse is explaining the pathophysiology of vaso-occlusive pain crisis to the parent of a pt with sickle cell anemia. : an American History (Eric Foner), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham), Psychology (David G. Myers; C. Nathan DeWall), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. Obstructive jaundice Home Care Issues: Pedi: Teach parents or caregivers how to accurately measure liquid medication and to use only the measuring device dispensed with the medication. X SAFE DOSAGE List Complications may occur related to dx, procedure, comorbidities: What nursing or medical interventions may prevent the above Alert or complications? diagnosed at 6 months old, and has been prescribed regular folic acid supplement. Labs; daily complete blood count and after the administration of the pain medication she seemed more comfortable. pressure taken at right upper arm via non-invasive BP cuff: 109/74 mmHg. During the nurse's initial assessment of a 5 y/o admitted w/ vaso-occlusive crisis, the pt reports a pain level of 4 on the FACES scale. Any orders or recommendations you may have for this patient. b) Sickled cells mix w/ normal RBCs and cause the immune system to become depressed, which makes your child more prone to illness pain, shortness of breath, weakness, slurring of speech) occurs. Document the patient history you obtained for Brittany Long, incluhospitalizations, precipitating events, medical treatment, and home management previous pain crises, Brittany Long is a 5 yr-old African American female with a history of sickle cell disease. She rates her pain as a 5/5 on the FACES scale. viral. d) Numeric pain intensity scale (0-10). e) Precipitating events 3. Which of the following would be the best response by the nurse?
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