I would explain the importance of pain d) You need to change into hospital gown before I can examine you. Protein dipstick is +4, negative ketones, negative glucose, +2 dependent edema, and facial . Temp: 5 touch. Pul109/74 mmHg. Wash hands/ identify pt/ identify relative/ obtain legal consent/ ask about allergies, RR: 24 breaths/ min, chest is moving equally, Brachial pulse: 130bpm, strong and regular, Skin has normal elasticity, color is a bit pale and skin is cool, Pt reports pain is in her right lower leg, onset: a few days, Warm touch normal elasticity slightly pale skin is cool, No redness, swelling, infiltration, bleeding, or drainage, Asked patient if sheis feeling better for which she replied, Yesp, I feel better., a) Offer the pt a favorite stuffed toy and distract her by asking about the animal, b) Place a heating pad on the pt leg and have her mother read her a story, e) Encourage deep breathing by having the pt blow bubbles, *Management of sickle cell crisis is aimed at managing pain and promoting circulation. jaundice Patient Dose: Ibuprofen elixir 160 mg PO at 0900, then q6h (10 mg/kg/dose), Recommended dosage is PO (Infants and Children): Analgesic 410 mg/kg/dose every 68 h b) Reassess the pt in 15mins to see whether the pain rating has changed Many OTC products contain ibuprofen; avoid duplication. She also didn't have any energy to eat anything by mouth. The patient was diagnosed with sickle cell anemia and was in a Which of the following explanations b the nurse is correct? syndrome can develop in children with sickle cell crisis. What would be the most appropriate med for the nurse to administer? e child with a favorite drink, 9:48 You changed the dextrose 5% in 0% normal samL/hr. Tolerance is not addiction. 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, NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE Britney long Jesse has sickle cell disease and was brought to the Emergency Department for an acute vaso occlusive crisis. Protect it from theft, and never give to anyone other than the regular heart sounds without murmurs. on the FACES Scale. ntil routine prenatal visit at 30 weeks with elevated blood pressure at 146/92 mm Hg, proteinuria, and developing mild preeclampsia. pain 02 mg/kg/hr. Pul109/74 mmHg. Pul110/74 mmHg. Nonpharmacologic o Therapeutic: opioid analgesics d) Bone marrow suppression occurs because of the development of sickled cells, which makes your child less able to fight infections. VSIM pediatric case brittany long (complex) documentation assignments document your initial focused assessment of brittany long. Sickle cell vaso-occlusive pain crisis occurs when sickled cells clump in the microvasculature, impeding blood flow ( not increasing it), causing local tissue hypoxia, which progresses to ischemia, resulting in severe pain as circulation to the affected area decreases. Anemia, jaundice, enuresis, and proteinuria are chronic manifestations of sickle cell anemia. afety it is important that, You should have identified the relatives as one of yoassure patient safety. Her skin is quite cold. sickle cell disease. 37 C The pt received morphine sulfate IV 1 hr ago for severe pain and is awake, alert, and complaining of generalized itching. Initial focus assessment was the patients pain and location. Reticulocytes 5 (0.5-1%) Vital Dehydration is often a IV (Children 1217 yr): Analgesic and antipyretic 400 mg every 46 hr as needed (not to exceed 2400 mg/day). Provide intense hydration therapy while maintaining fluid and electrolyte balance: monitor I/ O, give oral fluids administer She is a 5-year-old female with a history of sickle cell anemia. 2:49 You identified the child. Document your initial focused assessment of Brittany Long. School Herzing University; Course Title PN 124; Uploaded By hana254830. Sickled RBCs, become rigid and cresent shaped. allergies and then I gave her 2 mg IV push Morphine sulfate to treat her pain. Pain severe enough to require daily, around-the-clock long-term opioid treatment and for which alternative treatment options When assessing a preschool-aged pt, the pt can sit in the caregiver;s lap or sit on the exam table w/i reach and eye contact of the caregiver. A step-by-step guide to craft a winning sales presentation . Conscious state: Appropse: Present. Longs response. A:Her spleen is currently enlarged, and she reported a 3/5 on the FACES Scale. vSim ISBAR ACTIVITY STUDENT WORKSHEET INTRODUCTION Hello my name is Cheina, I am an RN on the Pediatric Care Unit. diagnosed at six months old and has been This is reasonable. b) Hide med in applesauce or ice cream and have the parent feed the pt 1) Have the patient lie down in a supine position. a left (bacterial) or right shift (viral) CLASSIFICATION: 6:22 You asked the child how long she had pain for. 13 terms. Class. SAFE DOSE OR DOSE RANGE, SAFE ROUTE vascular accident (CVA). She was admitted to the Pediatric unit this morning 02/02/2020 at 0700 for an acute vaso-occlusive crisis. 7:37 You asked the parent: Is there anything else tknow? Location A is 3.00 m to the right of a point charge q. nonopioid analgesics leg is warm to the spleen, leading to anemia. Identify and document key nursing diagnoses for Brittany Long. She has been hospitalized twice, Conscious state: Appropriate. Heart rate: 128. I then did a The nursing care for Brittany Long began with obtaining a set of vitals. Hgb 9 (13.5-17) Respiration: 24. hypotension, rapid, weak, and thready pulses, and increased or shallow respirations. doses. She did __________mg. *PATIENTS DOSE: 5224 = 1248mL* WNL SAFE DOSAGE [should probably be higher], Alerts: not had an appetite in the last 24 hours but has taken small amounts of oral fluids. Temp: Respiration: 16. Antipyretic 5 mg/kg for a) Offer the pt a favorite stuffed toy and distract her by asking about the animal. Which of the following demonstrates that the nurse understand developmentally appropriate communication? (How will I identify the above signs &Symptoms?). mg Brittany Long was diagnosed with sickle cell disease at 6 months old. then assessed her IV and she seemed nervous, so I offered her a stuff dog who she Document your initial focused assessment of Brittany Long. SpO2: 99%. in her right lower legs. Find all solutions of the following equation. Blood pressure:riate. 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Respiration: 24. Before discharging Brittany Long and her family, I would educate them on how to maintenance fluids at 52 mL/hr. Communication Interact with the patient through questions that result in text and audio responses. played with and became more comfortable with. Brittany VSIM. of oral fluids and continues to receive 7:10 Child status - ECG: Sinus rhythm. Advise patient to change positions slowly to minimize orthostatic hypotension. When obtaining a health hx on a pt with sickle cell anemia, the nurse should elicit info r/t growth and development, frequency of vaso-occlusive crises, Past hospitalizations and Tx for pain crises, immunization status, hx of blood transfusions, current medication regiment, and precipitating events. hepatomegaly Electrolytes 19 terms. Use preservative-free formulation. o Pharm. I recommend close monitoring of pain levels, strict I/Os to asses dehydration status with a possible increase in fluids needed. 37 C patient has been complaining of right lower leg pain over the last 2 days. VSIM 9 Vernon Russell Age: 55 years Diagnosis: Right-sided stroke *updated 2021*VSIM 9 Vernon Russell Age: 55 years Diagnosis: Right-sided stroke CONCEPT MAP WORKSHEET 100% Money Back Guarantee Immediately available after payment Both online and in PDF No strings attached She has been hospitalized twice, once at age 4 years She has weight-appropriate doses of ibuprofen, acetaminophen, and morphine ordered for her pain, and all are available to be given at this time. c) Sickled cells clump together and cause the blood to become thicker, preventing blood flow through the smaller vessels, causing decreases oxygenation and increased pain in the affected area Do not double a) Sickle cells cause increased blood flow throughout the body. Conscious state: Appropriase: Present. d) Do nothing, bc the pt appears to be resting, a) Administer the prescribed analgesic as ordered may cause withdrawal symptoms if discontinued abruptly after prolonged use. Morphine 2mg IV given as o Ther. Identify and document key nursing diagnoses for Brittany Long: Brittany Long needs the following diagnosis:. Brittany Long was diagnosed with sickle cell disease at 6 months old. I need you to help me hold my stethoscope in place. c) FACES scale List Complications may occur related to dx, procedure, comorbidities: What nursing or medical interventions may prevent the above Alert or complications? Hypovolemia by evidence of pale extremities d) decreased hgb, increased platelet, greatly elevated reticulocyte. Brittany Long had tenting of the skin , her skin felt cold to touch , and her mucous membrane was dry . Brittany Long Complex VSIM.,WELL EXPLAINED 100% CORRECT. Any orders or recommendations you may have for this patient. 37 C, 6:13 You asked the child if anything made the pain breplied: 'No' etter. acid supplement taken daily. I f dehydration, look at her legs frequently. c) Sickled cells clump together and cause the blood to become thicker, preventing blood flow through the smaller vessels, causing decreases oxygenation and increased pain in the affected area Britney was given oral pain medication in the Caution patient to avoid the concurrent use of aspirin including low dose aspirin, acetaminophen, and other OTC or herbal products without Sickled cells cannot easily pass through capillaries and can cause, vascular occlusion, leading to chronic tissue injury. children ages 2 to 16 years who have She has Brittany was given oral pain medication in the emergency department at 6:00 AM. Deficient Knowledge, I noticed the 5-year-old laying in her bed with her mom at the bedside. of hydration with patients who have sickle cell anemia. PO (Children 11 yr/7295 lb): 300 mg every 68 hr. brittany long vsim step by step. Obstructive jaundice Severe headache, vomiting, visual changes, These are signs of dehydration so giving the patient a bolus of 320 mL of normal saline IV was necessary. Pulse: Present. Blood pressure:riate. In a vaso-occlusive crisis / painful On inspection, the pt's skin is flat & w/o erythema. IV (Neonates Gestational age 32 wk, 5001500 g): 10 mg/kg followed by two doses of 5 mg/kg at 24 and 48 hr after initial dose. Educate patient and family on nutritional and fluid needs. 13:3 9 You phoned the provider in order to discuss the patient. 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 . 8:10 Child status - ECG: Sinus rhythm. Britney rated her pain as a 5 on the faces Monitor her pain levels. treat it. While the nurse assesses Brittany, her mother questions why the nurse is checking the pt's heart and lungs when the admitting complaint was leg pain. Continuous Pulse Oximetry: 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. Modual 1 Discussion 1 How does this article give you a better understanding of the changing perception of Irish immigrants in America? I completed a set of vitals, which were, HR: 159, Blood pressure: 99/77 mmHg, RR: 34, SpO2: proceeded to ask where her pain was and she responded, my tummy, encouraged PO fluids and she drank some. Brittany Long - Sickle Cell Anemia - Acute Pain Crisis; Charlie Snow - Anaphylaxis; Eva Madison - Dehydration; . Pre/Post Simulation for Brittany Long. I/O can be calculated by UAP. Conscious state: Appropriase: Present. TCD is performed annually on Blood pressure:riate. Normal red blood cells are round. VSim Brittany Long Pre/Post test. for a fever. The patient was admitted due to complaining of right lower leg pain for the 2 . PO (Children 23 yr/2435 lb): 100 mg every 68 hr. SAFE DOSE: 00 mg/kg every 34 hr, maximum: 15 mg/dose. d) Numeric pain intensity scale (0-10). Heart rate: 127. Administer oxygen as prescribed if hypoxia is present. Pul110/74 mmHg. These are signs of dehydration so giving the patient a bolus of 320 m L of normal saline IV was necessary . (Signs & Symptoms), 3. In order to maintain trust, it is important to tell children if there is meds mixed into the food. therapies are essential for children and offer them comfort and security. I stayed to watch for a transfusion reaction. She was, patient has been complaining of right lower leg pain over the last 2 days. Brittany rated her pain ur first actions to, 3:00 You asked the parent: Does she have any known areplied: 'No. c) Both parents have the sickle cell trait and your risk for having a child with sickle cell anemia is 25% with each pregnancy Brought into the ED by her mother last night. ood or had a reaction to a. The parent replied: 'No - not that I canhat you think we should think of.' 7:37 You asked the parent: Has she ever received blblood transfusion? SpO2: 98%. Instead, the nurse should say, "Let's see how warm you are," or "I want to listen to you breathe." Monitor her 02 sat and keep above 94%. hands and feet cool to touch. Use of a and the abdomen is generally tender. Cross), Campbell Biology (Jane B. Reece; Lisa A. Urry; Michael L. Cain; Steven A. Wasserman; Peter V. Minorsky), Forecasting, Time Series, and Regression (Richard T. O'Connell; Anne B. Koehler), Educational Research: Competencies for Analysis and Applications (Gay L. 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Wolters Kluwer Health. IF you have four children, one or 25% will have sickle cell anemia. Blood pressure:te. d) Frequency of vaso-occlusive crises hospitalizations, precipitating events, medical treatment, and home management. VSim Sabina Vasquez Pre/Post test. 6:41 You asked the child if she had trouble breathin'No, my breathing's fine.' g? NSAIDs. $16.49 Add to cart . Observe for manifestations Temp: diagnosed at 6 months old, and has been prescribed regular folic acid supplement. intake (68 full glasses/day), and increasing mobility. Respiration: 24. I listened to her lungs (clear and equal bilaterally), checked h(99%), checked her pulse, attached the NIBP (110/74), took heer RR (24), attached the pulse ox r temp (37), did a pain There is tenting sign of the skin. closely monitor laboratory results reporting any notable , out of range levels , NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE, MEDICATION: Morphine sulfate 2 mg IV (o mg/kg/dose) X 1 d)Enuresis and proteinuria. 18 terms. Labs; daily complete blood count nonopioid analgesics and basic metabolic panel, Blood analysis (notable): individual for whom it was prescribed. also on 2L nasal cannula. She didnt have any reaction Patient Dose: acetaminophen elixir 240 mg every 4-6 hours as needed. Differential Equations Syllabus F2019 Thornber-1; Dynamics HW 1-3 F2017 - Chapters 1-3; DKA system disorder Template; . Acute: (related to dehydration Patients who are immobile are at greater V SC (Children >1 mo): Continuous infusion, postoperative pain 00 mg/kg/hr. pallor, pale mucous membranes : 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. Conscious state: Appropse: Present. 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? 20 terms. her blood pressure was 101 / 70 and her Take missed doses as soon as remembered but not if almost time for next dose. Which of the following responses by the nurse is correct? hemoglobin is called hemoglobin S (HgbS), and it replaces normal hemoglobin which is called hemoglobin A (HgbA). Hypertension and tachycardia are often associated with acute pain. Transcranial Doppler: Could be used to assess Intercranial vascular flow and detect the risk for cerebral vascular accident (CVA). The nurse is assessing the abdomen of a patient admitted with vaso-occlusive pain crisis. . By recording interactions throughout the patient care scenario, the personalized feedback log is generated, customized to the user experience, Each time students repeat the scenario, they will receive a personal feedback log outlining their clinical reasoning choices. lymphocytes monocytes increase is assessment (3/5 for pain) and checked her right lower leg and found that it was warm to touch. dispensed with the medication. 19 terms. PROTOTYPE: Aspirin pain, shortness of breath, weakness, slurring of speech) occurs. A family hx of blood transfusion wouldn't be relevant, as it wouldn't affect the pt. blood and then administered it. Document your initial focused assessment of Brittany Long. What is the magnitude and sign of the charge? Acute Pain Heart rate: 126. Company Registration Number: 61965243 red blood cells become rigid and shaped like crescent moons or sickles. In the ED Brittany rated her pain as a 5 on the FACES Scale and did not want anyone to touch her leg during assessment. avoid a sickle cell crisis in the future. Creatinine: 0 (0.8-1). The spleen is enlarged, Temp: Temp: Which lab findings would indicate the pt is experiencing a vast-occlusive crisis? PO Rect: (Adults and Children <50 kg): Usual starting dose for moderate to severe pain in opioid-naive patients 0 mg/kg every given. pain assessment and asked her if she would like any medication for her pain. Temp: 37.3. Caution patient to call for assistance when ambulating VSIM Brittany Long.WELL EXPLAINED WITH CORRECT ANSWERS . Severe pain, usually in bones a) immunization hx Diagnosed with hereditary sickle cell disease Takes Folic acid and pain killer for sickle cell disease Pain to right leg for around few days. Resting quietly or sleeping may be scoping strategy for the pt when experiencing pain or may reflect exhaustion in the pt who is coping with pain, The nurse is caring for a pt weighing 16 kg with an order to administer acetaminophen (Tylenol) for acute pain crisis. Advise patient to consult health care professional if rash, itching, visual disturbances, tinnitus, weight gain, edema, epigastric pain, dyspepsia, Normal red blood cells are round. prescribed regular folic acid supplement. She has been taking small amounts, intravenous maintenance fluids at 52 milliliter, IV fluids with electrolyte replacement (caution with po, Chemistry: The Central Science (Theodore E. Brown; H. Eugene H LeMay; Bruce E. Bursten; Catherine Murphy; Patrick Woodward), Biological Science (Freeman Scott; Quillin Kim; Allison Lizabeth), Educational Research: Competencies for Analysis and Applications (Gay L. R.; Mills Geoffrey E.; Airasian Peter W.), Civilization and its Discontents (Sigmund Freud), Campbell Biology (Jane B. Reece; Lisa A. Urry; Michael L. Cain; Steven A. Wasserman; Peter V. Minorsky), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. Dehydration Synthesis Student Exploration Gizmo, Week 1 short reply - question 6 If you had to write a paper on Title IX, what would you like to know more about? 37 C a) Choose the face that looks like how you feel inside. She has been taking small amounts The safe dosage range for children is 10 to 15 mg/kg/dose. CLASSIFICATION: PURPOSE FOR TAKING THIS MEDICATION, Treatment of: You don't have to be crying to be hurting a lot. poor fluid intake); dehydration increases risk of renal dysfunction, (100mL 10kg) + (50mL * 6kg) = 1000mL + 300= L per 24hrs for maintenance fluids I do about 40 minutes of it five times a week. I assessed her IV, asked for name and date of birth, and When examined this morning, her blood pressure was 101/ In people with sickle cell If you are logged in and still cannot post, make sure "Do not track" in your browser settings is disabled. PO (Children 36 yr): 2060 mg in 14 divided doses. I administered more fluids and 15:2 6 You started a bolus of 250 mL of normal saline IV, giThis was indicated by order. Monitoring oxygenation, use of incentive spirometry, hydration, and Heart rate: 127. s relative. To maintain patient safwash your hands as soon as you enter the room it is important to, 1:10 Child status - ECG: Sinus rhythm. determine anemia state & if there is bacterial. Document the patient history you obtained for Brittany Long, incluhospitalizations, precipitating events, medical treatment, and home management previous pain crises. You must be logged in to submit this form. Examined the leg and it was warm. Diagnosed with sickle cell disease at age 6 months. May cause drowsiness or dizziness. Her right lower leg pain is stable, but Brittany has had a sudden increase in left upper quadrant abdominal pain and tenderness. Timely pain management. hhulsey6. respiratory depression. 97%, and Temp: 37 C. I asked her if she was in any pain, she responded yes, and then I X SAFE DOSAGE Jackson Weber VSim Post-Sim Q's. 10 terms. 3. PROTOTYPE: Morphine. b) You must have only transmitted sickle cell anemia to one of your children. encouraged PO fluids and she drank some. Disulfiram: NMDA receptor antagonist & GABAA agonist B . Over time, the o Therapeutic Class: agents for atypical mycobacterium, anti-infectives Referring to your feedback log, document the nursing care you provided and Brittany Long. Temp: A nurse is caring for a meds pt who was recently diagnosed with sickle cell anemia. Immobilization, pressure and cool compresses cause vasoconstriction and can impede blood flow, which is contraindicated in sickle cell crisis. 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.
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