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This is correcevery opportunity to provide patient education. of hypervolemia and transfusion reaction. encouraged PO fluids and she drank some. ur first actions to, 3:00 You asked the parent: Does she have any known areplied: &apos;No. every 34 hr, maximum: 15 mg/dose. Acute: (related to dehydration Which of the following responses by the nurse is correct? Educate patient and family on nutritional and fluid needs. Identify and document key nursing diagnoses for Brittany Long. Pul106/72 mmHg. pallor, pale mucous membranes She was, patient has been complaining of right lower leg pain over the last 2 days. 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. Naltrexone: -opioid receptor antagonist that reduces the. (Signs & Symptoms), awakened. Heart rate: 127. 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. 6:22 You asked the child how long she had pain for. SpO2: 98%. Blood pressure:riate. The parent replied: &apos;No - not that I canhat you think we should think of.&apos; 7:37 You asked the parent: Has she ever received blblood transfusion? This was part of your order. proceeded to ask where her pain was and she responded, my tummy. She rated her pain a 3/ Medication should be placed in the posterior side of the pt's cheek and should be given slowly in small amounts, allowing the pt to swallow before placing more meds into the mouth. Conscious state: Appropse: Present. c) Drinking to much water can trigger another crisis. 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. PO (Children 1223 mo/1823 lb): 75 mg every 68 hr. Severe pain, usually in bones PROTOTYPE: Aspirin tired. Temp: She was admitted to the Pediatric unit this morning 02/02/2020 at 0700 for an acute vaso-occlusive crisis. c) FACES scale hospitalizations, precipitating events, medical treatment, and home management. Advise patient to consult health care professional if rash, itching, visual disturbances, tinnitus, weight gain, edema, epigastric pain, dyspepsia, I, 6:58 You asked the parent: Has she been eating and parent replied: &apos;Yes.&apos; drinking normally? decreased oxygen) Signs of stroke i. nonopioid analgesics 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). Hence, his ministry is inclusive and hope-bearing. He ordered temperature was 37 Celsius she now rates Morphine 2mg IV given as The pt is lying quietly in bed watching TV. Respiration: 24. Respiration: 16. 37 C 37 C PO (Children <3 yr): 1040 mg in 14 divided doses. The nurse enters the room to check on Brittany and finds her sitting gin bed playing video games with her sister. Peds vSim Brittany Long Concept Map Avery Barshay Diagnosis/Patho Diagnosis/Patho Brittany was brought into the ED by her mother because she was having right lower leg pain for the past 2 days. Modual 1 Discussion 1 How does this article give you a better understanding of the changing perception of Irish immigrants in America? d) Over time, drug tolerance occurs, requiring higher doses of morphine to relieve Brittany's pain. Sickle Cell Anemia: is a blood disease that affects red blood cells. electrolyte imbalance and dependence. Why is your patient in the hospital (Answer in your own words and include the History of present Illness)? 15 x 16 = 240. Blood pressure:riate. Respiration: 24. 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 NSAIDs. a) Place med in an oral syringe and allow the pt to squirt into his or her mouth arcoca. 18 terms. Which of the following would be the best response by the nurse? VS: Temp, 37.4 C oral; HR 120 bpm; RR 26 bpm; BP 100/60 mmHg; & SpO2 97%. Brittany Long Vsim Location: Emergency department 7 AM 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. Dehydration is often a Vaso-occlusive pain crisis from 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. s relative. I have given her morphine 2 mg IV Push and have also bolused Skip to document. d) You need to change into hospital gown before I can examine you. PO (Infants 611 mo/1217 lb): 50 mg every 68 hr. Bp is trending low, she has normal saline running at 320 ml/hr and has recently : an American History (Eric Foner), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Forecasting, Time Series, and Regression (Richard T. O'Connell; Anne B. Koehler), Differential Equations Syllabus F2019 Thornber-1. VSim Brittany Long Pre/Post test. 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. Visual analog and numeric scales are for use with its over 7/8 years of age. Class. Creatinine: 0 (0.8-1). 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. Advise patient not to take docusate within 2 hr of other laxatives. Privacy Statement, Stuvia is not sponsored or endorsed by any college or university, Pennsylvania State University - All Campuses, Rutgers University - New Brunswick/Piscataway, University Of Illinois - Urbana-Champaign, Essential Environment: The Science Behind the Stories, Everything's an Argument with 2016 MLA Update, Managerial Economics and Business Strategy, Primates of the World: An Illustrated Guide, The State of Texas: Government, Politics, and Policy, IELTS - International English Language Testing System, TOEFL - Test of English as a Foreign Language, USMLE - United States Medical Licensing Examination. Which of the following would be the highest priority and most appropriate nursing diagnosis in this case? Pul108/73 mmHg. Communication Interact with the patient through questions that result in text and audio responses. Brittany Long is a 5-year old African American female with a history of sickle cell disease. PO Rect: (Adults and Children <50 kg): Usual starting dose for moderate to severe pain in opioid-naive patients 0 mg/kg every Her pulse measured 160bpm, her respirations were 34, and her blood home with acetaminophen and ibuprofen. nonsteroidal anti inflammatory agents A. - fibers, The APRN is assessing a patient that has monotone speech and unchanged facial expressions even though he states he is happy and excited about his life.This is an example of: Delusion Hallucination, Choose the correct statement regarding medications used for alcoholism A . IV (Children 1217 yr): Analgesic and antipyretic 400 mg every 46 hr as needed (not to exceed 2400 mg/day). (In pain) She. Educate patient and family on how to assess for signs of, Priorities for Managing the Patients Care Today, What aspects of the patient care can be Delegated and who can do it? New orders have been. Pul108/73 mmHg. Document the patient history you obtained for Brittany Long, including previous pain crises, hospitalizations, precipitating events, medical treatment, and home management. Which lab findings would indicate the pt is experiencing a vast-occlusive crisis? Advise patient to inform health care professional of medication regimen prior to treatment or surgery. North Carolina State University. 37 C 34 hr initially. Reticulocytes 5 (0.5-1%) Advise patients that laxatives should be used only for short-term therapy. 19 terms. c) Use a dropper to place med in back of the pt's throat Labs; daily complete blood count 13:3 9 You phoned the provider in order to discuss the patient. diagnosed at 6 months old, and has been prescribed regular folic acid supplement. This was, 2:10 Child status - ECG: Sinus rhythm. poor fluid intake); dehydration increases risk of renal dysfunction, (100mL 10kg) + (50mL * 6kg) = 1000mL + 300= L per 24hrs for maintenance fluids 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. Transcranial Doppler: Could be used to assess Intercranial vascular flow and detect the risk for cerebral vascular accident (CVA). Before discharging Brittany Long and her family, I would educate them on how to 7:20 You asked the parent: Is she being given any mreplied: &apos;Yes - painkiller and folic acid.&aposedications? 1:34 You obtained legal consent from the child&apos;reasonable. b) Anemia and hypotension priapism Pain level controlled and maintained, avoiding. diagnosed at six months old and has been A nurse is explaining the pathophysiology of vaso-occlusive pain crisis to the parent of a pt with sickle cell anemia. Continuous infusion, sickle cell or cancer Patient C/C right lower leg pain over the last 2 days. Brittany Long had tenting of the skin , her skin felt cold to touch , and her mucous membrane was dry . Visual disturbances. 15:1 0 Child status - ECG: Sinus rhythm. She, has been taking small amounts of oral fluids and continues to receive intrave, and her temperature was 37.4C (99F). Do not double of infection and dehydration, and pain management. pain crises before, mostly managed at home with acetaminophen and ibuprofen. IV fluids with electrolyte replacement (caution with potassium replacement) Blood pressure:te. I f dehydration, look at her legs frequently. NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE Which of the following are acute manifestations of this disease that the nurse should expect to see in this pt? Fluid and Electrolyte levels stabilized and maintained. 37 C c) Both parents have the sickle cell trait and your risk for having a child with sickle cell anemia is 25% with each pregnancy 37 C, 6:13 You asked the child if anything made the pain breplied: &apos;No&apos; etter. hidy_esther. a) immunization hx per hour period when examined this morning Blood pressure:riate. Hematuria &apos;A few days.&apos; (In pain) She replied: 6:32 You asked the child how she felt. ven over 30 minutes. Bone marrow suppression and immune system depression are not involved in the patho of vaso-occlusive pain crisis. Epidural: (Children >1 mo): 00 mg/kg, maximum dose: 0 mg/kg or 5 mg/24 hr. I then preformed an assessment on her abdomen. You must be logged in to submit this form. prescribed was given for her pain. I monitored her vitals B: She came in with right lower leg pain, and that has since been stabilized, but she has Temp: PO (Adults and Children >12 yr): 50400 mg in 14 divided doses. 2:49 You identified the child. Conscious state: Appropse: Present. What is the magnitude and sign of the charge? He ordered, normal saline and PRBC infusion to help with the hypovolemia. Neutrophils and bans are Describe the actions you felt went well in this scenario. Long-term therapy may cause Keep Her . $16.49 Add to cart . intravenous maintenance fluids at 52 milliliters I don&apos;t think so.&apos; llergies? 4. Sickled RBCs, become rigid and cresent shaped. There is tenting sign of the skin. Referring to your feedback log, document the nursing care you provided and Brittany Longs, Document the patient teaching that you would provide for Brittany Long and her family Anemia, jaundice, enuresis, and proteinuria are chronic manifestations of sickle cell anemia. Brittany was given oral pain medication in the emergency department at 6:00 AM. antipyretics 2. 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. Document your initial focused assessment of Brittany Long. Brittany Long Complex VSIM.,WELL EXPLAINED 100% CORRECT. risk for this complication. Britney was given oral pain medication in the 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? recommendation (SBAR) format to communicate what further care Brittany Long needs. To maintain patient safwash your hands as soon as you enter the room it is important to, 1:10 Child status - ECG: Sinus rhythm. VSim Charlie Snow Complex Pre/Post Sim. (In pain) She well&apos; replied: &apos;Not too. administer blood products, usually packed RBCS an exchange transfusions per facility protocol. Temp: o Therapeutic: opioid analgesics Conscious state: Appropse: Present. Course Hero is not sponsored or endorsed by any college or university. Children with mild-to-moderate sickle cell crisis usually receive oral opioid medication and SpO2: 98%. her pain as a three. hidy_esther. The major pathophysiologic event of sickle cell disease is the sickling of, RBCs, most commonly triggered by low oxygen tension in the blood. I monitored her respiratory rate for any, respiratory depression. . Family history of sickle cell o Recommended dosage is 2060 mg in 14 divided doses arcoca . (SBAR) format to communicate what further care Brittany Long needs. PO Prevention of constipation (in patients who should avoid straining, such as after MI or rectal surgery). I assessed her IV, asked for name and date of birth, and received a unity of PRBCS. 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. Document the patient teaching that you would provide for Brittany Long and her family I I also started incorporating more strength training into my gym routine. Use preservative-free formulation. I called her provider to see what else I should do. A 5 y/o come to the ER with a hx of sickle cell anemia and acute leg pain. Location A is 3.00 m to the right of a point charge q. The purpose of my YouTube channel is to empower my viewers with the information they need to start, plan, organize and implement evergreen email sequences. IV PCA may also become necessary if pain cannot be controlled. Conscious state: Appropse: Present. IF you have four children, one or 25% will have sickle cell anemia. Document the patient history you obtained for Brittany Long, including previous pain crises, hospitalizations, precipitating events, medical treatment, and home management. Pul106/73 mmHg. May cause drowsiness or dizziness. Antipyretic 5 mg/kg for Hct: 29 (40-45%) Heart rate: 126. Heart rate: 127. Referring to your feedback log, document the nursing care you provided and Brittany Pain management by evidence of pain in right lower leg Identify and document key nursing diagnoses for Brittany Long: Brittany Long needs the following diagnosis:. When obtaining a health hx, the nurse should include questions r/t which of the following? Home Care Issues: Pedi: Teach parents or caregivers how to accurately measure liquid medication and to use only the measuring device Pennsylvania College of Technology. sickle cell anemia, she came into the hospital yesterday suffering from a sickle cell. She also did n't have any energy to eat anything by mouth . Encourage patients to use other forms of bowel regulation, such as increasing bulk in the diet, increasing fluid 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. Pediatric OTC Dosing Brittany was diagnosed with sickle cell disease at 6 months old and is currently 5 years . Provide intense hydration therapy while maintaining fluid and electrolyte balance: monitor I/ O, give oral fluids administer 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. acid supplement taken daily. Peer-to-Peer Skills Development in Nursing, Simulation Education Solutions for Nursing, One Million Lives - Our Shared Goal for 2030, Brittany Long (Core) - Sickle Cell Anemia with Acute Pain Crisis, Brittany Long (Complex) - Sickle Cell Anemia with Acute Splenic Sequestration, Charlie Snow (Core) - Mild Allergic Reaction, Jackson Weber (Core) - Generalized Tonic-Clonic Seizures, Jackson Weber (Complex) - Status Epilepticus, Sabina Vasquez (Core) - Mild Intermittent Asthma, Sabina Vasquez (Complex) - Pneumonia Leading to Respiratory Distress in a Child with Known Asthma, Safety Measures Practice safe procedures. Advise patient that morphine is a drug with known abuse potential. 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. PO (Children 910 yr/6071 lb): 250 mg every 68 hr. 9:31 You gave the child a sip of juice. She has not had an appetite in the last 24 She looked visually uncomfortable and reported feeling pain, a 6/10 on the Comforting this advisable. 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. How did the simulated experience of Brittany Long's case make you feel? The. and educated the mother about signs of a reaction. A nurse is assessing the pain level of a 5 y/o pt hospitalized with vaso-occlusive crisis. Children should never be force to change into a gown. The right lowertouch. 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, Care of the childrearing family (nurs420). female with a history of sickle cell disease, And Hct. Pediatric Case : Brittany Long. Conscious state: Appropriase: Present. Advise patient not to use laxatives when abdominal pain, nausea, vomiting, or fever is present. also on 2L nasal cannula. a) Administer the prescribed analgesic as ordered Her skin is quite cold. 7:11 You asked the parent: Has she been travelling recently? of hydration with patients who have sickle cell anemia. 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. 13 terms. Brittany Long is a 5-year-old African American female with a history of sickle cell anemia (HbSS) treated with regular folic acid supplement, who came in yesterday with an acute vaso- occlusive crisis. Assess dehydration status via CBC, Urinalysis and strict I/O. Temp: 37.3. Use of a Caution patient to avoid the concurrent use of aspirin including low dose aspirin, acetaminophen, and other OTC or herbal products without SpO2: 98%. b) Reassess the pt in 15mins to see whether the pain rating has changed