Monitor her 02 sat and keep above 94%. Which of the following would be the highest priority and most appropriate nursing diagnosis in this case? 240 Which of the following should the nurse do? CBC w/ dif: SHOULD be ordered to determine anemia state & if there is a left (bacterial) or right shift (viral) and levels of neutrophils, changes in lymphocytes monocytes increase is viral. 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, dizziness Document your handoff report in the situation-background-assessment- b) Anemia and hypotension IV (Children 1217 yr): Analgesic and antipyretic 400 mg every 46 hr as needed (not to exceed 2400 mg/day). 11:1 0 Child status - ECG: Sinus rhythm. (In pain) She replied: 6:49 You asked the parent: When the problems starte&apos;A few days ago.&apos; d. The parent replied: 6:54 You asked the parent: Has she had fever? 1. Document the patient history you obtained for Brittany Long. shortness of breath, fatigue a) I want to listen to you breathe. When obtaining a health hx, the nurse should include questions r/t which of the following? 13:2 3 You examined the child&apos;s legs. Terms of Use Signs of stroke i. The nurse is caring for a patient with sickle cell anemia who is exhibiting signs of vaso-occlusive crisis. Her pain was a 3/5 on FACES scale If that is not sufficient to manage their pain, they may require morphine for Conscious state: Appropriase: Present. Pul98/67 mmHg. Fluid and Electrolyte levels stabilized and maintained. Advise patients to take ibuprofen with a full glass of water and to remain in an upright position for 1530 min after administration. A step-by-step guide to craft a winning sales presentation . 0:10 Child status - ECG: Sinus rhythm. 2. Respiration: 24. c) tachycardia and jaundice Identify and document key nursing diagnoses for Brittany Long. Comforting this advisable. Jennifer Hoffman - VSIM; Kenneth Bronson - VSIM; Brittany Long Care Plan; Other related documents. Hgb is most recently 7 g/dL. takes regular folic acid supplement as prescribed. SpO2: 98%. a) I want to listen to you breathe. Ineffective Tissue Perfusion d) You need to change into hospital gown before I can examine you. Are you considering implementing vSim for Nursing into your existing curricula? Hgb 9 (13.5-17) Copyright 2023 StudeerSnel B.V., Keizersgracht 424, 1016 GC Amsterdam, KVK: 56829787, BTW: NL852321363B01, then assessed her IV and she seemed nervou, Psychology (David G. Myers; C. Nathan DeWall), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. Class. pressure was low. Family members should be encourage to stay at the, bedside to offer comfort and help to minimize the tremors of hospitalization, DESCRIBE DISEASE PROCESS AFFECTING PATIENT, Sickle cell anemia is an inherited, autosomal recessive disorder characterized by an abnormal form, of hemoglobin in the RBC. Pedi: Advise parents or caregivers not to administer ibuprofen to children who may be dehydrated (can occur with vomiting, diarrhea, or Patient Dose: acetaminophen elixir 240 mg every 4-6 hours as needed. Modual 1 Discussion 1 How does this article give you a better understanding of the changing perception of Irish immigrants in America? Encourage patients to use other forms of bowel regulation, such as increasing bulk in the diet, increasing fluid 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. Document the patient history you obtained for Brittany Long, including previous pain crises. TCD is performed annually on children ages 2 to 16 years who have sickle cell disease. and after the administration of the pain medication she seemed more comfortable. She was a) call the provider and request an order for a med for the itching as needed. hospitalized twice, once at age 4 years for a vaso-occlusive crisis episode and once at age 3 years Antipyretic 5 mg/kg for Download these free nursing education guides for best practices on integrating virtual simulations into your nursing program. Monitor O2 saturation levels She has had pain crises before, mostly managed at awakened. PO (Children <3 yr): 1040 mg in 14 divided doses. 18 terms. Brittany Long Complex VSIM.,WELL EXPLAINED 100% CORRECT. SAFE DOSE: 00 mg/kg every 34 hr, maximum: 15 mg/dose. B: She came in with right lower leg pain, and that has since been stabilized, but she has pain, shortness of breath, weakness, slurring of speech) occurs. CLASSIFICATION: The increased blood flow through the blood vessels causes tour child to have severe pain A step-by-step guide to craft a winning sales presentation . 3. Brittany Long had tenting of the skin, her skin felt cold to touch, and her mucous membrane was dry. This was, 2:10 Child status - ECG: Sinus rhythm. The breath sounds are clear and equal bilaterally. The nurse is assessing the abdomen of a patient admitted with vaso-occlusive pain crisis. Initial focus assessment was the patients pain and location. Anemia, jaundice, enuresis, and proteinuria are chronic manifestations of sickle cell anemia. Administer oxygen as prescribed if hypoxia is present. Labs; daily complete blood count 34 hr initially. regular heart sounds without murmurs. These are signs of dehydration so giving the patient a bolus of 320 m L of normal saline IV was necessary . We have noticed you are logged in to ${country}. hypotension, rapid, weak, and thready pulses, and increased or shallow respirations. PO (Infants and Children): Analgesic 410 mg/kg/dose every 68 hr. PO (Children 45 yr/3647 lb): 150 mg every 68 hr. Document the patient history you obtained for Brittany Long, including previous pain crises, hospitalizations, precipitating events, medical treatment, and home management. She has been on bed rest at home until prenatal visit today with increasing symptoms, resulting in admission. critical, particularly in young children, whose fluid stores are rapidly depleted. Identify and document key nursing diagnoses for Brittany Long. 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! Respiration: 24. Do not stop taking without discussing with health care professional; You should have identified the relative, ng the child&apos;s before providing hemoglobin is called hemoglobin S (HgbS), and it replaces normal hemoglobin which is called hemoglobin A (HgbA). 1. Take missed doses as soon as remembered but not if almost time for next dose. 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The FLACC behavioral scale is appropriate for hone the pt can't accurately report his or her own level of pain due to age or developmental level. The safe dosage range for children is 10 to 15 mg/kg/dose. risk for this complication. These are signs of dehydration so giving the patient a bolus of 320 mL of normal saline IV was necessary. black stools, hematemesis, persistent headache, or influenza-like syndrome (chills, fever, muscle aches, pain), or cardiovascular events (chest As blood flow is impaired by sickled cells, vasospasm occurs, further. joints and abdomen. VS can be monitored and reported by the UAP. Respiration: 24. b) Tachycardia and jaundice. Brittany Long was diagnosed with sickle cell disease at 6 months old. Brittany Long (Complex) - Sickle Cell Anemia with Acute Splenic Sequestration. Obstructive jaundice Keep Her right lower leg pain is stable, but Brittany has had a sudden increase in left upper quadrant abdominal pain and tenderness. The and the abdomen is generally tender. flow and detect the risk for cerebral and her mother about why those were being given. ood or had a reaction to a. of hydration with patients who have sickle cell anemia. 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. 15:2 6 You started a bolus of 250 mL of normal saline IV, giThis was indicated by order. *PATIENTS DOSE: 5224 = 1248mL* WNL SAFE DOSAGE [should probably be higher], Alerts: vSim ISBAR ACTIVITY STUDENT WORKSHEET INTRODUCTION Hello my name is Cheina, I am an RN on the Pediatric Care Unit. b) Family hx of blood transfusion Heart rate: 126. 1. (16kg * 0 ) = 0 / (16kg * 0) = 3 = SAFE DOSE 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. What would be the effect on X\mathrm{X}X inactivation of adding siRNAs that eliminated the products of each of the following genes? Before discharging Brittany Long and her family, I would educate them on how to Britney long Jesse has sickle cell disease and was brought to the Emergency Department for an acute vaso occlusive crisis. Heart rate: 127. 19 terms. (Clinical slides 02.02.2020), It is an incurable disease that is often fatal by middle age because of renal failure, infection, pulmonary failure, and/or stroke, DIAGNOSTIC TESTS (REASON FOR TEST AND RESULTS). Stabilizing fluid levels to assist in relieving pain. Describe the actions you felt went well in this scenario. Referring to your feedback log, document the nursing care you provided and Brittany c) Both parents have the sickle cell trait and your risk for having a child with sickle cell anemia is 25% with each pregnancy 18 terms. She is asleep but is responsive when Temp: Course Hero is not sponsored or endorsed by any college or university. Advise patient to consult health care professional if rash, itching, visual disturbances, tinnitus, weight gain, edema, epigastric pain, dyspepsia, Pain severe enough to require daily, around-the-clock long-term opioid treatment and for which alternative treatment options her blood pressure was 101 / 70 and her Britney long is a 5 year old African American Pediatric OTC Dosing diagnosed at six months old and has been viral. managed at home with acetaminophen and spleen, leading to anemia. mg Brittany Long was diagnosed with sickle cell disease at 6 months old. Brittany VSIM. Visual analog and numeric scales are for use with its over 7/8 years of age. every 34 hr, maximum: 15 mg/dose. Location B lies on the same line and is 4.00 m to the right of the charge. rovided and Brittany Longs, 0:00 You introduced yourself. Examined the leg and it was warm. o Pharm. in her right lower legs. syndrome can develop in children with sickle cell crisis. sickle cell crisis. Brittany Long had tenting of the skin , her skin felt cold to touch , and her mucous membrane was dry . The provider has increased the morphine dose, but her mother voices concerns that Brittany is addicted to the medication. c) Morphine bc the pt reports severe pain. Her ven over 30 minutes. vSim - Brittany Long. Heart rate: 127. Which of the following should be included in the plan of care for this patient? List Complications may occur related to dx, procedure, comorbidities: What nursing or medical interventions may prevent the above Alert or complications? Monitoring oxygenation, use of incentive spirometry, hydration, and Find all solutions of the following equation. Immobilization, pressure and cool compresses cause vasoconstriction and can impede blood flow, which is contraindicated in sickle cell crisis. She has been having increase pain and, based on follow-up pain assessment scores, the morphine isn't as effective as it was initially. Brittany She May cause drowsiness or dizziness. b) Your mom will need to wait outside while I complete your assessment Dehydration is often a MEDICATION: Ibuprofen elixir 160 mg PO at 0900, then q6h (10 mg/kg/dose) a) immunization hx hours but has taken small amounts of oral Making a Note that the wording of the dictionary definition may vary from the wording below. Which of the following explanations b the nurse is correct? 8:10 Child status - ECG: Sinus rhythm. d) Over time, drug tolerance occurs, requiring higher doses of morphine to relieve Brittany's pain. b) Visual analog scale I d) put med into a medicine cup and pour entire amount into the pt's mouth @ 1 time. Heart rate: 127. What would be the most appropriate med for the nurse to administer? Diagnosed with sickle cell disease at age 6 months. Bandage is clean dry and intact , infusing as expected, PATIENTS DOSE: 52*24 = 1248mL WNL SAFE DOSAGE [should probably be higher]. I called her provider to see what else I should do. 37 C Pul106/73 mmHg. Hypertension and tachycardia are often associated with acute pain. She now rates her pain as a 3. I gave her the stuffed animal as a comfort tool to have while I preformed my assessments. Communication Interact with the patient through questions that result in text and audio responses. Her pulse measured 160bpm, her respirations were 34, and her blood A:Her spleen is currently enlarged, and she reported a 3/5 on the FACES Scale. headache vSim - Brittany Long. The major pathophysiologic event of sickle cell disease is the sickling of, RBCs, most commonly triggered by low oxygen tension in the blood. Impaired cardiac output related to sickle cell crisis as evidence by sickled RBC shape. 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. Pul108/73 mmHg. During my initial focused assessment of Brittany Long I found that her vital signs were She ha, pain crises before, mostly managed at home with acetaminophen and ibuprofen. She was, patient has been complaining of right lower leg pain over the last 2 days. SAFE DOSE: 0.050.2 mg/kg every 34 hr, maximum: 15 mg/dose. CLASSIFICATION: : 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. emergency Department at 0600. Home Care Issues: Pedi: Teach parents or caregivers how to accurately measure liquid medication and to use only the measuring device 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. Sickle Cell Anemia: is a blood disease that affects red blood cells. Blood pressure:riate. a) Sickle cells cause increased blood flow throughout the body. o Therapeutic Class: agents for atypical mycobacterium, anti-infectives Circulating sickle cells are hemolysized by the. Visual disturbances. NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE recommendation (SBAR) format to communicate what further care Brittany Long needs. You should have asked the relative about any known health problems. 37 C before discharge, including disease process, nutrition, signs and symptoms of crises, prevention, Document your handoff report in the situation-background-assessment-recommendation 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. for a vaso-occlusive crisis episode and once at age 3 years for a fever. d)Enuresis and proteinuria. 15:1 0 Child status - ECG: Sinus rhythm. ECG: normal Sinus rhythm. 2400 mg/day, whichever is less). 19 terms. VSim Sabina Vasquez Pre/Post test. She has gained 3 pounds since prenatal visit 1 week ago. I educated the pati, Chemistry: The Central Science (Theodore E. Brown; H. Eugene H LeMay; Bruce E. Bursten; Catherine Murphy; Patrick Woodward), The Methodology of the Social Sciences (Max Weber), Civilization and its Discontents (Sigmund Freud), Give Me Liberty! disposal of opioid analgesics with patients and caregivers with each Rx. d) decreased hgb, increased platelet, greatly elevated reticulocyte. Pennsylvania College of Technology. Voc Latin page 24. 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. Pul110/74 mmHg. : 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. The FACES pain rating scale is a self-report tool that can be used by children as young as 3 years of age. department during the night by her mother, who stated that the patient has been complaining Do your children have different fathers? Discuss safe use, risks, and proper storage and Manage her pain at home with acetaminophen and drink plenty of fluids. IV fluids with electrolyte replacement (caution with potassium replacement) 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 by her mother, who stated that the patient Protein dipstick is +4, negative ketones, negative glucose, +2 dependent edema, and facial . IV PCA may also become necessary if pain cannot be controlled. Normal bowel habits are variable and may vary from 3 Sets found in the same folder. Document your initial focused assessment of Brittany Long. Children should never be force to change into a gown. c) I am going to take your temp. (Abnormal) rapidity of the heart ____________________________________. Do not double Why is your patient in the hospital (Answer in your own words and include the History of present Illness)? Over time, the red blood cells become rigid and shaped like crescent moons or sickles. The padon&apos;t think so.&apos; rent replied: &apos;No. Jackson Weber Complex Pre/Post Quiz. The nurse is teaching Brittany how to use the FACES scale to rate pain. Identify and document key nursing diagnoses for Brittany Long: Brittany Long needs the following diagnosis:. SAFE DOSE OR DOSE RANGE, SAFE ROUTE decreased oxygen) For the latest news, offers and ideas, sign up to our newsletter. 1:34 You obtained legal consent from the child&apos;reasonable. Instruct patients not to take OTC ibuprofen preparations for more than 10 days for pain or more than 3 days for fever, and to consult health Heart rate: 126. Promote rest and provide adequate fluids and nutrition. c) Ask the parent whether the pt is hurting on the FACES Scale. The nurse is caring for 5 y/o Brittany, who was admitted with vast-occlusive pain crisis and is reporting pain in her leg. 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. female with a history of sickle cell disease, I, 6:58 You asked the parent: Has she been eating and parent replied: &apos;Yes.&apos; drinking normally? brittany long vsim step by step. 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. Her skin is quite cold. I need you to help me hold my stethoscope in place. Respiration: 15. unstable. VSIM Brittany Long.WELL EXPLAINED WITH CORRECT ANSWERS . SpO2: 98%. encouraged PO fluids and she drank some. The nurse is performing a physical assessment on a 5 y/o pt. It is important to allow children to stay in their own clothing and to wear shorts to underwear under a town as preferred. The parent ; 7:32 You asked the parent: Is there anything else tknow? . 7:20 You asked the parent: Is she being given any mreplied: &apos;Yes - painkiller and folic acid.&aposedications? Severe pain (the 20 mg/mL oral solution concentration should only be used in opioid-tolerant patients). hidy_esther. What is the magnitude and sign of the charge? and BP now She was diagnosed with SCD at six months of age and has had one hospitalization at age 4 for pain. Referring to your feedback log, document the nursing care you presponse. PO (Adults and Children >12 yr): 50400 mg in 14 divided doses. Pul109/74 mmHg. doses. Would you like to proceed ? May cause drowsiness or dizziness. What are you on alert for with this patient? 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). The nurse is reviewing lab data on a pt with sickle cell anemia. 9:03 You took a blood sample. d) Frequency of vaso-occlusive crises 7:03 You asked the parent: Has there been vomiting,The parent replied: &apos;No.&apos; diarrhea or constipation? Brittany was given oral pain medication in the emergency department at 6:00 AM. SpO2: 98%. (SBAR) format to communicate what further care Brittany Long needs. A heart rate of 86 bpm and temperature of 37.0C are normal findings. Brittany Long is a 5-year old African American female with a history of sickle cell disease. VSIM pediatric case brittany long (complex) documentation assignments document your initial focused assessment of brittany long.

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