Pediatric Case 4

Sabina Vasquez (Complex)

Guided Reflection Questions

An example of how the Guided reflection should like

Pediatric Case 4: Sabina Vasquez (Complex)

Guided Reflection Questions

Opening Questions

How did the simulated experience of Sabina Vasquez’s case make you feel?

At first, I was scared because I got breathing and there are several medications she has to take. After I started and the simulation progressed, I was able to calm myself and start using my mind and put thing according to prioritization. I assessed her breathing, and I gave her stat medications and little by little I managed the situation.

Describe the actions you felt went well in this scenario.

I made some mistake in the first episode I didn’t give her medication they were being administered (never noticed they were stat order). In the second simulation I corrected my mistakes and did well.

Scenario Analysis Questions[footnoteRef:1] [1: The Scenario Analysis Questions are correlated to the Quality and Safety Education for Nurses (QSEN) competencies: Patient-Centered Care (PCC), Teamwork and Collaboration (T&C), Evidence-Based Practice (EBP), Quality Improvement (QI), Safety (S), and Informatics (I). Find more information at: http://qsen.org/]

EBP List in order of priority your initial nursing actions for Sabina Vasquez based on physical findings and family interaction.

I introduced myself and washed my hands. I verified the patient with two identification and then I identified the mother with her ID. I needed to assess her ABC as she had a breathing difficulty and checked her oxygen level. I educated both the patient and the family of the care being given.

EBP What complications might Sabina Vasquez face if her symptoms are not recognized and if care is not initiated in a timely manner?

There would be several complication Sabina could have been face if her symptom wasn’t recognized and care initiated on time. Some of the problems are respiratory distress, decrease oxygen saturation and sepsis.

PCC What actions should be taken to ensure the delivery of appropriate information to Sabina Vasquez’s mother?

I will provide them copies of written materials in addition to utilizing an interpreter. Then, I request Sabina’s mother to show me the teaching I provided them.

PCC Recognizing the acuity of the situation, how would you include Sabina Vasquez and her mother in the decision-making process?

I would include Sabina in the decision-making process by giving option treatments so that I would treat her based on preferences. With regard to her mother, I will involve her in decision-making through education of the care plan of asthma and ask her to demonstrate what she had learned.

S/QI Reflect on ways to improve safety and quality of care based on your experience with Sabina Vasquez’s case.

I will teach Sabina and the family about the asthma action plan in case of emergency situation. Also, I will instruct her to finish her antibiotics even if she feels better.

T&C/I What key elements would you include in the handoff report for this patient? Consider the situation-background-assessment-recommendation (SBAR) format.

S: Sabina is a 5-year-old girl who came to ER with fever. An x-ray revealed that her right lower lobe pneumonia with effusion.

B: Sabina has a history of asthma and on several occasions, she has to use an albuterol inhaler at home

A: Sabina had audible wheezing and reduce sound breathing. I gave her 2.5 mg dose albuterol nebulizer at 1905. Now she is on 4 mL nasal cannula oxygen saturation 94% . she had fever 102 and had taken 240mg acetaminophen. An IV of D51/2 NS infusion at 61 mL/hr. with piggy-back of 475 mg cefuroxime.

R: I should encourage oral fluid and head of the bed elevated to facilitate. I would also recommend her oxygen saturated and BP to be check every 4 hours.

QI As you begin to think about discharge planning for Sabina Vasquez and her family, what teaching needs to be provided?

The teaching includes what to do during asthma attack, i.e., take albuterol and if the symptoms do not subside if there is wheezing, coughing and fever, call 911.

Concluding Questions

Reflecting on Sabina Vasquez’s case, were there any actions you would do differently? If so, what were these actions, and why would you do them differently?

No, what was done is correct.

Describe how you would apply the knowledge and skills obtained in Sabina Vasquez’s case to an actual patient care situation.

In an actual patient care situation, I would apply the knowledge and skills I obtained in Sabina Vasquez’s case to an actual patient care situation. I would use my knowledge of ABC’s and first assess her airway and breathing. I then would assess her oxygen saturation status by using the pulse oximeter. After providing treatment to the patient, I would go back and reassess his or her status to determine if the treatment improved the condition. In regard to family teaching upon discharge, I would educate them on the importance of finishing the course of antibiotics as well as contacting the primary care physician if there are further issues/complication.

From vSim for Nursing | Pediatric. © Wolters Kluwer Health.

From vSim for Nursing | Pediatric. © Wolters Kluwer Health.

This is an example of the Documentation

Pediatric Case 4: Sabina Vasquez (Complex)

Documentation Assignments

1. Document your initial focused assessment of Sabina Vasquez.

My initial assessment was: Sabina’s airway, examining her respiration, apical pulse and blood pressure, temperature, pain assessment with FACES

T: 102 BP: 120/80

BR: 29 wheezing, reduced breath sound pain: 1 scale 0 to 5

HR: 147 SPO2: 96

2. Identify and document key nursing diagnoses for Sabina Vasquez.

Impaired gas exchange evidenced by excess mucous production

Ineffective airway clearance as evidenced by pneumonia

Impaired comfort illness related symptoms as evidenced by dyspnea.

3. Referring to your feedback log, document the nursing care you provided and Sabina Vasquez’s response.

Sabina a nursing care delivered in response to her pneumonia: I took temperature it was 102 and advised them to drink enough fluid; I administered 240 mg dose of acetaminophen for pain. A piggy-back infusion of 475 cefuroxime IV was administered. Next, I have given her the prescription of 190mg azithromycin for her infection. Then, as her oxygen was 92% and her stat order for albuterol due in two hours so I contacted her provider to deliver a stat order 2.5 mg albuterol. I gave the albuterol 2.5mg immediately. Finally, I put the 4mL nasal cannula.

4. Document the patient teaching that you would provide for Sabina Vasquez and her family before discharge.

I taught them:

· Stay away from her allergy triggers such as pollens, dusts, animal fur

USING A PEAK FLOW METER

• Slide the arrow down to “zero.”

• Stand up straight.
• Take a deep breath and close the lips tightly around the mouthpiece.
• Blow out hard and fast.
• Note the number the arrow moves to.
• Repeat three times and record the highest reading.
• Keep a record of daily readings, being sure to measure peak flow at the same time each day.

Educate families and children on the appropriate use of nebulizers, metered-dose inhalers, spacers, dry-powder inhalers

Advised Sabina to complete her antibiotic treatment even if she feels better.

From vSim for Nursing | Pediatric. © Wolters Kluwer Health.