QuestionAnswered step-by-stepPedi Simulation Session: ICRSeizure; Focused Neurological Assessment of

QuestionAnswered step-by-stepPedi Simulation Session: ICRSeizure; Focused Neurological Assessment of the child  Student Learning Outcome- Completes all objectives within scenarioStudent Learning Objectives:Perform focused neurological assessment of a child with seizures including developmentally appropriate vital signs.Demonstrate evidence-based safe care of the pediatric client with seizures.Prioritizes nursing interventions for seizure management.Demonstrates effective teamwork.Calculate weight-based dosing medication and administer medications safely.Provides patient/family education and teaching.Communicates with interdisciplinary team members concerns and/or questions via SBAR report.Developmentally appropriate communication.Reflect on the simulation experience by completing a post sim reflection.Prepare for Scenario:  Complete the Packet:  Pedi Simulation Session: ICR Seizure; Focused Neurological Assessment of the child All medication information must be completed prior to simNormal VS for child in scenario must be completed prior to simATI – Video Case Studies RN 2.0 – Cultural Diversity – 80% achievementATI – The Communicator 2.0 – Technique Identifier: Respecting clients’ cultures – 80% achievementAdditional Preparation:Textbook material: Pearson Module 11 (ICR) pg. pg. 764-766; Seizures in Children and Status epilepticus. Skill 7.1 Glasgow coma scale &7.3 (Lumbar puncture) Review normal labs CBC, Electrolytes If you have any questions related to preparation, please contact your instructor at least 24 hrs prior to simulation.  Patient information: Lia Lee 5-year-old female Weight: 43 lbs.12 oz.NKDADOB: 2/5/20xxMR#: 39779Chief Complaint: Post Status Epilepticus                         Medical History:    Lia is a 5-year-old female who is previously healthy with a history of ear infections.  Social History LIa lives with parents and 8-year-old brother.  She is in kindergarten and attends an after-school program with her brother Chua. Her parents are Vietnamese and speak little English.   Complete prior to simulationVital signs for a school-age child       List normal range of Vital Signs for a 6-year-oldTemperature  (Method of assessment?)Heart rate 60-80Respiratory Rate 18-30BP 105/64 TO 140/80Pain Assessment Which Scale would we use for this age? FLAAC             MUST Complete Prior to Simulation Note orders on following pageCollaborative Management: Rationale for Interventions & Expected Outcomes  Care Provider Orders: What is the therapeutic dose for your patient (medications)? Nursing Implications: Acetaminophen: 240 mg every 4-6 hours PRN for fever > 101 or Pain. Do not exceed more than 5 doses in 24 hours.  Lorazepam:  2 mg slow IV push and notify MD    Fosphenytoin:  388 mg IV to be administered over 7 minutes for Status Epilepticus after diazepam and notifying MD  Phenobarbital 580 mg IVover 20 minutes after Fosphenytoin given Therapeutic range acetaminophen is 10-15 mg/kg/dose What’s safe dose range?   Therapeutic range for Lorazepam is 0.05-0.1 mg/kg/dose (Max 4mg/dose IM/IV) Safe dose?   Therapeutic Loading dose of Fosphenytoin 20 mg/kg/doseIs this safe dose?    Therapeutic range for Loading dose of Phenobarbital is 20-40mg/kg/doseWhat is the therapeutic range?  Hint: What do you monitor for?  What are contraindications or warnings?  Teaching?    Hint: How fast would you give it IV?  What would you monitor while giving? What is the major complication that the nurse should the nurse monitor?  What should the nurse monitor?  What is the difference between loading and maintenance dose?  What should the nurse anticipate as potential complications & how will she monitor/prevent?  What is the difference between PO & IV Phenobarbital? What should the nurse anticipate as potential complications? & how will she monitor/prevent?       Report: History of Present Complaint to ER:     Lia arrived at the ER after her afterschool director called 911.  Lia was in the gym when the after-school staff noticed that she seemed to be flushed and began shaking. The director called 911 and another after-school staff member called the parents. The seizure activity lasted “about 5 minutes” per after-school staff prior to EMS arriving.  EMS administered rectal diazepam (5 mg PR), applied oxygen 1 liter for low oxygen saturation of 90% per protocol and the seizures stopped. They obtained a full set of vital signs (T: 99.5 ax, HR: 150, RR: 40 & O2: 94% on 1l fiO2) and continued to monitor her until arrival at local hospital.  Lia’s mother and father were contacted, and they will come to the hospital as soon as possible. PIV of D5NS at maintenance rate per hour was started in right hand.  Lumbar Puncture, CBC w/differential, Electrolyte panel were completed and sent to lab. All results are pending.  Currently the client is sleepy but arousable, GCS of 13; PERRLA; Lungs sounds clear; RR 28; O2sats 98% on RA; HR 110; BP 108/68; T 99.2 Ax.Patient name: Lia LeeDOB: 04/05/20xx              MR#: 360078Age: 5-year-old                 Gender: femaleWeight: ____kg Diagnosis: Seizure  Allergies: NKDADate Time Prescriber Orders and Signature    Admit to Pediatrics    Diet: Regular as tolerated once alert/awakeStrict intake and output.    Activity: As tolerated    Seizure Precautions    Ensure IV access    IV fluids D5NS at maintenance rate per hour    Schedule EEG    Neuro consult    Place on CR monitor and pulse oximetry    Acetaminophen 240 mg po/pr every 4hrs prn for temp greater than 100.5° F    Lorazepam 2 mg IV push over 2 minutes for seizure greater than 5 minutes and notify MD, may repeat every 5 minutes If seizure persists or recur     Medications for Status epilepticus:         Fosphenytoin 380mg IV x1 to be administered over 7 minutes         Phenobarbital 580 mg IV over 20 minutes x1          Titrate oxygen to maintain O2 saturation > 94%.    Discharge Diastatâ teaching for parents & safety precautions prior to discharge; fever managementDate  Sarah Smith MD                          Complete the following and submit post sim   RELEVANT Data from Present Problem: Clinical Significance (How does this relate to her seizures?)   RELEVANT Data from Social History  Clinical Significance (How will this impact how you care for Lia and her family?)     Clinically significant Assessment data from simulation Why was it significant?           Nursing Interventions: Rationale: Expected Outcome: Seizure Precautions   Seizure management    What are they & why?  What were they & why?      Post simulation REFLECTION: What happened?  How did the patient respond?  What did you do next? Describe 3 ways your nursing care skills expanded during this experience. Name 3 things you would do differently in a similar situation. What additional knowledge, information and skills do you need when encountering this kind of situation in the future? Describe any changes in your values of feelings as a result of this experience.  (Safety and Quality Improvement, Professionalism)      Pedi Simulation Session: ICRSeizure; Focused Neurological Assessment of the child  Student Learning Outcome- Completes all objectives within scenarioStudent Learning Objectives:Perform focused neurological assessment of a child with seizures including developmentally appropriate vital signs.Demonstrate evidence-based safe care of the pediatric client with seizures.Prioritizes nursing interventions for seizure management.Demonstrates effective teamwork.Calculate weight-based dosing medication and administer medications safely.Provides patient/family education and teaching.Communicates with interdisciplinary team members concerns and/or questions via SBAR report.Developmentally appropriate communication.Reflect on the simulation experience by completing a post sim reflection.Prepare for Scenario:  Complete the Packet:  Pedi Simulation Session: ICR Seizure; Focused Neurological Assessment of the child All medication information must be completed prior to simNormal VS for child in scenario must be completed prior to simATI – Video Case Studies RN 2.0 – Cultural Diversity – 80% achievementATI – The Communicator 2.0 – Technique Identifier: Respecting clients’ cultures – 80% achievementAdditional Preparation:Textbook material: Pearson Module 11 (ICR) pg. pg. 764-766; Seizures in Children and Status epilepticus. Skill 7.1 Glasgow coma scale &7.3 (Lumbar puncture) Review normal labs CBC, Electrolytes If you have any questions related to preparation, please contact your instructor at least 24 hrs prior to simulation.  Patient information: Lia Lee 5-year-old female Weight: 43 lbs.12 oz.NKDADOB: 2/5/20xxMR#: 39779Chief Complaint: Post Status Epilepticus                         Medical History:    Lia is a 5-year-old female who is previously healthy with a history of ear infections.  Social History LIa lives with parents and 8-year-old brother.  She is in kindergarten and attends an after-school program with her brother Chua. Her parents are Vietnamese and speak little English.   Complete prior to simulationVital signs for a school-age child       List normal range of Vital Signs for a 6-year-oldTemperature  (Method of assessment?)Heart rate 60-80Respiratory Rate 18-30BP 105/64 TO 140/80Pain Assessment Which Scale would we use for this age? FLAAC             MUST Complete Prior to Simulation Note orders on following pageCollaborative Management: Rationale for Interventions & Expected Outcomes  Care Provider Orders: What is the therapeutic dose for your patient (medications)? Nursing Implications: Acetaminophen: 240 mg every 4-6 hours PRN for fever > 101 or Pain. Do not exceed more than 5 doses in 24 hours.  Lorazepam:  2 mg slow IV push and notify MD    Fosphenytoin:  388 mg IV to be administered over 7 minutes for Status Epilepticus after diazepam and notifying MD  Phenobarbital 580 mg IVover 20 minutes after Fosphenytoin given Therapeutic range acetaminophen is 10-15 mg/kg/dose What’s safe dose range?   Therapeutic range for Lorazepam is 0.05-0.1 mg/kg/dose (Max 4mg/dose IM/IV) Safe dose?   Therapeutic Loading dose of Fosphenytoin 20 mg/kg/doseIs this safe dose?    Therapeutic range for Loading dose of Phenobarbital is 20-40mg/kg/doseWhat is the therapeutic range?  Hint: What do you monitor for?  What are contraindications or warnings?  Teaching?    Hint: How fast would you give it IV?  What would you monitor while giving? What is the major complication that the nurse should the nurse monitor?  What should the nurse monitor?  What is the difference between loading and maintenance dose?  What should the nurse anticipate as potential complications & how will she monitor/prevent?  What is the difference between PO & IV Phenobarbital? What should the nurse anticipate as potential complications? & how will she monitor/prevent?       Report: History of Present Complaint to ER:     Lia arrived at the ER after her afterschool director called 911.  Lia was in the gym when the after-school staff noticed that she seemed to be flushed and began shaking. The director called 911 and another after-school staff member called the parents. The seizure activity lasted “about 5 minutes” per after-school staff prior to EMS arriving.  EMS administered rectal diazepam (5 mg PR), applied oxygen 1 liter for low oxygen saturation of 90% per protocol and the seizures stopped. They obtained a full set of vital signs (T: 99.5 ax, HR: 150, RR: 40 & O2: 94% on 1l fiO2) and continued to monitor her until arrival at local hospital.  Lia’s mother and father were contacted, and they will come to the hospital as soon as possible. PIV of D5NS at maintenance rate per hour was started in right hand.  Lumbar Puncture, CBC w/differential, Electrolyte panel were completed and sent to lab. All results are pending.  Currently the client is sleepy but arousable, GCS of 13; PERRLA; Lungs sounds clear; RR 28; O2sats 98% on RA; HR 110; BP 108/68; T 99.2 Ax.Patient name: Lia LeeDOB: 04/05/20xx              MR#: 360078Age: 5-year-old                 Gender: femaleWeight: ____kg Diagnosis: Seizure  Allergies: NKDADate Time Prescriber Orders and Signature    Admit to Pediatrics    Diet: Regular as tolerated once alert/awakeStrict intake and output.    Activity: As tolerated    Seizure Precautions    Ensure IV access    IV fluids D5NS at maintenance rate per hour    Schedule EEG    Neuro consult    Place on CR monitor and pulse oximetry    Acetaminophen 240 mg po/pr every 4hrs prn for temp greater than 100.5° F    Lorazepam 2 mg IV push over 2 minutes for seizure greater than 5 minutes and notify MD, may repeat every 5 minutes If seizure persists or recur     Medications for Status epilepticus:         Fosphenytoin 380mg IV x1 to be administered over 7 minutes         Phenobarbital 580 mg IV over 20 minutes x1          Titrate oxygen to maintain O2 saturation > 94%.    Discharge Diastatâ teaching for parents & safety precautions prior to discharge; fever managementDate  Sarah Smith MD                          Complete the following and submit post simulationLab Why was it ordered?CBC w/diff  Electrolyte panel  LP   Lab ResultsComplete Blood Count (CBC w/diff) Current: High/Low/WNL If abnormal why?WBC  6.8    Hgb  13    Platelets  324    Neutrophils 2    Lymphocytes 3    Monocytes; Eosinophils; Basophils  < 1    Electrolyte Panel Current: High/Low/WNL? If abnormal why?Na 129    K  4.8    Cl 101    Glucose 62    Lumbar Puncture Current High/Low/WNL? If abnormal why?Glucose 62    Total Protein 16    WBC 0    Gram Stain  neg    ICP  16                              RELEVANT Data from Present Problem: Clinical Significance (How does this relate to her seizures?)   RELEVANT Data from Social History  Clinical Significance (How will this impact how you care for Lia and her family?)     Clinically significant Assessment data from simulation Why was it significant?           Nursing Interventions: Rationale: Expected Outcome: Seizure Precautions   Seizure management    What are they & why?  What were they & why?        Health ScienceScienceNursingNURSING 1025EShare Question

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