Pediatrics - VSIM #3 Charlie Snow

VSIM #3 Charlie Snow Patient Introduction Charlie Snow is a 6-year-old Caucasian male staying with his aunt and uncle while his parents are serving overseas in the military. Charlie presents in the emergency department with tachycardia and dyspnea with mild stridor. His aunt and uncle report that he accidentally ate a cookie containing peanuts, and he has peanut allergies. When Charlie began having difficulty breathing, they rushed him to the emergency department. He is currently able to talk through the dyspnea and is on a nasal cannula at 2 liters. A saline lock has been placed in his left arm. He has been connected to a cardiac/apnea monitor with a SpO2 probe in place. Charlie is in bed, and the health care provider has been notified of Charlie's arrival. PRE-SIM QUIZ 1. A nurse is teaching new parents about preventing the development of food allergies. Which of the following foods should be avoided in patients younger than 1 year to prevent the development of a food allergy? a. Peanuts 2. The nurse is assessing a patient with an allergic reaction from a food allergen. Which finding is most concerning? a. Wheezing 3. A nurse is describing to a new nurse how epinephrine works. Which of the following correctly describes the mechanism of action of epinephrine? a. Increases systemic vascular resistance and heart rate. 4. The nurse is preparing a 6-year-old patient who is experiencing an allergic reaction for an intramuscular epinephrine injection. Which of the following demonstrates that the nurse understands developmentally appropriate communication? a. I am going to give you some medicine. It may make you feel a little shaky. Your parent can help hold your hand and your job is to hold your arm still. 5. The nurse is preparing to administer methylprednisolone to a 6year-old patient with anaphylaxis. The patient is allergic to peanuts with no other pertinent medical conditions. Which of the following is the priority for the nurse to monitor with administration? a. Blood pressure 6. A nurse is explaining to a coworker the relationship between anaphylaxis and distributive shock. The nurse's explanation is based on the knowledge that distributive shock is caused by which of the following? a. Massive systemic vasodilation 7. While completing a focused cardiovascular assessment on a 6year-old patient admitted with anaphylaxis, the nurse notes that the skin is cool, central and peripheral pulses are weak, and capillary refill is prolonged. The patient is responsive and anxious, with a heart rate of 140, respiratory rate of 32, blood pressure of 106/60, and oxygen saturation of 91%. What is the most appropriate initial intervention to support perfusion? a. Admin 20 mL/kg of IV fluid bolus 8. The nurse has an order to administer normal saline 20 mL/kg bolus intravenously over 30 minutes. The patient weighs 46.2 pounds. How many mL should the nurse prepare to administer? a. 420 SIMULATION: 1. 2. 3. 4. 5. 6. 7. 8. Wash hands Sit child up Identify patient Identify relatives Attach NIBP Change to non-rebreather mask Change to 10L oxygen Ask about allergies 9. Education both patient & relatives 10. Assess RR, HR, Skin and Temp 11. Auscultate lungs & heart 12. Assess the IV & flush 13. Obtain legal consent 14. Ask about any known health problems 15. Ask if patient is having difficulty breathing 16. Phone the provider 17. Start NS bolus 420mL over 30mins 18. Give Epi 0.3 mg 1:10,000 19. Give Diphenhydramine 25mg IV 20. Give 20mg ranitidine IV 21. Give 10mg methylprednisolone IV 22. Assess RR & HR 23. Auscultate lungs & Heart again 24. Provide education for patient and relatives 25. Ask how the patient is feeling 26. Offer the stuffed toy 27. Handoff POST-SIM QUIZ: What would be the highest priority and most appropriate nursing diagnosis for a patient exhibiting signs of anaphylaxis? Ineffective airway clearance related to airway inflammation A 6-year-old patient with anaphylaxis is receiving oxygen via nasal cannula at 2 L/min with an order to titrate oxygen saturations of greater than 94%. Fifteen minutes later, the nurse notes that the patient is sleepy, breathing with mouth open at a rate of 32 breaths per minute, and has oxygen saturations of 89%. Which of the following would be the best method of delivering oxygen delivery for the patient at this time? Nonrebreather mask at 12 L/min. The nurse is reviewing medication orders for a patient admitted with anaphylaxis. Which of the following intravenous (IV) medications is the priority for the nurse to administer at this time? Epinephrine 0.3 mg (1 : 10,000) A nurse is preparing a 6-year-old patient to have a peripheral IV line inserted. Which of the following demonstrates that the nurse understands developmentally appropriate communication? (Select all that apply) Some kids say it hurts a little bit when inserted but then the pain goes away; I am going to insert a tiny tube in your arm to help give your body a drink. The nurse is caring for a patient with anaphylaxis who is exhibiting signs of distributive shock. Which of the following should be included in the plan of care for this patient? (Select all that apply) Maintain an adequate airway; Support the blood pressure. The nurse is caring for a 21 kg (46.3 lb) patient with anaphylaxis and poor perfusion. Which of the following orders for intravenous (IV) fluids would the nurse expect to implement? Normal Saline 420 mL IV now over 30 minutes The nurse is reassessing a patient following rapid administration of normal saline bolus. Which of the following would indicate that the treatment has been effective? (Select all that apply) Increased oxygen saturations; Increased strength of peripheral pulses; Decreased capillary refill time; Decreased heart rate. The nurse is preparing a teaching session for Charlie's aunt regarding the use of an epinephrine auto-injector (EpiPen) for the treatment of an anaphylactic reaction. Which of the following best indicates that the teaching has been effective? I need to give Charlie the auto-injector immediately if he has a reaction with trouble breathing and then call 911 or take him to the doctor. Charlie demonstrates knowledge of appropriate food choices for avoidance of peanut-containing foods when he chooses which of the following meals? Baked chicken strips and broccoli The nurse is educating Charlie about avoidance of peanut allergens and management of allergic reactions. Which response by Charlie indicates the need for further teaching? It is OK to eat peanut butter cookies if I take a dose of diphenhydramine first.