Pediatric Case 7 Brittany Long Guided Reflection Questions

Pediatric Case 7: Brittany Long (Core) Guided Reflection Questions Opening Questions How did the simulated experience of Brittany Long’s case make you feel? This simulation was a little different than the ones I have done in the past, it was a pediatric case so it had a few variations so I felt a little lost but got the hang of it pretty quickly. Describe the actions you felt went well in this scenario. I feel like following the orders went well, as well as the communication with the mother of the patient to help get a health history. Scenario Analysis Questions1 EBP What is the relationship between fluid and oxygen therapy in the treatment of sickle cell anemia? A sickle cell crisis is very often caused by dehydration. Assessing a pediatric patient for signs and symptoms of dehydration would be very important. In children, their fluid stores can very quickly be depleted. IV fluids would be necessary if the child is not consuming enough fluids orally to maintain hydration. Hydration of the body is essential to prevent complications of sickle cell anemia such as a vaso-occlusive crisis. EBP What complications might Brittany Long face if her symptoms are not recognized and treated in a timely manner? She could develop acute chest syndrome, a stroke, organ damage, pulmonary hypertension or gallstones. EBP What methods of pain management did you use and what other methods should be considered for Brittany Long, based on the latest evidence-based practice? The patient had received ibuprofen in the emergency room. I administered 2 mg Morphine IV for her pain, she stated a 3/5 using the FACES scale. For mild pain NSAIDS would most likely be the method of pain management, possibly some opioids as well. Another method that could be 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). Pediatric Case 7 Brittany Long (Core) Guided Reflection Questions introduced for children above age 5 would be a PCA pump. Simple comfort measures may also help such as a stuffed animal or her favorite music. PCC/I What discharge teaching should be provided to assist Brittany Long’s mother with her home care? At discharge, the teaching that would probably be provided is how to recognize the signs and symptoms of a crisis and pain management methods. Also possible triggers of a crisis might also be taught. S/QI Reflect on ways to improve safety and quality of care based on your experience with Brittany Long’s case. Some ways to improve safety and quality of care would include pain management, ensuring someone is there to assist with ambulation and bathroom breaks. Also offering comfort items such as a stuffed animal or playing music. T&C/I Identify additional individuals who should be included on Brittany Long’s care team. Other members would include the nurses, primary care provider, social worker and family or any other caretakers. T&C/I What key elements would you include in the handoff report for this patient? Consider the situation-background-assessment-recommendation (SBAR) format. Situation: Brittany, 5 year old female in sickle cell crisis. Background: admitted to ER for pain in right leg, was given ibuprofen and Tylenol for pain, has IV fluids running in left antecubital space. Assessment: Vital signs within normal limits, after morphine pain reported at 0/5, continuous pulse ox and O2 via NC. Right lower leg feels warm. Recommendation: Continue monitoring her pain level and vital signs, and continue providing patient education about the disease and ways to prevent and manage crises. QI Discuss quality-of-care indicators for the management of children with sickle cell disease. Quality of care indicators would be mortality and morbidity rates. Pediatric Case 7 Brittany Long (Core) Guided Reflection Questions Concluding Questions Reflecting on Brittany Long’s case, were there any actions you would do differently? If so, what were these actions, and why would you do them differently? Actions I would do differently is examining the leg, I am not sure how long it was until I did examine the leg but seeing as that was the chief complaint I would do it earlier in the clinical setting. Describe how you would apply the knowledge and skills that you obtained in Brittany Long’s case to an actual patient care situation. I will use what I learned in this scenario to provide proper care of patients experiencing a crisis and implement this to my patients care as well as educate them on the signs and symptoms.