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. We're available through e-mail, live chat and Facebook. NSAIDs. 4. Anemia, jaundice, enuresis, and proteinuria are chronic manifestations of sickle cell anemia. She has been hospitalized twice, regular heart sounds without murmurs. 8:13 You provided patient education. dizziness The major pathophysiologic event of sickle cell disease is the sickling of, RBCs, most commonly triggered by low oxygen tension in the blood. No known allergies, immunizations are up to date. Situation: Brittany long is a 5-year-old African American female who has a history of sickle cell anemia, she came into the hospital yesterday suffering from a sickle . Would you like to proceed ? Document your initial focused assessment of Brittany Long. Brittany was diagnosed with sickle cell disease at 6 months old and is currently 5 years . I worked my way up to an hour of cardio per workout session. Document the patient history you obtained for Brittany Long, incluhospitalizations, precipitating events, medical treatment, and home management previous pain crises. Impaired Gas Exchange Impaired gas exchange R/T increased blood viscosity AEB pain in right leg . Family history of sickle cell afety it is important that, You should have identified the relatives as one of yoassure patient safety. VS: Temp, 37.4 C oral; HR 120 bpm; RR 26 bpm; BP 100/60 mmHg; & SpO2 97%. in her right lower legs. Before discharging Brittany Long and her family, I would educate them on how to PURPOSE FOR TAKING THIS MEDICATION, Treatment of: Location A is 3.00 m to the right of a point charge q. What are you on alert for with this patient? 2:49 You identified the child. Deficient Knowledge, I noticed the 5-year-old laying in her bed with her mom at the bedside. Protect it from theft, and never give to anyone other than the ur first actions to, 3:00 You asked the parent: Does she have any known areplied: 'No. Caution patient to call for assistance when ambulating per hour period when examined this morning PROTOTYPE: Aspirin 1) Have the patient lie down in a supine position. What is the maximum safe dose for this pt in mg? If you change the Country/Language, you will be logged out. of hydration with patients who have sickle cell anemia. 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. b) Reassess the pt in 15mins to see whether the pain rating has changed PO (Children >1 mo): Prompt-release tablets and solution 00 mg/kg every 46 hr as needed. o Pharm. I administered more fluids and SAFE DOSE OR DOSE RANGE, SAFE ROUTE Provide intense hydration therapy while maintaining fluid and electrolyte balance: monitor I/ O, give oral fluids administer b) Anemia and hypotension : 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. Voc Latin page 24. Conscious state: Appropse: Present. Heart rate: 128. Use preservative-free formulation. The FACES pain rating scale is a self-report tool that can be used by children as young as 3 years of age. What is the magnitude and sign of the charge? intake (68 full glasses/day), and increasing mobility. o Ther. Promote rest to decrease oxygen consumption. PDA Closure Severe pain, usually in bones A family hx of blood transfusion wouldn't be relevant, as it wouldn't affect the pt. TCD is performed annually on c) Both parents have the sickle cell trait and your risk for having a child with sickle cell anemia is 25% with each pregnancy hands and feet cool to touch. Patient Dose: acetaminophen elixir 240 mg every 4-6 hours as needed. NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE every 34 hr, maximum: 15 mg/dose. a) Place med in an oral syringe and allow the pt to squirt into his or her mouth We have noticed you are logged in to ${country}. Pul108/73 mmHg. Brittany Long is a 5-year-old African American female with a history of sickle cell disease, a left (bacterial) or right shift (viral) She has had pain crises before, mostly managed at d) You need to change into hospital gown before I can examine you. once at age 4 years for vaso-occlusive crisis Britney long Jesse has sickle cell disease and was brought to the Emergency Department for an acute vaso occlusive crisis. Longs response. 19 terms. Observe for manifestations and BP now CLASSIFICATION: Britney was given oral pain medication in the SpO2: 99%. SpO2: 98%. Document the patient history you obtained for Brittany Long, including previous pain crises. Normal bowel habits are variable and may vary from 3 Document the patient teaching that you would provide for Brittany Long and her family Severe headache, vomiting, visual changes, c) Past hospitalizations and Tx SpO2: 98%. ven over 30 minutes. respiratory depression. And Hct. Comforting this advisable. 1. If oral fluids are Heart rate: 107. 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! Circulating sickle cells are hemolysized by the. Transcranial Doppler : Could be Continuous infusion, sickle cell or cancer (How will I identify the above signs &Symptoms?). VBVA=45.0V.V _ { B } - V _ { A } = 45.0 \mathrm { V }. Advise patient that morphine is a drug with known abuse potential. Creatinine: 0 (0.8-1). The nursing care for Brittany Long began with obtaining a set of vitals. Controlled-release tablet 0 A dropper is appropriate for use w/ infants and younger children; older children can take oral meds from a medicine cup or measured medicine spoon. pressure was low. A nurse is explaining the pathophysiology of vaso-occlusive pain crisis to the parent of a pt with sickle cell anemia. Course Hero is not sponsored or endorsed by any college or university. Her pain was a 3/, in her right lower legs. 19 terms. nonopioid analgesics The vSim for Nursing | Pediatric solution features the following 10 virtual patients from the National League for Nursing (NLN) Simulation in Nursing Education - Pediatric Scenarios: Nursing students develop clinical reasoning skills by prioritizing and implementing actions within several dimensions, including: vSim for Nursing allows each student to have a different experience with the patient. Document your initial focused assessment of Brittany Long. I have a weekly show-- Ease Into . Rates pain at 5 on the FACES scale, Patients primary diagnosis, date of admission, current orders for patient. 18 terms. Continuous Pulse Oximetry: scale and did not want anyone to touch her 11:1 0 Child status - ECG: Sinus rhythm. She was given her first dose of codeine in the ED this morning but was still reporting pain in need of attention. 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). electrolyte imbalance and dependence. During my initial focused assessment of Brittany Long I found that her vital signs were 37 C, 6:13 You asked the child if anything made the pain breplied: 'No' etter. 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. Pages 15 Course Hero uses AI to attempt to automatically extract content from documents to surface to you and others so you can study better, e.g., in search results, to enrich docs, and more. Modual 1 Discussion 1 How does this article give you a better understanding of the changing perception of Irish immigrants in America? What are you on alert for with this patient? abdomen is generally tender. Identify and document key nursing diagnoses for Brittany Long: Brittany Long needs the following diagnosis:. tired. o Pharmacologic: opioid agonists The parent replied: 'No. Long-term therapy may cause (Select all that apply), a) Assess pain frequently and administer meds routinely. Britta, not had an appetite in the last 24 hours but has taken small amounts of oral fluids. emergency Department at 0600. dispensed with the medication. : 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. It is important to use, 8:21 You provided education to the relative regardicondition. 37 C hemoglobin is called hemoglobin S (HgbS), and it replaces normal hemoglobin which is called hemoglobin A (HgbA). The preschool-aged or young school-aged child may enjoy using an oral syringe to squirt meds into his or her mouth; it is engaging and gives them sense of control. CBC due Q 4 hours. pain 02 mg/kg/hr. I gave her the stuffed animal as a comfort tool to have while I preformed my assessments. Her right lower leg pain is stable, but Brittany has had a sudden increase in left upper quadrant abdominal pain and tenderness. diagnosed at 6 months old, and has been prescribed regular folic acid supplement. Describe the actions you felt went well in this scenario. 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. 97%, and Temp: 37 C. I asked her if she was in any pain, she responded yes, and then I PO (Children 612 yr): 40150 mg in 14 divided doses. This was part of your order. Impaired cardiac output related to sickle cell crisis as evidence by sickled RBC shape. greenstickynotes. IM IV SC Neonates: 0 mg/kg every 48 hr, maximum dose: 0 mg/kg. Bandage is clean dry and intact , infusing as expected, PATIENTS DOSE: 52*24 = 1248mL WNL SAFE DOSAGE [should probably be higher]. Initial focus assessment was the patients pain and location. A heart rate of 86 bpm and temperature of 37.0C are normal findings. Conscious state: Appropse: Present. Preschoolers should be given a job during the assessment process, such as holding the stethoscope or pen light. Identify and document key nursing diagnoses for Brittany Long. management so it does not turn into a crisis. Pediatric Case 7: Brittany Long (Core) Documentation Assignments. In a vaso-occlusive crisis / painful 13:3 9 You phoned the provider in order to discuss the patient. Bp is trending low, she has normal saline running at 320 ml/hr and has recently vSim ISBAR ACTIVITY STUDENT WORKSHEET INTRODUCTION Hello my name is Cheina, I am an RN on the Pediatric Care Unit. PATIENT EDUCATION WHILE TAKING THIS MEDICATION These are signs of dehydration so giving the patient a bolus of 320 m L of normal saline IV was necessary . PO (Children 1223 mo/1823 lb): 75 mg every 68 hr. 6:22 You asked the child how long she had pain for. Her 9:10 Child status - ECG: Sinus rhythm. then assessed her IV and she seemed nervous, so I offered her a stuff dog who she I, 6:58 You asked the parent: Has she been eating and parent replied: 'Yes.' drinking normally? Strict I and Copyright 2023 StudeerSnel B.V., Keizersgracht 424, 1016 GC Amsterdam, KVK: 56829787, BTW: NL852321363B01, DESCRIBE DISEASE PROCESS AFFECTING PATIENT (INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS), Sickle Cell Anemia: is a blood disease that affects red blood cells. hidy_esther. NURS 3440 (NURS3440) Institution. PO (Infants 611 mo/1217 lb): 50 mg every 68 hr. early recognition are critical in preventing respiratory complications and failure. The nurse enters the room to check on Brittany and finds her sitting gin bed playing video games with her sister. avoid a sickle cell crisis in the future. Verify your answer in a medical dictionary. Document your . Naltrexone: -opioid receptor antagonist that reduces the. 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 Communication Interact with the patient through questions that result in text and audio responses. hospitalized twice, once at age 4 years for a vaso-occlusive crisis episode and once at age 3 years . Monitor her pain levels. On inspection, the pt's skin is flat & w/o erythema. jaundice Initial focus assessment was the patients pain and location. Antipyretic 5 mg/kg for maintenance fluids at 52 mL/hr. Normal red blood cells are round. Epidural: (Children >1 mo): 00 mg/kg, maximum dose: 0 mg/kg or 5 mg/24 hr. Sickle cell vaso-occlusive pain crisis occurs when sickled cells clump in the microvasculature, impeding blood flow ( not increasing it), causing local tissue hypoxia, which progresses to ischemia, resulting in severe pain as circulation to the affected area decreases. 37 C She has pain a 6/10 on the faces scale and is receiving morphine to s relative. Take note of A 5 y/o is old enough to accurately report his or her own pain level and may be lying still as a coping strategy of bc the movement is painful. Neutrophils and bans are episode When assessing a preschool-aged pt, the pt can sit in the caregiver;s lap or sit on the exam table w/i reach and eye contact of the caregiver. Temp: 5 touch. a) Acute leg pain and dactylitis. The faulty Obstructive jaundice therapies are essential for children and offer them comfort and security. Temp: 37.3. and educated the mother about signs of a reaction. Leadership class , week 3 executive summary, I am doing my essay on the Ted Talk titaled How One Photo Captured a Humanitie Crisis https, School-Plan - School Plan of San Juan Integrated School, SEC-502-RS-Dispositions Self-Assessment Survey T3 (1), Techniques DE Separation ET Analyse EN Biochimi 1, Care of the childrearing family (nurs420). Temp: Document the patient history you obtained for Brittany Long, including previous pain crises, hospitalizations, precipitating events, medical treatment, and home management. Brought into the ED by her mother last night. Pain management by evidence of pain in right lower leg 2. precipitating factor in sickle cell crises. 34 hr initially. You should have asked the relative about any known health problems. a) Administer the prescribed analgesic as ordered Pulmonary edema. 19 terms. Management of Care: What needs to be done for this Patient Today? pallor, pale mucous membranes Referring to your feedback log, document the nursing care you provided and Brittany Long. Vital SpO2: 99%. 37 C Ninon_sassy. used to assess Intercranial vascular b) Tachycardia and jaundice. Brittany Long had tenting of the skin, her skin felt cold to touch, and her mucous membrane was dry. After the nurse has given discharge instructions regarding prevention of vaso-occlusive pain crisis, which response b Brittany's mother indicates that further teaching is needed? Document the patient history you obtained for Brittany Long, incluhospitalizations, precipitating events, medical treatment, and home management previous pain crises, Brittany Long is a 5 yr-old African American female with a history of sickle cell disease. arcoca. a) I want to listen to you breathe. and pain management. unstable. splenomegaly SAFE DOSE: 0.050.2 mg/kg every 34 hr, maximum: 15 mg/dose. vascular accident (CVA). To maintain patient syou quickly identify the child. I verified with two nurses in regard to the I have given her morphine 2 mg IV Push and have also bolused Conscious state: Appropse: Present. headache I monitored her respiratory rate for any Which of the following would be the highest priority and most appropriate nursing diagnosis in this case? Pedi: Advise parents or caregivers not to administer ibuprofen to children who may be dehydrated (can occur with vomiting, diarrhea, or The provider has increased the morphine dose, but her mother voices concerns that Brittany is addicted to the medication. Transcranial Doppler: Could be used to assess Intercranial vascular flow and detect the risk for cerebral vascular accident (CVA). Over time, the The patient was diagnosed with sickle cell anemia and was in a VSim Charlie Snow Complex Pre/Post Sim. intravenous maintenance fluids at 52 milliliters The nurse is assessing the abdomen of a patient admitted with vaso-occlusive pain crisis. female with a history of sickle cell disease, signs Q2 hours. a. Xist I I 13:2 3 You examined the child's legs. Which of the following are acute manifestations of this disease that the nurse should expect to see in this pt? Many OTC products contain ibuprofen; avoid duplication. line infusion rate to 52. a) Sickle cells cause increased blood flow throughout the body. c) I am going to take your temp. A. Somatization disorder - manifests as a pain syndrome with a significant loss of or alteration in physical function that mimics a physical, Of the axons involved in the transmission of pain, which one is thinly myelinated and conducts that first feeling of pain that is often felt as coming on as a sharp, rapid feeling? Monitor O2 saturation levels She also didn't have any energy to eat anything by mouth. In a vaso-occlusive crisis / painful episode, This is Carly in the Pediatric Unit at the Our Lady Ginsburg Ruth Bader Hospital, Your name, position (RN), unit you are working on, Patients name, age, specific reason for visit, I am calling regarding Brittany Long, 16kg. PO Rect: (Adults and Children <50 kg): Usual starting dose for moderate to severe pain in opioid-naive patients 0 mg/kg every Which of the following would be the best response by the nurse? department during the night by her mother, who stated that the patient has been complaining 2. If that is not sufficient to manage their pain, they may require morphine for ood or had a reaction to a. I do about 40 minutes of it five times a week. PO (Adults and Children >12 yr): 50400 mg in 14 divided doses. I also started incorporating more strength training into my gym routine. PO (Children 910 yr/6071 lb): 250 mg every 68 hr. Immobilization, pressure and cool compresses cause vasoconstriction and can impede blood flow, which is contraindicated in sickle cell crisis. (In pain) She well' replied: 'Not too. Brittany Long (Complex) - Sickle Cell Anemia with Acute Splenic Sequestration. Encourage patients to use other forms of bowel regulation, such as increasing bulk in the diet, increasing fluid d) Bone marrow suppression occurs because of the development of sickled cells, which makes your child less able to fight infections. e child with a favorite drink, 9:48 You changed the dextrose 5% in 0% normal samL/hr. 2400 mg/day, whichever is less). Administer oxygen as prescribed if hypoxia is present. She now rates her pain as a 3. temperature was 37 Celsius she now rates education. Jackson Weber VSim Post-Sim Q's. 10 terms. had a sudden increase in pain in her abdomen. b) You must have only transmitted sickle cell anemia to one of your children. pressure taken at right upper arm via non-invasive BP cuff: 109/74 mmHg. 2. hepatomegaly SAFE DOSAGE: 16kg*4mg/10mg = 64mg to 160mg, PO (Children 6 mo12 yr): Anti-inflammatory 3050 mg/kg/day in 34 divided doses (maximum dose: 2 g/day). Temp: Instead, the nurse should say, "Let's see how warm you are," or "I want to listen to you breathe." 20 terms. He ordered of hypervolemia and transfusion reaction. IV fluids with electrolyte replacement (caution with potassium replacement) Recent flashcard sets . Use of a Morphine 2mg IV given as Heart rate: 127. 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. 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. lymphocytes monocytes increase is Documentation Assignments. Respiration: 25. blood and then administered it. The. Protein dipstick is +4, negative ketones, negative glucose, +2 dependent edema, and facial .
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