Posted: January 10th, 2023

James Scott age 5 year old admitted early

Name: ______________________________________________
Date:__________________________
SCENARIO HISTORY:
James Scott age 5 year old admitted early this morning for asthma exacerbation
22kg, allergic to eggs and strawberries
DOB: 12/25/20xx
Part I Scenario:
✓ Mia Nurse from ER gave you report (attached)
✓ Mother of James Scott also gave you additional information (attached)
1. You are the Pediatric admission nurse. You walk in the room and his head of bed is flat,
and James is complaining of pain in his chest. You were also told that you have a set of
medication orders that you need to carry out. Utilizing the report from the emergency
room answer the following:
a. How does the nurse ensure that James is correctly identified?
b. What care does James need at this point?
2. Identify team members and their specific roles in the care of a patient with asthma.
3. List Asthma triggers and appropriate patient and parent education for families with
Asthma
4. Assessment data for JAMES:
• Temperature: 99.9O F
• Apical Rate: 105 bpm
• Respiratory Rate: 28 breaths per minute
• Blood pressure 90/48
• Pain (face scale) 4/10 described as “feels like Mom is hugging me tight”
• Respiratory: wheezing across lung fields, O2 sats 94% Room air, moist cough
with green sputum
a. What concerns does the nurse have?
b. What diagnostic tests are warranted by these assessment findings?
5. Doctor ordered the following for Samuel Vasquez.
List of the medications ordered:
• Albuterol MDI INH 2 puffs every 6 hours
• Prednisone 20mg by mouth every day
• D5% 0.45NS with 20mEqKcl to start at ______mL/hr (based on wt:22kg)
• Ampicillin 16mg/kg IVP every 6 hours.
a. Based on the assessment findings, list the medications in order of priority.
b. What are the nursing responsibilities when administering medications?
c. Using the pediatric reference guide, determine if the dosages for each medication is
safe for patient.
d. Get custom essay samples and course-specific study resources via course hero homework for you service – Include appropriate calculations
e. Ace my homework – Write a patient education including use and side effects for each of the
medication:
• Albuterol MDI INH 2 puffs every 6 hours
• Prednisone 20mg by mouth every day
• D5% 0.45NS with 20mEqKcl to start at ______mL/hr (based on wt:27kg)
• Ampicillin 16mg/kg IVP every 6 hours.
You administered medications, and delivered non-pharmacological interventions for
patient comfort. You reevaluated 30 minutes after you have administered all his
medications and these are the assessment findings:
• Temperature: 99.9O F
• Apical Rate: 103 bpm
• Respiratory Rate: 28 breaths per minute
• Blood pressure 90/48
• Pain (face scale) 2/10 described as “It now hurts a little, little”
• Respiratory: O2 sats 98%, clear upper lobes and minimal wheezing on
expiration on the lower lobes.
• Samuel verbalizes “thank you for taking care of me!”
6. List 2 priority nursing diagnoses for this patient that you cared for.
7. What nursing interventions were appropriate for this patient? (List 2 nursing interventions
for each nursing diagnosis listed above)
PART 2 SCENARIO:
8. SBAR report of previous nurse was given:
a. Situation- Asthma exacerbation, was admitted previous shift
b. Background- admitted in the ER for shortness of breath and wheezing (see Mia
RN’s report for detailed background in the emergency room)
c. AssessmentLast vital signs:
▪ Temperature: 99.9O F
▪ Apical Rate: 103 bpm
▪ Respiratory Rate: 28 breaths per minute
▪ Blood pressure 90/48
▪ Pain (face scale) 2/10 described as “It now hurts a little, little”
Respiratory: O2 sats 98%, clear upper lobes and minimal wheezing on
expiration on the lower lobes.
d. Recommendations: Nurses administered Albuterol 2puffs, prednisone 20mg,
ampicillin 352mg given and started him on Maintenance IV fluids at 62mL/hr, IV
patent. Lab results pending. RSV, CoViD, Influenza A/B all ruled out. Waiting for
sputum culture and Xray results.
9. Mom just came in and has not been updated on patient plan of care. Introduce yourselves
and write an update appropriate for James Scott’s parents at this time.
10. How does the nurse ensure that James is correctly identified?
11. What steps do you take as nurses to ensure that James is safe?
12. You started assessment on James Scott and here are your assessment data:
• Neuro- A &O X4, “whiny” per Mom
• Vital Signs:
o Temperature: 101.6O F
o Apical Rate: 111 bpm
o Respiratory Rate: 39 breaths per minute
o Blood pressure 90/62
o Pain (face scale) 8/10 described as “It hurts a lot and it’s hard to
breathe!”
• Respiratory: moderate retractions noted on the subcostal and intercostal
area, wheezing heard on expiration but diminished lung sounds on the bases,
nasal flaring noted. Moist cough with green sputum present
• Cardio: Cap refill 3-4 sec, hands cool to touch, but color normal for ethnicity.
Peripheral pulses 2+. Regular rhythm
a. What care does James need at this point?
b. Identify team members and their specific roles in the care of a patient with asthma.
c. What diagnostic tests are warranted by these assessment findings?
13.Here are laboratory and diagnostic results:
WBC 15.5
RBC 5.3
Neutrophils 75
Lymphocytes 20
Monocytes 4.9
Eosinophils 6
Band 3.2H
Sputum Cx- 2+ streptococcus pneumonia
CXR:
▪ Air trapping in bilateral lungs, consistent with history of Asthma
▪ Consolidation in lower lobe of left lung, suggestive of Pneumonia
▪ No evidence of acute cardiac pathology
▪ No evidence of bony deformity or fracture
a) What laboratory values are concerning?
b) What precautionary measures do you anticipate the doctors to order based on the
Xray and culture results?
14. Physician notified. He ordered the following for James Scott.
List of the medications ordered:
• Albuterol NEB INH 2.5mg every 2 hours PRN for wheezing and shortness of
breath
• Solumedrol 0.84mg/kg/dose IVP every 12 hours
• Ceftriaxone 25mg/kg/dose IVPB to run for 30 minutes every 8 hours
i. Determine dose
ii. Determine volume
iii. Determine rate mL/hr
• Acetaminophen 15mg/kg/dose PO every 6 hours PRN for temperature above
101F
a. What are the nursing responsibilities when administering medications?
b. Using the pediatric reference guide, determine if the dosages for each medication is
safe for James.
c. Get custom essay samples and course-specific study resources via course hero homework for you service – Include appropriate calculations
d. Ace my homework – Write a patient education including use and side effects for each of the medication:
o Albuterol NEB INH 2.5mg every 2 hours PRN for wheezing and shortness of
breath
o Solumedrol 0.84mg/kg/dose IVP every 12 hours
o Ceftriaxone 25mg/kg/dose IVPB to run for 30 minutes every 8 hours
o Acetaminophen 15mg/kg/dose PO every 6 hours PRN for temperature above
101F
You administered medications, and delivered non-pharmacological interventions for
patient comfort. You reevaluated 30 minutes after you have administered all his
medications and these are the assessment findings:
• Temperature: 100.2O F
• Apical Rate: 132 bpm
• Respiratory Rate: 33 breaths per minute
• Blood pressure 90/48
• Pain (face scale) 4/10 described as “It’s easier to breathe”
• Respiratory: O2 sats 98%, after treatment and with oxygen simple mask at 6L flow,
wheezing breath sounds on all lobes, mild supraclavicular retractions noted but no
other signs of respiratory distress
• James verbalizes “thank you for taking care of me!”
15. List 2 priority nursing diagnoses for this patient that you cared for.
16. What nursing interventions were appropriate for this patient? (List 2 nursing
interventions for each nursing diagnosis listed above)
17. Ace my homework – Write your SBAR report for the upcoming shift.
ER NURSE MIA Report:
James Scott
6 years old
DOB: 12/25/20XX
Wt: 27kg
Allergies: Eggs and Strawberries
MD: Joanne Jalili
Room 1: Pediatrics Unit
Hospital: West Coast Medical Cent
Situation: Asthma Exacerbation
Background: He was diagnosed with Asthma when he was 3 years old. His only home medication
is PRN Proventil (albuterol). Asthma’s well controlled per mother. Over the last 5 days, he’s been
having cough and cold and had to use his rescue inhaler at least once a day. Last night, he was
running with his dog, Diego, and had shortness of breath and wheezing. Mom gave him a treatment,
and tolerated it well. This morning, he woke up with the same symptoms and Mom gave another
treatment—didn’t work. Mother brought him to the ED. He was admitted 5 hours ago. What time do
you have now? Can you please note it? Thanks.
Assessment: Systems
Neuro: A &O X4, appropriate for age. Tmax was 101.2F , ibuprofen given 4 hours ago,
latest temperature now 36.9C.
Respiratory: Initially, he was mild distress. O2 sats were 87-88%, patient was having
retractions, respiratory rate 40’s, nasal flaring noted. He was wheezing but diminished
in the bases. We gave him a nebulized dose of Albuterol, he got a little tachy but
tolerated the treatment overall. His current respiratory status now: O2 Sats kept at
room air and Sats have been 94-96%, RR 28-33, he is now wheezing all over, moving
air more. He still has some mild retractions but no other signs of distress at this time.
We were able to rule out for the following: RSV, influenza A & B, Rapid Covid-19.
Cardio: Good pulses and perfusion. HR baseline 80’s-90’s, but got tachy at 110’s after
breathing treatment. His last BP was 98/63.
GI: Abdomen soft and flat, active BS all quadrant, had a BM last night, no issues.
GU: Patient is voiding, last void was 75mL.
Lines: He has a right peripheral 22g IV on the antecubital (AC). Patent, saline locked.
Labs: Additional labs sent: CBC, complete metabolic panel, chest x ray was done, sputum
culture was sent—waiting for results.
Recommendations: Admitted overnight for observation, possible D/C tomorrow. Room air, to keep
sats above 94%, noninvasive O2 available, patient has regular diet for age. Medications:
Prednisone 20mg (needs to start), IVFluids need to start, routine Albuterol MDI ordered.
Mom went home will be back soon, parents signed consent for treatment.
Information from James’ Mother
• James “Jimmy” Scott
• DOB 12/25/2015 – Research Paper Writing Help Service
ALLERGIES: Strawberries and eggs
PEDIATRICIAN: Dr. Joan Jalili.
CHIEF COMPLAINT:
• Had a cough and cold for 3 days
• Last night he was running around the back yard with his dog and started to have
difficulty breathing, treatment given X1
• He was fine and went to school but started having wheezing and dyspnea, treatment
given but with worsening symptoms
PAST MEDICAL HISTORY:
• Diagnosed with Asthma when he was 3 years old
• Had bronchiolitis “when he was a baby” but wasn’t hospitalized for that
• A previous hospitalization for asthma exacerbation, most recently 2 years ago. He was
sick at home and rescue inhaler wasn’t helping, so he had to be admitted for steroids
and breathing treatments.
• No significant family medical history
Home meds: Albuterol inhaler, 2 puffs every 6 hours as needed for wheezing
Psychosocial:
• No problems with smoking, recreational drug use in the family
• His favorite cousin vapes but doesn’t visit often
• No other concerns at this time
OTHER INFO:
• Immunizations Up-to-date: Except for annual Flu-shot due to allergy to eggs
• No changes to level of consciousness
• Developmentally appropriate for age
• No cardiac complaints
• 6 year old boy in First Grade, can read sight words and knows how to count to 100
• No siblings; has a dog named Diego
• Poor appetite
• Stool and urine normal
• Enjoys swim team; usually very active
SCENARIO HISTORY:
James Scott,
Age: 6yo
Wt: 27kg
Allergy: Eggs and strawberries
DOB: 12/25/20XX
Date:
Name:
1) It is now 6pm and his last urine output is documented at 12pm. It is 75mL. What is his current
Pediatric urine output? (volume/time/weight)
2) Order: 20mL/kg Normal saline fluid bolus to run for 30 minutes.
a. Determine volume to be infused (VTBI)= mL
b. Determine the rate of infusion= mL/hr
3) The doctor ordered maintenance IV fluids for him: D5% 0.45NS with 20meq of kcL to run
continuously via IV. What is his hourly fluid maintenance rate? (100-50-20 method or 4-2-1
method)
4) Order: Ceftriaxone 25mg/kg IVPB every 8 hours to run for 30 minutes. Cefriaxone 2g/50mL
Dose = mg
Volume= mL
Rate= mL/hr
5) Order: Ampicillin 16mg/kg IVP every 8 hours. Ampicillin 250mg/mL
Dose = mg
Volume= mL
6) Order: Solumedrol (methylprednisolone) 0.84mg/kg IVP every 12 hours.
Methylprednisolone 125mg/2mL
Dose = mg
Volume= mL
7) Order: Dextrose 50% 25g/50mL
500mg/kg to run for 30 minutes.
a. How many mg?
b. Convert to g
c. How many mL (Concentration: 25g/50mL)
d. What is the rate? mL/hr
8) Order: Vancomycin 20mg/kg IVPB every 8 hours to run for an hour.
Vancomycin 500mg/100mL
Dose = mg
Volume= mL
Rate= mL/hr

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