NU 215 Pediatric Simulation Scenario for Summer 2013

RSV (Respiratory Syncytial Virus/Bronchiolitis) Inpatient unit

Patient: Jacob Brown age 9 months Background: Jacob, age 9 months, was born at 30 weeks gestation and weighed 3 lbs. 2 oz. at birth. He currently is 26 inches and weighs 16 lbs. (students will need to convert lbs. to kg for medication administration). He currently attends daycare 4 days a week. He attended a birthday party one week ago (RSV s/s show 5-8 days after incubation) for his cousin, age 3 years. 4 other children were present aged 6 months to 4 years of age. 2 had had persistent coughing and runny noses, but their mothers stated they are fine. His mother brought him to the ER yesterday with the following symptoms: runny nose with clear to light yellow drainage, conjunctivitis, a Temperature of 100.8. Mom stated that he has been cranky for the past 2 days and he has not been eating (R/T pharyngitis). He has been coughing and sneezing sporadically for 2 days. Sunken fontanelle. Upon auscultation, lungs reveal scattered wheezes. His RR was 42/min with slight nasal flaring and intercostal retractions. After an Albuterol Nebulizer treatment, O2 and a dose of prednisolone, Jacob is admitted to the inpatient pediatric unit with RSV and Bronchiolitis. Family History: Mom: Alyssa (24 years old); works part-time as a paralegal. Medical history: Family history of renal disease and she has had recurrent UTIs & renal calculi with Lithotripsy X2. Allergies: PCN, Sulfa Dad: John (28 years old), Staff Sergeant, U.S. Army Enlisted, deployed 2 weeks ago for the first time. No significant medical history. Allergies: Environmental. Jacob: (9 months); only child. Born @ 30 weeks gestation and weighed 3 lbs 2 oz and was 16 inches long @ birth. He is currently 26 inches long and weighs 16 lbs. upon admission to the unit. NKDA. He had 2 doses of Synagis (palivizumab). Physicians orders: Droplet Isolation Precautions Vital Signs Q4 hours Humidified oxygen via mask Deep nasal suctioning PRN NPO Blood cultures for Temp >=102.0 Chest X-Ray for Temp>= 102.0 Childrens Ibuprofen suspension 100mg/5ml Q 6 hours T>=102.0 Albuterol Nebulizer treatments: Albuterol nebulizer solution (5 mg/mL) 0.50 mg/dose diluted in 2 mL of NS q 4-6 hours as needed 0.05 to 0.15 mg/kg/dose Q4-6 hours (normal ordering guidelines) Pulmicort Respules (budesonide inhalation suspension) 0.025 mg ampules b.i.d (normal dosage 0.25 mg/2mls ampules) I.V. 2.5% Dextrose & 0.45 Sodium Chloride injection 500 ml bag over 24 hours

SITUATION, TIME & PLACE: Monday morning on the inpatient pediatric unit. The charge nurse is reviewing the list of clients for assignment. Vitals are needed on all clients by 0800 as the Pediatricians will be rounding. The Nursing Technician is seen entering the clients room to take VS. The Nursing Tech comes out of the room and tells the nurse that he needs a treatment and enters another room. RN and Pediatrician enter Jacobs room and find the following: Temp 102.2 RR 54/min, nasal flaring and intercostal retractions, loud wheezing.

Other clients on the unit: 3- year old with Bacterial Conjunctivitis 18-month old with Croup 12-year old post-op repair of a fractured radius/ulna to be discharged later this afternoon. 5-year old with a WBC count of 28.8 to be prepped for a Bone Marrow Biopsy this AM 7-year old admitted for IV antibiotics after a dog bite on his face.

Completed 12/27/2011 RAS/(Reviewed and approved by CLZ).