Student Name:
Date: 7/17/23
Course: Peds 4110
Clinical Instructor: Dr. Valcin
Concept Map Worksheet
Pt Name: Brittany Long Age: 5 y.o.
Allergies: NKDA/NKFA
Immz: Up to date
DOB: 12/10/2017 Ht: 3 ft 9.7 in. (116 cm)
Next of Kin: Mother
Gender: F
Wt: 35.3 Lbs (16 kg)
1. Describe disease process or condition affecting patient (include pathophysiology)
Sickle cell anemia is an autosomal recessive inherited disorder in which erythrocytes
become characteristically elongated and crescent shaped when there is low oxygen tension, a
low blood pH, or increased blood viscosity, such as with dehydration or hypoxia. When the RBCs
take on a sickle shape, they cannot move freely through blood vessels. This increases risk of
acute pain due to ischemia and stasis, tissue hypoxia, respiratory distress, and acidosis. In the
case of Brittany Long, she was experiencing a vaso-occlusive crisis characterized by blood
pooling, swelling, and acute pain and is typically seen in the lower extremities.
2. Diagnostic Tests (reason for tests and results)
3. Anticipated physical findings
●
●
●
●
Pain
Pallor (paleness of skin and mucous membranes)
Lower than average growth and development
Swelling of hands and feet (hand-foot syndrome)
4. Anticipated nursing interventions
● Pain management through both pharmaceutical and
comfort measures
● Hydration through IV fluids
● Infection prevention
● Oxygen therapy
● Monitor intake and output
● Frequent vitals
Student Name:
Date: 7/17/23
Course: Peds 4110
Clinical Instructor: Dr. Valcin
INTRODUCTION
Your name, position (RN), unit you
are working on
Hi, my name is ( ). I am a nurse in the pediatric unit.
SITUATION
Brittany Long is a 5 year old female who was admitted due to
Patient’s name, age, specific reason for visit Sickle cell anemia.
BACKGROUND
Patient’s primary diagnosis, date of
admission, current orders for patient
ASSESSMENT
Current pertinent assessment data using
head to toe approach, pertinent
diagnostics, vital signs
RECOMMENDATION
Any orders or recommendations you may
have for this patient
Brittany Long has a history of sickle cell disease, diagnosed at 6
months old, and has been prescribed a regular folic acid
supplement. The parent stated the patient had been
complaining of right lower leg pain over the last 2 days. She has
not had an appetite in the last 24 hours but is taking small
amounts of oral fluids. She has had pain crises before, mostly
managed at home with acetaminophen and ibuprofen. She has
been hospitalized twice, once at age 4 years for a
vaso-occlusive crisis episode and once at age 3 years for a fever.
She was admitted through the ED last night.
Brittany is having pain in her right leg that is exacerbated with
movement or touch. Temperature, circulation, and pulses in the
legs are equal bilaterally. Heart and bowel sounds were normal,
and lungs were clear to auscultation. Upon initial assessment,
the patient was rating her pain a 6/10, HR was 128, and BP was
110/68. Patient and family requested medication for pain relief.
Per provider orders, the patient was given 1.6 mg of morphine
IVP and a 250-mL fluid bolus of 0.9% sodium chloride with a
maintenance infusion of 5% dextrose and 0.45% sodium
chloride infusing at 52 mL/hr. Vital signs following morphine
and fluid bolus are heart rate 110, respiratory rate 26, blood
pressure 100/60, temperature 99.3°(37.4°C), and SpO2 97%,
and her pain rating is now 2/10. The family of the patient
demonstrated a good understanding of the importance of
hydration, ambulation, and management of sickle cell disease
in general.
Continue to monitor patient pain level and offer additional
nonpharmacological methods of support for pain management.
Continue with monitoring hydration status and ensure the
patient maintains regular ambulation and breathing exercises.
Student Name:
Date: 7/17/23
Course: Peds 4110
Clinical Instructor: Dr. Valcin
PATIENT EDUCATION WORKSHEET
NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE
Morphine sulfate
Opioid analgesic
SAFE DOSE OR DOSE RANGE, SAFE ROUTE
Brittany Long was prescribed: 1.6mg (0.1mg/kg/dose) IV q3h
Children >1 month: 0.02-2.6mg/kg/hr continuous infusion for sickle cell or cancer pain
PURPOSE FOR TAKING THIS MEDICATION
Used for severe pain. Works by binding to opiate receptors in the CNS. Alters the perception of pain,
generalized CNS depression.
PATIENT EDUCATION WHILE TAKING THIS MEDICATION
Common side effects include hypotension, constipation, confusion, and sedation.
Use with caution with other CNS depressants, can cause profound sedation, leading to coma and possibly
death.
Initials: BL
Diagnosis:
Sickle cell
Age: 5 y.o
Allergies:
NKDA/KNFA
Student Name:
Date: 7/17/23
HCP: n/a
Isolation: standard
IV Type: isotonic
Consults:
n/a
Fall Risk:
increased
Location: R ac
Transfer: n/a
Course: Peds 4110
Clinical Instructor: Dr. Valcin
Fluid/Rate: 250 mL 0.9 NaCl IV
over 30 min
M/F: F
Critical Labs:
Creat
Cl
Hct
Hb
RBC
RDW
Other
Services:
n/a
Consults
Needed:
n/a
Length of
stay: n/a
Code Status:
Full code
Why is your patient in the hospital (Answer in your own words and include the History of present illness)?: Brittany Long was admitted to the ED last
night for pain in her right leg. She has PMHX sickle cell disease, taking regular folic acid supplements. The parent reported she had been complaining of
right lower leg pain over the last 2 days. She has not had an appetite in the last 24 hours but is taking small amounts of oral fluids. She has had pain
crises before, mostly managed at home with acetaminophen and ibuprofen. She has been hospitalized twice, once at age 4 years for a vaso-occlusive
crisis episode and once at age 3 years for a fever.
Health History/Comorbidities (that relate to this hospitalization):
● Sickle cell disease
● Hx of vaso-occlusive crisis (4 yrs ago)
Shift Goals/Patient Education: The patient's pain will be appropriately managed. The patient will not experience a vaso-occlusive crisis.
Path to Discharge: Monitor and treat pt’s pain, perform patient and relative education.
Path to Death or Injury: vaso-occlusive crisis, ACS, stroke, infection, organ damage, pain crisis, medication errors, fluid/electrolyte overload
Management of Care
Alerts
1. Changes in O2 sat: can indicate vaso-occlusive crisis or
ACS.
2. Signs of pain: patients with sickle cell are typically in a lot
of pain.
3. Fluid status: dehydration can trigger a crisis.
1. Taking vital signs and looking for an
abnormalities
2. Assessing pt’s pain using FACES scale
3. Administer ordered medications
4. Patient and relative education
Assessments
Priorities for Management
1.
2.
3.
4.
Medical history
Labs: CBC and HGB
Pain levels
Vitals/O2 sat
Complications
1. Promptly assess and manage pain using appropriate
analgesics and interventions.
2. Monitor for respiratory symptoms, obtain a chest X-ray if
necessary, and initiate appropriate interventions, including
oxygen therapy and antibiotics.
3. Be vigilant for signs of infection, including fever, chills, rapid
breathing, and localized symptoms. Promptly evaluate and
initiate appropriate antibiotic therapy.
4. Urgently evaluate and consider interventions to prevent or
treat stroke, including blood transfusion therapy.
1. Pain Crisis: sudden, severe pain is a hallmark of sickle cell
disease.
2. Acute Chest Syndrome: a serious complication
characterized by chest pain, fever, cough, and difficulty
breathing.
3. Infections: sickle cell disease increases the risk of bacterial Delegation
infections, particularly pneumonia and meningitis.
1. Taking vitals and helping to feed the patient can be delegated
4. Stroke: sickle cell disease can predispose to strokes,
to the PCA.
especially in children.
Interventions
1. Check Iv site for an redness, swelling or signs of infiltration
2. Ensure proper fluid intake and encourage oral fluids