Pediatrics Day 2
Clinical Education Center and Simulation
Learning Activities
Clinical Education Center – 3rd Floor
Welcome, Attendance and Questions/Answers
2 Instructors
12 students
1 hour and 45 minutes
Simulation Center – 5th Floor
Welcome, Attendance and Questions/Answers
2 Instructors
12 students
2 hours
Activity #1
Medication Considerations
Activity #2
Respiratory Considerations
Simulation #1 -Room 2 (30 min)
Wyatt Carlson
Simulation #2-Room 2 (30 min)
Wyatt Carlson
Activity #3
Simulation #3-Room 3 (60 min)
Reed Jackson
Pediatric Early Warning Signs (PEWS)
 The Clinical Education Center is packed with new clinical content and nursing application
 Please prepare for the simulation scenarios as you would for a clinical day.
 Be prepared to provide knowledgeable, effective, and safe patient care in each of the simulation scenarios today.
You will need to prepare for simulation in advance.
Please prepare before this experience:
 Complete the Nursing Care Plan tool utilizing the patient data for Reed Jackson. Please develop 3 nursing diagnoses’ using
the 5 column chart (available at the end of this workbook)
 Please review the Bates video to review pediatric assessment available through the library online.
http://hslibrary.ucdenver.edu/node/250?q=visual-guides/bates
Please read before this experience:
 This workbook
 Selected procedures as needed
 The assigned article: Schuh, S. (2011). Update on management of bronchiolitis. Infectious diseases and immunizations, 110114.
Please bring to this experience:
 This workbook, please review the simulation in detail. You should be familiar with the patient’s PMH, admitting diagnosis,
possible interventions which include medications
 Completed Care Plan
 Stethoscope
 Clinical resources i.e. pen, penlight, clipboard, calculator
 Davis Drug book
Clinical Education Center
Activity #1
Medication Considerations
Medication administration is a big part of caring for the pediatric patient. Errors which would not hurt an
adult will cause harm to a child, sometimes serious harm. Come prepared to do drug calculations! Bring your
drug guide and your calculator as well as paper and a writing utensil. We will be looking at many different
forms of medication administration.
PEDS Day 2 CEC/Sim Workbook
1
1. PO medications
A. A 3 year old presents with complaint of tugging at ears. VS are as follows: HR 120, RR 24, Temp:
39.2C, 35lbs. The MD writes an order for ibuprofen per protocol for fever. What is the per kg standard
for ibuprofen dosing?
What dose should this pt receive?
Should this patient receive the dose?
Why or why not?
What form (liquid, tablets) should this patient receive?
B. An 18 month old presents with chief complaint of fever. VS are as follows: HR 130, RR 28, Temp 99.8F,
26lbs. The MD writes an order for acetaminophen per protocol for fever. What is the mg per kg
standard for acetaminophen dosing?
What dose should this patient receive?
Should this patient receive the dose?
What is the rationale for this decision?
What form of the medication should the nurse deliver?
C. A 7 year old presents with complaint of fall from slide resulting in injury to right ankle. VS are as
follows: HR 110, RR 20, Temp 37.2C, 65lbs. The MD writes an order for acetaminophen per protocol
for pain. How much acetaminophen are you going to give this patient?
What form of this medication will the nurse use?
2. IM Medications
You have a 16 month old who is presenting with acute otitis media (AOM). Pt has been seen multiple times in
the last six months with the same chief complaint. The child most recently finished a prescription of
amoxicillin. The MD orders ceftriaxone IM. The pt weighs 25lbs.
Why did the MD order this medication?
Why give the medication IM as opposed to PO?
How much medication is the RN going to administer (mg and ml)?
What methods could be used to administer this amount of medication?
3. IV push medication administration
You are taking care of a 7 year old status post appendix removal. He states his pain is currently an 8/10. He is
crying and guarding his abdomen. The patient weighs 55lbs. You have an order to give morphine 1-2mg IV
every 4 hours for pain greater than a 6.
Is this a safe order for morphine?
What is the mg per kg dosing of morphine?
How long are you going to administer the medication over?
PEDS Day 2 CEC/Sim Workbook
2
4. Fluid Bolus/Maintenance Fluid Administration
You are taking care of a patient who has had vomiting and diarrhea for the last several days. This is an 18
month old who weighs 28lbs who has not had a wet diaper in over 12 hours. The patient does not make tears
when crying. The MD has a high level of concern the pt is dehydrated. A fluid bolus is ordered. What fluid are
you going to give to the pt?
What is the standard calculation for the administration of a bolus to a pediatric patient?
How quickly is the bolus going to be administered?
Spike fluid and program the pump to deliver the fluid bolus.
The MD continues their order to say once the bolus is finished, put the patient on the hourly maintenance for
the patient’s weight.
Activity #2
Respiratory Considerations
The quickest way for pediatric patients to get into peril is deterioration of their respiratory status. We will
look at how to administer oxygen to the pediatric patient, different ways to maintain a patent airway, and
what to do when the pediatric patient is experiencing respiratory distress.
Not only do you need to know how to administer oxygen, you also need to know how to maintain a patent
airway. There are many different ways to do this. Yankauer, nasal aspirator and deep suctioning are three
such devices used to do just that.
The pediatric COR is not something anyone wants to talk about. It is important to recognize the difference
between pediatrics and adults in this situation. We will discuss the very basics of this event.
Activity #3
Come prepared to assign a PEWS score to patients from different scenarios. Please review your notes from
class.
 Patient #1- You enter the room and the infant is crying. The child does not soothe with swaddling,
holding, rocking, or nursing. On assessment their cap refill is 3 seconds, all VS are WNL. What PEWS
score would you give and what would you do?

Patient #2- You enter the room and the 3yo child appears to be sleeping. She is very quiet, awakens
only briefly when you talk to her, and moves very slowly and uncoordinated during your basic
assessment. VS: HR 70, RR 22, O2 94%RA, Temp 99F. What PEWS score would you give and what
would you do?
 Patient #3- The 6 year old child is awake, alert, and playing Mario Brothers on the Wii. Cap refill is <
2 seconds, VS: HR 135, RR 22, O2 93%RA, Temp 98.6F. What PEWS score would you give and what
would you do?
Simulation
PEDS Day 2 CEC/Sim Workbook
3
Your role as a student nurse: Be prepared to work for 15 minutes in groups of 3 to complete objectives for each scenario. Three
students will actively participate in simulation and 3 students will actively observe having comments to share with the group
regarding nursing interventions, assessment, and safety. All 6 students will actively participate for 15 minutes with an instructor
guided debrief.
Please review this workbook including each scenario, the patient’s medical orders, MAR, and admission report.
General Patient Medical Information for Scenario 1 and 2
Primary Medical Diagnosis: Vomiting, Dehydration, Hypoglycemia
Situation: Inpatient 5 month old with vomiting, dehydration, respiratory distress
Back Ground: Wyatt is an otherwise healthy 5 month old who presented with his parents to the Emergency Department
after vomiting, diarrhea, and fever at home for greater than 48 hours. He also had an episode of respiratory distress
with questionable aspiration. He has been a healthy infant; he was born by vaginal delivery at 40 weeks. He’s on no
home medications and his immunizations are up to date. He lives in a non-smoking home with his parents and a 3 year
old sister who is well.
Assessment: On initial presentation to the emergency department he presented was lethargic with a cap refill of 4
seconds. Wyatt was given supplemental oxygen, an IV line was established, a fluid bolus was given 10mL/kg X 2, and he
required suctioning of vomit X 2. He also received glucose for initial blood glucose of 54. Currently Wyatt has improved
and is being admitted for supplemental oxygen and rehydration.
Scenario #1- New Admission at 0800
Sim room 4
Recommendations.
At minimum please complete:
 A basic assessment including any needed focused assessments. Please include a set of vital signs.
 Provide patient and family education to hospital process and care, orders, and overall plan of care.
 Verify and initiate admission orders and verify MAR
 Also provide any nursing care for patient and communication to provider as needed
PEDS Day 2 CEC/Sim Workbook
4
Admission Orders
Dispensing by non-proprietary name under formulary system is permitted, unless checked here: 
DATE:
Today
ATTENDING PHYSICIAN:
0700
Dr. John Fugate UPI ID #284067
TIME:
Wyatt Carlson
D.O.B. – 10/4
MRN: 4563789
ORDERING HEALTHCARE PROVIDER:
Dr. Fugate
GME/UPI
284067
SERVICE: Pediatrics
PAGER:
3567
1
2
3
4
5
6
7
8
9
10
11
12
CODE STATUS:
Full
ALLERGIES: Iodine (rash)
ADMISSION WEIGHT: 6.2 kg.
Admit to Pediatric Floor. Diagnosis: dehydration/respiratory distress
Vital Signs every hour for severe dehydration until stable, then every 4 hours
Call HO: Temp ≥ 38.3 C or ≤ 35,
SBP ≥ 155 or ≤ 70,
HR ≥ 140 or ≤ 60,
RR ≥ 30 or ≤ 18
Blood glucose < 55 or >200
Intake and Output q 4 hours
IV Dextrose 5% and 0.225% Sodium Chloride at 32mL per hour
After 2 hours of IV fluids, offer Pedialyte 0.5 mL/kg every 5 minutes.
If tolerates for 1 hour, decrease IV rate by 50%. Then continue to increase oral rehydration. Discontinue IVF after
next 2hours if tolerating oral fluids.
Check blood glucose and repeat every hour if less than 60 mg/dL
Zofran 0.15mg per kg IVP every 8 hours if patient is receiving IV fluids.
Tylenol liquid 15mg per kg PO/PR every 4 hours PRN mild pain, fever, or irritability.
Suction PRN
Titrate supplemental oxygen as needed to maintain SpO2 > 93%
Dr. John Fugate
UPI ID #284067
Verified by:
PEDS Day 2 CEC/Sim Workbook
5
Title:
Date:
Time:
Medication Administration Record (MAR)
Date: Today
Name: Wyatt Carlson
MRN: 4563789
Date of Birth: 10/4
Allergies: Iodine
Admit height :
26”
Admit weight:
6.2 Kg
Scheduled Medications
Time
IV Dextrose 5% and 0.225% Sodium Chloride at 32mL per hour.
If tolerates Pedialyte (see below) for 1 hour, decrease IV rate by 50%. (1000)
Then continue to increase oral rehydration.
Discontinue IVF after next 2hours if tolerating oral fluids. (1200)
0700
Pedialyte 0.5 mL/kg every 5 minutes after 2 hours of IVF.
0900
PRN Medications
Time
Today
Started at
0700 KW
Today
Zofran 0.15mg per kg IVP every 8 hours if patient is receiving IV fluids.
0100 SS (in
ED)
Tylenol liquid 15mg per kg PO/PR every 4 hours PRN mild pain, fever, or irritability.
0100 SS (in
ED)
Signature
Katie Weiland RN
Initial
KW
PEDS Day 2 CEC/Sim Workbook
6
Signature
Tomorrow
Tomorrow
Initial
SITUATION
Emergency Department Faxed Report Form CON Simulation
Date:_Today__ Time:__Now___ Room #___Sim____ MD___Dr.
Wyatt Carlson
DOB: 10/4
MRN: 4563789
Diagnosis or Chief Complaint __Dehydration,
Admission History
Yes
No Isolation Required:
Yes
Jones ____
Vomiting, Fever
No Type:_____________
BACKGRO
UND
5 month old arrived in ED 8 hrs ago, lethargic,  work of breathing after 2 days of vomiting, dehydration,
fever, ? febrile seizure with aspiration @ home. Limited po intake; pt given O 2 in ED, fluid bolus, dextrose.
Baby responded well, now fussy and alert
Allergy: Iodine,
Last Set of Vital Signs
Temp. _38__ Pulse Rate/Rhythm_150_/__Reg__ Resp: _29__
O2 Sat.__92%_____RA/O2__iL NC____ B/P_cap refill< 2 sec_
Physical Assessment
Neuro:
A/O x4 Alert
Awake ↓LOC Lethargic (@ admit)
Comatose Fluctuating Agitated Confused Combative
Other:
Integumentary
Skin W/D
Color WNL
Cap Refill < 3 sec
Other:
ASSESSMENT
Respiratory:
Unlabored
Labored
Tachypneic
Clear
Wheezes
Crackles
Diminished
Other:
GI: BS
Present
Other:
MS: No deficits
Other:
Hypoactive
Contracted
Hyperactive
Cachetic
Abd. Distended
Amputation________
Pain Management
Pain level before meds: _0/10 Pain level now: _0_/10
Location of Pain: ________________________________
Pain Medication: __Tylenol 15mg/kg
Last Dose Given At: 0100 Pain Goal: less than 3/10
Interventions
Labs: See attached lab results sheet
CBC,
CMP/BMP,
TROP,
UA,
Other:
Abnormal/Pertinent Results: __See Labs___________________
Radiology: CT, XR , U/S Type: Chest xray- right sided infiltrate
Abnormal/Pertinent Results: _
Tubes: Foley Size ___N/A- voids_____ NGT Size____ N/A _____
Chest Tube: R L Air Leak Crepitus Drainage Color_________
Other:
Input & Output
Admission IV Fluid: __See admission orders__________________
IV Location/Size: 1.___ 24g / R AC_ 2._________/__________
Input:
Oral _ 30 __cc’s IV _ 124 __cc’s Other: _
__cc’s
Output: Urine _ _cc’s
Emesis: _cc’s
NGT_
cc’s
CT Drainage _ _ cc’s Other: __one diaper 6 hrs ago
Social Assessment
With Assistance
Activity:
Independent
Pt lives:
W/ Family
Alone
Deficits:
Deaf/HOH
Blind/Vision Impaired
Nursing Swallow Evaluation:
Comment:
See triage note for list of home meds
Medications
Meds given in ED: Tylenol 15mg/kg @ 0100; Zofran 0.15mg per kg IVP @ 0100
Antibiotic Started: Yes
No
N/A Type________________ Time ________________
PEDS Day 2 CEC/Sim Workbook
7
Homeless,
Pass
Fail
Dependent
Caregiver
Other:
N/A
Not done
Goals/ Things to watch out for:
Frequent vomiting requiring bulb suctioning
RECOMMENDATION
S
Precautions: none
Care Issues: Parent at bedside, supportive and helpful
Special Equipment Needed:
No wet diapers in 6 hours
Labs or Medications to be done soon:
See orders
Scenario #2- Continuing Care at 0900
Sim room 4
See PMH, background, assessment, orders, and MAR from Scenario #1.
Situation: It is now an hour later (0900) and you are going to check on Wyatt to see how he is doing.
Recommendations:
At minimum please complete:
 A basic assessment including any needed focused assessments. Please include a set of vital signs.
 Provide any nursing care for patient and communication to provider as needed.
 Determine the appropriate Pediatric Early Warning Signs (PEWS) score for this patient.

General Patient Medical Information for Scenario 3
Primary Medical Diagnosis: Reed Jackson was diagnosed with seizures 2 years ago, after which he was started on phenobarbital.
He has been seizure free since then, until today.
Situation: Inpatient 6 year old with seizure activity.
Back Ground: Reed is a 6 year old male with known generalized tonic-clonic seizures who was admitted to the ED after
experiencing 4 seizures at home during the last 12 hours. His parent reports his first 3 seizures lasted between 3-5 minutes and each
resolved without intervention. His fourth seizure lasted approximately 7 minutes and resolved after she administered 4 mg of rectal
Diastat
® (Diazepam in a rectal gel).His immunizations are up to date and he is developmentally appropriate.
Assessment: Reed is resting comfortably. He is sleepy but arousable. He is on a cardiac apnea monitor and vital signs are stable. He
has a PIV in his right arm with D5NS + 20 KCL/L infusing at 58 mL/hr. He was given a loading dose of phenobarbital and a CBC w/ diff
and a phenobarbital level were drawn and sent to the lab. Reed’s mom was at the bedside and was tearful and has just informed us
that she lost her job 3 months ago and has not had the money to purchase Reed’s phenobarbital. She has left the bedside to put her
other children to bed at home and will return in the morning.
Recommendations
At minimum please complete:
 A basic assessment including any needed focused assessments. Please include a set of vital signs.
 Provide patient education to hospital process and care, orders and overall plan of care.
 Verify admission orders, verify MAR, and verify IVF along with review what medications the patient received in ED.
 Also provide any nursing care for patient and communication to provider as needed.
PEDS Day 2 CEC/Sim Workbook
8
Dispensing by non-proprietary name under formulary system is permitted, unless checked here: 
DATE:
Today
ATTENDING PHYSICIAN:
TIME: 2000
Dr. John Fugate
Reed Jackson
D.O.B. 02/14
MRN: 6782345
UPI ID #284067
ORDERING HEALTHCARE PROVIDER:
Dr. Fugate
GME/UPI
284067
SERVICE: Pediatrics
PAGER:
3567
CODE STATUS:
Full
Iodine (rash)
ADMISSION WEIGHT: 18.2 kg.
Admit to Pediatric Floor. Diagnosis: Seizures
Vital Signs every 2 hours
Call HO: Temp ≥ 38 C
SBP ≤ 80,
HR ≥ 140 or ≤ 60,
RR ≥ 28 or ≤ 8
With all seizure activity
Neuro checks every 2 hours
Continuous pulse oximetry with cardiac apnea monitor
Intake and Output q 4 hours
IV D5NS + 20 mEq KCL/l at 58mL per hour
NPO
Lorazepam 2mg IV push x 1 with seizure activity PRN. May repeat dose in 10 minutes if
seizure continues
Labs: CBC with diff and Phenobarbital level (DONE)
Oxygen titrate supplemental oxygen to maintain pulse oximetry level greater than 93%
Phenobarbital 200 mg IV loading dose if phenobarbital level is below 10 mcg/ml
Phenobarbital level x 1 after loading dose given
ALLERGIES:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Dr. Fugate
Verified by:
UPI ID #284067
PEDS Day 2 CEC/Sim Workbook
9
Title:
Date:
Time:
Medication Administration Record (MAR)
Date: Today
Name: Reed Jackson
MRN: 6782345
Date of Birth: 2/14
Allergies: Iodine
Admit weight:
18.2 Kg
Scheduled Medications
Time
IV D5NS + 20 mEq KCL/l at 58mL per hour
2000
PRN Medications
Time
Today
Tomorrow
Started at
2000 KW
Today
Tomorrow
Lorazepam 2mg IV push x 1 with seizure activity PRN. May repeat dose in
10 minutes if seizure continues
Phenobarbital 200 mg IV loading dose if phenobarbital level is below 10
mcg/ml
Signature
Katie Weiland RN
Initial
KW
PEDS Day 2 CEC/Sim Workbook
10
Signature
Initial
Nursing Care Plan
Student Name:
Patient Initials:
Date:
Patient Medical Diagnosis:
Nursing Diagnosis #1:
Assessment Data
(Include at least two
subjective and/or
objective pieces of data
that lead to the nursing
diagnosis)
Goals/Outcome
Criteria
(Use SMART format:
pt/family specific; actionoriented; measurable;
time-specific; and
realistic.)
Nursing Interventions
(List all nursing and
multidisciplinary
interventions that will
assist this patient in
meeting goals; include
teaching and discharge
planning)
PEDS Day 2 CEC/Sim Workbook
11
Rationale
(Provide reason why
intervention is
indicated/therapeutic;
provide references as
appropriate)
Outcome Evaluation
and Replanning
(Was goal(s) met? How
would you revise the plan
of care according the
patient’s response to
current plan of care?)