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Lewis University
College of Nursing and Health Professions
30-333 Health Maintenance & Restoration: Children
Pediatric Simulation and Unfolding Case Study
Strategy Overview
This pediatric simulation and unfolding case study takes place in the Lewis University College of
Nursing and Health Professions (CONHP) lab or classroom. It stands as an experience that is
comprehensive and interactive. The simulation and unfolding case study is aimed at promoting
creative and critical thinking. It specifies the learning objectives, equipment, and an unfolding
case study of an ill infant demonstrating pediatric nursing skill. Patient data are presented as the
situation progresses. Questions are posed to encourage decision-making and critical inquiry.
Simulation Objectives
At the end of this simulation scenario, the learner will be able to:
1. Implement Joint Commission safety standards in the care of an acutely ill pediatric patient.
2. Include use of identification, situation, background, assessment, recommendation, and
readback (I-SBAR-R) with the patient transfer process throughout the continuum of care.
3. Provide safe nursing care in a variety of settings for a pediatric patient with multiple health
care needs.
4. Demonstrate evidence-based safe care for the pediatric patient receiving IV therapy and
medications (rectal, po, nebulizer, IV, IM)
5. Calculate accurate medication doses based on the pediatric patient’s weight.
6. Perform a systematic physical assessment on a simulated, acutely ill, pediatric patient.
7. Identify developmental expectations of a 12-month-old child and appropriate nursing
interventions.
8. Analyze pediatric laboratory values and their influence on patient care decisions.
9. Demonstrate intradisciplinary and interdisciplinary collaboration during the simulation.
10. Implement family-centered care in a variety of pediatric settings.
11. Demonstrate adherence to infection control standards when performing nursing care.
12. Determine nursing roles and delegation considerations to ensure continuity of care
(outpatient, inpatient, and community pediatric settings).
13. Provide culturally competent counseling to a vulnerable parent.
14. Develop a comprehensive discharge plan, which considers medical follow-up needs,
medication counseling, community referrals, physical assessments, and nutritional
guidelines.
Adapted by Anne McShane, MSN, RN & Sheila Berkemeyer, MSN, RN of Lewis University
College of Nursing and Health Professions from: http://www.qsen.org/terms_conditions.php
Pediatric Simulation and Unfolding Case Study: Anne McGrorty, RN, MSN, CPNP & Kristine
Ellis, MSN, RN of La Salle University, School of Nursing and Health Sciences
The content of this simulation reflects the clinical experience of the faculty, information from
the clinical agencies used for our pediatric nursing course, and a literature review of main
content areas. Please adhere to your state regulations, agency policies and procedures, and
professional guidelines.
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Learning Objectives
Core-Competency: Patient-Centered Care
This teaching strategy is designed to evaluate the following:
Knowledge: Integrates understanding of family-centered care for the pediatric population and
involving parents/siblings in all aspects of patient care including plans of care, communication,
education, and emotional support.
Attitude: Encourages parental involvement in patient care. Recognizes the need for emotional
support of family members.
Skills: Acknowledges family as a part of patient care and outcomes through effective
communication and evaluation of parental involvement and knowledge of care.
Core-Competency: Safety
This teaching strategy is designed to evaluate the following:
Knowledge: Describes the nurse’s role in providing safe, effective patient care and the impact of
Joint Commission standards on nursing care.
Attitude: Seeks to educate the mother about safety throughout the hospital stay.
Skills: Implements Joint Commission standards of safe patient care through the use of
medication reconciliation, communication, error reporting, patient identifiers, medication safe
doses, abbreviations, I- SBAR-R technique during patient transfer, and the six rights of
medication administration.
Core Competency: Team and Collaboration
This teaching strategy is designed to evaluate the following:
Knowledge: Demonstrates the importance of effective communication and delegation among
different healthcare providers (nurses, physician, and Certified Nursing Assistant).
Attitude: Implements the importance of effective communication with physicians and other
members of the healthcare team to ensure patient safety and positive outcomes.
Skills: Gives report for a patient using I-SBAR-R technique. Communicates safety threats to the
physician prescribing medication orders. Uses the American Nurses Association delegation
principles.
Core Competency: Evidence-Based Practice
This teaching strategy is designed to evaluate the following:
Knowledge: Differentiates between clinical opinion and scientific evidence while performing
specific diagnostic tests and assessments.
Attitude: Values the use of evidence-based practice to make decisions in the clinical setting.
Skills: Identifies potential medical errors and possible conflicts with other health care providers.
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Pediatric Simulation Scenario
Equipment needed to run simulation scenario (may be adapted to setting)
Simulation Manikin
Patient Name Wrist Band
Calculator
Stethoscope
Pediatric Blood Pressure Cuff
Pulse Oximeter & Probe
O2 Mask & Nasal Cannula
Scale
Droplet Isolation Items
IV Tubing, IV Pump, and Pole
Normal Saline 250 mL Bag
D5.2 NSS w/10 meq KCL/L Bag
Urine Bag
IV Flush (3 mL NS x 2)
IV Syringe Pump
Syringes 1 mL/3 mL/10 mL
Tympanic Membrane Thermometer for Inpatient use
Thermometer to give Mother at Discharge
Acetaminophen (Tylenol) po 160 mg/5 mL & Per Rectum (Suppository) 120 mg
Ceftriaxone Sodium (Rocephin) Powder for Reconstitution 500 mg & 1.8 mL Diluent
Trivalent Inactivated Influenza Vaccine (TIV) 0.25 mL Prefilled Syringe
Xopenex (Levalbuterol HCL) 0.31 mg/3 mL
Zofran (Ondansetron) 2 mg/1 mL
Growth Chart
Lab Sheet with MR#9933725113764
Physician’s Orders
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Pediatric Clinic
12-month-old Lilliana (Lilli) Garcia has been vomiting for the past 12 hours. It is 5:00 p.m. and
Lilli’s mother is becoming concerned. Since waking at 5:00 a.m., she has “not held anything
down.” She calls the pediatric clinic and speaks to the Charge Nurse.
As the Charge Nurse, what other questions would you ask on the phone?
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Signs and symptoms (S & S) in the past 24 to 48 hours: pulling on ears, increased
irritability, inability to get comfortable when lying down, waking frequently during
sleep, foul smelling urine, any new onset rashes, increased temperature, respiratory
distress, cough (symptoms could indicate another underlying illness such as ear
infection, urinary tract infection, vomiting, and/or RSV pneumonia, other)
Intake: oral (fluids & solids)
Has she had any new foods?
Output: urine, stool, emesis
Medications given at home
Mother does not have a thermometer at home; information needs to be given
Did she have any contact with other sick children or adults?
Dehydration S & S (e.g., sunken fontanel, decreased urine output, dry mucous
membranes, absence of tears, and sick general appearance)
What would you recommend?
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Parent bring Lilli to the pediatric clinic for evaluation
Lilli arrives at the clinic at 6:00 p.m. Which staff member should complete the initial assessment
and obtain the vital signs?
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Certified Nursing Assistant could complete VS
Staff Nurse should complete health history and overall assessment
Staff Nurse is responsible for initial assessment
Pediatric Clinic Findings:
Temperature: 38.8 °C (101.8° F)
Apical rate: 160 beats per minute
Respiratory rate: 40 breaths per minute
Blood pressure 90/48
Birth weight: 3.64 Kg (8 pounds)
Current weight: 9.82 Kg (21.6 pounds)
Current height: 73.7 cm (29 inches)
Head circumference: 44.5 cm (17.5 inches)
Weight at 12-month-old visit 2 weeks ago: 11 Kg (24.2 pounds)
Lethargic and very quiet
Signs of dehydration
Chest congestion, slight bilateral wheezing, dry cough, & nasal congestion
Maculopapular rash on abdomen
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What other questions should the Charge Nurse or Staff Nurse ask?
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Questions the Nurse should ask:
When was the last diaper change? Where does Lilli live? Who lives in the home? Is
there anyone else in the home ill? Does she attend daycare? Was there any daycare
exposure to illness? How often does she attend daycare?
Which vaccinations did Lilli receive at her 12-month visit 2 weeks ago?
o MMR, Varicella, Hib, PCV 13, Hepatitis A -- Is the rash from the vaccines?
o Would fever from vaccines result in this type of body weight loss, vomiting,
and dehydration? Would these vaccines cause a rash?
Has Lilli traveled outside of the United States in the past few weeks?
Does Lilli take any medications at home on a daily basis?
Complete the medication reconciliation as defined by Quality and Safety Education
for Nurses (2007) by asking about any medications taken in the home.
What are the Staff Nurse’s primary concerns based on these findings?
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Age of patient (DOB = 8-5-20XX)
Dehydration S & S: prolonged capillary refill [>2 seconds], abnormal skin turgor,
abnormal respiratory pattern, absence of tears, dry mucous membranes, sunken
fontanel, rapid pulse, pale color, decreased level of consciousness [lethargy]
Associated S & S: fever, malaise, dry cough, nasal congestion, chest congestion,
slight bilateral wheezing, maculopapular rash on abdomen
Determine severity of dehydration based on your reference.
FLACC Pain Assessment (2 m/o-7 y/o)
o Face, legs, activity, cry, consolability (0 = no pain & 10 = worst pain)
Dry diaper > than 8 hours
Convert Celsius to Fahrenheit Temperature of 101.8° F
o Infection (bacterial or viral)
Apical rate elevated (Typical Norms)
Respiratory rate elevated (Typical Norms)
B/P elevated (Typical Norms)
Recent weight loss of 1.18 Kg (over 1 Kg ~ 2.6 pounds)
Birth weight should be tripled by 12 m/o --- should be 10.92 Kg (was okay at 12 m/o)
Plot height, weight, and head circumference (12 month and today’s findings)
Lilli’s mother reports that she loves her milk and usually drinks about 40 ounces of skim milk
per day. However, for the past 24 hours she has not wanted anything to eat or drink. What
additional questions should the Staff Nurse ask the mother at this point?
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What are Lilli’s normal eating habits?
o 40 oz per day is excessive (concerns about anemia); she can have table foods
at this age.
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Physician writes orders. Is the order for Acetaminophen (Tylenol) appropriate for Lilli?
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Acetaminophen (Tylenol) po 160 mg/5 mL & per rectum (suppository) 120 mg;
calculate safe dose per your resource
Should be per rectum (suppository) d/t vomiting; calculate safe dose per your
resource
Tylenol dosing 80 mg/0.8 mL (500 mg/5 mL) changed to 160 mg/5 mL (32 mg/1 mL)
National Safety Goals presented by Joint Commission
o No trailing zeroes in medication orders; nurse needs to verify the dosage with
the physician --- 650.0 mg could be interpreted as 6500 mg if the Staff Nurse
fails to see the decimal point
What further actions should be taken regarding her fever? When the mother asks about
alternating Tylenol and Motrin, what is the appropriate response?
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Staff Nurse directs the Certified Nursing Assistant to recheck temperature to ensure
effectiveness of medication
Staff Nurse should note that Mother does not have a thermometer; she can give her
one now or pass this info on to Emergency Department (ED).
What are the nursing responsibilities when administering medications?
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Are there any known drug allergies? What are her reactions like?
2 Patient Identifiers per National Patient Safety Goal presented by Joint
Commission (2008) --- use for all medications administered in the simulation
o Full name, ID number, date of birth, telephone number, or other personspecific identifier
o Identify individual as the person for whom service or treatment is intended
o To match the service or treatment to that individual, they must be in the
same location (patient wristband or chart label)
Rights of Medication Administration
o Right patient
o Route
o Dose
o Time
o Medication
o Right to refuse
o Documentation
What care does Lilli need?
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Refer severely dehydrated child to nearest hospital for IV fluids and workup.
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Physician writes orders to transfer the child to the Emergency Department. The mother does not
have a car and asks the staff to transport the child to the Emergency Department. The mother is
concerned about the cost of an ambulance.
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D/T safety issues and critical nature of child’s illness, the clinic staff is not equipped
to transport the child. Staff call an ambulance.
Transportation via ambulance addressed at hospital.
As the Charge Nurse, you call the Emergency Department using the I-SBAR-R format to provide
report to the Emergency Department staff.
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I-Identification of yourself and your patient
o 2 Identifiers --- DOB & Full Name
S-Situation (Describe what is going on)
B-Background (Concise history)
A-Assessment (Present status)
R-Recommendation (What needs to happen)
R-Readback (Restate information you provided)
Emergency Department (ED)
Emergency Department (ED) Charge Nurse assists with admitting Lilli. What nursing
interventions are appropriate at this time?
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RN completes health history (same as in clinic-no need to repeat now)
RN completes admission physical assessment
Apply patient ID band
Recheck patient’s weight
Emergency Department Findings:
Temperature: 38.2 °C (100.8° F)
Apical rate: 165 beats per minute
Respiratory rate: 45 breaths per minute
Blood pressure 90/45
Current weight: 9.5 Kg (20.9 pounds)
O2 Saturation 90 %
Lethargic and very quiet
Crying at times without tears
Chest congestion, slight bilateral wheezing, & mild intercostal retractions
Dry cough, nasal congestion, & bulging, erythematous left tympanic membrane
Maculopapular rash on abdomen
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Why does the Certified Nursing Assistant (CNA) need to repeat the weight when she just had
one done in the office?
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It is always good to get an accurate weight at the nurse’s facility to ensure that the
nurse has a correct reading. It can be dangerous to take measurements from other
facilities because all medications and IV fluids are calculated based on the patient’s
weight. If the nurse directly asks the mother, she may forget and give him/her an
estimated number. In addition, a new nurse will not know if the weight was taken
with clothes off, and if there is a slight difference in the actual scale measurements.
Physician has completed the exam and has written initial orders for Lilli. Staff Nurse refers to
physician orders. Can Lilli receive another dose of Acetaminophen? How does the Staff Nurse
proceed?
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Review physician orders for accuracy
Only 1 hour has passed since administration of Acetaminophen (Tylenol) at clinic
Lilli is evidencing circumoral cyanosis. The physician writes the order for Oxygen per Nasal
Cannula when O2 saturation is <95 %. What are the nursing responsibilities with administration
of oxygen? Is the amount and route accurate?
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Oxygen needs to be humidified & should be changed following Respiratory
Therapist recommendation to 1 L per Nasal Cannula
Notify physician if saturation goes below 95 %
Pulse Oximeter and Probe
Would the bolus order be appropriate for Lilli? Is the order accurate?
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Need to replace 1500 mL = 1500 gm that Lilli lost (1.5 Kg weight loss); calculate
fluid needs per your resource
Measure output to determine hydration status; no Potassium until urinating
Joint Commission National Safety Goals states cc are never used, only mL
Calculate Lilli’s daily maintenance fluid requirements and expected hourly output.
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Based on weight of 9.5 Kg, Lilli should be receiving 100 mL/Kg/day
o 100 mL/Kg 1st 10 Kg; 50 mL/Kg next 10 Kg; 20 mL/Kg remaining Kg
o 950 mL/day
Hourly output for an infant should be 2-3 mL/Kg
o 19-28.5 mL/hour
During the insertion of a peripheral IV, Lilli lies quietly throughout the procedure. What
concerns does the Staff Nurse have?
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An alert 12-month-old should be very upset and irritable while having an IV placed.
Sometimes the child will require that several nurses physically restrain the child
while this is being done.
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Lilli's mother wants to know if there is anything that the nurse can give Lilli to help stop the
vomiting. The nurse plans to administer the Zofran. What are the nursing actions for this
responsibility?
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2 Patient Identifiers & Rights of Medication Administration
Zofran (Ondansetron); calculate safe dose per your resource
Route needs to be identified on order
What is the rationale for the ordered diagnostic tests?
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Chest X-ray to r/o pneumonia
Urine bagging to r/o UTI
CBC, CMP to r/o sepsis or other lab abnormalities
RSV nasal washing and Rapid Respiratory Panel to r/o RSV
Pulse oximetry to determine oxygen saturation levels
After administration of the bolus (x 3), Lilli is more active and responsive. Now that Lilli is
improving, what is the Staff Nurse’s next priority?
General Pediatric Unit
Lilli is transferred to the General Pediatric Unit. The Emergency Department (ED) Staff Nurse
hands-off Lilli to the General Pediatric Unit Charge Nurse using I-SBAR-R format. What would
be included?
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I-Identification of yourself and your patient
o 2 Identifiers --- DOB & Full Name
S-Situation (Describe what is going on)
B-Background (Concise history)
A-Assessment (Present status)
R-Recommendation (What needs to happen)
R-Readback (Restate information you provided)
How does the Staff Nurse on the Pediatric Unit ensure correct identification of Lilli?
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2 Patient Identifiers per National Patient Safety Goal presented by Joint
Commission (2008)
o Full name, ID number, date of birth, telephone number, or other personspecific identifier
o Identify individual as the person for whom service or treatment is intended
o To match the service or treatment to that individual, they must be in the
same location (patient wristband or chart label)
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After receiving report, the Charge Nurse admits Lilli to the pediatric unit. What assessments and
immediate interventions does Lilli need? The Charge Nurse directs the Certified Nursing
Assistant (CNA) to complete initial vital signs. What are the responsibilities of the nurse?
Complete a physical assessment with the following focus:
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Airway, breathing, circulation
Level of consciousness
Plan of care for Lilli
Orientation to room and unit
Patient safety and use of crib rails in room
Medication reconciliation
Renewal of all assessments
Physician’s orders
Check IV site & infusing fluids
General Pediatric Unit Findings:
Temperature: 37.2 °C (99° F)
Apical rate: 140 beats per minute
Respiratory rate: 38 breaths per minute
Blood pressure 88/38
Current weight: 9.5 Kg (20.9 pounds)
Moderate bilateral wheezing, mild intercostal retractions, & nasal flaring
Dry cough, nasal congestion, & bulging, erythematous left tympanic membrane
Maculopapular rash on abdomen
Lilli is beginning to cry, has a wet diaper, and her mother asks for a bottle. The Certified Nursing
Assistant (CNA) hands the bottle to Lilli and Lilli refuses to hold her own bottle. When asked,
her mother says, “Oh she is just lazy. She won’t stand up on her own either!” The Certified
Nursing Assistant (CNA) reports the mother’s comment to the Staff Nurse. Why does this
concern the Staff Nurse?
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The patient is 12-months-old and her mother is stating that she is unable to stand up
on her own or hold her own bottle.
Her mother may have unrealistic expectations for her sick child.
o Developmental monitoring and parental counseling may be needed to ensure
that the safety of the child and to evaluate the need for further testing.
Arrange for a possible consult for a social worker to come speak with Lilli’s
mother and evaluate the child/parent relationship.
o Developmental referral
o Mother’s knowledge deficit of developmental levels
o Remind staff about mother’s dietary knowledge deficit r/t milk
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Physician writes orders that include D5.2 NSS with 10 meq KCL/L @ 30 mL/hour. Is this order
accurate? Are there any factors to consider when the physician orders IV fluids with additives in
them such as potassium (K+)?
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Check for urine output prior to administering fluids with additives such as K+. It
helps prevent toxic buildup of electrolytes in the body and demonstrates the kidneys
are functioning properly.
After bolus, calculate safe dose per your resource.
Lilli’s laboratory values come back. Is any information missing from the report?
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Date and time of blood draw
What laboratory values are concerning?
 Hgb - 11 Gm
 WBC - 20,000 mm3
 Urine Leukocytes
 Urine Ketones
 Serum tC02
 Urine Specific gravity
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The Respiratory Syncytial Virus (RSV) results are positive. What type of isolation is necessary?
Who can room with this child?
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Isolation should have been initiated in the Emergency Department (ED); follow
agency policy
Preferably the assignment would not include Respiratory Syncytial Virus (RSV)
with any child who is immunocompromised
Lilli is wheezing and the physician orders Levalbuterol HCL (Xopenex) 31 mg per Nebulizer q 4
hours. What are the nursing considerations when collaborating with respiratory therapy to
administer and monitor this medication? What are the nursing considerations when collaborating
with respiratory therapy to administer and monitor this medication?
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2 Patient Identifiers & Rights of Medication Administration
How do you proceed? (phone pharmacy or pulmonologist)
Levalbuterol HCL (Xopenex) Ensure accurate dose and time; calculate safe dose
per your resource
Ensure accurate administration
Evaluate pre- and post-treatment respiratory status
Evaluate side effects
Lilli's chest X-ray is positive for left lower lobe pneumonia. Physician orders Ceftriaxone 500
mg IV q 12 hours. For which diagnosis is the child receiving antibiotics?
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Bacterial Pneumonia
2 Patient Identifiers & Rights of Medication Administration
Ceftriaxone (Rocephin); calculate safe dose per your resource
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Lilli’s mother consistently avoids isolation precautions and states, “I have already been exposed
to Lilli so I won’t get sick?” How should the staff respond?
Lilli is napping in the room. Her mother is settled and the Staff Nurse goes to the Nurses’ Station
to fill out the correct admission paperwork. A secretary at the front desk looks at the chart and
says, “Hey, I know this family. They live right up the street from me. What is she here for?”
What would be an appropriate answer for the Staff Nurse to give?
A. “She is here for dehydration. Her mother seems to be anxious and even had the nerve to call
her ‘lazy’ down in the Emergency Department.”
B. “I am sorry, but because of HIPAA (Health Insurance Portability and Accountability Act)
privacy rule, I am unable to discuss any patient information with you at this time.”
C. “Yes her name is Lilli. Would you like to review her chart for yourself?”
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Answer is B. This answer follows the Health Insurance Portability and
Accountability Act privacy rule.
The Health Insurance Portability and Accountability Act privacy rule is a part of the U.S.
Department of Health and Human Services Office for Civil Rights (2007). This law gives
you rights to your health information, sets rules, and sets limits on who can look at and
receive your information, and protects the privacy of your health information.
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All healthcare providers, health insurance companies, Medicare and Medicaid
programs, and any person working in patient care settings must comply with this
law helping to protect healthcare information.
Information from the medical record, conversations carried out between patients
and providers, information in healthcare computer systems, patient billing
information, most other health information about you held by those who must
follow this law (U.S. Department of Health and Human Services Office for Civil
Rights, 2007)
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Discharge Plans
Lilli has recovered enough for discharge. The Discharge Planning Nurse works with the Staff
Nurse and Lilli’s mother to develop a plan for discharge. Describe intradisciplinary and
interdisciplinary communication necessary for planning Lilli’s discharge. Lilli receives a
diagnosis of Asthma prior to discharge. Call the physician for discharge orders. The Discharge
Planning Nurse conducts the necessary teaching to prepare the patient and her mother for care
following this hospitalization. Mother states she will refuse the Flu vaccine when she goes to the
clinic for the follow visit. How does the nurse respond to this statement?
Review the pertinent information necessary to maintain child's health with the mother
including the following:
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List signs and symptoms to monitor r/t dehydration, asthma, fever
Review Asthma Action Plan
Describe treatments and procedures and means to obtain equipment and medication
Verify mother is comfortable with the nebulizer
Provide instructions regarding dose and administration of medications
(Levalbuterol HCL [Xopenex], Acetaminophen [Tylenol])
o Levalbuterol HCL (Xopenex) prn including signs and symptoms
Acetaminophen (Tylenol) prn for fever / pain
o Provide dose-measuring device for oral medications
Educate about thermometer and provide one for home use
Identify immunization issues (parent and child)
Administer Influenza Vaccine
o Would child receive when sick?
o Did she receive the first dose previously?
o Follow infant dosing guidelines
o Tdap and Influenza Vaccine for mother and other adults caring for child
Identify dietary needs and dietary consult r/t milk consumption
Explain activity guidelines
o When can the child return to daycare?
Arrange for a Social Service consult
o Assistance with transportation issues and concerns about obtaining
prescriptions
o Identify community programs (e.g., Women, Infants, and Children [WIC],
Head Start, housing, financial support, other)
Inform mother to schedule appointment with Pediatrician and Pulmonologist
o Provide physician contact information
Inform mother to schedule appointment with Developmental Screening Clinic for
promotion of growth and development r/t developmental delay (not holding bottles,
not standing on own)
o Provide contact information
Mother verbalizes and demonstrates knowledge of home care plans
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References
Centers for Disease Control. (2012). 2007 Guideline for isolation precautions: Preventing
transmission of infectious agents in healthcare settings. Retrieved on October 22, 2012
from http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf
Hockenberry, M. J., & Wilson, D. (2011). Wong’s nursing care of infants and children (9th ed.).
St. Louis, MO: Mosby.
Joint Commission (2008). Facts about patient safety: Safety initiatives. Retrieved on
April 24, 2008 from http://www.jointcommission.org/PatientSafety/
Quality and Safety Education for Nurses (2007). Quality and safety competencies.
Retrieved on April 17, 2008 from www.qsen.org/competencydomains
U.S. Department of Health and Human Services for Civil Rights. (2007). Medical
privacy-National standards to protect the privacy of personal health information.
Retrieved on April 17, 2008 from http://www.hhs.gov/ocr/hipaa/finalreg.html
Wilson, D., & Hockenberry, M. J. (2012). Wong’s clinical manual of pediatric nursing (8th ed.).
St. Louis, MO: Mosby.
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Lasallian Hospital
Pediatric Clinic
Physician’s Orders
Date/Time
Order
8-20-20XX
1800
Diet as tolerated
Noted
Acetaminophen 650.0 mg po prn pain/fever q 4 hours
J. Doe, MD
Lilliana Garcia
DOB: 8-5-20xx
MR#9933725113764
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Lasallian Hospital
Pediatric Clinic
Physician’s Orders
Date/Time
Order
8-20-20XX
1900
NPO
Noted
Acetaminophen 120 mg per rectum (suppository) prn fever q
4 hours
Transfer to Lasallian Hospital via Ambulance
J. Doe, MD
Lilliana Garcia
DOB: 8-5-20XX
MR#9933725113764
17
Lasallian Hospital
Emergency Department
Physician’s Orders
Date/Time
8-20-20XX
2000
Order
Admit to Emergency Department
Noted
Diagnosis:
Dehydration
LOM
r/o Sepsis
r/o RSV
r/o Pneumonia
r/o UTI
NKA
Diet: NPO
Continuous Pulse Oximetry
Oxygen 6 L per Mask for O2 Sats <95 %
Insert PIV and give NSS bolus of 250 cc IV x 3
Acetaminophen 120 mg per rectum (suppository) prn
fever/pain q 4 hours
Zofran 143 mg IV x 1
Labs:
CBC
CMP
Blood cultures
Sedimentation rate
Urinalysis
Urine culture
Chest x-ray
RSV nasal washing and rapid respiratory panel
E. D. Doc, MD
Lilliana Garcia
DOB: 8-5-20XX
MR#9933725113764
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Lasallian Hospital
Emergency Department
Physician’s Orders
Date/Time
Order
8-20-20XX
2030
Oxygen 1 L per Nasal Cannula for O2 Sats <95 %
Noted
Insert PIV and give NSS bolus of 190 mL IV x 3 (20 minutes
each)
Zofran 1.43 mg IV x 1
E. D. Doc, MD
Lilliana Garcia
DOB: 8-5-20XX
MR#9933725113764
19
Lasallian Hospital
Emergency Department
Physician’s Orders
Date/Time
Order
8-20-20XX
2100
Transfer to General Pediatric Unit 2 West
Noted
E. D. Doc, MD
Lilliana Garcia
DOB: 8-5-20XX
MR#9933725113764
20
Lasallian Hospital
General Pediatric Unit
Physician’s Orders
Date/Time
Order
8-20-20XX
2130
Admit to General Pediatric Unit 2 West
Noted
Diagnosis:
Dehydration
LOM
RSV
Bacterial Pneumonia
NKA
Continuous Pulse Oximetry
Oxygen 1 L per Nasal Cannula for O2 Saturation <95 %
After completion of NS bolus:
Start D5.2 NSS w/10 KCL @ 30 mL/hour
Acetaminophen 120 mg po prn fever q 4 hours
Vital Signs q 4 hours
Activity orders: Up with assistance
Diet: General as tolerated
I&O
Daily weights
A. Kidsdoc, MD
Lilliana Garcia
DOB: 8-5-20XX
MR#9933725113764
21
Lasallian Hospital
General Pediatric Unit
Physician’s Orders
Date/Time
Order
8-20-20XX
2200
After completion of NS bolus:
Start D5.2 NSS w/10 mEq KCL/L @ 65.3 mL/hour
Xopenex 31 mg per Nebulizer q 4 hours
Noted
Ceftriaxone 500 mg IV q 12 hours
A. Kidsdoc, MD
Lilliana Garcia
DOB: 8-5-20XX
MR#9933725113764
22
Lasallian Hospital
General Pediatric Unit
Physician’s Orders
Date/Time
Order
8-20-20XX
2230
Xopenex 0.31 mg per Nebulizer every 8 hours prn
Noted
Ceftriaxone 275 mg IV q 12 hours
A. Kidsdoc, MD
Lilliana Garcia
DOB: 8-5-20XX
MR#9933725113764
23
Lasallian Hospital
General Pediatric Unit
Physician’s Orders
Date/Time
Order
8-26-XX
1300
Diagnosis:
Asthma
Discharge to home
Noted
Levalbuterol HCL (Xopenex) 0.31 mg per Nebulizer every 8
hours as needed
Return to Pediatric Clinic one week from discharge
Mother to schedule appointment with Pediatrician and
Pulmonologist
Diet as tolerated
Acetaminophen (Tylenol) 120 mg by mouth every 4 hours as
needed
Administer TIV Fluzone (Flu Vaccine) 0.25 mL prior to
discharge
A. Kidsdoc, MD
Lilliana Garcia
DOB: 8-5-20XX
MR#9933725113764
24
Asthma Action Plan
Provide Asthma Action Plan from your agency.
25
Lasallian Hospital
Patient Lab Test Results
Patient Name:
Lilliana Garcia
Physician Name:
E. D. Doc, MD
Medical Record Number:
9933725113764
Patient Date of Birth:
8-5-20XX
Today’s Date:
8-20-20XX
Time of Draw:
2030
TEST: CBC
RESULT
NORMAL
REFERENCE RANGE
Hgb
HCT
WBC
RBC
MCV
MCH
PLATELETS
11.0
TEST: CMP
RESULT
POTASSIUM
SODIUM
tCO2
CHLORIDE
ALBUMIN
TOTAL PROTEIN
GLUCOSE
CALCIUM, TOTAL
BUN
CREATININE
ALT
AST
4.2
20.0
NORMAL
REFERENCE RANGE
15
75
7
0.5
Lilliana Garcia
DOB: 8-5-20XX
MR#9933725113764
26
Lasallian Hospital
Patient Lab Test Results
Patient Name:
Lilliana Garcia
Physician Name:
E. D. Doc, MD
Medical Record Number:
9933725113764
Patient Date of Birth:
8-5-20XX
Today’s Date:
8-20-20XX
Time of Draw:
2030
TEST: U/A
RESULT
NORMAL
REFERENCE RANGE
COLOR
pH
SPECIFIC GRAVITY
PROTEIN
GLUCOSE
KETONES
NITRITES
LEUKOESTERASE
CRYSTALS
CASTS
WBCs
RBCs
URINE OSMOLALITY
URINE SODIUM
TEST: RSV SCREEN
1.035
Large amount
Negative
Small amount
10
RESULT
NORMAL
REFERENCE RANGE
Positive
Lilliana Garcia
DOB: 8-5-20XX
MR#9933725113764
27
Lilliana Garcia
DOB: 8-5-20XX
MR#9933725113764
28
Lilliana Garcia
DOB: 8-5-20XX
MR#9933725113764