Pre/Post Simulation for Brittany Long
While the nurse assesses Brittany, her mother questions why the nurse is checking the pt's heart and lungs when the admitting complaint was leg pain. The nurse is assessing for which of the following complications of vast-occlusive crisis? a) Splenomegaly b) Dactylitis c) Pneumothorax d) Chest syndrome
d) Chest syndrome Acute chest syndrome is caused b the clumping of sickled cells in the lungs, which results in decreased gas exchange, producing hypoxia, and further sickling. Pneumothorax, or collection of air in the pleural space, is not associated w/ vaso-occlusive crisis that occurs when blood is sequestered in the spleen; however, this would warrant assessment of the abdomen, not the heart and lungs. Dactylitis, another complication, is swelling of the fingers and toes.
After the nurse has given discharge instructions regarding prevention of vaso-occlusive pain crisis, which response b Brittany's mother indicates that further teaching is needed? a) Too much stress can cause Brittany to have a crisis b) If Brittany gets hurt badly, she could have a crisis c) Drinking to much water can trigger another crisis d) Brittany could go into crisis if she gets an infection
c) Drinking to much water can trigger another crisis Trauma, stress, illness, dehydration, and severe temp changes are all factors in vaso-occlusive pain crises; fluid overload is nota trigger.
The nurse is caring for a pt weighing 16 kg with an order to administer acetaminophen (Tylenol) for acute pain crisis. The safe dosage range for children is 10 to 15 mg/kg/dose. What is the maximum safe dose for this pt in mg? __________mg
240 To determine the maximum safe dose for this pt, multiple the high end of the dosage range by the pt's weight in kg: 15 x 16 = 240. Thus, the maximum safe dose is 240 mg.
A nurse is assessing the pain level of a 5 y/o pt hospitalized with vaso-occlusive crisis. Which of the following would be the best scale to use w/ this pt? a) FLACC scale b) Visual analog scale c) FACES scale d) Numeric pain intensity scale (0-10)
c) FACES scale The FACES pain rating scale is a self-report tool that is acceptable for use w/ a developmentally appropriate 5 y/o. Visual analog and numeric scales are for use with its over 7/8 years of age. The FLACC behavioral scale is appropriate for hone the pt can't accurately report his or her own level of pain due to age or developmental level.
The nurse is reviewing lab data on a pt with sickle cell anemia. Which lab findings would indicate the pt is experiencing a vast-occlusive crisis? a) increased hgb, decreased platelet, and elevated reticulocyte b) decreased hgb, decreased platelet, and decreased reticulocyte c) increased hgb, increased platelet, decreased reticulocyte d) decreased hgb, increased platelet, greatly elevated reticulocyte
d) decreased hgb, increased platelet, greatly elevated reticulocyte Lab data associated with sickle cell anemia includes decreased hgb, increased platelet, greatly elevated reticulocyte, and elevated erythrocyte sedimentation rate. Peripheral blood smears will indicate the presence of sickle-shaped cells.
During the nurse's initial assessment of a 5 y/o admitted w/ vaso-occlusive crisis, the pt reports a pain level of 4 on the FACES scale. The pt is lying quietly in bed watching TV. Which of the following should the nurse do? a) Administer the prescribed analgesic as ordered b) Reassess the pt in 15mins to see whether the pain rating has changed c) Ask the parent whether the pt is hurting d) Do nothing, bc the pt appears to be resting
a) Administer the prescribed analgesic as ordered The FACES pain rating scale is a self-report tool that can be used by children as young as 3 years of age. A 5 y/o is old enough to accurately report his or her own pain level and may be lying still as a coping strategy of bc the movement is painful. Resting quietly or sleeping may be scoping strategy for the pt when experiencing pain or may reflect exhaustion in the pt who is coping with pain
The nurse is caring for a patient with sickle cell anemia who is exhibiting signs of vaso-occlusive crisis. Which of the following should be included in the plan of care for this patient? (Select all that apply) a) Assess pain frequently and administer meds routinely b) Restrict oral fluid intake to decrease stress on the kidneys during crisis c) Encourage pt to visit with other children in the playroom d) Administer O2 if saturations are <92% to promote adequate oxygenation e) Administer hypotonic fluid IV to promote hemodilution
a) Assess pain frequently and administer meds routinely d) Administer O2 if saturations are <92% to promote adequate oxygenation e) Administer hypotonic fluid IV to promote hemodilution The immediate priorities in the Tx of vaso-occlusive crisis are pain management, adequate hydration, and administration of O2 to prevent further sickling. Fluid requirements are increased during a crisis, so increased oral fluid intake should be encouraged in addition to IV fluid replacement using hypotonic fluids. During the initial management of vaso-occlusive crisis, pain should be assessed frequently and pain meds given w/a fixed dose on a timed schedule. A quiet environment should be provided to allow the pt to rest; playing w/ other children in the playroom likely would not be restful. Distraction with music, TV, or relaxation techniques can be used in addition to pharmacological methods to help manage pain.
The nurse is teaching Brittany how to use the FACES scale to rate pain. Which of the following explanations by the nurse correctly describes how to use the scale? a) Choose the face that looks like how you feel inside. You don't have to be crying to be hurting a lot b) I will be able to tell how much pain you are in by asking your mom and watching how you behave c) Look at the pictures and choose the face that looks the most like you d)Pick a number 0-5 with 0 meaning no pain and 5 meaning severe pain
a) Choose the face that looks like how you feel inside. You don't have to be crying to be hurting a lot The FACES pain rating scale is a self-report tool that is acceptable for use w/ a developmentally appropriate 5 y/o. To use the tool, the pt is asked to choose the face that most closely resembles how he or she feels. During the initial health hx & assessment, the nurse should ask which words the pt uses to describe pain and use those terms when assessing the pt's pain level. It is important to reinforce that the pt doesn't have to actually look like the face bc the scale intended to show how he or she is feeling versus his or her behavior.
The nurse is performing a physical assessment on a 5 y/o pt. Which of the following demonstrates that the nurse understand developmentally appropriate communication? a) I want to listen to you breathe. I need you to help me hold my stethoscope in place. b) Your mom will need to wait outside while I complete your assessment c) I am going to take your temp. and BP now d) You need to change into hospital gown before I can examine you
a) I want to listen to you breathe. I need you to help me hold my stethoscope in place. Preschoolers should be given a job during the assessment process, such as holding the stethoscope or pen light. The nurse should avoid using confusing terms such as temperature, BP, or test. Instead, the nurse should say, "Let's see how warm you are," or "I want to listen to you breathe." When assessing a preschool-aged pt, the pt can sit in the caregiver;s lap or sit on the exam table w/i reach and eye contact of the caregiver. Children should never be force to change into a gown. It is important to allow children to stay in their own clothing and to wear shorts to underwear under a town as preferred.
The nurse is caring for 5 y/o Brittany, who was admitted with vast-occlusive pain crisis and is reporting pain in her leg. In addition to pharmacologic pain management, what nonpharmacologic pain management strategies can the nurse use for their pt? a) Offer the pt a favorite stuffed toy and distract her by asking about the animal b) Place a heating pad on the pt leg and have her mother read her a story c) Immobilize the pt leg and apply an ice pack for 15 minutes d) Ask the parents to leave the room so that the pt can rest e) Encourage deep breathing by having the pt blow bubbles
a) Offer the pt a favorite stuffed toy and distract her by asking about the animal b) Place a heating pad on the pt leg and have her mother read her a story e) Encourage deep breathing by having the pt blow bubbles Management of sickle cell crisis is aimed at managing pain and promoting circulation. Deep breathing, application of heat, and offering a toy are all effective ways of managing pain. Immobilization, pressure and cool compresses cause vasoconstriction and can impede blood flow, which is contraindicated in sickle cell crisis. Family members should be encourage to stay at the bedside to offer comfort and help to minimize the tremors of hospitalization
A 5 y/o pt with sickle cell anemia has an order for oral codeine elixir 8 mg Q4H around the clock for pain. Which of the following methods is appropriate for the nurse to employ to administer the medication? a) Place med in an oral syringe and allow the pt to squirt into his or her mouth b) Hide med in applesauce or ice cream and have the parent feed the pt c) Use a dropper to place med in back of the pt's throat d) put med into a medicine cup and pour entire amount into the pt's mouth @ 1 time
a) Place med in an oral syringe and allow the pt to squirt into his or her mouth The preschool-aged or young school-aged child may enjoy using an oral syringe to squirt meds into his or her mouth; it is engaging and gives them sense of control. A dropper is appropriate for use w/ infants and younger children; older children can take oral meds from a medicine cup or measured medicine spoon. Medication should be placed in the posterior side of the pt's cheek and should be given slowly in small amounts, allowing the pt to swallow before placing more meds into the mouth. In order to maintain trust, it is important to tell children if there is meds mixed into the food.
A pt came to the emergency room with acute pain crisis secondary to sickle cell anemia. The pt received morphine sulfate IV 1 hr ago for severe pain and is awake, alert, and complaining of generalized itching. On inspection, the pt's skin is flat & w/o erythema. What action should the nurse take? a) call the provider and request an order for a med for the itching as needed b) Prepare and administer naloxone as an antidote to the opioid c) Administer acetaminophen for pain since the pt cannot tolerate the opioid d) stop administration of the opioid and note the pt's allergy
a) call the provider and request an order for a med for the itching as needed Itching (pruritus) is a common side effect of opiate meds. Antipruritic meds can be prescribes to manage itching, and stopping admin of the morphine is not indicated. Naloxone would be used to revers the effects of the opioid in the case of resp. depression, which is not needed int his case bc the pt is awake and alert. Urticaria may indicate that the pt is experiencing an allergic reaction to the med and should be reported to the provider, but this is not occurring in this case, as the pt's skin is flat and w/o erythema.
A nurse is caring for a meds pt who was recently diagnosed with sickle cell anemia. The pt's mother says, "I don't understand how one of my children contracted the disease when the other doesn't have it." Which of the following would be the best response by the nurse? a) Sickle cell anemia is transmitted through he father. Do your children have different fathers? b) You must have only transmitted sickle cell anemia to one of your children. Your other child definitely carries the trait c) Both parents have the sickle cell trait and your risk for having a child with sickle cell anemia is 25% with each pregnancy d) Sickle cell anemia is transmitted through the mother. IF you have four children, one or 25% will have sickle cell anemia.
c) Both parents have the sickle cell trait and your risk for having a child with sickle cell anemia is 25% with each pregnancy Sickle cell anemia is an autosomal recessive disorder; both parents have the trait for child to have the disease. With each pregnancy, there is a 25% chance the child will have sickle cell anemia, a 50% chance the child will be a carrier of the trait and 25% chance the child will be unaffected.
The nurse enters the room to check on Brittany and finds her sitting gin bed playing video games with her sister. VS: Temp, 37.4 C oral; HR 120 bpm; RR 26 bpm; BP 100/60 mmHg; & SpO2 97%. She rates her pain as a 5/5 on the FACES scale. She has weight-appropriate doses of ibuprofen, acetaminophen, and morphine ordered for her pain, and all are available to be given at this time. What would be the most appropriate med for the nurse to administer? a) Ibuprofen bc the pt is exhibiting signs of mild pain b) Acetaminophen bc the pt is not exhibiting signs of severe pain c) Morphine bc the pt reports severe pain d) Nothing bc the pt's behavior doesn't indicate signs of pain
c) Morphine bc the pt reports severe pain The pr self-reports pain 5/5 on the FACES pain scale, which indicates severe pain, and thus should be medicated with and opioid analgesic; morphine is the gold standard opioid agonist and drug of choice for severe pain. The pt's behavior and external signs are not as accurate as the self-report scale for indicating pain
A nurse is explaining the pathophysiology of vaso-occlusive pain crisis to the parent of a pt with sickle cell anemia. Which of the following explanations b the nurse is correct? a) Sickle cells cause increased blood flow throughout the body. The increased blood flow through the blood vessels causes tour child to have severe pain b) Sickled cells mix w/ normal RBCs and cause the immune system to become depressed, which makes your child more prone to illness c) Sickled cells clump together and cause the blood to become thicker, preventing blood flow through the smaller vessels, causing decreases oxygenation and increased pain in the affected area d) Bone marrow suppression occurs because of the development of sickled cells, which makes your child less able to fight infections.
c) Sickled cells clump together and cause the blood to become thicker, preventing blood flow through the smaller vessels, causing decreases oxygenation and increased pain in the affected area Sickle cell vaso-occlusive pain crisis occurs when sickled cells clump in the microvasculature, impeding blood flow ( not increasing it), causing local tissue hypoxia, which progresses to ischemia, resulting in severe pain as circulation to the affected area decreases. Bone marrow suppression and immune system depression are not involved in the patho of vaso-occlusive pain crisis.
Brittany has been receiving IV morphine for pain associated with a vaso-occlusive crisis for 1 week. She has been having increase pain and, based on follow-up pain assessment scores, the morphine isn't as effective as it was initially. The provider has increased the morphine dose, but her mother voices concerns that Brittany is addicted to the medication. Which of the following responses by the nurse is correct? a) You are right; Brittany has become dependent on the morphine. I will ask the provider to order meperidine instead. b) Brittany is addicted, but it won't last long. The addiction will go away as soon as we stop giving her the morphine. c) Brittany is not addicted to the morphine. Only adults can become addicted to meds d) Over time, drug tolerance occurs, requiring higher doses of morphine to relieve Brittany's pain. Tolerance is not addiction
d) Over time, drug tolerance occurs, requiring higher doses of morphine to relieve Brittany's pain. Tolerance is not addiction Brittany is demonstrating drug tolerance,which is different from physical dependence, or addiction. Drug tolerance occurs when increasing doses of medication are required to manage pain. Physical dependence, which can occur after as few as 5 days of continuous medication use, is a perceives need by the pt to continue taking the drug to prevent sx of withdrawal, which can occur if suddenly stopped. Addiction to narcotics when used to treat children's pain is very rare but does occur. Meperidine is not recommended for pain relief in children, as severe side effects such as seizures are associated w/ use.
A pt with sickle cell disease experiencing vaso-occlusive crisis comes tot he ER for evaluation. Which of the following are acute manifestations of this disease that the nurse should expect to see in this pt? a) acute leg pain and dactylitis b) Anemia and hypotension c) tachycardia and jaundice d)Enuresis and proteinuria
a) acute leg pain and dactylitis Acute manifestations of sickle cell anemia in a vaso-occlusive crisis include pain crisis and swelling of the fingers and toes (dactylitis). Hypertension and tachycardia are often associated with acute pain. Anemia, jaundice, enuresis, and proteinuria are chronic manifestations of sickle cell anemia.
A 5 y/o come to the ER with a hx of sickle cell anemia and acute leg pain. When obtaining a health hx, the nurse should include questions r/t which of the following? a) immunization hx b) Family hx of blood transfusion c) Past hospitalizations and Tx d) Frequency of vaso-occlusive crises e) Precipitating events
a) immunization hx c) Past hospitalizations and Tx d) Frequency of vaso-occlusive crises e) Precipitating events When obtaining a health hx on a pt with sickle cell anemia, the nurse should elicit info r/t growth and development, frequency of vaso-occlusive crises, Past hospitalizations and Tx for pain crises, immunization status, hx of blood transfusions, current medication regiment, and precipitating events. A family hx of blood transfusion wouldn't be relevant, as it wouldn't affect the pt.
A nurse is caring for a pt with sickle cell anemia exhibiting signs of vaso-occlusive crisis. Which of the following would be the highest priority and most appropriate nursing diagnosis in this case? a) fatigue r/t inadequate tissue oxygenation b) Anxiety r/t hospitalization c) Impaired physical mobility r/t to pain d) Acute pain r/t tissue ischemia
d) Acute pain r/t tissue ischemia Tx of sickle cell crisis focuses on pain management. Thus, the diagnoses pertains to fatigue, impaired mobility, and anxiety would be lower priority that that of acute pain