Nursing 356 - Simulation Skills Laboratory Activities

Week 1: Pediatric Physical Assessment

Activity 1: Demonstrate a complete head to toe physical assessment on Sim-Baby. Document your findings on the attached physical assessment form (adapted from the short care plan).

Activity 2: Complete the following:

Ref: Study Guide for Nursing Care of Children; Prinicples and Practice. (2nd ed). Rosner & Kiehne. 2002.

Answer the following as either true or false.

  1. It is appropriate to auscultate the heart, lungs, and abdomen while an infant is sleeping. ______
  2. Stranger anxiety makes the physical examination of an older infant more difficult. ______
  3. Parents should not be present during a young child’s physical examination.______
  4. In all age groups, invasive procedures should be saved until the end of the examination.______
  5. Adolescents should be allowed to participate in deciding who will be present during the physical examination.______
  6. Axillary temperatures are preferable to rectal temperatures because they are less invasive.______
  7. The apical impulse is palpated to determine the position of the heart.______
  8. All irregular heart rhythms in children require immediate attention.______
  9. The respiratory rate in infants can be counted by observing the movements of the abdomen.______
  10. A blood pressure cuff that covers three-quarters of the distance between the child’s antecubital fossa and shoulder will give a falsely low reading.______
  11. Breathing is diaphragmatic in a school-age child.______
  12. Prior to auscultating breath sounds, have a toddler sit on the parents lap.______
  13. Normal breath sounds are called adventitious.______
  14. The apical pulse is also called the point of maximal impulse (PMI).______
  15. Auscultation of the heart is best done by listening with the bell of the stethoscope only.______
  16. Splitting of the S2 heart sound is a normal finding in children.______
  17. Functional heart murmurs require immediate intervention.______
  18. For adolescents, the physical examination proceeds from head to toe.______

Fill in the blanks.

  1. Chest circumference is measured at the ______.
  2. On a child, the nurse assesses skin turgor on the ______.
  3. Unusual hair loss is called______.
  4. Excessive hair growth is called ______.
  5. When a child has head lice, nits are found in the ______.
  6. Capillary refill should be within ______seconds in a healthy child.

PHYSICAL ASSESSMENTDate: ______Time: ______

Client Name:______Client Diagnosis:______

(Please highlight abnormal findings)

Current vital signs, Ht/Wt/ HC and percentiles:

General Survey:

Skin:

Head:

Eyes/Vision:

Ears/Hearing:

Nose:

Mouth:

Neck:

Heart:

Thorax/Lungs/Breasts:

Abdomen:

Genitalia:

Spine/ Back/ Extremities/MS:

Neurologic/Glasgow/Reflexes:

Psychosocial:

Pain (include which scale was used for rating):

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Week 2: Pediatric Medication Administration and National Patient Safety Guidelines

Activity 1: Review the National Patient Safety Guidelines

Activity 2: Medication Calculations

  1. You are administering Aldactone/ spironolactone to a 3 year old child diagnosed with CHF who weighs 33 pounds. The child has a history of edema and hypertension.
  • What is the recommended weight based children’s dose (use your med book)?
  • What is the safe dose range for this child?
  • What would be the top 3 nursing considerations?
  1. You are admitting a 4 year old child with sepsis weighing 45 pounds who is febrile. The doctor has not ordered any antipyretics and you need to call him for an order.
  • What is the recommended weight based children’s dose (use your med book)?
  • What is the safe dose range for this child?
  • What would be the top 3 nursing considerations?
  1. You are caring for a 9 year old weighing 88 pounds who has an abscess that cultures positive for MRSA. The doctor has ordered vancomycin IV every 8 hours.
  • What is the recommended weight based children’s dose (use your med book)?
  • What is the safe dose range for this child?
  • What would be the top 5 nursing considerations when administering this medication?
  • What is the recommended dilution for this medication IV?
  • Which IV fluids are compatible with this medication?
  1. You are administering prednisone to a 6 year old child with Status Asthmaticus who weighs 62 pounds. The doctor ordered Solumedrol 40 mg IV every 6 hours. The child is also taking INH and rifampin for TB.
  • What is the recommended weight based children’s dose (use your med book)?
  • What is the safe dose range for this child?
  • What would be the top 3 nursing considerations?
  1. You are caring for a 10 month old child with pneumonia who has a harsh, choky cough. The doctor is ruling out pertussis and has ordered erythromycin po. The child weighs 17 pounds. The child is also receiving nebulized albuterol every 4 hours and prn.
  • What is the recommended weight based children’s dose (use your med book)?
  • What is the safe dose range for this child?
  • What would be the top 3 nursing considerations?
  • If ordered IV – how would you give it?

6. A nurse should routinely ask a colleague to double-check a medication calculation and the actual medication before administering which of the following medications?

Select all that apply.

a. / Antibiotics
b. / Insulin
c. / Anticonvulsants
d. / Anticoagulants

e. Narcotics

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Week 3: Pediatric Fluid and Electrolytes

Activity 1: Pediatric IV starts on Sim- Baby. Work with instructor in groups of 1-2.

Activity 2: Complete the following.

24 hour Fluid Calculations

Calculate the 24 hour fluid requirements for each of the following patients:

  1. Three year old weighing 36 pounds.
  1. One year old weighing 19 pounds.
  1. Five year old weighing 53 pounds.
  1. Ten year old weighing 41 kg.
  1. Infant weighing 9#6oz.
  1. You are admitting a 2 year patient weighing 25 pounds with a history of diarrhea and vomiting for 3 days. The doctor has ordered IV fluids at 1.5 maintenance for the first 24 hours. What will the rate be?
  1. The doctor has ordered a fluid bolus of NS 100ml/kg over 2 hours on a child who weighs 44 pounds. What is the total volume of the fluid bolus? How many ml’s will you give per hour?
  1. You are caring for a 21 kg child with MRSA and renal failure. The child is on fluid restrictions of 1500 ml per day. The child is receiving D5E48 @ 10 ml/hr; Vancomycin 40 mg/kg/day divided into 3 doses given every 8 hours that is diluted with D5W to equal 5 mg/ml and given over 60 minutes.
  • How many ml of fluid per day is the child receiving in IVF and IV medications?
  • What is the maximum volume of po fluid the child safely take per day without surpassing his fluid restriction?

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Week 4: Genitourinary System and Immune System

Activity 1: Catheterization of pediatric patients using Sim-Baby, 1-2 students per group.

Activity 2: Case Study – answer the following questions.

CASE STUDY –

REF: R. Belkengren, MD & S. Sapala, EdD, CPNP

Pediatric Management Problems, Pediatric Nursing

May-June, 1997/vol.23/No.3

(modified from original format and study)

Case:

Al, age 9 years old, is sent home from school by his teacher because he is disrupting the class by constantly coughing. Ms. Beta, Al’s grandmother and legal guardian, recently registered Al in the nearby ambulatory HMO clinic. A review of the health history forms for medication or significant illness is negative. Al said he got a cold and started coughing this morning on the way to school, and during gym (physical education) class his chest was hurting.

FAMILY/SOCIAL HISTORY

Al, and his brother, age 12 years old, recently moved to California to live with their grandmother. Their mother died in an automobile accident 3 months ago.

PAST MEDICAL HISTORY

Ms. Beta was unable to add any additional information regarding past medical illnesses. She gave Al a dose of Tylenol this morning because he felt warm.

PHYSICAL EXAMINATION

Vital Signs- Wt: 55 lbs Ht: 51 inches

Temp. 100 (ax), BP 100/64; HR 92; RR 28.

General Appearance: pale, coughing, anxious, able to answer questions, but short of breath with speaking.

Eyes: Conjunctiva clear, no discharge, no icterus

Ears: TM’s intact, light reflex present, no injection

Nose: Rhinorrhea (mild), clear in color

Throat: no injection, no exudate, + gag reflex

Lungs: bilateral wheezing, prolonged expiratory phase, using abdominal muscles to breathe, no nasal flaring, O2 sats 89%.

Heart: S1S2 normal, no murmur, rate 92 and regular.

Abdomen: no organomegaly, normal bowel sounds, no tenderness.

Additional data: unable to use peak flow meter, unable to blow hard enough.

What is your assessment?

  1. Highlight data from above that is not within “normal” parameters.
  1. What medical diagnosis should be considered for this child?
  1. What 5 things should be included in the doctor’s admission orders?
  1. What are the top 3 nursing diagnosis you would consider for this child?
  1. Which nursing interventions should be a priority for this child, why?
  1. What are his percentiles on the growth chart for HT and WT? Based on this information, what teaching should be included in your plan of care?

NCLEX QUESTIONS: Alternate Format

  1. You are caring for a child weighing 44 pounds who is hospitalized with vomiting and severe dehydration. The doctor has ordered parenteral rehydration therapy to restore circulation. The order is for sodium chloride (0.9%) solution in a 20ml/kg bolus. How much will you give? (Show all calculations!)

8. You are the nurse caring for a child with celiac disease. Which of the following food choices by a parent indicates understanding of teaching? Select all that apply.

a. / Oatmeal
b. / Steamed Rice
c. / Corn on the cob
d. / Baked chicken

e. Peanutbutter and jelly sandwhich on wheat bread

9. A child with secondary enuresis who complains of dysuria or urgency should be evaluated for which of the following conditions? Select all that apply.

a. / Hypocalciuria
b. / Nephrotic syndrome
c. / Glomerulonephritis
d. / Urinary tract infection

e. Diabetes mellitus

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Week 5 – Respiratory and Cardiac Systems

Activity 1: Pediatric Simulation. Break into 2-3 groups. Each group will work together through the simulation case.

Activity 2: NCLEX questions related to the respiratory and cardiac systems.

Ref: Instructor’s Electronic Resource to accompany Nursing Care of Children: Principles and Practice (2nd ed). James, Ashwill, & Droske, 2002.

RESPIRATORY

1. Which of the following changes in the respiratory system occur postnatally?
1. Respirations are stimulated by hypoxemia.
2. It takes up to 48 hours for most of the alveoli to expand.
3. Surfactant in the lungs interferes with lung expansion.
4. Pulmonary blood flow decreases after birth.
2. What information would the nurse teach families about reducing exposure to pollens and dust?
1. Replace wood and tile floors with wall-to-wall carpeting.
2. Do not use an air conditioner. Open windows for ventilation.
3. Put dust-proof covers on pillows and mattresses.
4. Keep humidity in the house above 60 percent.
3. A child has had cold symptoms for over 2 weeks, a headache, and a cough that increases during sleep. The nurse recognizes these symptoms are characteristic of which respiratory condition?
1. Allergic rhinitis
2. Bronchitis
3. Asthma
4. Sinusitis
4. The child with chronic otitis media with effusion should be evaluated for which of the following problems?
1. Brain abscess
2. Meningitis
3. Hearing loss
4. Perforation of the tympanic membrane
5. The nurse would expect a child with an acute otitis media infection to receive which of the following treatments?
1. If asymptomatic, no treatment necessary
2. An oral antibiotic, such as amoxicillin, several times a day for 7 days
3. A sulfonamide orally once a day at bedtime
4. Myringotomy with tympanoplasty tubes
6. Which statement made by a parent indicates understanding about treatment of streptococcal pharnygitis?
1. “I guess my child will need to have his tonsils removed.”
2. “A couple of days of rest and some ibuprofen will take care of this.”
3. “I should give the penicillin 3 times a day for 10 days.”
4. “I am giving my child prednisone to decrease the swelling of the tonsils.”
7. Which of the following symptoms is characteristic of laryngomalacia?
1. Stridor
2. High-pitched cry
3. Nasal congestion
4. Irritability
8. The nurse would assess a child who has had a tonsillectomy for which of the following signs?
1. Frequent swallowing
2. Inspiratory stridor
3. Rhonchi
4. Elevated white blood cell count
9. Which of the following is a distinguishing manifestation of spasmodic croup?
1. It has a gradual onset.
2. It has a sudden onset, usually at night.
3. It is bacterial in nature.
4. The child complains of a sore throat prior to onset.
10. Which of the following interventions for treating croup at home should be taught to parents?
1. Have a decongestant available to give the child when an attack occurs.
2. Have the child sleep in a dry room.
3. Sit with the child in the bathroom with the shower on when an attack occurs.
4. Give the child a prophylactic bronchodilator at bedtime.

11. The nurse is planning care for a three year old child with epiglottitis. Prioritize the following nursing concerns in the management of a child with epiglottitis. Use the numbers 1,2,3,4,5. Prioritize from highest priority (number 1) to lowest priority (number 5).

___ / Adequate hydration
___ / Maintain a patent airway
___ / Decrease anxiety
___ / Ensure adequate rest
Ensure safety

CARDIAC

1. Which of the following statements about fetal circulation is correct?
1. Oxygen is carried to the fetus by the umbilical arteries.
2. Blood from the inferior vena cava is shunted directly to the right ventricle through the foramen ovale.
3. Pulmonary vascular resistance is high because the lungs are filled with fluid.
4. Blood flows from the ductus arteriosus to the pulmonary artery.
2. Which of the following postoperative interventions would be questioned for a child following a cardiac catheterization?
1. Continue intravenous I(V) fluids until the infant is tolerating oral fluids.
2. Check the dressing for bleeding.
3. Assess peripheral circulation on the affected extremity.
4. Keep the affected leg flexed and elevated.
3. Which of the following information would be included in the nurse’s discharge instructions for a child who underwent a cardiac catheterization earlier in the day?
1. Inspect the catheter insertion site for bleeding or drainage.
2. The child may soak in the tub beginning tomorrow.
3. Contact sports can be resumed in 1 month.
4. The child can return to school after a follow-up visit with the cardiologist.
4. Which of the following is done first in a cardiac assessment?
1. Percussion
2. Palpation
3. Auscultation
4. History and inspection
5. In which of the following situations is there a risk that a newborn will have a congenital heart defect (CHD)?
1. Trisomy 21 detected on amniocentesis
2. Family history of myocardial infarction
3. Father has type 1 diabetes mellitus
4. Older sibling born with Turner’s syndrome
6. Before giving a dose of digoxin (Lanoxin), the nurse checked an infant’s apical heart rate and it was 114 beats per minute. What should the nurse do next?
1. Administer the dose as ordered.
2. Hold the medication until the next dose.
3. Wait and recheck the apical heart rate in 30 minutes.
4. Notify the physician about the infant’s heart rate.
7. Which of the following interventions would be included in the plan of care for an infant with the nursing diagnosis: Fluid Volume Excess related to congestive heart failure?
1. Weigh the infant every day on the same scale at the same time.
2. Notify the physician when weight gain exceeds more than 20 g/day.
3. Put the infant in a car seat to minimize movement.
4. Administer digoxin (Lanoxin) as ordered by the physician.
8. The nurse assessing a premature newborn auscultates a continuous machinery-like murmur. This finding is associated with which congenital heart defect?
1. Pulmonary stenosis
2. Patent ductus arteriosus
3. Ventricular septal defect
4. Coarctation of the aorta
9. Which of the following is an expected assessment finding in a child with coarctation of the aorta?
1. Orthostatic hypotension
2. Systolic hypertension in the lower extremities
3. Blood pressure higher on left side of the body
4. Disparity in blood pressure between the upper and lower extremities
10. Which of the following is a compensatory response to chronic hypoxia?
1. Polycythemia
2. Pulmonary hypotension
3. Dehydration
4. Anemia
11. Which statement made by a parent indicates understanding of activity restrictions for a child following cardiac surgery?
1. “My child needs to get extra rest for a few weeks.”
2. “My son is really looking forward to riding his bike next week.”
3. “I’m so glad we can attend services as a family this coming Sunday.”
4. “I am going to keep my child out of day care for 6 weeks.”

Week 6 – Movie Week!

Caring for Children Undergoing Procedures, Conscious Sedation

Health Problems: Cancer, Eating Disorders, Skin Alterations

Activity 1: View and discuss the following movies:

  1. Pediatric Conscious Sedation
  2. Common Rashes - #RJ 511 C65
  3. Kids with Cancer - #RC 281 C4 K44 1922

4. Dying to be Thin

Activity 2: Review forms and policies from Memorial and KMC related to conscious sedation.

Answer the following questions:

  1. What are the pre-sedation requirements for a child who will be undergoing conscious sedation?
  1. What are the intra-sedation nursing activities and considerations for a child undergoing conscious sedation?
  1. What are the post-sedation nursing activities and considerations for a child who has completed conscious sedation?
  1. Name three medications that would be considered “conscious sedation”.

NCLEX QUESTIONS: Alternate Format

5. Which of the following medications are the most effective choices for treating pain associated with inflammation in children? Select all that apply.

a. / Morphine
b. / Acetaminophen (tylenol)
c. / Ibuprofen (advil)
d.
e. / Toradol (ketorolac)
Aspirin

6. A child who is hospitalized has just received a dose of IV morphine for pain and has an anaphylactic reaction. Which of the following does the nurse identify as serious features of anaphlaxis?

a. / Itching of the skin
b. / Cyanosis
c. / Hypertension
d. / Wheezing

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Week 7 - Hematologic, Shock, Endocrine function,Infectious Diseases

Activity 1: Sim Baby

Activity 2: Read and complete the following.

Ref: Study Guide for Whaley & Wong’s Nursing Care of Infants and Children (6th ed.). Wong, Hockenberry-Eaton, Wilson, Winkelstein, Ahmann, Divito-Thomas.

Case Study #1

Mary, Age 9, has sickle cell anemia. She is admitted to the hospital with knee and back pain and is diagnosed with sickle cell vaso-occlusive crisis.

  1. In developing a plan of care for Mary, you understand that Mary’s pain is related to what?
  1. Describe the nursing interventions that you will include in your plan of care to control pain during this vaso-occlusive crisis.
  1. You are developing an educational plan about sickle cell anemia for Mary and her parents. What will you include in your teaching plan that will help prevent recurrence of crisis?
  1. Based on Mary’s age, what stages of growth and development has she entered?

Piaget