Pediatric Case 7: Brittany Long (Core) : Guided Reflection Questions

Pediatric Case 7: Brittany Long (Core)
Guided Reflection Questions
Opening Questions
How did the simulated experience of Brittany Long’s case make you feel?
It made me feel confident in determining what my initial focused assessment needed to be in order to
make Brittany comfortable.
Describe the actions you felt went well in this scenario.
I felt like my nursing intervention were age appropriate for Brittany. I felt like her pain management
went well because her pain began as a 3/5 and after intervention it was 0/5.
Scenario Analysis Questions1

EBP What is the relationship between fluid and oxygen therapy in the treatment of sickle cell
anemia?
Dehydration can cause a sickle cell crisis. If the child can’t orally hydrate, the IV fluid are
necessary. Monitoring O2, educating the child and parents on the use of the incentive
spirometry, proper hydration, an early recognition of a crisis, and how they are imperative in
preventing respiration complications and failure.
EBP What complications might Brittany Long face if her symptoms are not recognized and treated in
a timely manner?
Brittany could face the development of leg ulcers, restrictive lung disease, necrosis of the hip,
retinopathy respiration failure, and/or delayed puberty.
EBP What methods of pain management did you use and what other methods should be considered
for Brittany Long, based on the latest evidence-based practice?
The patient had ibuprofen in the ER and when I got her I gave her Morphine 2mg IV for her pain
3/5 based on the physician’s order. NSAIDs and oral opioids are given for mild to moderate
sickle cell crisis. If the pain is severe a PCA pump may need to be considers. Also offer her any
comfort measures like a toy or favorite drink if able.
1
The Scenario Analysis Questions are correlated to the Quality and Safety Education for Nurses (QSEN)
competencies: Patient-Centered Care (PCC), Teamwork and Collaboration (T&C), Evidence-Based Practice (EBP),
Quality Improvement (QI), Safety (S), and Informatics (I). Find more information at: http://qsen.org/
From vSim for Nursing | Pediatric. © Wolters Kluwer Health.

Pediatric Case 7
Brittany Long (Core)
PCC/I What discharge teaching should be provided to assist Brittany Long’s mother with her home
care?
Brittany’s mother and the family should be educated on the diagnosis, treatment regimen, need
for follow-up care, warning signs or potential problems that require medical attention. Ensuring
that the parents or caregivers are able to obtain the prescribed medications; ensure that they
know the desired effect and side effect of these meds. The mother or caregivers also be taught
on how to use the incentive spirometer, early recognition of signs and symptoms of a crisis.
S/QI Reflect on ways to improve safety and quality of care based on your experience with Brittany
Long’s case.
To improve safety and quality of care, I should manage her pain, making sure that she has
assistance when ambulating to the bathroom or other activities, keeping her bed in a low
position, and offering her comfort toys.
T&C/I Identify additional individuals who should be included on Brittany Long’s care team.
Other members of her care team should include physical therapy, family and friends, any
caregivers at home, the nurses and doctors.
T&C/I What key elements would you include in the handoff report for this patient? Consider the
situation-background-assessment-recommendation (SBAR) format.
S: Brittany Long, 5 year-old African American female, has history of sickle cell disease. She was
brought into the ED during the night by her mother. She stated that Brittany complaining of
right lower leg pain over the last 2 days. Brittany rated her pain as a 5 on the FACES scale, she
did not want anyone to touch her leg during assessment. She has taken small amount of fluid
and had not eat anything.
B: Her history of SCD was diagnosed at 6 months old and has been described regular folic acid
supplement. She has had pain crisis before and managed at home with acetaminophen and
ibuprofen. She was in the hospital twice due to vaso-occlusive crisis episode and once for a
fever.
A: HR 134, BP 106/72, T 37.3C, RR 25, SpO2 98%; there was normal elasticity of the skin, she
looked slightly pale and her skin is cool. The breath sounds were clear and equal bilaterally. The
right leg was warm to touch. Pain assessment was also performed and Brit reported the pain 3
out of 5 on the FACED scale. IV site was assessed and no redness, swelling, infiltration, bleeding,
or drainage; the dressing was dry and intact.
R: continue monitoring pain and vital signs and continue providing education about the disease
and what to do in crisis and prevents.

Pediatric Case 7
QI Discuss quality-of-care indicators for the management of children with sickle cell disease.
They have large morbidity and early mortality because of this disease so quality of care measure
should be utilized and used for hospital care management.

Pediatric Case 7
Concluding Questions
Reflecting on Brittany Long’s case, were there any actions you would do differently? If so, what were
these actions, and why would you do them differently?
I repeated the scenario 2 times, and I would have asked her mother any known health problems to
prevent further complications include acute chest syndrome, pulmonary hypertension, heart failure,
retinopathy, et cetera.
Describe how you would apply the knowledge and skills that you obtained in Brittany Long’s case to an
actual patient care situation.
I will apply the patient education that I have learned about early signs for recognition of a crisis and
implement this in my patients care and I will be able to educate them as well of these signs and
symptoms.

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Pediatric Case 7: Brittany Long (Core)

Guided Reflection Questions

Describe the actions you felt went well in this scenario.

Scenario Analysis Questions1

From vSim for Nursing | Pediatric. © Wolters Kluwer Health.

From vSim for Nursing | Pediatric. © Wolters Kluwer Health.

From vSim for Nursing | Pediatric. © Wolters Kluwer Health.

From vSim for Nursing | Pediatric. © Wolters Kluwer Health.

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