SR Pedi Answers Updated / Swift Rivers scenarios (answered) updated Spring 2022.

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SR Pedi Answers Updated Hayden Clark Room 305 Hayden Clark, 6-year-old male, weighing 44 lbs., comes to school looking disheveled, and not wearing a coat with the outside temperature in the low 40... ’s. Hannah Johnson Room 304 Hannah Johnson, 10-year-old female presented to the ED 45 minutes ago with dehydration, dysuria, and significant weight loss of 18 pounds over the last 2 months. Both parents are with the child, the father is insisting that he be notified of all interventions before they are initiated.  Initial assessment reveals: Skin dry and warm to touch, B/P 90/58, T 99.2 F, 37.3 C, HR 110, RR30. Child appears thin. Breathing is fast and deep. Noted fruity odor to breath. Initial labs: CBC WNL, K+ 2.89, BG 459, Urinalysis: Positive for ketones, glucose, and bacteria. Orders: IV 0.9% normal Saline at 150 ml/hour, Add 20 mEq K+ after first liter, Ampicillin 250 mg PO q 6 hours, finger stick blood glucose (FSBG) q 1 hour Amanda Blaire Room 301 Amanda Blaire, 14-year-old female, who was in an ATV accident and now has a fractured tibia and fibula. Her vital signs are Temperature 98.6 F, 37.0 C, HR 87, BP 111/72, RR 18, PaO2 97%. She is post-op day 1 with continuous traction and skeletal pins to immobilize leg. Baby Harris Room 302 Baby Harris, 4-hour-old newborn male, weight 6.6 lbs. with a length of 18” and approximate gestational age of 36 weeks. Late prenatal care. Mom has history of methamphetamine and heroin addiction. In addition, the mom admits to smoking 1 pack per day through pregnancy. Urine drug test on baby positive for heroin and methamphetamine. VS: T 98.1 F, 36.7 C, HR 178, R 70, PaO2 96%. Paul Windsor Room 303 Paul Windsor, 4-year-old male admitted yesterday from the clinic with a diagnosis of Nephrotic Syndrome. Vital signs: Temperature 99.0 F, 37.2 C, HR 88, BP 104/76, RR 22, PaO2 95%. He presented yesterday with his parents reporting a gradual increase in pain and “swelling” around his eyes and ankles, and now his stomach is getting “bigger". Paul has little to no appetite. Current weight is 56 pounds compared to a usual weight of 43 pounds. Urinalysis: Thick, frothy appearance. Specific gravity: 1.025. Protein 3+. Blood 2+. Other labs: Triglycerides 180 mg/dl. Cholesterol 190 mg/dl. Group B strep Paula Smith Room 304 Paula Smith, 16-year-old female. She is a dancer who presents to the clinic for a yearly physical, and is found to have significant weight loss, loss of menstrual cycles, and depression. She is 5’7” and weighs 94 pounds. culture negative in office. Baby Strickland Room 305 Maria Hernandez Room 306 Maria Hernandez, 6-year-old female, weighing 39.6 lbs. with a history of Sickle Cell Disease. She has presented to the ED in sickle cell crisis and has a history of UTIs. Vital signs: Temp 101.8 F, 38.8 C, B/P 131/79, HR 108, PaO2 87% room air, RR 51. Mark Quinn Room 307 Jonathan Gibbons Room 308 Hannah Johnson 10-year-old female presented to the ED 45 minutes ago with dehydration, dysuria, and significant weight loss of 18 pounds over the last 2 months. Both parents are with the child, the father is insisting that he be notified of all interventions before they are initiated.  Initial assessment reveals: Skin dry and warm to touch, B/P 90/58, T 99.2 F, 37.3 C, HR 110, RR 30. Child appears thin. Breathing is fast and deep. Noted fruity odor to breath. Initial labs: CBC WNL, K+ 2.89, BG 459, Urinalysis: Positive for ketones, glucose, and bacteria. Orders: IV 0.9% normal Saline at 150 ml/hour, Add 20 mEq K+ after first liter, Ampicillin 250 mg PO q 6 hours, finger stick blood glucose (FSBG) q 1 hour. Baby Harris 4-hour-old newborn male, weight 6.6 lbs. with a length of 18” and approximate gestational age of 36 weeks. Late prenatal care. Mom has history of methamphetamine and heroin addiction. In addition, the mom admits to smoking 1 pack per day through pregnancy. Urine drug test on baby positive for heroin and methamphetamine. VS: T 98.1 F, 36.7 C, HR 178, R 70, PaO2 96%. Baby Strickland 1-hour-old newborn female, 37-week gestational age born via C-section, weight 9.9 lbs. Mom has history of diabetes, not well controlled. Jonathan Gibbons 13-year-old male diagnosed with asthma since he was 3 years old. He uses a rescue albuterol inhaler (PRN) on an "as needed" basis. Jonathan presents to the clinic with what his mother calls a “bad cold and cough” that has been present for 3 days. Vital signs and assessment: B/P 110/65 T100.8 F, 38.2 C, HR 110 RR 26, PaO2 92%. Bilateral wheezing can be heard throughout all lung fields. Jonathan is seen in a tenting position and using accessory muscles to breathe. He has been using his rescue albuterol inhaler q 2 hours for the last 6 hours with minimal relief. Orders: Admit to the pediatric unit at Children’s hospital, IV methylprednisolone 40mg q day, Ampicillin 250 mg IV q 6 hours, Tylenol 500 mg PO q 6 hours prn Temp/Pain, Xopenex 0.63 mg q 6 hours per nebulizer and PRN. Maria Hernandez 6-year-old female, weighing 39.6 lbs. with a history of Sickle Cell Disease. She has presented to the ED in sickle cell crisis and has a history of UTIs. Vital signs: Temp 101.8 F, 38.8 C, B/P 131/79, HR 108, PaO2 87% room air, RR 51 Mark Quinn 9-year-old male comes to the school nurse with complaints of abdominal pain and nausea. Vital signs: Temperature 98.2 F, 36.8 C, HR 87, BP 104/ 67, RR 22, PaO2 97%. The nursing assessment reveals diffuse lower abdominal pain, tenderness, and normoactive bowel sounds. After consultation with the child and the parents, the child is sent home with a possible viral intestinal infection. Paul Windsor 4-year-old male admitted yesterday from the clinic with a diagnosis of Nephrotic Syndrome. Vital signs: Temperature 99.0 F, 37.2 C, HR 88, BP 104/76, RR 22, PaO2 95%. He presented yesterday with his parents reporting a gradual increase in pain and “swelling” around his eyes and ankles, and now his stomach is getting “bigger". Paul has little to no appetite. Current weight is 56 pounds compared to a usual weight of 43 pounds. Urinalysis: Thick, frothy appearance. Specific gravity: 1.025. Protein 3+. Blood 2+. Other labs: Triglycerides 180 mg/dl. Cholesterol 190 mg/dl. Group B strep culture negative in office Paula Smith 16-year-old female. She is a dancer who presents to the clinic for a yearly physical, and is found to have significant weight loss, loss of menstrual cycles, and depression. She is 5’7” and weighs 94 pounds. Amanda Blaire 14-year-old female, who was in an ATV accident and now has a fractured tibia and fibula. Her vital signs are Temperature 98.6 F, 37.0 C, HR 87, BP 111/72, RR 18, PaO2 97%. She is post-op day 1 with continuous traction and skeletal pins to immobilize leg. Suzanne Williams 5-year-old female, weight 35.2 lbs., recently diagnosed with leukemia. CBC results: neutroph count 30,000. She is reporting gradual arm and leg pain at a 6/10 over the last 4 weeks. Pare “growing pains”. Patient experiencing n/v/d and loss of appetite. Vital Signs Temperature 100 100/65, RR 23, PaO2 95%. The patient is beginning a second round of chemotherapy. Baby Harris Scenario 1 You are concerned about this baby four hours after birth because he is now exhibiting exces has a high-pitched cry. To confirm your suspicion that he is a drug addicted baby, your treatm Baby Strickland Scenario 1 Assessment: baby appears jittery, temp 97.2 under warmer, RR 62, HR 160 Jonathan Gibbons Scenario 1 Jonathan states that he is having increased difficulty breathing over the last 20 minutes. Maria Hernandez Scenario 1 Assessment reveals: left knee swollen, red, and tender to touch. Pain is rated 9/10. Temperat 130/74, HR 110 pulse oximeter is 86% on room air. Maria is crying, unable to be consoled. H Mark Quinn Scenario 1 Mark, 9 years old, presents to the ED with abdominal cramps, nausea, vomiting x 2 days wit F. HR 98 RR 24 B/P 120/74 O2 sat 98% in room air. Paul Windsor Scenario 1 CBC from last night shows the following: Hgb -18g/dl, and Hct 43%. Paul’s skin is dry to touc manda Blaire Scenario 1 Amanda is due now for a scheduled 2-hour position change Hannah Johnson Scenario 1 Hannah is fearful of administering insulin. You must attempt to help her gain confidence. Suzanne Williams Scenarios 1 -5 The parents do not know anything about Leukemia, or the treatments. The nurse is providing parents and Suzanne. Hayden Clark Scenario 1-5 Hayden has come to the school nurse complaining of a stomachache. [Show More]

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