Worksheets to Prepare for Simulation Cases Module - Pediatric vSim Scenario (Patient) – Brittany Long (Complex) Part 1: Plan of Care Concept Map (adapted from vSim template) Simulation Patient O... verview Client summary: presentation, medical history and background, physical assessment findings, medications, diagnostics brief summary of pathophysiology and rationale for clinical manifestations Brittany Long is a 5-year-old African American female with a history of sickle cell anemia (HbSS) treated with regular folic acid supplement who came in yesterday with an acute vaso-occlusive pain crisis. Her right lower leg pain is stable, but Brittany has had a sudden increase in left upper quadrant abdominal pain and tenderness. Her spleen is palpated 3 cm below the left costal margin. She rated her abdominal pain a 5 on the FACES Scale and received morphine sulfate. She continues to receive intravenous maintenance fluids at 52 mL/hr and is on a nasal cannula with oxygen 2 L/min. She is pale and weak and just wants to sleep. Her mother is concerned about her increasing fatigue. Her urinary output is decreased, and she no longer wants to take fluids by mouth, not even for mom. Her vital signs have been taken every 2 hours, and she had labs drawn twice. Her last hemoglobin was decreased by 1.3 g/dL and is now 7.5 g/dL; platelets are also decreasing and are 200; her reticulocyte count is increasing and is 7.5. Legal consent to give blood products has been obtained from the mother. Sickle cell disease is a group of inherited hemoglobinopathies in which the RBCs do not carry the normal adult hemoglobin, but instead carry a less effective type. Instead of Hgb AA, individuals with sick cell anemia have Hgb SS. In hemoglobin S, glutamic acid is replaced with valine in the hemoglobin molecule. This results in an elongated RBC with a shortened life span. The elongated cell is more rigid than a normal cell and becomes sickled in shape. Complications of sickle cell anemia include recurrent vaso-occlusive pain crises, stroke, sepsis, acute chest syndrome, splenic sequestration, reduced visual acuity related to decreased retinal blood flow, chronic leg ulcers, cholestasis and gallstones, delated growth and development, delayed puberty, and priapism. Children with sickle cell anemia have an increas [Show More]
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