Pediatric Case 1: Jackson Weber (Core)

Guided Reflection Questions

Opening Questions
1. How did the simulated experience of Jackson Weber’s case make you feel?
a. I panic the first go around. I felt like I was not taking care of the patient and that I was
killing him.
2. Describe the actions you felt went well in this scenario.
a. I was so relived when I got to the end of the scenario and I had done most everything
right and had not scored as poorly as I thought.
b. So the second time around I felt more confident in what I was doing and scored 97. It
was a very helpful SIM.

Scenario Analysis Questions1

1. EBP/S
a. What priority problem did you identify for Jackson Weber?
i. Ineffective seizure management/compliance
2. EBP
a. What complications might Jackson Weber face if safety precautions are not taken during
the seizure activity and if treatment is not implemented after the seizure?
i. He could aspirate  suctioning
ii. Fall out of bed and injure himself if siderails are not up
iii. He could hurt himself if items are left in the bed
iv. His O2 sat could drop  O2
v. he could try to get out of bed or bath on his own if call light isn’t accessible
3. PCC
a. What should the nurse teach Jackson Weber’s mother regarding the ongoing care of his
condition?
i. To remain calm
ii. Ease to the ground if standing or sitting if possible
iii. Time the seizure episode
iv. Tight clothing and jewelry around the neck should be loosened, if possible
v. Place child on one side and open airway, if possible
vi. Do not restrain the child
vii. Remove hazards in the area

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.

 viii. Do not forcibly open jaw with a tongue blade or finger
ix. Document length of seizure and movements noted, also cyanosis or loss of
bladder or bowel control and any other characteristics
x. Remain with child until fully conscious
xi. Call EMS if
1. The child stops breathing
2. Any injury has occurred
3. Seizure lasts for more than 5 min
4. If this is the child’s first seizure
5. If child is unresponsive to painful stimuli after seizure
xii. How important compliance with medications/dr visits/ blood work for the
client’s condition
xiii. Educate on the medications along with adverse effects and if the child is unable
to take the medications (ex: vomiting)
4. PCC/S
a. What seizure precautions should be taken by the nurse in anticipation of and at the
onset of Jackson Weber’s seizure? How might such precautions vary from hospital to
hospital?
i. Make sure O2 mask and tubing are in the room and the O2 works
ii. Make sure suctioning equipment works and new suctioning tubing and cannister
are available
iii. Pads on bed siderails
iv. All side rails are up
v. Make sure there are no objects in the bed the child could harm himself on if he
has a seizure
vi. Pt has seizure medical alert bracelet
vii. Pt is supervised during bathing, ambulation and other potentially hazardous
activities
viii. Be prepared to admin meds

5. PCC/S Describe strategies to empower Jackson Weber and his mother in the management of
his seizures.
a. Make sure not only the patient but family members are educated about the disorder to
reduce any anxiety they may have about the seizures
b. Make sure the parents understand how important it is for the child to understand, once
he is old enough, about the disorder and its management
c. Referral to support groups
d. Any helpful information about the disorder
e. Make sure the patients’ family/caregivers and patient know how important compliance
is with all treatments including lab work

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

 6. T&C
a. List potential team members in Jackson Weber’s care. (Explain your answer.)
i. Possible social worker to address/assist with any financial issues/needs
ii. Pharmacist to assist with any questions/advice on medications
iii. Support group facilitation/information
iv. Case management to on working with school nurse for patient care
7.
a. T&C/I What key elements would you include in the handoff report for this patient?
Consider the situation-background-assessment-recommendation (SBAR) format.
i. S Jackson Weber, 5-year-old Caucasian male. Diagnosed with generalized tonic-
colonic seizure 2 years ago. pt came in today for a seizure through ED following
a three min seizure tonic colonic seizure and was admitted for observation;
ii. B Has a hx of seizures but has been seizure free for 15 months until today. Pt is
on phenobarbital orally at home. Mom is single parent and hasn’t taken the
client back to his neurologist for follow ups due to work
iii. A eating well; has urine output; vital signs were stable and then during my
assessment he another 1 min. seizure; phenobarbital 50mg was administered;
pt last vital signs were BP- 120/81 HR – 85 RR – 18 TEMP – 98
iv. R Continue to monitor q 4hrs. Neuro Checks every 4 q hours; maintain Seizure
precautions; Dr has specific parameters for the patient to maintain if not
contact prescriber

Concluding Questions
8. Reflecting on Jackson Weber’s case, were there any actions you would do differently? If so, what
were these actions, and why would you do them differently?
a. I would have gotten to the interventions faster
b. I would have been more prepared for the seizure
c. I would have educated the relative faster as well

9. Describe how you would apply the knowledge and skills you obtained in Jackson Weber’s case to
an actual patient care situation.
a. seizure precautions  how to maintain and prevent injury
b. On patient/family education  information and amount of people who need educating
c. Team members possibly needed to be involved in care  way to provide support to
family dealing with health related financial issues
d. More prepared to handle a patient who has a seizure  confidence in my abilities

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