Pediatric Case 5: Eva Madison (Core)

Guided Reflection Questions

Opening Questions
How did the simulated experience of Eva Madison’s case make you feel?

I felt very good about this scenario, I feel that I was able to put knowledge into practice and treat the
patient in the right way with the best result.

Describe the actions you felt went well in this scenario.

During this scenario I felt well, I was able to assess the patient quickly and efficiently, I directed my
assessment primarily to the symptoms and functions related to her symptoms, vital signs, pain and GI
assessment.

Scenario Analysis Questions1

EBP What priority problem did you identify for Eva Madison?

Based on the information the mom gave me, I prioritized dehydration and pain for Eva Madison

EBP What complications might Eva Madison face if her symptoms are not recognized and actions are
not initiated in a timely manner?

She could face severe dehydration which could cause other complications such as
urinary/kidney problems, seizure, hypovolemic shocks. At the assessment, she began to show
signs such as dry and crackle lips, and her heart rate stated to rise.

PCC What actions should be implemented to decrease anxiety in Eva Madison and her mother?

I would first calm the mother and Eva Madison then explained to them that Eva Madison had
gastroenteritis. Instruct them that she has order for oral rehydration fluid to hydrating her, and
she should feel better. I also provide the girl with stuffed animal, allow the mother to be with
the child and participate in some way in the procedure that can be done.

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.

PCC Describe age-appropriate strategies to empower Eva Madison and her mother in all aspects of
the health care process.

It is important to include both mother and Eva Madison into her care. They should be aware of
everything that is going on, what procedures the nurse is going to do and the treatment to help
them. Using the pictures can help in teaching the girl.

PCC/S What should you teach Eva Madison and her mother about home care of a patient with
gastroenteritis?

The patient must remain on a clear liquid diet for the next 24 hours, avoid sweet carbonated
and caffeinated drinks. If vomiting or diarrhea persist or worsens return to doctors/ED, watch
for signs of dehydration such as thirst, dry cracked lips, dark color urine, sleepiness, low energy

T&C What role do you feel Eva Madison’s mother has as a member of her health care team? (Explain
your answer.)

Eva will be more comfortable with her mom than with any nurse who cares for her, more likely
to cooperate with any procedure when her mother is there. She is very important member of
Eva’s healthcare team because she will be the one who continues Eva’s care once they go home.
Education is very important part of the care plan to ensure that Eva’s mother can provide
accurate and beneficial care.

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: Eva Madison is admitted to the ED with vomiting, diarrhea, for 2 days. The lips are dry and
crackle, her mouth is still moist.

B: Eva Madison is 5 years old Caucasian female. She is 20.5 kg and stay the same since the last
check-up few month ago, and height is 120 cm. She has no significant medical history.

A: Vital Signs: HR 110, BP 133/92, RR 18, T 37.8, SpO2 97%. She had normal breathing; the chest
is moving equally. She reported no pain on the FACES pain scale. She had normal elasticity of the
skin. Her color normal and not sweating. Her bowel sound was hyperactive. She reported that
she feels nauseated at all time. The stool culture was obtained to rule out her condition.

R: Assess vital signs frequently. Assess for dehydration. Assess for ABGs result. Educate the
patient and her mother on continue care at home and watch for signs of dehydration.

Concluding Questions
Reflecting on Eva Madison’s case, were there any actions you would do differently? If so, what were
these actions, and why would you do them differently?

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

I would not do anything differently to be honest. However, if in the reality, I would give education about
gastroenteritis and dehydration, signs and symptoms, and the importance of returning to the hospital if
symptoms don’t improve or worsen.

Describe how you would apply the knowledge and skills that you obtained in Eva Madison’s case to an
actual patient care situation.

This scenario gives me more confidence to interact with patients, made me realize that evaluation is
very important and gives clues to a diagnosis. Every time the nurse walks into the room, give a new
medication, or implement a new intervention is important assess the patient and see if there was any
change.

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