Question

Sabina Vasquez is a 5-year-old Hispanic girl admitted today from the emergency room with a diagnosis of pneumonia. She has a history of asthma and has had several episodes requiring the use of an albuterol inhaler at home. Sabina has had an upper airway infection for the past few days. Earlier today she developed a fever of 39°C (102.2°F), so her mother brought her to the emergency room. She was placed on oxygen via nasal cannula at 2 L/min. She received a 380-mL bolus of normal saline and an albuterol nebulizer treatment at 5:00 PM. This improved her oxygen saturation to 94%. The chest x-ray revealed right lower lobe pneumonia with effusion. An intravenous infusion of D5 ½NS is infusing at 61 mL/hr. Sabina just got settled in bed, and her mother is at the bedside.

Physicians orders are: Admit inpatient peds unit, cardio monitoring, Vital signs every 4 hours, continuous pulse oximetry, regular diet, oxygen 2 L per Nasal cannula, order x-ray of the chest, D5 ½ NS at 61 mL/hr

Cefuroxime 475 mg piggyback infusion over 30 minutes.

Azithromycin 190 mg(10mg/kg) orally now

Acetaminophen elixir (10-15 mg/kg), 240 mg PO every 4-6 hours as need for fever >36.6 C (101.5 F)

Albuterol nebulized 2.5 mg (0.5 mL) in 2 mL NS every 4 hours.

5 years old female, past history has asthma. The patient has pain in breathing and difficulties in breathing, Vital Signs are 122/88 BP, 151 HR, 31 Resp, 90% O2, 102.2 temp.

No known allergies. The patient does not feel like doing anything at all. Mom stated: "this all started yesterday" and mom brought her to the ER. Now she patient is inpatient.

Use the SBAR framework to communicate Sabina's change in client condition to the physician and:

· What are two priority RN actions to reduce harm to Sabina Vasquez  and

· Explain how soliciting input from the interprofessional team plays a role in performance improvement?

Answer 1

SBAR framework:
S-situation - 5 year old child brought to emergency with pain in breathing and differ in breathing with high temperature and oxygen saturaiton 90%.
B-Background - Patient has a hisptry of asthma with several episodes and had upper airway infection for the past few days. admitted in the inpatient pediatric unit for further evaluation.
A-assessment- patient vital signs include T-102.2degree F, R-31,BP-122/88, P-151.Assess the respiration rate, rhythm, chest movement, general condition, cough effectiveness, and hydration status, closely monitor the child for infection, and its complication. assess the child's pain level using pain score.
R- recommendation- nursing action should clear the child's airway from secretion or obstruction to maintain a clear airway, encourage child fluid intake, and teach the child for deep breathing exercises, coughing, and splitting. reduce the child's risk of infection by close monitoring vital signs, encourage adequate rest and adequate nutritional intake, and administering antimicrobial agents as per doctor advice.
Interprofessional care teams from multiple departments provide care for the child to improve the quality of life and outcome with complex health problems.
Primary care physician role in child care to eliminate patient symptoms and reducing infection and pain.
chest physician will prescribe medication for airway clearance and gas exchange to enhance normal breathing patterns.
Pharmacist role for educating the family for effective medication adherence and prescribing medication.
Pathologist role to make appropriate lab results to identify pathogens for effective interventions.
Nurses' role in making the complete and apprehensive assessments, monitoring patient progress and illness, encourage family and child for self-care, and fulfilling their emotional needs with energy conservation.
Physiotherapy role for mobilizing the patient and teaching deep breathing, cough exercise to maintain a clear airway.
dietitian role in maintaining fluid balance and adequate nutritional needs for the patient.