Nursing
We have two student responses. •Each response must include specific examples from simulation feedback, class content or
clinical experience.
Each response about 2 paragraphs.
Discussion Questions:
Student 1
1) What actions should be implemented to decrease anxiety in Eva and her mother?
Experiencing an event that would cause hospitalization is bound to be a very stressful event that would lead to an increase
in Eva and her mother’s anxiety. The first thing that can be done to decrease anxiety would be to provide a calm environment
and speak to the patient and family in a calm manner as well. It is also important to educate and inform the patient about
their situation and why they are in the hospital. Eva and her mother should also be informed about the plan of care and what
interventions will most likely be implemented. Letting both Eva and her mother know that all of their health care providers
are solely focused on helping Eva get better will also help decrease anxiety. Because Eva is a preschooler it is possible
that she may think that her illness is some sort of punishment for something bad she did. Eva needs to be informed that her
illness is in no relation to whatever action she may believe to have caused it.
2.) What role do you feel Eva’s mother has as a member of her health care team?
As a member of Eva’s health care team I feel that Eva’s mother has one of the most important roles in regards to Eva’s
treatment and well-being. Because Eva is only 5 years old, Eva’s mother is the primary decision maker for her daughter
regarding her care. Additionally, aside from Eva herself, her mother knows the most about her daughter, providing essential
information to her health care providers. One final important role of Eva’s mother would be a support system for her
daughter. Separation anxiety is still a concern in preschoolers and having the presence of her mother by her side would
significantly reduce Eva’s fear and anxiety during such a stressful time.
3.) When initiating a fluid bolus for a dehydrated child, what type of fluid should be given and why?
When giving an IV fluid bolus normal saline or lactated Ringer’s solution is given over 20 mL/kg. This bolus can be given
multiple times and once the child’s hydration status has improved ORT can be started afterwards at 100 mL/kg over 2-4 hrs
(James, Nelson, & Ashwill, 2013). Normal saline and lactated Ringer’s can also be known as isotonic solutions. These
solutions are given for dehydration because its composition and balance of fluids and electrolytes are the same as the fluids
in the body. With this similar composition, these boluses would not cause any shifts in fluids from the intra- or
extracellular spaces causing further damage in combination with dehydration.
4.) Reflection 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?
One thing that I would do differently during the Eva Madison case would be to change her position before administering oral
fluids. I would make sure to have Eva sitting up in order to reduce her risk of aspiration. Keeping Eva in a high Fowler’s or
semi-Fowler’s position would greatly reduce her risk of potential aspiration and cause even more problems on top of her
primary reason for her hospitalization. Additionally, although a blood test was already performed, the only information
provided was her electrolytes. I would most likely recommend testing for her pH levels which could drastically change due to
her vomiting and diarrhea and should be addressed immediately.
Student 2
1. What actions should be implemented to decrease anxiety in Eva and her mother?
We understand that anxiety are very common in preschoolers and their family members during the time in the hospital.
Therefore, it is really important for us to answer Eva and her mother any questions or concerns which they have. We should
explain to Eva and her mother any procedures or interventions to help them more understood and cooperative. Eva is 5 year old
kid, she might have anxiety about intrusion and mutilation. So she may often ask several questions when we perform the
medical procedures. In that situation, we have to explain the procedure to the child in clear, simple words and concrete
terms which are understandable and appropriate to her developmental age. It helps her decrease fear and anxiety about
mutilation. We can allow Eva so see and touch any equipment she may encounter in advance to lessen her fear. Moreover, asking
open-ended question or providing choices are better than giving them yes-no questions (Nursing Care of Children Principle &
Practice, p.39). Then we can reward Eva with a hug, a toy, or sticker for her cooperative behaviors after the procedures. We
also want to encourage Eva’s mother that she should be in the room with her during any procedures to reduce Eva’s anxiety.
2. What role to you feel Eva’s mother has as a member of her health care team? (Explain your answer)
Eva’s mother has a very important role to help the child calm and cooperative during hospital time. She is the only person
who is able to provide the nurses and health care providers about the child’s information and problems before and during
hospitalization. In addition, Eva is 5 year old girl, she might has separation anxiety which may make her withdrawn and
uncooperative with any medical procedures and interventions. Therefore, the role of Eva’s mother is very important to lessen
Eva’s fear and anxiety by helping healthcare worker to explain and comfort the child.
3. When initiating a fluid bolus for a dehydrated child, what type of fluid should be given and why?
At the beginning to treat dehydration, we should give a child with a fluid bolus of normal saline or lactate Ringer’s
solution by the dose of 20ml/kg. This will help the child replacing the fluid loss immediately to maintain proper
circulation, and tissue perfusion. So the doctor’s order is correct dose for Eva with 400mL of NS over 15 minutes (20.5kg x
20ml/kg = 400mL). Then based on the Eva’s lab result at 0730, she has high potassium (4.7 mEq/L) and high sodium (145 mEq/L).
After the IV bolus, we may give her D5W 1/2NS to correct her electrolyte imbalance. We should give the child at a therapeutic
rate that continues replacing the remaining fluid deficit over the next 24hr until Eva is able to drink and vomiting is
stopped. (p.345)
4. Reflection 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?
Based on assessment data, I think Eva has dehydration which occurs secondary to her gastroenteritis (stomach flu). This is
self-healing disease. So rest and rehydration are best treatment plan for Eva right now. Therefore, fluid bolus of normal
saline and D5W ½ NS was accurate and appropriate in order to rehydrate Eva and replace fluid loss. When her vomiting and
diarrhea are subside, we can give her oral dehydration solution. The doctor also ordered to obtain urine sample and stool
sample for further diagnostic tests which is clearly correct and important for Eva. Moreover, Eva’s blood glucose is slightly
low right now (65 mg/dl) which shows that Eva hasn’t eaten well since she was sick. We should report to doctor about this
value and recommend some effective interventions to prevent hypoglycemia and lack of nutrition. Health care providers may
require bedside blood glucose every 4 hour to closely monitor the blood glucose for Eva. In the worst case, the doctor may
order TPN for Eva if her condition get worse.