Jackson Weber is a 5-year-old Caucasian male. He was diagnosed with generalized tonic-clonic seizures 2 years ago. Upon diagnosis, Jackson’s neurologist started him on oral phenobarbital. Jackson has been seizure-free until last night, when his mother brought him to the emergency department following a 3-minute tonic-clonic seizure. She is a single mother and the sole source of financial support.
Jackson has not seen his neurologist in 15 months due to his mother’s work schedule. Jackson was seen by his health care provider this morning and currently has an intravenous infusion in his left arm running D5 NS + 20 mEq KCl/L at 58 mL/hr.
He has been eating well, has urine output, and vital signs are stable. His pupils are equal and reactive to light. He is able to move all extremities equally. He is awake and alert and is watching cartoons. His mother is at the bedside.
2) Patient Introduction
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 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.
3) Patient Introduction
Eva Madison is a 5-year-old female who just arrived to the pediatric floor from the emergency department, where she arrived at 7:00 AM with a 3-day history of vomiting and diarrhea, inability to keep fluids down, and no urination since 8:00 PM yesterday.
At her last check-up a few months ago, her weight was 21.2 kg, and today her weight is 20.5 kg. She is pale and listless, and her mucous membranes are dry. An intravenous saline bolus of 400 mL was started in the emergency department and has just finished. Maintenance fluids are to follow.
Medication: Sodium chloride
4) Patient Introduction
Brittany Long is a 5-year-old African American female with a history of sickle cell disease, diagnosed at 6 months old, and has been prescribed regular folic acid supplement.
She was brought into the emergency department during the night by her mother, who stated that the patient has been complaining of right lower leg pain over the last 2 days. Brittany rated her pain as a 5 on the FACES Scale and did not want anyone to touch her leg during assessment. She has not had an appetite in the last 24 hours but has taken small amounts of oral fluids.
She has had pain crises before, mostly managed at home with acetaminophen and ibuprofen. She has been hospitalized twice, once at age 4 years for a vaso-occlusive crisis episode and once at age 3 years for a fever.
Brittany was given oral pain medication in the emergency department at 6:00 AM. She is asleep but is responsive when awakened. She has been taking small amounts of oral fluids and continues to receive intravenous maintenance fluids at 52 mL/hr. When examined this morning, her blood pressure was 101/70 and her temperature was 37.4°C (99°F). She now rates her pain as a 3. New orders have been given.
5) Patient Introduction
Charlie Snow is a 6-year-old Caucasian male staying with his aunt and uncle while his parents are serving overseas in the military. Charlie presents in the emergency department with tachycardia and dyspnea with mild stridor. His aunt and uncle report that he accidentally ate a cookie containing peanuts, and he has peanut allergies. When Charlie began having difficulty breathing, they rushed him to the emergency department.
He is currently able to talk through the dyspnea and is on a nasal cannula at 2 liters. A saline lock has been placed in his left arm. He has been connected to a cardiac/apnea monitor with a SpO2 probe in place. Charlie is in bed, and the health care provider has been notified of Charlie’s arrival.
Medication: Ranitidine hydrochloride