Scenario Library for Bedside PEWS Implementation
Josephine 3 1/2 years
Dx Cerebral Bleed
History-
Josephine weighs 17.5 kg. Josephine sustained a severe neurological insult from cerebral bleed in her left lateral ventricle 6 months ago. The interventricular hemorrhage had no identifiable etiology. As a result she has experienced developmental delay and is non verbal, not yet walking and is g-tube fed at present. She responds to her mother and family members and communicates through crying and or cooing when happy. Yesterday evening she experienced a generalized seizure lasting approx. 4 mins. She was admitted to the paediatric ward from the emergency department 12 hours ago where she was found to be febrile and treated with Lorazepam. Josephine has not experienced any further seizures. Initial diagnostics were completed including CXR, blood work (electrolytes, cultures and therapeutic drug levels have been done. She has not been on any prophylactic medication for seizures at home. She has been at home with Mom for three days for a ‘cold’.
The patient was described at handover as…
PERRL
No seizures since admitted 12 hours ago.
Lethargic but rousable to voice
Responds with handling from parents by moaning and none specific movements of her extremities.
FLACC pain score moderate
HR range 120’s
NBP range 100/62 to 110’s/70’s
Febrile 39.0 max rectally
Peripheral pulses present and normal strength
Capillary refill 2 seconds central and peripheral
Pink and warm
PIV is D5NS at 45ml/h to left AC
Respiratory rate 30’s with effort noted- Nasal flaring and no accessory muscle use noted.
Moderate crackles throughout all lung fields. Nonproductive spontaneous cough.
Expiratory wheeze to upper lobes
Nasal flaring
No indrawing
x3 back to back salbutamol inhalation masks, with effect
Saturation 90’s on 50% face mask high flow
Voiding in diaper. TFI is 100% and fluid balance over past 12 hours is positive 230 cc.
Nothing by mouth
G-Tube intact and is vented at present
Dad at bedside
Vital Signs:
Sheila 11 months old with heart disease
History- Shelia weights 9.22 kg. She has a small unrepaired ventricular septal defect (VSD) and has been diagnosed with upper respiratory viral infection (RSV). Shelia was admitted to the paeds ward from the Emergency Department 24 hours ago. She has never been in hospital before Blood cultures and NP swab are pending.
The patient was described at handover as...
Awake and interactive, irritable according to mother
FLACC pain score moderate
PERRL
HR 140’s in Sinus rhythm
Afebrile
Doppler BP 90’s/palpable, positive 10 degree gradient between L upper and L lower systolic B/P
Warm and pink
Peripheral pulses present and equal
Capillary refill 3 seconds
Respiratory rate 40’s
some use of intercostals and sub sternal indrawing noted with respiratory effort
Saturation high 90’s on 50% high flow oxy hood
Productive cough with yellow sputum noted when aspirate taken
Decreased air entry to bases and crackles to upper airways clearing with coughing
Expiratory wheezing throughout, some clearing post ventolin inhalation
PIV interstitial in right hand and removed
Abdomen soft
Bowels sounds present
Positive fluid balance of 120ml
Bottle feeding for short periods of time but tires
Vital Signs:
History; Joel weighs 14 kg. He has Acute Lymphocytic Leukemia (ALL) diagnosed 7 weeks ago. He presented last evening in the Emergency Department with fever, and general malaise. His last cycle of chemotherapy was 7 days ago in clinic. Joel central line was accessed, cultures were drawn and antibiotics were started in the Emergency Department. He arrived just before change of shift.
The patient was described at handover…
Alert and awake
FLACC pain score moderate
PERRL
Morphine infusing @ 20mcg/kg/h for moderate mucositis as Joel refused oral fluid without pain management
Pain scale 3/10
HR 160’s
BP 80’s/systolic
Febrile 38.5 rectally
Warm and flushed over all body
Peripheral pulses present and full
Capillary refill 2 seconds centrally and peripherally
Double lumen Hickman , large lumen infusing maintenance fluid of 0.9% NACL and morphine. The smaller lumen accessed for blood work.
Chest clear
Respiratory rate 30’s
Normal work of breathing
Saturation 97% on room air
Abdomen is soft
Does not appear nauseated and has had no vomiting
Taking sips of water
Positive fluid balance of 300ml
Chest x-ray ordered
Vital Signs:
Bedside PEWS library case #10
Kim 9 years old with meningitis
History: Kim weighs 30 kg. She has been complaining of headaches for three days, generalized weakness, nausea and high fever. A lumbar puncture was done in the Emergency Department. Initial diagnosis is bacterial meningitis. She was started on antibiotics 24 hours ago.
The patient was described at handover as...
Oreintated and sleepy , easy to arouse
PERRL
GCS 15
Headache pain (numeric pain scale score 4/10)
HR 70’s
BP 100’s/50’s
Afebrile
Warm and pink
Peripheral pulses present
Capillary refill 2 seconds
PIV in right hand infusing NS @50ml/h
Chest clear
Respiratory rate mid teens
Saturation mid 90’s on room air
Abdomen is soft
Complaints of nausea
Voiding in commode
Fluid balance is negative 250ml
Mom present at bedside
Vital Signs:
Bedside PEWS library case #11
Christy 4 month old admitted for BCPS
History: Christy weights 5 kg. She was diagnosed with hypo plastic left heart syndrome at one week of age and had a successful Norwood palliative procedure. She has just been electively admitted for Bicable pulmonary shunt repair procedure (BCPS). Christy spent three days in the cardiac critical care unit postoperatively and had a predictable trajectory in her recovery. She was transferred to the ward two days ago as she was improving.
The patient was described at handover as...
Alert and interactive
No desats with handling and cares
FLACC pain score moderate
HR 160’s
BP 80’s systolic
Low grade temperature-38.0 rectally
Pale pink and warm
Peripheral pulses present
Capillary refill 3
Some venous congestion to face and neck, particularly perioribital
PIV saline locked to left foot
Chest clear
Mild sub coastal in drawing
Grunting with each breath
Saturation 80’s on 30% oxy hood
Respiratory rate 40’s
Abdomen soft, soft regular stools
Fed via NG tube, Enfamil 30 ml q3h
Negative fluid balance of 60 ml
Mom assisting with all care
Medication:
Furosemide Q8H
Captopril Q12H
Acetaminophen and codeine given for pain PRN
Vital Signs:
Riland
2 months old with AVSD
History: Riland weighs 5 kg and has a large atrial ventricular septal defect. He was admitted 48 hours with suspected congestive heart failure. He has been lethargic and listless since admission to the ward.
The patient was described at handover as...
FLACC pain score mild
PERRL
GCS 11
Fontanel soft and level
Alert, fussy and hard to settle
HR 140’s
BP 70’s
Afebrile
Pale pink and warm
Mottled legs and abdomen when handled
Peripheral pulses present
Capillary refill 3
Respiratory rate 50’s
Normal work of breathing
Fine crackles throughout
Saturation mid 90’s on room air
De-saturation to high 80’s with handling
Abdomen soft
Breast feeds ad lib
Fluid balance is even
Mom and dad at bedside
Medications:
Acetaminophen
Furosemide
Vital Signs:
Bedside PEWS library case #18
Nina
10 months old with Noonan syndrome and GERD
History: Nina weighs 9 kg and was diagnosed with Noonan syndrome and GERD. Nina received an ABO compatible heart transplant 4 months ago. Her course of recovery included problems with multiple clots which have require intensive anti- coagulation therapy and lost access lines, hepatomegaly, renal dysfunction and a bought with fungal sepsis.
Nina was admitted from clinic after being seen for chest congestion and a pneumonia was confirmed on clinical exam..
The patient was described at handover as...
Awake but irritable with handling and cares
FLACC pain score moderate
PERRL
HR 160’s
BP 90/60’s
Febrile, up to 40 degrees rectally
Peripheral pulses bounding
Capillary refill 3 seconds with mottled appearance to skin
Centrally warm but peripherally cool
PICC intact to right arm
Respiratory rate 40’s
Saturation 90’s on 2 liters nasal prongs
Moderate sub-sternal indrawing
Fine crackles throughout with bilateral expiratory wheeze
Productive cough
Suctioned orally for small amounts of white secretions
Abdomen soft
Positive fluid balance of 100ml
Mom at bedside
Medications:
FK506
Furosemide q6h
Salbutamol q4h and PRN
Pulmicort BID puffs
Vital Signs:
Brian 4 months old with RSV
History-Brian weighs 7 kg and was diagnosed with RSV one week ago. He has remained in hospital for treatment and close monitoring. Initially, he was on 60% oxy hood and demonstrated moderate work of breathing. His work of breathing has improved and oxygen requirements have decreased to room air. During this episode, he has lost significant weight and his nutritional status is being evaluated and managed as he is prepared for discharge.
The patient was described at handover as...
Alert and interactive
FLACC pain score mild
PERRL
Fontanel soft and level
HR 120’s
BP 80’s systolic
A febrile
Warm and pink to touch
Peripheral pulses present
Capillary refill 2 sec
Respiratory rate 30’s
Fine crackles to the bases
No work of breathing noted
No wheezes
Saturation 96% on room air
Taking minimal amount by bottle but appears not interested
Supplemented by nasogastric feed
Abdomen soft Bowel sounds present
Voiding well in diaper, normovolimic
Vital Signs:
Bedside PEWS library case #45
Carlos 3 years old with ALL
History: Carlos weighs 15 kg and was admitted to the ward from the oncology clinic this morning for fever and neutropenia. He was diagnosed with Acute Lymphocytic Leukemia (ALL) last year and is still under going treatment. Last chemo treatment was 5 days ago and he developed a fever last night.
Patient was described at handover as…
Awake and irritable. Difficult to console
Verbal pain score little
PERRL
Interacts only with family
RR 25-28
Chest clear, Good air entry throughout
O2 Saturations >97% on room air
HR 130-140’s
BP 100’s/ systolic
Maximum Temp = 38.5 ax
Acetaminophen last given at 0500 with good effect
Skin pale (normal for pt.)
Peripheral pulses present and full
Cap refill <3sec
Voiding well, even fluid balance
Abdomen soft and non-distended
Bowel sounds present x 3 bowel movement
Dad and brother at bedside
Vital Signs:
Katie 9 years old with fall
History: Katie weighs 40 kg. She fell in gymnastics class from the uneven bars yesterday morning. She struck her head when landing. There was no loss of consciousness, no nausea and vomiting, and no complaints of neck pain. She was taken to the Emergency Department and received full trauma care including spinal immobilization and cervical collar. Her C-spine was cleared by x-ray and clinically. She complained of a headache to the back of her head while in the Emergency Department prior to discharge. At that time they did a CT scan and noted a small subdural bleed in the occipital region. Neurosurgical team was consulted and they recommended neurological observation for two days and a repeat CT scan at 24 hours. She was admitted to the paediatric ward for observation and neurological observation.
The nurse reports her condition as:
PERRL
No complaints of pain
GCS 15
No nausea or vomiting
Sleepy but easily aroused
HR 68 -100’s
Warm and pink
BP 110 / systolic over 60’s
Capillary refill 2 seconds
Temperature 37.0’s
PIV saline lock to left hand
Respiratory rate 20’s
Saturation 98% on room air
Chest assessment, clear air entry to bases
No work of breathing
Abdomen soft
Tolerating a full diet
Voiding and up to bathroom
Vital Signs:
SN26
Sophie 4 months old
Hypoplastic Left Heart Syndrome
History: She weighs 3.58 kg. Sophie was admitted at birth to the critical care unit with HLHS. She was surgically repaired wo weeks age with stage 1 Norwood Procedure. Post operatively she had decreased right ventrical function and moderate tricupspid reguritation. She developed a right internal jugular non occulsive clot and was treated with low dose heparin. She was transferred to the cardiac ward 7 days ago.
The patient was described at handover as…
Awake and crying
GCS 15
Fontanel soft and sunken
HR 140’saaa
Sinus Rhythm
BP’s 80’s
Pale pink and warm
Periperal pulses present
Capillary refill 3 seconds
afebrile
PICC line intact
Heparin infusion 12 units / kg / hr
respiratory rate 60 ‘s
saturation high 70’s
fine crackles throughout moderate inter costal in drawing
mild tracheal tug
abdomen soft
nasogastric feed episodes of gagging
negative balance 60 ml
Medications: lasix and captopril
Vital Signs:
Kimberley 15 years old with cardiomyopathy
SN42
History: She weighs 40 kg. Kimberly presented in emergency with shortness of breath, intermittent chest pain and generalized weakness 24 hours agao. She had a fainting spell at home. She has been diagnosed with cardiomyopathy after an echocardiogram. She has been admitted to the paediatric ward in a community hospital. She is now awaiting transfer to the teritary care centre. The echocardiogram noted a ejection fraction of 35%.
The patient was described at handover as…
PERL , Awake and alert
HR 64
Sinus Rhythm
BP 100 / 60
Afebrile capillary refill 2 seconds pink and warm
PIV intact respiratory rate 20’s sats 98 %
abdonmen soft / bowel sounds present fluid restricted negative balance activity with assistance
Medications: lasix
Vital Signs:
Case # 10
Jessie is 2 months. Diagnosed with Tracheal stenosis and
SN1
History: Jessie weight is 6 kg. Sophie was admitted to paediatric ward from emergency 24 hours ago for congestive heart failure. She is bright and alert. Feeding ad lib with breast milk. Her primary concern is her productive cough, congestion and congestive heart faliure.
The patient was described at handover as...
Awake and alert
PERL
Fixes and follows
Fontanel soft and level
HR 150’s
Sinus rhythm
BP 110’s/palpable
Afebrile
Peripheral pulses present
Capillary refill 2 seconds
Warm and pink
Respiratory rate 74
Mild work of breathing
Fine crackles throughout
Saturation 99% on 1 Liter nasal prongs
Desaturation to high 80’s with room air
Breast feeding add lib
Abdomen soft
Bowel sounds present
Peripheral intravenous saline locked
Voiding in diaper
Fluid balance even
Vital Signs: NEED UPDATING
Mattie is 3 1/2 years old
Diagnosed with acute lyphoblastic lymphoma (ALL)
SN48
History: Mattie weight is 6 kg. He was diagnosed with ALL 4 months ago. Mattie was admitted from clinic yesterday for his third cycle of chemotherapy.
The patient was described at handover as...
Sleep over night
Alert and intereactive when awake
No complaints of pain
HR 120’s
BP 105 / 70
Afebrile
Pale and warm
Capillary refill 2 seconds
Port-a-cath accessed with NS infusing at 20 ml / hr.
Respiratory rate 24
Saturation 99% on room air
No work of breathing
Chest clear to bases
Non productive cough
Abdomen soft, bowel sounds present
Diet as tolerated
Up to bathroom with parent
Negative balance
Parents assisting with all care
Chemo to start at 0800 am.
Vital Signs:
David is 2 years old
Diagnosed with umbilical hernia.
SN46
History: David weight is 24 kg. He was diagnosed with umbilical hernia 1 week ago. He had laproscopic urgical repaired yesterday. He was admitted to the paediatric ward for post operative care. He started on clear fluids post operative day 1.
The patient was described at handover as...
Sleep on and off over night
Alert and intereactive when awake
Crying when in pain
Points to dressing saying ouch.
Faces pain scale 6 - 10
Morphine given twice over night
Tylenol and codien given at 0600
HR 120’s
BP 100’s ystolic / 60’s diastolic
pink and warm
afebrile
capillary refill 2 seconds
peripheral intravenous intact normal saline 30 ml / h
respiratory rate 20’s
saturation 99% on room air
no work of breathing
clear air entry to bases
bowel sounds present
sips clear fluids started this am
incision clean, steri strips intact
diapered
Vital Signs:
SN20
Sam is 7 years old
Diagnosed with cerebral palsy.
History: Sam weight is 30 kg. He was diagnosed with cerebral palsy at birth. He is non-verbal but he has a pleasant disposition. He is managed will at thome with parents. Sam was admitted from the emergency department with pneumonia two days ago. He had a two day history of cough, chest congestion and then a fever started.
The patient was described at handover as...
PERL Responsive to family
Bromage score 1
Sleepy but arousable
HR 100’s
BP 100/58
Febrile 39
Pink and warm
Peripheral intravenous D5 NS at 20ml / h
Respiratory rate 30
Fine to medium crackles throughout chest
Productive cough with yellow sputum
Mild respiratory effort
saturation high 90’s with 28% oxygen via face mask
de-saturates to 80’s on room air
chest physio therapy three times a day with physitherapist
abdomen soft
gastrotomy tube intact
Positive balance 240 ml
Chest xray, blood work and blood culture done. Pending results
Medications: Antibiotics
Vital Signs:
SN30
History: Jocelyn weight is 50 kg. She was diagnosed with viral menigitis last night in emergency. She had a two day history of fever, nausea, vomiting and increased confusion. She had a CT scan and lumbar puncture that was positive for menigitis.
The patient was described at handover as...
PERL, Alert
Complains of headace
Pain scale 6 / 10
Tylenol given for pain every 4-6 hours
HR 70’s
BP’s 110’s / 60’s
Febrile 38
Pink and warm
Capillary refill 2 seconds
Respiratory rate 20’s
Saturaiton 99% room air
No respiratory effort
Chest clear to bases
Abdomen soft
Tolerating light diet
Nausea and vomitting on and off
Ambulating with assistance
Mom at bedside
Medications: Tylenol, Gravol
Vital Signs:
Jocelyn is 13 years old Diagnosed with viral meningitis.
SN13
Melanie 14 years old
Diagnosed with acute lymphblastic lymphoma.
History: She was diagnosed with ALL two months ago. She has multiple metastases to the brain , kidneys and lungs. She has been undergoing treatment involving chemotherapy and radiation. She was admitted for cycle two chemotherapy.
The patient was described at handover as...
PERL, Alert
Complains of headace
Pain scale 5/ 10
HR 80’s
BP 130/90’s
Flushed and warm
Afebrile
Capillary refill 2 seconds
peripheral pulses present
Port a cath accessed
Pre - chemotherapy hydration started
Respiratory rate 20’s
Saturation 99% on room air
no respiratory effort
Non productive dry cough
Abdoment soft
No nausea or vomiting
Ambulates in room
Mom at bedside
Tests: CT scan head
Vital Signs:
Kevin is 16 years old.
Diagnosed with Ewing’s Sarcoma .
SN29
History: Kevin was diagnosed 2 years ago with Ewing’s Sarcoma. He had surgical excision, chemotherapy and radiation in the past 2 years. He recently presented in emergency with swollen lymph nodes and pain in his pelvis with walking three weeks ago. He started on chemotherapy 2 weeks ago and was discharged home. He has been admitted from clinic with fever and neutropenia. He had a positive urine culture and antibiotics were started.
The patient was described at handover as...
Alert and awake
No complaints of pain
HR 140’s
BP 90/60’s
Febrile 39.9
Flushed and warm
Capillary refill 2 seconds
PICC line 0.9 NS infusing 50 ml / h
Respiratory rate 28
Saturation 99% on room air
No respiratory effort
Abdomen soft, bowel sounds
Taking oral fluids
Negative balance
Medications: Tylenol and Codiene, Antibiotics
Vital Signs:
SN28
History: His weight is 12 kg. Michael is also diagnosed with GERD, global delay and reactive airway disease. Michael has recently been diagnosed with aspiration pneumonia. He was admitted from emergency 2 days ago with respiratory symptoms into ARO and droplet precautions. His is being closely observed and monitored for his respiratory status.
The patient was described at handover as...
Sleepy but arousable
GCS 11 Bromage score 1
PERL
HR 140’s
BP 90/40’s
Afebrile
Pink and warm
Capillary refill 2 seconds
Peripheral intravenous D5NS 20kcl/L at 35 ml
Respiratory rate 60’s
Saturation mid 90’s on 60% oxygen high flow face mask
Moderate sub coastal in drawing
Positional stridor
Decreased air entry to the bases
Fines crackles throughout
Chest physiotherapy twice daily with physiotherapist
Abdomen soft
G tube site reddened with purulent discharge
Postive balance 150ml
Tests: Chest XRAY, G Tube swab sent, NP swab
Medications: Tylenol and Antibiotics
Vital Signs:
Michael is 2 years old. Diagnosed with seizure disorder.
SN341
History: Her weight is 30 kg. She was diagnosed with left lower lobe pneumonia. She had a history of fever, cough, increased tiredness, decreased appetite and no improvement on oral antibiotics. She has been admitted for intravenous antibiotics. She has been placed in ARO isloation.
The patient was described at handover as...
Alert and bright when awake
PERL HR 110’s
BP 100’s / 60 ‘s
Capillary refill 2 seconds
Febrile 38.0
Warm and pink
Peripheral intravenous D5NS 45 ml/h
Respiratory rate 20 - 30’s
Mid coastal in drawling respiratory effort
Saturation 97% on 1.5 L nasal prongs
Course cracklesto LLL
Productive cough
Chest physiotherapy started
Abdomen soft
Taking small amounts by mouth
Activity as tolerated
Medications: Tylenol and Antibiotics
Vital Signs:
Cindy is 3 years old. Diagnosed with pneumonia.
SN347
History: His weight is 6 kg. He is diagnosed with small ASD. He was had a two week history of congested non productive cough with decreased feeding. Chest xray done in ER and blood work. He was admitted last night from emergency with cough and fever to the paediatric ward.
The patient was described at handover as...
Alert, PERL
Fontanel sunken
HR 120’s
BP 90’s systolic
Capillary refill 3 seconds
Warm and pink
Peripheral pulses present
Febrile 38.0
Peripheral intravenous D5NS 24 ml/ h
Respiratory rate 40 - 50’s
1 L nasal prongs
Saturation 96 %
Mild respiratory effort
Sub coastal in drawling
Non productive cough
Abdomen soft
Bottle feeds
Negative balance
Tests: Echocardiogram
Medications: Tylenol and Lasix
Vital Signs:
Moe is 3 months old. Diagnosed with ASD.Bedside PEWS library case #
Peter 3 years
Dx with query pleural effusion
Weight: 12 kg
History:
James presented to the Emergency Department with a 6-day history of worsening cough and fever and increased work of breathing. James’ mom also reported that patient has been taking very little fluids and is voiding dark, concentrated amounts of urine. A CXR done in the ED showed LLL pneumonia with query left-sided pleural effusion. James is admitted to 3N for treatment for pneumonia and dehydration. NP swabs for influenza and RSV are pending.
The patient was described at handover as…
Awake but lethargic
Febrile
Mucous membranes dry
Refusing oral fluids
Decreased air entry and crackles to left lung base
Moderate substernal indrawing
Tachypneic and tachycardic
Abdomen soft, bowel sounds present
Does not appear nauseated and has had no vomiting
Chest U/S scheduled for tomorrow to assess left-sided pleural effusion
Parents present at bedside
Vital Signs:
Joshua 6 years old - pneumonia
Weight 28 kg
History:
He arrived in the Emergency Department for a 3-week history of a worsening cough and fever. Joshua has been receiving treatment for step throat and influenza for the last 2 weeks, however, he continues to experience worsening symptoms, including fever, body aches, decreased appetite, lethargy, increased work of breathing and sharp pains to his left chest. A chest x-ray shows LLL pneumonia. Blood cultures and NP swabs are pending. Joshua is admitted to 3N for IV antibiotics and monitoring for bacterial pneumonia and dehydration.
The patient was described at handover:
Awake but lethargic
Cheeks flushed, skin hot to touch
Mucous membranes dry
Capillary refill time less than 3 seconds
Decreased air entry to left lung base
Increased work of breathing
Tachycardic and tachypneic
Febrile
Triage
Emily 2 years with Nephrotic Syndrome
Weight: 11 kg
History:
She was recently diagnosed with nephrotic syndrome and today presented in Emergency Department due to ++ edema. Sarah was admitted to 3N to receive albumin (for hypoalbumenemia secondary to proteinuria) and lasix IV while awaiting transfer to Sick Kids for a kidney biopsy.
The patient was described at handover:
Awake and alert
FLACC score minimal
All vital signs stable and afebrile
Warm and pink
++ periorbital edema
Pitting edema in the legs extending above the knees
Respiratory status stable, chest clear, breathing easily, saturations >95% in R/A
Pedal pulses difficult to assess due to edema, radial pulses easily palpable, full and regular CRT reduced in lower extremities, adequate in finger nail beds
Abdomen soft, bowel sounds present
Positive fluid balance of 1 L
Decreased appetite
Abdomen distended but soft.
Vital Signs:
Melaine
10 months old with acute asthma axacerbation
Weight: 8.2 kg
History:
She presented to the Emergency Department with a 2 day history of worsening cough and shortness of breath. Melanie was seen in the ED yesterday and was discharged home on flovent and ventolin with no improvement and worsening respiratory distress. Today, Melanie returned is admitted to 3N from the ED for monitoring and treatment of an acute asthma exacerbation.
The patient was described at handover:
Awake and alert
Mucous membranes moist and pink
Capillary refill time <2 seconds
Flat, non-sunken fontanelles
Increased work of breathing and crackles throughout chest, decreased air entry to lung bases
Nasal flaring and indrawing +++
HR 172, RR 42, oxygen saturation 94% in room air, BP not available
Abdomen soft, bowel sounds present
Bottle feeding for short periods of time but tires easily
Vital Signs:
Oliva 17 years old with anorexia nervosa
Weight: 44 kg (68% of ideal body weight)
History:
Olivia has a 3 year history of anorexia nervosa and has had 2 hospitalizations for medical stabilization in the past. Today, Olivia is being admitted to 3N for medical stabilization and nutritional rehabilitation.
The patient was described at handover:
Alert and awake
Extremely emaciated
Chest is clear, normal work of breathing
HR 30’s
Abdomen soft
Skin warm and pink
Peripheral pulses palpable
Vital Signs:
Peter 15 years with sickle cell crisis of lower back
Weight: 56 kg
History: Peter is a 15 year old patient with sickle cell disease. He presented to the Emergency Department with an acute pain crisis of his lower back and legs with a pain score of 10/10. This is Peter’s second Emergency Department visit in two months for an acute painful episode. On the first visit Peter was discharged home from the ED after achieving adequate pain control with oral analgesics. With this admission, however, Peter is admitted to 3N for IV continuous analgesic therapy following several IV bolus doses of morphine.
The patient was described at handover:
Awake and alert
Complaining of ++ pain 10/10
Chest clear, breathing easily
Skin warm and dry to the touch
Capillary refill = 2 sec, palpable pulses
Abdomen soft, bowel sounds present
Saline lock in right hand
Triage vital signs: T 38, HR 80, RR 18, oxygen saturation 100% in room air, BP 124/67
Vital Signs:
Emma 15 month old admitted with croup
Weight: 10 kg
History: Emma was admitted yesterday with croup to the general medicine ward. Two day history of runny nose, fever, cough and worsening to barky cough on the night of admission. Otherwise healthy child. She has noted intercoastal retractions and increased respiratory rate.
The patient was described at handover:
Alert and awake
HR 170’s
SBP 120/p’s
RR 50’s
Mild to moderate respiratory effort
Intercoastal retractions
Chest is clear to all lobes
Saturation is 97% on room air
Capillary refill 2 seconds
Pink and warm
Abdomen soft
Taking sips of water
No appetite
Parents at bedside
Vital Signs:
Sam 7 months with bronchitis
Weight: 7 kg
History:
Admitted to the acute care unit 2 days ago with bronchitis and positive for RSV. She has been on 1 L oxygen since admission with frequent suctioning. She has mild sub coastal retractions and increased respiratory rate. Intermittend breast feeding, with frequent breaks.
The patient was described at handover:
Awake and alert
HR 140’s
SBP 100/p
RR 50’s
Saturation 98% on 1l NP
Respiratory effort mild sub coastal retratctions, intermittent nasal flaring
Capillary refill 2 sec
Pink and warm
Intermittent breast feeding
Abdomen soft.
PIV to left hand D5NS with 20kcl/l at 8 ml/h.
Parents at bedside.
Vital Signs:
Ethan 5 years - sepsis
Weight: 23 kg
History:
Ethan was admitted from an outside hospital with fever of unknown origin for three days. On admission he was afebrile. Decreased appetite. Decreased activity. Overall appearance is unwell.
The patient was described at handover:
Awake but lethargic
HR 110’s
BP 100’s
RR 30
Saturation is 99% on room air
No work of breathing.
Chest clear to all lobes
Pink and Warm
Capillary Refill 2 seconds.
Temperature 38.0
Abdomen is soft
Decreased appetite.
No complaints of pain
Mom at bedside
Vital Signs: