EPOCH scenario library

Scenario Library for Bedside PEWS Implementation

Age Group Age Complaint Page

0-<3months 4 days old term Jaundice 34 2 months AVSD 7 2 months Tracheal Stenosis 14 7 months Brochitis 31 3-12months 3 months ASD 23 4 months RSV 9 4 months BCPS 6 4 months HLHS 12 10 months Asthma 27 11 months VSD with RSV 3 10 months Noonan Syndrome 8 1-<5years 15 months Croup 30 2 years Nephrotic Syndrome 26 3 years Pleural Effusion 24 2 1/2 years ALL 4 3 years Intercrainal Bleed 2 3 years ALL 10 3 1/2 years ALL 15 2 years Hernia 16 2 years Seizure Disorder 21 3 years Pneumonia 22 4 years Asthma 33

5-<12years 5 years Sepsis 32 9 years Meningitis 5 9 years Trauma 11 7 years CP with Pneumonia 17 6 years pneumonia 25

>= 12years 15 years Sickle Cell Crisis 29 13 years Meningitis 18 15 years Cardiomyopathy 13 14 years ALL 19 16 years Ewings Sarcoma 20 17 years Anorexia 28

Bedside PEWS library case #

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:

Bedside PEWS library case #5

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:

Salbutamol inhalation

Salbutamol inhalation

Bedside PEWS library case #6

2 1/2 year old with ALL

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:

0.9% Bolus

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:

Skin flushed Pupils not equal nor reactive

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

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

Skin Pale Irritable ECHO ordered 25ml NS bolus

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

occasion drowsy

Irritable Skin mottled

Salbutamol PICU assessing

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

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:

Bedside PEWS library case #60

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:

Time

Bedside PEWS library case #67

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 trans ferred 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

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

Jessie is 2 months. Diagnosed with Tracheal stenosis and

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)

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: Time

Bedside PEWS library case #

David is 2 years old Diagnosed with umbilical hernia.

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 opera tive 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

PEWS library case #

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

Jocelyn is 13 years old Diagnosed with viral meningitis.

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

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: Time

Bedside PEWS library case #

Kevin is 16 years old. Diagnosed with Ewing’s Sarcoma .

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

Michael is 2 years old. Diagnosed with seizure disorder.

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 admit ted 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

Bedside PEWS library case #

Cindy is 3 years old. Diagnosed with pneumonia.

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

is 3 months old. Diagnosed with ASD.

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

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

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 appe tite, 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

Pain to left chest 7/10 Triage vital signs: T 38.9, HR 147, RR 30, oxygen saturation 96% in room air

Vital Signs:

bolus

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: Time

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 short ness 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:

Time HR RR NBP SaO2 O2 Resp Effort Cap Refill Temp Sedation Comment 0800 180 48 108/61 94% RA moderate 2 sec 36.5 awake ventolin mask

1200 200 60 103/49 93% RA moderate 2 sec 37.2 awake ventolin mask 1600 200 62 na 92% RA severe 2 sec 36.8 awake magnesium sulfate

1700 170 36 84/p 95% RA mild 2 sec 37.0 asleep

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 stabili zation 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:

96% RA normal 2 sec 37.5 awake none present 1200 31 16 85/p 97% RA normal 2 sec 37.2 awake none present 1600 45 13 92/p 96% RA normal 2 sec 37.3 awake none present

0800 38 16 90/p sitting 75/p standing

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:

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:

MET called, Patient transferred to PICU

Bedside PEWS library case #

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:

Bedside PEWS library case #

- 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:

4 years old admitted with asthma

Weight: 22 kg

History:

Admitted from emergency after being on a continuous salbuteral treatments. He was able to be transitioned to treatments every 2 hours before arrival to the ward.

The patient was described at handover:

Alert and awake HR 150’s BP 120/80

Repiratory rate 70’s

Saturation 100% on 3 L NP Coughing intermittently Moderate respiratory effort and retractions Capillary refill 2 seconds

Pink and warm Abdomen firm PIV to left hand D5NS with 4o KCL at 25 ml / h

Vital Signs:

1500 172 72 120/80 100% 3L NP moderate 2 sec 37.4 awake

1600 180 68 118/76 98% 5L FM moderate 2 sec awake NS bolus

1630 165 54 112/70 99% 3L NP moderate 2 sec awake ventolin

1800 180 72 126/80 96% 6L FM moderate 2 sec awake

Patient transferred to PICU

Bedside PEWS library case #

4 days old with jaudice

Weight: 4 kg

History:

Admitted overnight from emergency. One day history of poor feeding, lethargy, low grade fever and jaundice skin. Breast feeding consultant contacted. Supplementing with bottle feeds.

The patient was described at handover: sleeping fontenlle sunken and soft PERL

GCS 15 when awake HR 150 RR 40 SBP 80/p Saturation 99% Patient on room air Chest clear, no respiratory effort noted Capillary refill is 3 seconds Abdomen soft Soft dark stools Decreased urine output

Baby in phototherapy when not feeding with parents.

Vital Signs:

Bedside PEWS library case #