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Child Healthcare Assignment Skit

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Benjamin Jones- mannequin
Linda Jones- Grandmother played by Heaven Casey
Roger Jones- Grandfather at home taking care of Benjamin’s 4 yr old brother and 6
yr old sister
Nurse Nakia- played by Nakia Conner
Nurse Carmen- played by Carmen Clonniger
------------------------------------------------------------------------------------------------------------------------------------Linda Jones comes into the Pediatrician’s office with her grandson, Benjamin
because he’s got a fever, he’s been vomiting since last night, and has diarrhea that
had caused diaper rash.
Nurse Nakia: Hello, My name is Nakia, and I have another nurse named Carmen
assisting me today.
Nurse Carmen: Hello. What brings you into the office today?
Grandmother: I am really concerned about my grandson, Benjamin. My husband,
Roger and I been taking care of the kids for the last week since our son and his wife
are on a cruise taking a second honeymoon. Poor Benji started to get sick
yesterday, and I want to know what I can do to make him feel better.
Nurse Carmen: Let’s start with how Benjamin’s symptoms began. When did
Benjamin’s symptoms start?
Grandmother: Benjamin’s symptoms started yesterday after we ate Chinese food for
dinner. Since then, he has been unable to keep fluids down, not feeling himself,
vomiting, and has had several diarrhea diapers.
Nurse Nakia: So, has Benjamin showed any interest in potty training yet or is he
mostly using diapers? Grandmother: Benji started showing interest in potty training
around 18 months, and then stopped for a little bit. We followed his lead until he
starts showing interest again.
Nurse Nakia: How many wet diapers has Benjamin gone through in the last 24
hours? How many BMs has Benjamin had in the last 24 hours?
Mrs. Jones: Benji has had 5 BM diarrhea diapers yesterday. This morning, I changed
him at 7:45, and he had a wet diaper with loose, watery, greenish-yellow diarrhea.
After breakfast and his bath, he had another wet, yellowish brown diarrhea diaper
that stuck to his bottom. I noticed that his bottom has started looking pinker. He

also had a wet diaper at 9:45 this morning when we came in, and the wet diaper
was a dark yellow color.
Nurse Carmen: Benji, do you hurt? Where does it hurt?
Benjamin: Tummy hurts!
Nurse Carmen: Mrs. Jones, has Benjamin complained about pain? Where is the pain
located? How long has this pain or these symptoms lasted?
Grandmother: Poor Benji has been complaining that his tummy hurts. He’s been
feeling sick since last night at 6:45pm after we had dinner.
Nurse Nakia: Can you describe how Benjamin has been feeling?
Grandmother: Benji hasn’t been acting himself. Normally he’s playing with his
brother and sister, and always fighting over toys, but today he’s been restless,
weak, irritable, and just wants to sleep. That’s so not like him.
Nurse Carmen: Can you describe what you have done to help alleviate Benjamin’s
pain? Has it helped?
Grandmother: This morning, I checked his temperature at 8am under his arm, and
it was 102.1. I gave him breakfast which was a sippy cup of milk with dry cereal,
and drew him a bath with tepid water to try to decrease his temperature.
Unfortunately, he just wanted to lay in the bath, and was very restless and irritable.
After the bath, I checked his temperature, and it was 101.6. So his temperature has
decreased, but not significantly. Benji does better sitting up and watching TV or
resting. I don’t think giving him milk was a good idea this morning since he threw up
his breakfast at 9:45 this morning.
Nurse Nakia: Can you describe things that make Benjamin’s vomiting and diarrhea
worse?
Grandmother: Benji doesn’t want to stoop down to pick up anything or bend over. I
have noticed he starts throwing up after picking up his toys off of the ground when
trying to play with his brother.
Nurse Carmen: Benjamin said that he had pain in his tummy. Does the abdominal
pain move to other areas of his body?
Grandmother: He’s just been complaining about his tummy, but I can tell that he is
weak and restless. He’s not himself today; he’s been frowning and quivering. He has
complained that he’s always cold. He’s been feeling restless and tense. When he’s
watching Thomas the Tank, he’s able to lie quietly and is very distractible. He’s
been crying, moaning, and whimpering with complaints that his tummy hurts. I have
tried to console him to make it better, and luckily I can distract him from his pain.

Nurse Nakia: Has Benjamin’s symptoms gotten better or worse? Is there a time of
day when his symptoms seem worse?
Grandmother: He gets very hungry throughout the day, and he starts throwing up
about 1-2 hours after he eats or drinks anything. Benji’s throwing up has only gotten
worse and his diarrhea is so bad that his bottom is starting to look raw. His bottom
is getting so red and raw, and he cries with every diaper change. I need to know
what I can do to make him feel better.
Nurse Nakia: We are going to try to make you feel better, Benjamin. Let’s go and
check your weight, height and get your vital signs.
Weight- 24 lbs. 2 oz
Height- 2’11”
Temperature-101.8 Axillary; elevated due to diarrhea
Pulse- 130
Respirations- 30
Pain Level with FLACC scale: 6 Moderate Pain
 Assessment: Physical Assessment: Upper GI
General appearance, Behavior, Nutritional Status, Breathing effort, Posture
Check skin turgor for dehydration
Urinalysis to check for dehydration
Ask grandparent about intake of fluid; 24 hour recall
Oral Cavity Findings: TMJ, lips, teeth, gums, buccal mucosa, tongue, tonsils,
hard palate, soft palate, uvula, pharynx
Abdomen Inspection: Color, skin condition, bruises, discoloration, rashes,
inflammation, lesions, scars, umbilicus, contour, symmetry, surface
movement – surface abdominal breathing, no peristalsis visible
Auscultation of Abdomen: Listen in systematic progression in all 4 quadrants
and epigastric area. Note frequency length and type of sounds.
Palpation of Abdomen: Assess tenderness, muscle tone, surface
characteristics. Palpate in all 4 quadrants. Note pain, tenderness, muscle
tension or rigidity. Perform light palpation to abdomen to assess umbilicus.
Note bulge, nodules, and umbilical rings.
Nurse Carmen: What has Benjamin had to eat and drink within the last 24 hours?
Grandmother: We had sesame chicken, broccoli, and white rice at 6:45pm last night.
I gave him a Sippy cup of diluted apple juice with his meal. I gave him a sippy cup of
milk last night before sleep. This morning, I gave him dry cheerios with a sippy cup
of milk. Before the waiting room, I gave him an apple nutrigrain bar.

--------------------------------------------------------------------------------------------------------------------Nurse Nakia: Is it okay if Benjamin goes with Nurse Carmen into the waiting room?
Grandmother: sure.
Nurse Carmen takes Benjamin into the other room to color and play with toys.
Nurse Carmen (to Benjamin): Washing your hands keeps you from getting sick. This
is how we wash our hands.
Nurse Carmen demonstrates how to wash hands with Benjamin.
“Washy Washy Clean Song” on YouTube
-------------------------------------------------------------------------------------------------------------------------Nurse Nakia: According to Doctor Smith, Benjamin has signs and symptoms of viral
gastroenteritis, which is a stomach bug that he may have picked up from
contaminated food or water. We’re going to try to make him feel better here, let you
know what you could do to make him feel better, and prevent the spread of
infection, because he’s contagious right now, and could spread the stomach bug to
you, your husband, or to the other kids.
Grandmother: Thank you.
Nurse Nakia: First things first, Benjamin is losing more fluid than he is taking in, so
do what you can to encourage him to take in his fluids. Diluted Gatorade or
pedialyte is good because of their sweet taste for little kids, so he may be more
open to taking in fluids. He needs to drink 36 oz of fluid daily, which could be water,
pedialyte, milk, or diluted juice, but he must drink his fluids. Other options to get
fluid in are jello packs, or chicken broth. Since Benjamin hasn’t been able to keep
fluids or food down, make sure to introduce food and fluids slowly to make sure he
can handle it.
Secondly, Introduction of food will take some time, so I would try the BRAT diet first,
after he is able to keep down fluids. I would suggest Bread, Rice, Applesauce, Toast,
or a banana. He will need to eat foods that are soft with high fiber and bulk to add
to his diet to stop some of the diarrhea.
Nurse Carmen: Mrs. Jones, could you identify for me 4 foods that could be used to
reintroduce food back into Benjamin’s Diet?
Mrs. Jones: I will make sure that Benji takes his diet slowly; I will give him a fluids for
now and give him foods like bananas, toast, applesauce, and yogurt when he is
ready.

Nurse Nakia: Once Benjamin is able to keep down foods, I would suggest offering
him yogurt with acidophilus. With kids who have vomiting and diarrhea, the good
bacteria in the stomach come out as well as the bad bacteria that made him sick in
the first place. The yogurt replaces the good bacteria (normal flora) in the stomach,
to get him to feeling better.
For his pain today, we will give him Motrin to bring down his fever and decrease his
pain. You can get some Motrin at the drug store and go by the manufacturer label
for his age and weight. Do not give Benjamin more medication than indicated,
because it will not decrease his pain or fever anymore than at therapeutic levels.
Another thing I am concerned about is Benjamin’s diarrhea and how it’s affecting
the skin on his bottom. You said that he cries with every diaper change and that his
bottom is very pinkish red and raw. Diapers should be changed immediately after
you notice that he has a BM, so that you can protect his skin from diaper rash. Baby
wipes can be very irritating to the bottom even if they are alcohol free, so I would
suggest using baby wash cloths with water in the meantime to keep Benjamin’s
bottom clean and dry. Also, it’s less painful for Benjamin to dab the wet washcloth
to clean than it is to rub it due to the diaper rash. After the diaper area is clean and
dry, apply a medicinal salve like and a diaper rash cream like destitin to the bottom
to protect the bottom with a barrier between the bottom and the diaper.
Nurse Nakia: We had talked about how you could take care of Benjamin’s diaper
rash to prevent it from getting worse. Could you name 2 things you could do to
protect his skin when changing his diaper?
Mrs. Jones: I will use a wet wash cloth, and dab it gently instead of rubbing it to
keep his bottom clean and dry. I will also put diaper rash cream on his bottom to
protect it from getting worse.
Nurse Nakia waves Nurse Carmen that she has finished talking with Mrs. Jones, and
it is okay to bring Benjamin into the room.
Nurse Carmen: Benjamin, I know your tummy hurts right now. I am going to give
you some medicine now to make you feel better.
Nurse Carmen (to Grandmother): Another thing that will be very beneficial is trying
to keep Benjamin away from his brother and sister right now. The stomach bug is
very contagious and often runs through families, so I would suggest keeping him in
another room away from his brother and sister, so that they don’t catch it.
Grandmother: I will have to let my husband Roger know that. He likes to keep the
kids playing all in one room, but I don’t want the other kids getting sick while my
son and my daughter in law are away.

Nurse Nakia: Do you or your family have the resources to pick up the foods, fluids,
and medicine that we suggested? Do you have the transportation to pick these
things up on the way home?
Grandmother: I will have to ask Roger to come pick me up from the pediatrician’s
office, and let him know that we will need to stop at the drug store before we head
home.
Nurse Carmen: Do you have any more questions or is there anything else we can do
to assist you today?
Mrs. Jones: You have taught me a lot of things I could do to get Benjamin to feel
better. Thank you so much.