Pediatric Case 2: Jackson Weber (Complex)

Guided Reflection Questions

Opening Questions
1. How did the simulated experience of Jackson Weber’s case make you feel?
a. The scenario was quite intense for me because I was trying to remember the
assessments and interventions I am supposed to do, and I felt like I was forgetting
something. I thought I would have had to repeat the scenario but after receiving my
score I was shocked and felt good overall.
2. Describe the actions you felt went well in this scenario.
a. Actions that went well in the scenario was knowing to turn the patient to side-lying
position and remove items from the area that may cause injury when he was seizing.
Then after I called the doctor, administer IV lorazepam, assessed his airway and
suctioned.

Scenario Analysis Questions1

1. EBP List in order of priority your initial nursing actions identified for Jackson Weber based on
physical findings and family interaction.
a. Implement seizure precautions
b. Assess vital signs and perform neuro checks.
c. Maintaining patent airway. Maintain side-lying position
d. Administer oxygen
e. Assess IV access.
f. Administration of 2mg IV lorazepam followed by IV bolus of phenobarbital 300mg when
seizures ceased.
g. Assess the airway and performed suctioning. Place patient on oxygen 2L via NC.
h. After seizure, vital signs were assessed and performed neuro checks.
i. Continue to monitor the patient.
2. EBP What complications might Jackson Weber face if his symptoms are not recognized and
treated in a timely manner?
a. Status epilepticus
b. Developmental delays
3. PCC What communication techniques should be initiated to decrease anxiety in Jackson
Weber’s mother while simultaneously caring for him?

1
The Scenario Analysis Questions are correlated to the Quality and Safety Education for Nurses (QSEN)
competencies: Patient-Centered Care (PCC), Teamwork and Collaboration (T&C), Evidence-Based Practice (EBP),
Quality Improvement (QI), Safety (S), and Informatics (I). Find more information at:  http://qsen.org/

From vSim for Nursing | Pediatric. © Wolters Kluwer Health.

 Pediatric Case 2
Jackson Weber (Complex)
Guided Reflection Questions

a. Therapeutic communication, establish trust, allow the mother to express her concerns,
answer any questions and provide emotional support. Give reassurance that we are
doing everything to take care of her son. Keep her up to date on Jackson’s condition and
inform her of the purpose of medications given.
4. PCC/S What seizure precautions should be taken by the nurse in anticipation of and at the
onset of Jackson Weber’s seizure? How might such precautions vary from hospital to hospital?
a. Seizure precautions in place, bed in the lowest position, remove any items nearby to
prevent injury, keep the room dark, quiet and calm as possible and have suction and
oxygen nearby. During the seizure, position to side-lying position, do not insert into the
mouth, do not restrain the patient and loosen restrictive clothing. After the seizure,
maintain side-lying position, assess vital signs and neuro status, reorient and calm the
patient and document onset, duration and characteristics of the seizure and
observations prior to and after the seizure.
b. I’m not sure how precautions vary from hospital to hospital. Maybe hospitals pad the
bed differently, have a different protocol for the management of seizures, and maybe
initiate a “Code seizure.”
5. S/QI Reflect on ways to improve safety and quality of care based on your experience with
Jackson Weber’s case.
a. Ensure that all patients admitted for seizure have all the appropriate supplies if a seizure
occurs, such as having suction and oxygen available.
b. Ensure that seizure precaution protocol or policy is evidenced-based as the best
practice.
c. As part of quality improvement, monitor patient outcome and safety for patients
admitted for seizures.
6. T&C/I What key elements would you include in the handoff report for this patient? Consider
the situation-background-assessment-recommendation (SBAR) format.
a. S – Jackson Weber is admitted to the ER after having 4 seizures at home in the past 12
hours. His mother states his first 3 seizures lasted approx. 3 and 5 mins each without
intervention. His 4th seizure lasted approx. 7 mins and resolved after rectal Diastat.
b. B – Jackson Weber is a 5 year old boy with a history of seizures (ht 118cm; wt 18kg),
brought in by his mother after having 4 seizures at home in the past 12 hours. Consent
has been obtained for treatment. He normally takes phenobarbital for seizures but has
not taken it for the past 3 months since his mother lost her job and cannot afford them.
c. A - During the ED admission, Jackson had 3 seizures. 2mg of IV lorazepam was
administered and seizures ceased. Then 300mg IV bolus of phenobarbital administered.
Patient was suctioned after the seizure. Patient placed on oxygen 2L via NC. Pupils 4mm
and reactive, neurological status assessed, and patient is barely responsive. Upon
auscultation of the lungs, obstructed breath sounds and increased respiratory effort. V/S
HR 120, BP 119/80, RR 24, Sa02 96% on 2L oxygen, and temp 100F.

From vSim for Nursing | Pediatric. © Wolters Kluwer Health.

 Pediatric Case 2
Jackson Weber (Complex)
Guided Reflection Questions

d. R – I recommend to continue monitoring the patient, neuro checks and assess vital signs
frequently. After 300mg IV bolus of phenobarbital loading dose has completed, obtain
phenobarbital level.
7. QI List additional support and health care team members to include to improve the quality
of care and to prevent reoccurrence of seizure activity and future hospitalizations for Jackson
Weber.
a. Nurse leader
b. Charge nurse
c. Floor nurse, ER nurses and school nurse
d. Respiratory therapist
e. Pediatric neurologist, critical care specialist, pediatrician, and hospitalist
f. Psychiatrist
g. Pharmacist
h. Social worker

Concluding Questions
1. Reflecting on Jackson Weber’s case, were there any actions you would do differently? If so, what
were these actions, and why would you do them differently?
a. There was a delay in the administration of oxygen therapy because I was focused on
administering medications to decrease seizures. I thought the administration of oxygen
would difficult since he was seizing with his arms rising. I thought it best to administer
the medication then apply oxygen given that the Sp02 was 95%. There was no option for
this in the scenario, but I was not able to assess his mouth to see if he bit his tongue and
assess for any incontinence of urine or bowel.
2. Describe how you would apply the knowledge and skills you obtained in Jackson Weber’s case to
an actual patient care situation.
a. The scenario was realistic, and I felt like I was always forgetting to do something in
terms of assessment and prioritizing interventions. I was just focused on treating the
seizures. Through the scenario, it reiterated the assessments and interventions that
need to be done during and after seizures, which I plan to apply in future client
situations.

From vSim for Nursing | Pediatric. © Wolters Kluwer Health.

 Pediatric Case 2
Jackson Weber (Complex)
Guided Reflection Questions

From vSim for Nursing | Pediatric. © Wolters Kluwer Health.