Visualise yourself in the role of a second year BN (Bachelor of Nursing) student on the last week of clinical placement in a busy Paediatric Emergency Department (PED) providing care for the following pa@ent in the aAernoon shiA along with your mentor RN (Registered Nurses). Pa>ent informa>on Name: Oscar Wilson Age: 4 years Sex: Male Accompanied by: Meghan Wilson (mother) and Patricia Foster (Grandmother) Present Medical History Oscar presented to Paediatric Emergency Department (PED) at 1400. Chief complaints included lethargy, fever (very high temperatures), runny nose, and producCve cough for the past three to four days. Oscar appeared to be very sleepy and stayed in bed all the Cme over the past two days. His oral intake was poor during the past week. Oscar has complained of nausea, refused oral food/fluids and had two episodes of vomiCng since this morning. He also had one episode of seizures (generalised tonic clonic seizures) this morning @ around 1000. Past Medical History History of recurrent cold and cough, latest occurrence approximately 4-6 weeks ago Hospital admission X 5 days for Acute gastroenteriCs 2 years ago Allergies: Nil known Perinatal History First baby, Antenatal period was unevenWul Vaginal birth at 38 weeks, Birth weight: 3.5 Kg, Length & Head circumference: data not available Postnatal: Developed neonatal jaundice, received phototherapy Developmental History Summary based on family report: Oscar can walk around in the house and lawn, have started to run around for short distances, however, is not confident to use stairs. Oscar is not toilet trained by day and need diapers. Oscar can scribble on paper or a board, however, is not able to draw lines or circles. Oscar can put words together to communicate, however his speech is difficult to understand. can Immunisa>on History Unvaccinated due to cultural reasons Nutri>onal History Predominantly bocle-fed in infancy, semi-solid food started at 4 months of age, mealCme is usually extended due to poor acceptance (need coercion/distracCon), prefers finger foods. Family History Meghan (Oscar’s mother) has a history of depression, management has been irregular in the past one year; Oscar’s Dad has history of asthma, diabetes. Social History Oscar has not been enrolled to childcare/ Early Learning Centre. Meghan does not work. Oscar’s Dad works as a truck driver and will be home only for a few days in a month. Meghan’s mum lives close by and was summoned for help when Oscar had the seizure episode this morning. Physical Examina>on General appearance Oscar appears very Cred, drowsy and unsecled. He also appears underweight, skin is smudged with dirt, and clothes are smelly Anthropometry Length: 98.0 cm Weight: 12.2 kg Vital signs Respiratory rate: 34-38 breaths per minute Oxygen saturaCon: 95-97 % on room air Heart rate: 150-160 beats per minute Blood Pressure: 90/58 mm of Hg Capillary refill Cme: 3 seconds Temperature: 39.1°C Neurological GCS 13/15 (E3V4M6), Neck sCffness++, Pain, associated involuntary effort to reduce meningeal stretching (Brudzinski sign +, Kernig sign+), Pupils bilaterally equal and reacCve, History of one episode of seizure Respiratory Rhinorrhoea and occasional producCve cough Mild increased work of breathing Cardiac/Abdomen/Musculoskeletal: Nil issues noted, abdomen sop, non-tender Renal: last diaper change was 14 hours ago (small amount of urine, yellow) Skin and mucous membranes Dry lips and mouth Few petechial spots on trunk Medical diagnosis ? Acute Bacterial MeningiIs Treatment plan Admission Contact and Droplet precauCons ConCnuous monitoring of RR, HR, SpO2 Hourly (and PRN) monitoring for - full neurological observaCons, seizures, blood pressure, temperature and Fluid Balance Chart (FBC) Nil by Mouth unCl review Blood sample for Venous gas, Full Blood EvaluaCon (FBE), Biochemistry, Culture Lumbar puncture – Cerebrospinal Fluid (CSF) for biochemistry, microscopy, and culture (before commencing anCbioCcs) IV cannulaCon, IV fluids - 0.9% sodium chloride + 5% glucose for maintenance (consider 2/3 of maintenance volume. To be revised based on hydraCon status, Na+ levels, and acid-base status) IV AnCbioCcs, steroids, paracetamol Seizure management Paediatric Medical team to review Consider CT /MRI (MagneCc Resonance Imaging) and further management aper Paediatric Medical Consultant’s review 8) . Appraise suitable risk assessment tools, and apply one tool to determine the risk management measures to be integrated into the child’s care plan.