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Emma’s mother brought her to A&E after noticing that she had been lethargic, with a temperature of 38.9º C for the past 24 hours.

                                                                                        :                                                        Template word count = 690 Student word count =

2000-word Assessment

Overall, this is a 2000-word report in the format of a template. All 9 sections need to be completed. The Word count for students = 2000. Word count in template =690

 

Patient and Scenario Information

Name

Emma Johnson

Age/ DOB

7-year-old

Weight/Height

22kg

Gender

Female

Scenario Setting

Emma’s mother brought her to A&E after noticing that she had been lethargic, with a temperature of 38.9º C for the past 24 hours. The mother reports that Emma has been complaining of abdominal pains and she has vomited twice. She also mentions that Emma seems more irritable and hasn’t bee.n drinking much. A&E suspect sepsis.  

 

Patient

Past medical History:

Information

No known allergies.

 

Emma has autism spectrum disorder

 

Social History:

 

 Emma lives with her parents and brother. Her father and 5-year-old     brother also have autism spectrum disorder.

 

 

 

 

 

Assessment Data

No use of accessory muscles No recessions

AVPU = A, alert but in pain

GCS = 13/15 (eye opening 3, verbal response 4, motor response 6)

PEARL = 3mm

Respiratory rate= 30

SpO2 = 95% on room air.

Peripheral Capillary refill time = 4 seconds

Temperature= 39.8 º C

Blood pressure = 85/45

No rashes but pale and mottled skin on extremities

Heart rate = 140

Urinary output decreased

No audible obstruction in airway

No visible obstruction in airway

Lethargic

Abdomen soft but tender

Blood sugar level= 4 mmol/L

Peripheries warm to touch

 

 

 

 

Introduction: students need to show the presenting condition and a brief outline of the plan of care and refer to the learning outcomes that will be covered. They will need to be succinct.

  • Provide a summary of the patient’s (Emma)presenting complaint and outline the plan of care.
  • Brief overview of the learning outcomes that will be covered.

       References not needed 100 words

Approx: 100 words

ABCDE Assessment: Students need to discuss why and when this is used and explore some of the advantages and disadvantages.

  • Discuss why and when an ABCDE assessment would be used.
  • Appraise the ABCDE assessment by exploring the advantages, disadvantages and limitations.

References are needed in this section 150 words

Approx: 150 words

 

ABCDE Table

In the following table, demonstrate how the A-E assessment would be applied to recognise the acutely ill child in the scenario (Emma)

Students need to demonstrate how the A-E assessment would be applied to recognise the acutely ill child in the scenario. Here is  part of the table as the students will see it.

They need to write in full sentences and provide references to back up statements made about normal values and the evidence base. They can bullet point the interventions/ management. (800 words)

 

ABCDE

Assessment

Intervention/Management/ Investigation

Rationale and Evidence- Base

 

Identify the correct assessment data that corresponds to each section of the ABCDE assessment.

 

 

Identify abnormal assessment data in relation to normal evidenced based ranges.

List the appropriate intervention/ management and/or investigation for the patient

Provide an evidenced based rationale for the intervention/ management and/or investigation based on the patient’s condition.

Airway

Assessment

Intervention/Management/ Investigation

Rationale and Evidence-base

 

 

 

Breathing

Assessment

Intervention/Management/ Investigation

Rationale and Evidence-base

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Circulation

Assessment

Intervention/management/ investigation

Rationale and Evidence base

 

 

 

 

 

 

 

 

 

 

Disability

Assessment

Intervention/management/ investigation

Rationale and Evidence base

 

 

 

 

 

 

 

 

Exposure

Assessment

Intervention/management/ investigation

Rationale and Evidence base

 

 

 

 

                                                                                        Template word count = 690 Student word count =

 

 
   

 

 

Please calculate overall PEWS score

PEWS =

 

 

 

                                                                                                                                                                                          

 

 

 

 

 
   

 

0

1

2

4

 
 

 

Have you set your alarm limits?

RR

SpO2

HR

BP

Other

Type of monitor

 
 

 

Does your patient have any additional risk factors?

NOT APPLICABLE

Risk Factor

THINK!

Baseline vital signs outside of normal reference ranges

Always score the relevant PEWS value even if this is normal for the patient (e.g. cardiac patient)

Vital sign:

Patient’s normal value:

Tracheostomy/Airway Risk

Do you need additional help in an airway emergency?

Invasive/Non-Invasive Ventilation/High Flow

Check oxygen requirement on additional respiratory support. Remember High Flow/BiPaP and CPAP score maximum of 4 on oxygen delivery

Neutropenic/Immunocompromised

Sepsis recognition and escalation has a lower threshold

<40 weeks corrected gestation

Sepsis recognition and escalation has a lower threshold (beware hypothermia)

Neurological condition (ie meningitis, seizures)

Remember to check pupillary response if anything other than Alert on AVPU

Neurodiversity or Learning Disability

Be aware of the range of responses to pain and physiological changes

Outlier

Do you need support from home ward/team?

 
 

National Paediatric Early Warning System Observation and Escalation Chart

Patient Name:      Hospital No.      NHS No.    

Date of Birth:                                                          

 

5-12 years


Consultant:                                                          

 

 

Carer question: Ask your parent/carer: How is your child different since I last saw them? You decide if their response means:


Date Time

Date Time

 

W - Worse S - Same B - Better


A – Parent/Carer Asleep U – Unavailable

 

 

Respiratory distress

 

 

 

 

 

 

 

 

Severe

  • • Tripoding
  • • Supraclavicular recession
  • • Grunting
  • • Exhaustion
    • Impending respiratory arrest

 

 

 

 

 

 

Respiratory support device (RSD)


Frequency

W/S/B/A/U

Value

Mild

  • • Accessory muscle use
 

>50

50

45

Moderate

  • • Tracheal tug
  • • Intercostal recession
    • • Inspiratory or expiratory noises
 

40

35

30

25

20

15

10

<10

Severe Moderate

Mild None

≥95% 92% - 94%

≤91%

SpO2 probe change ( )

RSD CODE

(maximum score is 4)

100%


 

 

 

 

 

>50

50

45

40

35

30

25

20

15

10

<10


Frequency

W/S/B/A/U

Value

>50

50

45

40

35

30

25

20

15

10

<10

Severe Moderate Mild None

≥95%

92% - 94%

≤91%

SpO2 probe change ( )

RSD CODE

(maximum score is 4)

 

HF = High Flow BiP = BiPAP

CP = CPAP


Scores the maximum of 4


90%

80%                                                                                                                                                                                                                                                                                                                                          15

70%                                                                                                                                                                                                                                                                                                                                          10

60%                                                                                                                                                                                                                                                                                                                                          8

50%                                                                                                                                                                                                                                                                                                                                          6

40%                                                                                                                                                                                                                                                                                                                                          4

 

Other delivery methods

NP = nasal prongs


30%                                                                                                                                                                                                                                                                                                                                           2

28%                                                                                                                                                                                                                                                                                                                                           1

 

FM = face mask HB = head box NRB = Non-

rebreather


Score as per oxygen


24%

<21%

Document ‘Air’ or Value

Delivery method

/RSD flow rate

Value

>190

190

180

170

160

150

140

130

120

110

100

90

80

70

60

50

<50


 

 

 

 

 

 

>190

190

180

170

160

150

140

130

120

110

100

90

80

70

60

50

<50


0.1

<0.01

 

 

 

Value

>190

190

180

170

160

150

140

130

120

110

100

90

80

70

60

50

<50

 

 

Record position of BP taken by inserting relavant initials above systolic arrow

LA - Left Arm RA - Right Arm LL - Left Leg RL - Right Leg

 

Derogation Code if required:

Not attempted (No concern)

- NCO (this scores 0)

Unsuccessful attempt (Concern) - U4 (this scores 4)
 

Unsuccessful Attempt (No Concern) - U0 (this scores 0)


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CRT


BP Value or Code

" v:shapes="Textbox_x0020_56" class="shape" v:dpi="96">>150

150

140

130

120

110

100

90

80

70

60

50

40

30

<30

≥3 secs


 

 

>150

150

140

130

120

110

100

90

80

70

60

50

40

30

<30

≥3


BP Value or

Code

>150

150

140

130

120

110

100

90

80

70

60

50

40

30

<30

≥3 secs

 

 

 

 

 

If V or less do GCS

A = Alert


Record in seconds

PEWS AVPU


≤2 secs


≤2                                                                                                                                                                    ≤2 secs

PEWS AVPU

 

V = Responsive to voice P = Responsive to pain U = Unresponsive

If asleep with no reason for altered conscious state (e.g. sepsis) write ‘asleep’.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Clinical intuition

If you’re feeling that the patient is ‘just not right’ despite a low PEWS or natural carer concern *(Y/N)

 

Trigger criteria Cause(s) for escalation: SC = Specific Concern CQ = Carer Question

CI = Clinical Intuition P = PEWS

0 = None


Blood glucose

 

Pain score

(as per local policy)

Value

>39

39

38.5

38

37.5

37

36.5

36

35.5

35

34.5

<34.5

New suspicion of sepsis or septic shock (Y/N)

Clinical intuition

(Y/N)

Trigger criteria Escalation level Escalated (Y/Plan)

Time NIC informed Time clinician informed Time clinician arrived PICU/transport team called

ESCALATION LEVEL

LOW (L)

MEDIUM (M)

HIGH (H)

EMERGENCY (E)

TRIGGER CRITERIA:

 

Respond as per the highest level based on

CHANGE in

ANY ONE

of these criteria

Specific concern (neurology, sepsis, or pre-existing risk factor)

 

New suspicion of sepsis

AVPU: Change to AVPU - V ‘ Responsive only to Voice’ or New suspicion of septic shock

AVPU: Change to AVPU - P or U ‘Res- ponsive only to Pain’ or ‘Unresponsive’ OR Abnormal pupillary response

Clinical Intuition

Nurse/clinician concern that patient needs increased monitoring despite low PEWS

Nurse/clinician concern that patient needs a medical review irrespective of PEWS

Nurse/clinician concern that patient needs a ‘Rapid Review’ irrespective of PEWS

Nurse/clinician concern that patient needs emergency review for

life-threatening situation

Carer Question

Carer uses words that suggests the child needs increased monitoring or intervention despite the low PEWS

Carer uses words that suggests the child needs a clinical review irrespective of PEWS

Carer uses words that suggests the child needs a ‘Rapid Review’ irrespective of PEWS

Carer uses words that suggests the child has collapsed or significantly deteriorated

Paediatric Early Warning Score

1-4

5-8

9-12

≥13

Communication & response (use ISBAR Framework)

 

Medical plan for stabilisation Structured medical plan to be documented including:

  1. specific actions to be taken
  2. expected outcome
  3. outcome deadline
  4. escalation if outcome not met by deadline.

Inform Nurse-in-charge

 

 

Consider Medical Review by ST3+ or equivalent

 

 

 

Bedside nurse to feed back plan to parents

Review by Nurse-in-charge for potential escalation (and/or Outreach nurse or equivalent)

Request Medical Review by ST3+ or equivalent

 

Stabilisation plan to be considered

 

Bedside nurse to feed back plan to parents

Immediate review by Nurse-in-charge for potential escalation

 

Call for ‘Rapid Review’: Medical incl. airway skills ST3+ or equivalent and outreach nurse (if available or equivalent)

Stabilisation plan to be discussed with consultant

Senior nurse to feed back plan to parents

Immediate 2222 call: “Paediatric Medical Emergency” and review by Nurse-in-charge

Consultant informed urgently to confirm stabilisation plan

Senior nurse to support and feedback to parents

[In specialist environments rapid review can replace 2222 but only with prior agreement between consultant and nurse- in-charge]

Medical review timings

As agreed with medical team

Within 30 minutes

Within 15 minutes

Immediate

Minimal observations

Repeated escalation if remaining in one level not required but ongoing plan must be clearly documented in notes.

Must reassess within 60 minutes (and then document ongoing plan)

Must reassess within 30 minutes (and then document ongoing plan) Continuous Oxygen Saturation monitoring needed

Every 30 minutes and continuous monitoring of Respiratory Rate / Oxygen Saturation / ECG

GCS recording if change in AVPU

Every 15 minutes and continuous monitoring of Respiratory Rate / Oxygen Saturation / ECG

GCS recording if change in AVPU or abnormal pupillary response

FOR EMERGENCY OR LIFE-THREATENING SITUATIONS: CALL 2222 AND STATE “PAEDIATRIC MEDICAL EMERGENCY”

 
 

Signature

 

 

>39

39

38.5

38

37.5

37

36.5

36

35.5

35

34.5

<34.5


Blood glucose

 

Pain score

(as per local policy)

Value

>39

39

38.5

38

37.5

37

36.5

36

35.5

35

34.5

<34.5

New suspicion of sepsis or septic shock (Y/N)

 

Clinical intuition (Y/N)

Trigger criteria Escalation level

Escalated (Y/Plan)

Time NIC informed

Time clinician informed

Time clinician arrived

PICU/transport team called

THINK! Could this be sepsis?

Think sepsis if any of the following are present:

  • Neutropenia or immunocompromised (call medical professional for immediate review)
  • Known or suspected infection
  • Temperature ≥38°C or <36°C
  • Increasing oxygen requirement
  • Unexplained tachypnoea/ tachycardia
  • Altered mental state (e.g. lethargy/floppy)
  • Prolonged CRT, mottled or ashen appearance

If suspicion of sepsis, inform nurse in charge. Escalate to patient’s own or on-call team.

 
 

Signature 

 

 

 

Escalation:

Using the PEWS score, discuss the escalation response you would follow for this patient and when you would consider escalating this patient.

 

 

 

 

 

Approx 100 words

 

 

Communication:

Examine the effectiveness of using communication strategies within healthcare and appraise the SBAR communication tool considering the advantages and limitations.

 

 

In the table below, provide an example of the SBAR discussion you would use in escalating this patient.

Approx 300 words

 

Situation

 

 

 

Background

 

 

 

Assessment

 

 

 

Recommendation

 

 

 

Citation

 

 

 

 

 

Reference List:

 

REFERENCES

Need to be in the Harvard style of referencing as per university guidelines. 15 refs as a minimum.

Guidelines should refer to reputable resources

1) NICE guidelines

2) RCPCH website

3) NHS England website

4) RCN

5) BTS and SIGN

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