James is a 15month old boy who has presented to the emergency department with acute respiratory distress. James has a history of cerebral palsy, seizures and developmental delay. His growth and development has been hindered by difficulty with feeding. He is accompanied by his mother.

Week 1: 1st December 2007- 1100hrs

James has been admitted to your ward with a diagnosis of aspiration pneumonia. On admission his mother states her husband has recently left the family.

James observations are as follows:

• Height : 75cm
• Weight: 9.5kg
• Temp: 37.5
• Respiratory rate: 50
• Heart rate: 144
• BP:95/50

Simulation Laboratory Activities

• Conduct a nursing admission
• Complete a nursing care plan that outlines all issues associated with the care of James
• Plot height and weight on percentile chart and evaluate your finding
• Write a written report and prepare a verbal nursing report.

Week 2: 1st December 2007- 1400hrs

James’ mother states she feels that James is “struggling to breath”. You conduct a respiratory assessment, PaO2 87%.  Alert the nurse in charge.

Simulation Laboratory Activities

• Conduct a respiratory and vital signs assessment
• Monitor pulse oximetry
• Administer O2 via a Hudson mask

The medical officer assesses James and prescribes Salbutamol via a nebuliser

• Administer Salbutamol
• Write a written report and prepare a verbal nursing report

Week 3: December 1st 2007 1600hrs

James has been ordered chest physiotherapy. James’ mother has also requested a review by the Occupational Therapist as he will miss his regular appointment due to this hospitalisation. James has been commenced on intravenous (IV) antibiotics and made NBM due to increasing work of breathing.

Simulation Laboratory Activities

• Attend vital signs, asses and document
• Calculate IV maintenance fluids
• Administer IV antibiotics
• Position James for optimal chest expansion and….
• Write a written report and prepare a verbal nursing report

Week 4: 2nd December 2007 - 1000hrs

James has a trial of oral feeds; he continues to aspirate. The medical officer has ordered insertion of Nasogastric tube and nasogastric feeds.

Simulation Laboratory Activities

• Complete vital signs assessment
• Commence Nasogastric feeds as ordered
• Administer medication via nasogastric tube
• Write a written report and prepare a verbal nursing report

Week 5: 3rd December 2007 - 1200hrs

James spikes a temperature of 39.5°. His mother states that James’ urine is offensive. Multiple attempts to collect a urine specimen are unsuccessful. The medical officer orders an intermittent catheter to collect a specimen.

Simulation Laboratory Activities

• Perform vital signs assessment
• Administer paracetamol
• Obtain consent
• Perform catheterisation
• Attend to documentation
• Perform verbal handover

Week 6: December 4th, 2007 - 1100hrs

James has a tonic-clonic seizure. He is noted to be apnoeic. Attend to this critical incident.

Simulation Laboratory Activities

• Identify signs of respiratory /cardiac arrest
• Identify priorities for management of this incident
• Write a written report and prepare a verbal nursing report

Week 7

Review all skills