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. 3) Analyse the aetiology, risk factors, signs, and symptoms of the clinical diagnosis in relation to the current clinical presentation of the child ?

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.

3) Analyse the aetiology, risk factors, signs, and symptoms of the clinical diagnosis in
relation to the current clinical presentation of the child ?