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Worksheets to Prepare for Simulation Cases Module - Pediatric vSim Scenario (Patient) – Eva Madison (Complex) Part 1: Plan of Care Concept Map (adapted from vSim template) Simulation Patient Overview Client summary: presentation, medical history and background, physical assessment findings, medications, diagnostics brief summary of pathophysiology and rationale for clinical manifestations Eva Madison is a 5-year-old female who just arrived to the pediatric floor from the emergency department, where she arrived at 7:00 AM with a 3-day history of vomiting and diarrhea, inability to keep fluids down, and no urination since 8:00 PM yesterday. At her last check-up a few months ago, her weight was 21.2 kg, and today her weight is 20.5 kg. She is pale and listless, and her mucous membranes are dry. An intravenous saline bolus of 400 mL was started in the emergency department and has just finished. Maintenance fluids are to follow. Dehydration occurs more readily in infants and young children than it does in adults. The risk is increased in infants and young children because they have an increased extracellular fluid percentage and a relative increase in body water compared to adults. Increased basal metabolic rate, increased body surface area, immature renal function, and increased insensible fluid loss through temperature elevation also contribute to the increased risk for dehydration in infants and young children as compared to adults. Dehydration left unchecked leads to shock, so early recognition and treatment of dehydration is critical to prevent progression to hypovolemic shock. The goals of therapeutic management of dehydration are to restore appropriate fluid balance and to prevent complications. Vomiting is the forceful expulsion of gastric contents through the mouth. It occurs as a reflex with three different phases: prodromal period, retching, and vomiting. Vomiting in infants and children has many different causes and is considered to be a symptom of some other condition.

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