Background: Marcus has been out of sorts according to his mother. She says for the past 2 days he has had a dry cough Marcus started with a runny nose two days ago. However, she has been self-medicating with paracetamol and simple linctus. Last night Marcus became lethargic.

Assessment: Marcus looks very unwell. He has a dry cough, runny nose, and watery eyes. He has a high temperature.

Recommendation: This is Marcus' third day of symptoms. Explain what you need to do.

Michaela, a 13-year-old student, was participating in the school sports day when she suddenly became breathless and dizzy. She was unable to continue running and had to stop and sit down. The school nurse was called, and she assessed Michaela and decided to call an ambulance to bring her to the emergency department (A&E).

Background:

Michaela has a history of mild asthma, which is well-controlled with her inhaler. She uses her inhaler as prescribed and has not had any recent episodes of breathlessness. She is otherwise fit and healthy, with no other significant medical conditions.

Assessment:

On arrival in A&E, Michaela is sitting on a trolley, looking anxious and short of breath. Her respiratory rate is 28 breaths per minute, and her oxygen saturation is 92% on room air. She has a grade 2/6 systolic murmur in her lungs. Her blood pressure is 110/70 mmHg, and her heart rate is 100 beats per minute. Her temperature is 37.2°C (normal).

Response:

Based on the PEWS score what would your decision be give rationale for your plan of care.

Thoughts and feelings:

• Difficult life changes - loss of stability and security

• Abdominal pain- ask if she needs pain killer/ How long she had pain?

• Homeless - treat her with dignity

• Observation- Consent? She might not be confident or open.

• Documentation

Scenario 2:

• Introduce yourself to Jason

• History taking: ask about the incident, who was supervising? , household members, recent changes in house?, concerns that Jason might have

• Inform Jason that you need to report all injuries that might not be accidental by law

• CPS?

• Any other children in the house?

Scenario 3:

• psychosis

• loss of appetite, lack of sleep, memory loss (2 weeks)

• Change of environmental factors

• Advice about smoking - side effects, services.