
Read Sim Case 2 before completing the Sim Case 2 Assessment. Enter your information below and click “Start” to begin the assessment.Â
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Nurse/Provider Sign-out
- Baby Paige was born on due date and is now 3-days old.
- Mom is on buprenorphine for 2 years and doing well; she is on Zoloft for depression.
- Baby was jittery and had high tone and poor feeding on first day, but was better on second day. Symptoms thought likely due to Zoloft and nicotine withdrawal at that time.
- During past day, Paige breastfed 8 times, had 3 voids, 3 stools, weight down 5%, 24-hour transcutaneous bilirubinometry (TcB) = 4.0.
- Last assessment, approximately 3-hours ago: vital signs stable and jaundice to face. Baby is fussy with slight increase in muscle tone and tremors during exam. Symptoms improve as soon as baby is picked up.
- Mom’s recovery coach has been helping in between clinic appointments. No family close by; father of baby is home caring for their 2 other children.
- Mom received prenatal education from her recovery coach, and mom is keeping baby with her all the time in a calm, quiet room. Mom is spending lots of time holding baby skin-to-skin when mom is awake. Baby fussy when placed in bassinette.
Sim Case 2
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Categories
- CARE PLAN 0%
- CONSOLING 0%
- EATING 0%
- NON-PHARM CARE INTERVENTIONS 0%
- NOWS/NAS RISK ASSESSMENT 0%
- PARENT/CAREGIVER PRESENCE SINCE LAST ASSESSMENT 0%
- SLEEPING 0%
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Question 1 of 27
1. Question
Category: NOWS/NAS RISK ASSESSMENTAre signs of withdrawal present?
CorrectIncorrectHint
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Question 2 of 27
2. Question
Category: NOWS/NAS RISK ASSESSMENTCorrectIncorrect -
Question 3 of 27
3. Question
Category: NOWS/NAS RISK ASSESSMENTAre co-exposures present that may be contributing to signs of withdrawal?
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Question 4 of 27
4. Question
Category: NOWS/NAS RISK ASSESSMENTAre nonpharmacologic care interventions (NPIs) maximized to fullest extent possible in infant’s clinical setting?
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Question 5 of 27
5. Question
Category: EATINGTakes > 10 min to coordinate feeding or breastfeeds < 10 min or feeds < 10 mL (or other age-appropriate duration/volume) due to NOWS/NAS?
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Question 6 of 27
6. Question
Category: SLEEPINGSleeps < 1 hour due to NOWS/NAS?
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Question 7 of 27
7. Question
Category: CONSOLINGTakes > 10 min to console (or cannot stay consoled for at least 10 min) due to NOWS/NAS?
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Question 8 of 27
8. Question
Category: CONSOLINGConsoling Support Needed
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Question 9 of 27
9. Question
Category: CARE PLANFormal Parent/Caregiver Huddle to be performed to formally review NPIs to be increased further? (choose NA if Full Care Team Huddle indicated as this includes a Parent/Caregiver)
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Question 10 of 27
10. Question
Category: CARE PLANFull Care Team Huddle to be performed to formally consider all possible etiologies for symptoms, re-assess if NPIs are maximized to the fullest extent possible, and determine if NOWS/NAS medication treatment is needed?
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Question 11 of 27
11. Question
Category: CARE PLANManagement Decision
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Question 12 of 27
12. Question
Category: PARENT/CAREGIVER PRESENCE SINCE LAST ASSESSMENTCorrectIncorrect -
Question 13 of 27
13. Question
Category: NON-PHARM CARE INTERVENTIONSRooming-in (i.e., caring for infant in their own room with earlier caregiver response to infant stress or hunger cues)
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Question 14 of 27
14. Question
Category: NON-PHARM CARE INTERVENTIONSParent/caregiver presence to help calm and care for infant
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Question 15 of 27
15. Question
Category: NON-PHARM CARE INTERVENTIONSSkin-to-skin contact when caregiver fully awake/alert to help organize infant feeding behaviors, calming & sleep
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Question 16 of 27
16. Question
Category: NON-PHARM CARE INTERVENTIONSHolding by parent/caregiver/cuddler to help calm infant & aid in sleep (with caregiver fully awake/alert)
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Question 17 of 27
17. Question
Category: NON-PHARM CARE INTERVENTIONSSafe & effective swaddling (e.g., extremities swaddled in flexed position, blanket snug, no extra blanket around baby’s face)
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Question 18 of 27
18. Question
Category: NON-PHARM CARE INTERVENTIONSOptimal feeding (e.g., baby offered feedings when showing hunger cues & fed till content)
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Question 19 of 27
19. Question
Category: NON-PHARM CARE INTERVENTIONSNon-nutritive sucking with infant’s hand, pacifier, adult caregiver’s washed or gloved finger
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Question 20 of 27
20. Question
Category: NON-PHARM CARE INTERVENTIONSQuiet, low light environment to help limit overstimulation of infant (e.g., tv volume down, quiet “white noise” machine or phone app)
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Question 21 of 27
21. Question
Category: NON-PHARM CARE INTERVENTIONSRhythmic movement provided by parent/caregiver or infant calming device (e.g., “jiggling” or infant swing in presence of alter adult)
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Question 22 of 27
22. Question
Category: NON-PHARM CARE INTERVENTIONSAdditional help/support in room (e.g., other parent, family member, friend, cuddler, staff member, recovery coach, DCYF worker)
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Question 23 of 27
23. Question
Category: NON-PHARM CARE INTERVENTIONSLimiting # of visitors & duration of visit(s) to minimize disruptions in infant’s care environment & sleep
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Question 24 of 27
24. Question
Category: NON-PHARM CARE INTERVENTIONSClustering care & assessments with infant’s awake times (e.g., RN & infant provider perform assessment together after infant feedings)
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Question 25 of 27
25. Question
Category: NON-PHARM CARE INTERVENTIONSSafe sleep/fall prevention (e.g., infant sleeps on back, safely swaddled, in own sleep space)
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Question 26 of 27
26. Question
Category: NON-PHARM CARE INTERVENTIONSParent/caregiver self-care & rest (e.g., identifying another adult to care for infant so parent can rest or take a walk/break)
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Question 27 of 27
27. Question
Category: NON-PHARM CARE INTERVENTIONSOther Comments: (e.g., Staff caring for/consoling baby as parents not available or able to safely care for baby)
CorrectIncorrect