Formative Simulation Script

1. Professionalism (Opening)

  • Perform hand hygiene.

  • Introduce self and role.

  • Confirm patient name and Date of Birth (DOB).

  • Use open-ended question to begin the patient interaction.

    • Example Script: "Hi, my name is Jaquierra Cook. I’m a nurse practitioner student working with your provider today. Can you confirm Liam’s full name and date of birth? I understand he hasn’t been feeling well. Tell me what’s been going on."

2. History – Reporter Level

A. Chief Complaint:

  • Document caregiver’s exact words regarding the complaint.

B. Fever Details:

  • When did the fever start?

  • What was the highest temperature and how was it measured?

  • Is the fever constant or intermittent?

  • What medications have been given? Include dose and timing.

C. Symptom Screen:

  • Is there congestion or cough?

  • Any difficulty breathing?

  • Vomiting or diarrhea present?

  • Any rash?

  • Is the child pulling ears or worse when lying flat?

  • Any change in the number of wet diapers?

    • Since fever began, how many wet diapers per day?

  • Any change in urine smell or crying with urination?

  • Is the child harder to wake or more sleepy than usual?

  • Any seizures?

  • Any recent sick contacts? Is Liam in daycare?

D. Past & Baseline History:

  • Any allergies?

  • Past medical conditions?

  • Was the birth full-term?

  • Any hospitalizations?

  • Is Liam up-to-date on immunizations?

  • Any daily medications?

E. Developmental Confirmation (9-Month Visit):

  • Can Liam crawl and pull to stand?

  • Is he babbling and responding to his name?

  • Any caregiver concerns?

3. Physical Exam – Reporter

  • General appearance: Please assess if the child is alert, interactive, and consolable.

  • Fontanelle assessment: Visual examination of the fontanelles to check for any abnormalities.

  • Tympanic membranes: Must be visualized bilaterally to check for signs of infection.

  • Lung examination: Always required during the check-up.

  • Cardiac assessment: Always required during the check-up.

  • Abdominal assessment: Include auscultation and palpation.

  • Skin examination: Check for any rash or petechiae.

  • Hydration assessment: Evaluate capillary refill time and condition of mucous membranes.

4. Interpreter – Clinical Reasoning Statement

  • Summary: "Liam is a 9-month-old previously healthy male presenting with 24 hours of fever and mild congestion. He is well-appearing and hydrated with no focal source identified on physical exam. In infants under 12 months, urinary tract infection is the primary serious bacterial infection that must be ruled out when fever has no clear source."

5. Manager – Plan

A. Diagnostic Tests:

  • Obtain a catheterized urinalysis and urine culture to evaluate for UTI given fever without a clear source.

    • Note: In a well-appearing 9-month-old with fever and no clear source, urinary tract infection is the primary serious bacterial infection that must be ruled out.

B. Medication Administration:

  • Acetaminophen Dosage: 15 mg/kg (Calculate based on weight).

  • Ibuprofen Dosage (for children > 6 months): 10 mg/kg every 6–8 hours.

C. Recommendations:

  • Encourage fluids and monitor urine output.

  • Schedule follow-up within 24–48 hours or sooner if patient condition worsens.

6. Educator – Parent Education & Return Precautions

  • Inform that most fevers are viral, but urinary tract infection must be ruled out in infants.

  • Advise to return immediately if any of the following occur:

    • Difficulty waking the child.

    • Persistent vomiting.

    • Fewer than 3 wet diapers.

    • New rash appears.

    • Fever lasts more than 3 days.

  • Use teach-back method to confirm understanding:

    • Example: "Can you tell me when you would seek urgent care?"

7. Closure

  • Ask if there are any questions from the caregiver:

    • Example Script: "What questions do you have for me today?"

  • Thank the caregiver for bringing Liam in:

    • Example Script: "Thank you for bringing Liam in."