570. CASE STUDIES I- Case Study: Care of the Child in Inpatient and Outpatient Settings Jordan is 9-year-old male who is a direct admit for observation. He has a history of vomiting and diarrhea for 48 hours. Subjective Data Nausea and vomiting for 24 hours Has not voided today Unable to tolerate oral fluids Objective Data Vital signs: T 37.8° C, P 120, R24, BP 110/60 Weight: 34 kg Hyperactive bowel sounds to auscultation 1. Question 1 When should the discharge teaching begin for Jordan and his family? 2. Question 2 What is the best way to approach Jordan regarding the IV that has been ordered. 3. Question 3 What would be good distractions for a child of Jordan’s age? II- Case Study: Pediatric Cancer Mario is a 7-year-old male who presents with a 1-week history of body aches and pallor. He has a 2-day history of fever to 103° F and a 1-day history of bruising and lethargy. Subjective Data Complains of hurting all over States he feels very tired States he feels dizzy when he stands up Objective Data Weight 26.1 kg Vital signs: T 38.9° C, P 140, R 40, BP 108/54, O2 sat 100% Purpural rash on extremities WBC 0.7 HGB 3.1 Hct 8.5 Plt .08 ANC 0.1 4. Question 1 Which of Mario’s presenting symptoms must be treated and stabilized before chemotherapy induction? 5. Question 2 What testing is required for a definitive diagnosis of meningitis? 6. Question 3 What should the nurse do in this clinical situation? Prioritize actions. III- Case Study: Pediatric Respiratory System Will is a 4-month-old infant born at 34 weeks of gestation. Wills mother states that he has not been able to go to day care because he has been coughing with a fever for the past 3 days. She states today he is unable to feed well from the bottle because of nasal secretions. Subjective Data Mother complains that infant has had cough for 3 days Mother states that infant is having trouble sleeping Not voided in past 6 hours Objective Data Birth Weight: 1.9 kg Todays Weight: 5.5 kg Vital Signs: T 38° C, P 186, R 60, BP 90/52, Pulse Oximetry 93% Thick yellow nasal secretions Nasal flaring with moderate intercostal retractions Breath sounds decreased with crackles bilaterally to auscultation 7. Question 1 What risk factors does Will have for contracting bronchiolitis? 8. Question 2 What is the first priority for Will’s treatment? 9. Question 3 What should the nurse do in this clinical situation? Prioritize actions. IV- Case Study: Pediatric Gastrointestinal System Lucy is a 44-day-old formula-fed infant who presents with a 4-day history of vomiting. Subjective Data Mother states infant has been vomiting undigested formula after feedings Mother states that infant has not had fever or diarrhea Mother states that infant has had 8 wet diapers in the past 24 hours Objective Data Weight 4.8 kg (birth weight 3.5 kg) Vital signs: T 37.1° C (rectal), P 130, R 30, BP 92/52 Mucous membranes moist, anterior fontanel flat and soft Awake and alert, lusty cry Good muscle tone Olive-sized mass palpated at epigastrium 10. Question 1 What test will be used to diagnose pyloric stenosis? 11. Question 2 What should the nurse do in this clinical situation? Using the case study above, the first prioritization step the nurse would take is ____. 12. Question 3 The second prioritization step the nurse would take is ____. 13. Question 4 The third prioritization step the nurse would take is ____. 14. Question 5 The fourth prioritization step the nurse would take is ____. 15. Question 6 The fifth prioritization step the nurse would take is ____. 16. Question 7 The sixth prioritization step the nurse would take is ____. 17. Question 8 The seventh prioritization step the nurse would take is ____. 18. Question 9 The eighth prioritization step the nurse would take is ____. V- Case Study: Pediatric Cardiovascular System Michael is a 7-week-old breastfed infant who presents with a 2-day history of irritability and poor feeding. Subjective Data Mom states patient has been fussy for past 2 days Only feeds for a few minutes at a time Breathing heavily and fast for 2 days Objective Data Weight: 4.8 kg Vital Signs: T 36.8° C, P 250, R 65, BP 84/58 Breath sounds clear to auscultation Oxygen Saturation 95% Central capillary refill 4 sec 19. Question 1 What is the treatment for an unstable patient with SVT? 20. Question 2 Decreased cardiac output from prolonged SVT will produce what complication? 21. Question 3 In this clinical situation what should the nurse do? Prioritize actions. VI- Case Study: Hematologic System Liam is an 8-year-old male with a history of hemophilia. Liam presents today with a 1-day history of right elbow pain. Subjective Data Right elbow pain for 1 day Patient states he hit his right elbow on desk yesterday Patient complains that he cannot move his elbow Objective Data Weight 31.6 kg Vital sighs: T 37.4° C, P 82, R 20, BP 108/68 Rates pain 6 on scale of 10 22. Question 1 How should the nurse respond when Liam’s father explains that they watched and waited to see if Liam needed treatment after his injury? 23. Question 2 Why are neuro checks an important part of Liam’s physical exam? 24. Question 3 What should the nurse do in this clinical situation? Prioritize actions. VII- Case Study: Common Disorders of the Red Blood Cells Susan is a 26-year-old G1P0 at 6 weeks of gestation with type 2 diabetes. Her BMI is 32. Her hemoglobin A1C is 9. She uses glyburide 10 mg PO daily. The physician has switched her to insulin at this time. 1. Question 1 What is the nursing priority at this time? 2. Question 2 What should Susan be taught about insulin needs during pregnancy? 3. Question 3 What additional risk factor does Susan have? 4. Question 4 How should Susan be counseled regarding weight gain in pregnancy? 5. Question 5 What advice can be given to Susan regarding exercise? VIII- Case Study: Pediatric Genitourinary System Lilly is a 3-year-old female who presents with complaints of abdominal pain and fever since yesterday. Subjective Data Complains of lower abdominal pain Fever for 24 hours Lilly has wet her pants despite being recently potty trained Objective Data Vital signs: T38.5° C, P 114, R 32, BP 104/62 Urine positive for WBCs, nitrites, blood 6. Question 1 What risk factors does Lilly have for UTI? 7. Question 2 What might prevent Lilly from a recurring UTI? 8. Question 3 What should the nurse do in this situation? Prioritize actions. IX- Case Study: Pediatric Neurologic System Abby is a 1-year-old female who presents after a reported seizure at day care. Subjective Data Fever for 1 hour Eating and drinking normally per mother Objective Data Vital signs: T 40° C, HR 160, R 44, BP 104/68 Awake and alert Skin hot to touch, otherwise normal physical examination 9. Question 1 How should the nurse respond to Abby’s mother when she asks if Abby has epilepsy? 10. Question 2 How should the nurse respond to Abby’s mothers question about brain damage? 11. Question 3 In this clinical situation what should the nurse do?