Pediatric Nursing Case Studies

NUR 2209 Case Study 2 Please submit your answers to the drop box by 9/28/2020. You must submit three pages double spaced to receive credit for clinical time. This will count for three clinical hours for you. Client Profile: Isabel is a 21 ⁄2-year-old toddler who lives with her parents and 13-monthold sister in a rural community. Her father is a migrant worker and her mother stays at home with the children. Both parents are smokers. Both Isabel and her sister experienced recurrent episodes of otitis media during infancy although Isabel’s infections have become less frequent. Isabel’s speech is delayed; however, her mother believes that this is due to her lack of interactions with other children her age. Their culture and financial situation does not encourage daycare settings for children if the mother can stay at home with them. Most of Isabel’s speech is not understandable although she babbles “constantly.” Both children have received their scheduled immunizations at the local pediatric clinic. Isabel is brought to the clinic by her parents when she places a small toy in her ear that her parents are unable to remove. Case Study: During the admission history, Isabel’s mother tells the nurse that she has had “behavior problems” with Isabel since she was 11 months old although she stated she had not mentioned this to the staff at the clinic because she was embarrassed. On further questioning, Isabel’s mother explains that Isabel “never listens to me and doesn’t even look at me when I talk to her.” She further states that Isabel doesn’t talk so they can understand her even though they have friends whose children not only talk all the time, but she can understand what they are saying. “Isabel’s problems are probably my fault because I didn’t raise her right. Now I’m afraid she is retarded and I don’t know how to help her.” Isabel sits in her mother’s lap babbling during the interview and does not make eye contact with her parents or the nurse during their conversation or when addressed. She appears disinterested in her surroundings. 1. Discuss the significance of Isabel’s clinical manifestations. 2. Discuss the relationship between Isabel’s history of otitis media and her present condition. 3. What is the incidence of hearing impairment in children? 4. Discuss the types of hearing impairment. 5. Discuss Isabel’s mother’s comment that Isabel “has always been a behavior problem” and “Isabel’s problems are probably my fault because I didn’t raise her right. Now I’m afraid she is retarded and I don’t know how to help her.” 6. What other assessment data would be helpful for the nurse to have to prepare Isabel’s care plan? 7. What are the priorities of care for Isabel? 8. Discuss the effects of hearing impairment on Isabel’s growth and development. 9. Discuss the standards of medical-surgical care for Isabel’s hearing impairment. 10. Pediatric Nursing Case Studies

Discuss your feelings about parents’ behavior that places their children at risk. 11. How could the nurse approach Isabel’s parents about their cigarette smoking and how it compromises their children? NUR 2209 Case Study 1 Please submit your answers to the drop box by 9/28/2020. You must submit three pages double spaced to receive credit for clinical time. This will count for three clinical hours for you. Client Profile: Jonathan is a preschooler who is celebrating his fourth birthday today. He lives with his mother, aunt, siblings, and grandparents. His father was killed in a construction accident when Jonathan was an infant. He has a 6-year-old sister and an 8-year-old brother. Jonathan enjoys preschool and playing with his friends there. The family has been planning a birthday party for him and has invited his preschool class to attend as well as one of his sister’s friends and his brother’s best friend from school. Jonathan is very excited about the party and wants to help in all of the preparations. Case Study: Two hours before his party begins, Jonathan is brought to the emergency department of the hospital located two blocks from his home by his mother and aunt. His mother is very upset and tells the nurse he had “swallowed a party balloon” that he found on the table at home. He is in respiratory distress when his mother and aunt bring him to the hospital. As the nurse assesses the client’s airway, she asks the nursing assistant to take Jonathan’s vital signs with the following results: Temperature: 36° C (96.8° F) Pulse: 140 beats/minute Blood pressure: 70/40 Respirations: irregular The child’s pulse oximetry reading is 78% on admission. The nurse’s assessment reveals barely audible and diminished breath sounds bilaterally; stridor and use of accessory muscles; heart sounds weak and irregular; cool, clammy skin; and decreased responsiveness. Questions 1. 2. 3. 4. 5. What are your impressions of the above situation. What do you think is going on? What are the nurse’s priority interventions? What is the significance of his level of consciousness, vital signs, and oxygen saturation? Discuss how you think Jonathan’s mother and aunt are feeling at this point. Pediatric Nursing Case Studies

The health care provider prescribes the following for Jonathan: Order stat chest X-ray. Initiate PIV of 5% Dextrose and 0.2% normal saline to infuse at 70 mL/hour. Monitor oxygen saturation via pulse oximetry. Maintain nothing by mouth (NPO). Monitor continuous vital signs. 6. Following the chest X-ray which reveals a foreign body in his trachea, Jonathan is scheduled for an emergency bronchoscopy. What is the rationale for this procedure in this case? 7. Following the successful bronchoscopy, what assessments should the nurse perform on Jonathan? 8. The health care provider prescribes cefazolin 160 mg IV q6h 3 doses with the first dose to be administered stat. Pediatric Nursing Case Studies

You asked the nursing assistant to weigh Jonathan on the scales on his hospital bed and you communicate the medication order to pharmacy. The nursing assistant reports that Jonathan weighs 16.5 kg (36.3 lb). Did the nurse act appropriately when she delegated obtaining Sok Wu’s weight to the nursing assistant? 9. What process does the nurse use when administering medications to this child? 10. Describe your feelings about this situation, considering Jonathan’s level of growth and development. 11. Thirty-six hours following his admission to the hospital, Jonathan is discharged with no complications associated with his FBA. He is sent home with his mother and aunt. What would be the nurse’s focus in discharge teaching for Jonathan’s mother and aunt? ..Pediatric Nursing Case Studies