CASE STUDIESI- Case Study: Care of the Child in Inpatient and Outpatient SettingsJordan is 9-year-old male who is a direct admit for observation. He has a history of vomiting and diarrhea for 48 hours.Subjective DataNausea and vomiting for 24 hoursHas not voided todayUnable to tolerate oral fluidsObjective DataVital signs: T 37.8ø C, P 120, R24, BP 110/60Weight: 34 kgHyperactive bowel sounds to auscultation1. Question 1When should the discharge teaching begin for Jordan and his family?2. Question 2What is the best way to approach Jordan regarding the IV that has been ordered.3. Question 3What would be good distractions for a child of Jordan’s age?II- Case Study: Pediatric CancerMario 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 103ø F and a 1-day history of bruising and lethargy.Subjective DataComplains of hurting all overStates he feels very tiredStates he feels dizzy when he stands upObjective DataWeight 26.1 kgVital signs: T 38.9ø C, P 140, R 40, BP 108/54, O2 sat 100%Purpural rash on extremitiesWBC 0.7HGB 3.1Hct 8.5Plt .08ANC 0.14. Question 1Which of Mario’s presenting symptoms must be treated and stabilized before chemotherapy induction?5. Question 2What testing is required for a definitive diagnosis of meningitis?6. Question 3What should the nurse do in this clinical situation? Prioritize actions.III- ÿCase Study: Pediatric Respiratory SystemWill is a 4-month-old infant born at 34 weeks of gestation. Will?s 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 DataMother complains that infant has had cough for 3 daysMother states that infant is having trouble sleepingNot voided in past 6 hoursObjective DataBirth Weight: 1.9 kgToday?s Weight: 5.5 kgVital Signs: T 38ø C, P 186, R 60, BP 90/52, Pulse Oximetry 93%Thick yellow nasal secretionsNasal flaring with moderate intercostal retractionsBreath sounds decreased with crackles bilaterally to auscultation7. Question 1What risk factors does Will have for contracting bronchiolitis?8. Question 2What is the first priority for Will’s treatment?9. Question 3What should the nurse do in this clinical situation? Prioritize actions.IV- ÿCase Study: Pediatric Gastrointestinal SystemLucy is a 44-day-old formula-fed infant who presents with a 4-day history of vomiting.Subjective DataMother states infant has been vomiting undigested formula after feedingsMother states that infant has not had fever or diarrheaMother states that infant has had 8 wet diapers in the past 24 hoursObjective DataWeight 4.8 kg (birth weight 3.5 kg)Vital signs: T 37.1ø C (rectal), P 130, R 30, BP 92/52Mucous membranes moist, anterior fontanel flat and softAwake and alert, lusty cryGood muscle toneOlive-sized mass palpated at epigastrium10. Question 1What test will be used to diagnose pyloric stenosis?11. Question 2What should the nurse do in this clinical situation? Using the case study above, the first prioritization step the nurse would take is ____.12. Question 3The second prioritization step the nurse would take is ____.13. Question 4The third prioritization step the nurse would take is ____.14. Question 5The fourth prioritization step the nurse would take is ____.15. Question 6The fifth prioritization step the nurse would take is ____.16. Question 7The sixth prioritization step the nurse would take is ____.17. Question 8The seventh prioritization step the nurse would take is ____.18. Question 9The eighth prioritization step the nurse would take is ____.V- Case Study: Pediatric Cardiovascular SystemMichael is a 7-week-old breastfed infant who presents with a 2-day history of irritability and poor feeding.Subjective DataMom states patient has been ?fussy? for past 2 daysOnly feeds for a ?few? minutes at a timeBreathing heavily and fast for 2 daysObjective DataWeight: 4.8 kgVital Signs: T 36.8ø C, P 250, R 65, BP 84/58Breath sounds clear to auscultationOxygen Saturation 95%Central capillary refill 4 sec19. Question 1What is the treatment for an unstable patient with SVT?20. Question 2Decreased cardiac output from prolonged SVT will produce what complication?21. Question 3In this clinical situation what should the nurse do? Prioritize actions.VI- ÿCase Study: Hematologic SystemLiam is an 8-year-old male with a history of hemophilia. Liam presents today with a 1-day history of right elbow pain.Subjective DataRight elbow pain for 1 dayPatient states he hit his right elbow on desk yesterdayPatient complains that he cannot move his elbowObjective DataWeight 31.6 kgVital sighs: T 37.4ø C, P 82, R 20, BP 108/68Rates pain 6 on scale of 1022. Question 1How 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 2Why are neuro checks an important part of Liam’s physical exam?24. Question 3What should the nurse do in this clinical situation? Prioritize actions.VII- Case Study: Common Disorders of the Red Blood CellsSusan 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 1What is the nursing priority at this time?2. Question 2What should Susan be taught about insulin needs during pregnancy?3. Question 3What additional risk factor does Susan have?4. Question 4How should Susan be counseled regarding weight gain in pregnancy?5. Question 5What advice can be given to Susan regarding exercise?VIII- ÿCase Study: Pediatric Genitourinary SystemLilly is a 3-year-old female who presents with complaints of abdominal pain and fever since yesterday.Subjective DataComplains of lower abdominal painFever for 24 hoursLilly has ?wet her pants? despite being recently potty trainedObjective DataVital signs: T38.5ø C, P 114, R 32, BP 104/62Urine positive for WBCs, nitrites, blood6. Question 1What risk factors does Lilly have for UTI?7. Question 2What might prevent Lilly from a recurring UTI?8. Question 3What should the nurse do in this situation? Prioritize actions.IX- ÿCase Study: Pediatric Neurologic SystemAbby is a 1-year-old female who presents after a reported seizure at day care.Subjective DataFever for 1 hourEating and drinking normally per motherObjective DataVital signs: T 40ø C, HR 160, R 44, BP 104/68Awake and alertSkin hot to touch, otherwise normal physical examination9. Question 1How should the nurse respond to Abby’s mother when she asks if Abby has epilepsy?10. Question 2How should the nurse respond to Abby’s mothers question about brain damage?11. Question 3In this clinical situation what should the nurse do?
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