Question

Jesse is a 3-year-old boy who was diagnosed with Osteogenesis Imperfecta (Page 1699-1700) – A congenital life-long condition that impacts the strength of the bones. Jesse will be pre-disposed to multiple broken bones throughout his life. He is being seen today in the emergency room setting related to a broken right arm. Jesse’s parents have been struggling with the diagnosis but have slowly been adapting their lives to support Jesse. Jesse’s mother quit her job and decided to remain home to provide care for Jesse and his older siblings. Jesse’s father as a computer analyst has allowed Jesse’s mother to be a stay-at-home mother, but the finances are tight at times.

1. What are the effects of special needs on Jesse?
   • How will the nurse address and assess Jesse based on his developmental age?
   • What vital signs would the nurse document and what method would they use to obtain these values?
2. What are the effects of special needs on Jesse’s family?
3. What is involved in the nursing management of a medically fragile child?
   • How would the nurse assess Jesse’s pain?
     • What tool would the nurse use to assess Jesse’s pain?
4. Ibuprofen is the preferred NSAID for pain management for fractures. Based on the order below, how many mLs would the nurse administer to the patient?
   • ORDER: Ibuprofen - 115 mg (10 mg/kg/dose) PO every 6 - 8 hours (Max daily dose 40 mg/kg/day)
   • On hand: 100 mg / 5 mL
   • Child weight: 11.5 kg
   • (Round to the tenth's place)
5. What teaching would the nurse provide to the family to promote safety going home related to pain management?
   • What additional discharge teaching might the nurse provide to the family?

Answer 1

1.Jessie is a 3 year of age who is diagnosed with fracture of right arm and has a history of osteogenesis imperfecta.He is a boy who will have restrictions in his physical activity due his mediacl condition.

Here the nurse when appriches him for assessing always should be kept in mind he is physically not active like other children of Jessie's age.he should not be compared with others and should be treated as a normal child.His assessment should be done by keeping in mind thet he had right hand fracture and condition of brittle bones.

The nurse should record his vitals including heart rate,blood pressure, Respiratory rate,and pain score.while using the monitor always try less to use cuff pressure when checking the blood pressure as he fragile and thin bones.

Special needs that can effect Jesse family are

In the above matter said that Jessie mother left the job and is staying at home to take care of Jessie duevto his condition,so that the family had lost one income source,so they become financially tight.

Jessie should take while he is playing and other physical activities and his age group are more vulnerable to injuries while Playing.

Chronic pain management is required.

Assisting Jessie's daily activities are very important.

Jessie should be supported by his family as well as society due to his conditions.

3.As Jessie is a 3 year old boy and so the pain scale used here by the nurse is Face pain scale.Here the child will choose the face which best reflects the pain.

Here the tool used is Faces pain scale.

4.The child dose or order dose is 115mg every 6 to 8 hours ,it is caluclated as per the weight of the child.Dose in hand is 100 mg/5ml

Caluclation of dose in ml as follows

ml=ordered dose /dose in hand ×quantity(ml)

ml=115mg/100mg×5ml

ml =1015×5

ml=5.75ml

ml=5.8ml to be given every 6 to 8 hours.

5.Discharge instructions are;

Immobilise the right arm till further orders from the physician.

Increase strength and function of affected arm.

Nutrition should be evaluated periodically,needs diet with Calcium,minerals and vitamin rich.

Should be free from injury.

Improving physical therapy that is improving joint mobility and developing strength of the muscles.

Dental hygiene is important for children with osteogenesis imperfecta.