Question

Case Study:

For the case study section only: Please only provide short answers for the case study No more than 2 sentence response. Answer all the questions in all case study scenarios.

Case Study # 1

Jordan is a 9-year-old boy who is a direct admit for observation. He has had a history of vomiting and diarrhea for 48 hours.

Subjective Data

Has a history of nausea and vomiting for 24 hours.

Has not voided today.

Is unable to tolerate oral fluids.

Objective Data

Vital signs: temp, 37.8º C; pulse, 120 bpm; resp, 24 breaths/min; blood pressure, 110/60 mm Hg

Weight: 34 kg

Hyperactive bowel sounds to auscultation

Questions:

1. When should the discharge teaching begin for Jordan and his family?
2. What is the best way to approach Jordan regarding the intravenous (IV) line that has been ordered?
3. What would be good distractions for a child of Jordan’s age?

Case Study #2

Susan is a 4-year-old girl with a 7-day history of fever and lethargy. Susan’s physician has ordered laboratory work that includes a blood culture.

Subjective Data

Susan has had fever for 1 week.

Her mother has noticed a decreased activity level.

Susan states she is “afraid” of needles.

Objective Data

Weight: 26.1 kg

Vital signs: temp, 39.3º C; pulse, 110 bpm; resp, 40 breaths/min; blood pressure, 108/54 mm Hg; oxygen saturation (O₂ sat) 100%

No abnormal findings on physical examination

Questions:

1. When should Susan’s nurse explain the procedure to her?
2. To give Susan some control over this situation, what choices could be given to her?
3. What actions should the nurse take in this clinical situation? Prioritize the actions.

Discussion Topic: What is the Perez reflex? Why is it important to know how to elicit it? Discuss the use of the Perez reflex in collecting urine specimens from infants.

Answer 1

CASE # 1

a ) When to being the discharge teaching for The child & family

It should begin soon after Jordan is admitted to the hospital or several days before you planned the discharge ( because child & family will becaome mentally ready to understand such things once the condition of the child became stable)

b ) Best way to approach the child regarding the IV insertion

Teach him about the condition & importance of the procedure with the demonstration of the equipments which are going to use or either by colourful cards in a soft & understanding words after maintaining a good rapport with him in the first meet. Involved the family for teaching & through out the procedure for making the child comfortable.

c ) Good Distraction methods

As a 9 year old child, Jordan is coming under School Age, so for better distraction the child can be asked about his school life such as friends, teachers, favourite subjects etc.

CASE # 2

a ) When to explain the procedure to the child

Sometimes before you planned the procedure is the appropriate time to explain the procedure to the child as a nurse. Gaining the parental presence along with the health care provider will make the things more understanding as well as comfortable to her.

b ) What choices can be given to the child

The child should be allowed to choose where she want to be during the procedure, in mother's mot or on the observation table.

c ) Priority action to be taken as a nurse

Nurse should make sure that the child should not get any physical & mental trauma during the hospital stay.

For that she has approach the child in a soft way with warm touch in the prescence of family

DISCUSSION TOPIC

a ) Perez Reflux

While running a finger down the spine of an infant held supported in a prone position will normally cause the whole body to become extended ie, flexion of arms & legs with extension of neck & cry.

Appear at birth & disappear at 6 weeks.

b ) Why it is important to elicit the reflex

Usually Perez Reflux disappeas when the child reaches 6 weeks. After that period child is assessed for the prescence of this refux, which is considered as an abnormality pointing to;

Multiple Sclerosis

Parkinson Disease

Stroke

Spinal abnormalities

Diabetes . etc

c) Use in Urine collection in infants

It is very helpful for collecting urine from infants.

This reflex usually stimulate the bladder ( in child bladder control usually attain at the age of three ) of the child which releases urine, which can be collected in a specimen bag.

Urinary incontinence is the loss of bladder control. Children's under age three it is normal to have loss if bladder control.

Through Perez Reflux we can easily collect urine from infants by running the finger down to spine which stimulates the bladder & release urine.