Question

CASE STUDY 3

Febrile Seizure

Abby is a 1-year-old girl who presents after a reported seizure at daycare.

Subjective Data

Fever for 1 hour

Eating and drinking normally per mother

Objective Data

Vital signs: T 40, HR 160, R 44, BP 104/68

Awake and alert

Skin hot to touch, otherwise normal physical examination

A. How should the nurse respond to Abby’s mother when she asks if Abby has epilepsy?

B. How should the nurse respond to Abby’s mothers question about brain damage?

C. In this clinical situation what should the nurse do?

CASE 4.

Distal Radius and Ulnar Fracture (Buckle)

Billy is a 10-year-old boy who presents with an obvious deformity to his right forearm. Billy fell on his arm while playing soccer 15 minutes before admission.

Subjective Data

Complains of pain to right forearm

States he is able to feel sensation to right hand

Denies any numbness or tingling to upper right extremity

Objective Data

Vital signs: T 36.8, P 110, RR 28, BP 122/60

Right radial pulses is strong to palpation

Capillary refill to right hand brisk <2 sec

Last PO intake 8 hours ago

A. What complications is Billy at risk for from a fracture?

B. What measures might have helped prevent this injury?

C. What should the nurse do in this clinical situation? Prioritize actions.

CASE 5.

Type 1 Diabetes Mellitus

Susan is an 8-year-old girl who has been brought to her pediatrician by her mother for a weight loss of 5 pounds over the past 2 months despite an increased food intake.

Subjective Data

Complains of thirst

Complains of hunger

Complains of frequent voiding

Objective Data

Today’s Weight: 25 kg

Weight from physical examination 6 months ago: 27.3 kg

Finger stick glucose: 325

HbA1c: 9.1

UA: glycosuria

pH 7.34

Father diagnosed with type 1 diabetes at age 8

A. Will Susan require hospitalization?

B. Susan plays after-school sports; will she have to stop these activities?

C. What should the nurse do in this situation? Prioritize actions.

NO PHOTOS PLEASE

Answer 1

Case study 3

A) Beforming reveling the patient condition the nurse must reassure the mother and give psychological support to her.Educate her about the disease condition and prognosis and reveal the truth.Reassure the parent.

Educate regarding patient care and management and educate her about dealing of such situation.Educate regrading first aid during convulsive episodes. Provide information regarding positing and patient care,and educate them about the importance of medical attention.educate about

• first aid
• Medical advice
• Management
• Medication
• Home care
• Management of fever.ie fever management in home set up

B). After patient admission to ward Normally we should assess patient condition.

Initially we will do

• History collection
• Nursing assessment
• Detailed physical examination
• Monitor vital signs
• Check doctors orders

While doing assessment we can identify the patieny situation and disabilities.but we r not suppose explain about patient condition.The Doctor has to explain about the patient condition, So inform the physician and clear the doubts.

C). In this situation if patient admitted to emergency means inform physician and give medication according to doctors orders.So if convulsion occurs in ward means notify the physician and carry out his orders.

Case study 4

A) Common complications after closed treatment of diaphyseal forearm fractures in children include re-displacement/loss of reduction, re-fracture, and forearm stiffness/loss of motion. Factors related to loss of reduction include increased initial fracture displacement, inability to obtain an anatomic reduction during initial treatment , and poor cast application as measured by cast index. Re-fracture after treatment of diaphyseal forearm fractures can occur in up to 5% of injuries and tend to occur within 6 weeks of discharge from orthopaedic care. Loss of motion after healing of forearm fractures is most directly related to residual angulation, however, may also be due to soft tissue causes such as fibrosis of the interosseous membrane or contracture of the interosseous ligament. (Noonan, 1998) Complications after operative treatment include infection, neuropraxia, hardware irritation (particularly from flexible intramedullary nails), tendon rupture (particularly extensor pollicus longus), radioulnar synostosis, compartment syndrome, and delayed union. Compartment syndrome is more common in open injuries, forearm fractures with associated distal humerus fractures.

So ther complications are

• Embolism
• Bleeding, hemorrhage
• Infections
• Nerve damage etc

B). Educate children's about the suffering behind the fracture and tell about them what all are the complications associated with this type of fracture.

• Try to avoid fractures
• Minimize injury
• Give health education regarding prevention of a cidents
• Educate about complications during management.
• Awareness regarding accidents.

C). Initially after admission to the ward.nurse has to greet the patient, provide bed and admission procedure has to complete.

After Admission procedure includes

• History collection
• Physical assessment
• Neurological assessment
• Identify client problem
• Formulate nursing diagnosis
• Plan care
• Assess effectiveness of care.

• Provide nursing care
• Assist patient daily routine.
• Price medication on time.
• Educate about follow up care.

Cade 5.

A). Better treatment has to given in children to the children hospitalisation can be provided because patient has severe hyperglycemia.

Patient has history of weight loss , so effective nutritional therapy is required.so if needed means IV nutritional therapy can be given .and manage hyperglycemia and related problems.

B). The child can continue his daily activities.it is the effective method to control excess glucose level in blood.

Best way to control hyperglycaemia is medication and lifestyle changes.so lifestyle changes can be made through exercises.so the child can actively involve in sports activities.

C). After admission of the patient ,nurse has to assess the patient condition and collect history regarding patient condition.so focus on

• Admission to the ward
• Assess the patient condition
• History collection
• Physical examination
• Identy the problems of the patient
• Planning for the patient care
• Plan for the interventions
• Implement the interventions
• Evaluate the patient condition and assess the effectiveness of interventions.
• If needed means replan the care.