Timmy, a 13-year-old boy lands himself in a rose thorn bush while playing football with his friends. A large thorn protrudes from his bloody finger, which starts to swell, turn red, feel warm to the touch and throb with pain. Timmy doesn’t go home to have the cut cleaned and bandaged, and instead continues to wrestle around in the dirt and ignore his sore finger. The next morning, Timmy’s finger doesn’t look any better and he has a slight fever, greenish-pus and swelling down his finger. It seems Timmy’s has a bacterial infection. Answer the questions below regarding how Timmy’s immune system attempts to prevent and fight the infection.

Which innate non-specific system uses a set of proteins to kill the bacteria causing Timmy’s infection?

Tommy, a 3-year-old boy with tetralogy of Fallot, has just returned to his hospital room from the cardiac catheterization recovery room. His mother calls you to the bedside to tell you that he is vomiting and bleeding. You arrive to find Tommy anxious, pale, crying, and sitting in a puddle of blood.

Questions

1. Evidence—Is there sufficient evidence to draw conclusions about Tommy’s situation?

2. Assumptions—Describe an underlying assumption about each of the following:

a. Risks of cardiac catheterization

b. Association between vomiting and bleeding after cardiac catheterization

c. Concerns related to acute blood loss

3. What priorities for nursing care should be established for Tommy?

4. Does the evidence support your nursing interventions?

Todd Lawrence is an 8-year-old boy who has been hospitalized for treatment with skeletal traction after sustaining a compound fracture of his left leg 8 days ago. During the night he developed a fever of 102.6°F (39.2°C). This morning his temperature is 101.8°F (38.8°C). The pin sites are red and inflamed and the upper leg area is tender to the touch. Todd is complaining of pain, rating it a 9 out of a possible 10 on a numerical pain rating scale. Laboratory tests reveal leukocytosis, an increased erythrocyte sedimentation rate (ESR) and positive blood cultures.

1. What data will you report to the provider? Provide rationales.
2. What is causing these symptoms in this patient?
3. What treatment would the nurse expect to be ordered?
4. Provide three interventions for the nurse to promote Todd’s growth and development while he is immobilized in traction and receiving prescribed treatment.

Case Scenarios 1 &2.

A.You are a nurse working with John, an 18-year-old boy who has been recovering for 1 week after a motor vehicle accident on the night of his senior prom. John has had an indwelling (Foley) catheter in place for 3 days, draining large amounts of urine. Yesterday, you noted that John’s urine was cloudy and he had a temperature of 37.8 °C. When you reported these fi ndings to the physician, he discontinued John’s catheter and ordered a urine sample for culture and sensitivity.

1. Identify risk factors that could alter John’s urinary function.

2. Analyzing the information provided, determine what alteration in urinary function the data suggest.

3. Construct appropriate patient teaching for when an indwelling catheter is removed. Plan how you will individualize this teaching for John.

B.You are working in a nursing home, caring for a 76-year-old woman with metastatic cancer. For the last few weeks, she has been receiving increasing doses of morphine to control her back pain. Her appetite is poor, and she spends most of the day in bed. At change of shift report, you learn that she has not had a bowel movement for 7 days and she has an order for an enema. When you go in to assess her and explain that she needs an enema, she replies, “Please leave me alone. Can’t you see how tired I am and how much I hurt?”

1. Examine factors that could contribute to the patient’s constipation.

2. Reflect on how you feel when you must ask patients questions about elimination or perform procedures such as enemas.

3. Appraise possible factors that may have influenced the woman’s refusal to have an enema.

4. Consider ethical and legal factors in determining how to respond to the patient.

5. Critique the use of therapeutic communication in responding to this patient.

Case Scenarios 1 &2.

A.You are a nurse working with John, an 18-year-old boy who has been recovering for 1 week after a motor vehicle accident on the night of his senior prom. John has had an indwelling (Foley) catheter in place for 3 days, draining large amounts of urine. Yesterday, you noted that John’s urine was cloudy and he had a temperature of 37.8 °C. When you reported these fi ndings to the physician, he discontinued John’s catheter and ordered a urine sample for culture and sensitivity.

1. Identify risk factors that could alter John’s urinary function.

2. Analyzing the information provided, determine what alteration in urinary function the data suggest.

3. Construct appropriate patient teaching for when an indwelling catheter is removed. Plan how you will individualize this teaching for John.

B.You are working in a nursing home, caring for a 76-year-old woman with metastatic cancer. For the last few weeks, she has been receiving increasing doses of morphine to control her back pain. Her appetite is poor, and she spends most of the day in bed. At change of shift report, you learn that she has not had a bowel movement for 7 days and she has an order for an enema. When you go in to assess her and explain that she needs an enema, she replies, “Please leave me alone. Can’t you see how tired I am and how much I hurt?”

1. Examine factors that could contribute to the patient’s constipation.

2. Reflect on how you feel when you must ask patients questions about elimination or perform procedures such as enemas.

3. Appraise possible factors that may have influenced the woman’s refusal to have an enema.

4. Consider ethical and legal factors in determining how to respond to the patient.

5. Critique the use of therapeutic communication in responding to this patient.

Todd Lawrence is an 8-year-old boy who has been hospitalized for treatment with skeletal traction after sustaining a compound fracture of his left leg 8 days ago. During the night he developed a fever of 102.6°F (39.2°C). This morning his temperature is 101.8°F (38.8°C). The pin sites are red and inflamed and the upper leg area is tender to the touch. Todd is complaining of pain, rating it a 9 out of a possible 10 on a numerical pain rating scale. Laboratory tests reveal leukocytosis, an increased erythrocyte sedimentation rate (ESR) and positive blood cultures.

1. What data will you report to the provider? Provide rationales.
2. What is causing these symptoms in this patient?
3. What treatment would the nurse expect to be ordered?
4. Provide three interventions for the nurse to promote Todd’s growth and development while he is immobilized in traction and receiving prescribed treatment.

Children Case Study

Subjective

Medical History

Mr. ST, a 16 yr old Caucasian boy, who was previously diagnosed with juvenile idiopathic arthritis (JIA) at the age of 12, has recently been determined to be in remission. Previously this patient did not respond well to a number of nonsteroidal anti-inflammatories. After a period of trial and error, the patient responded well to azathioprine and seems to have better control of his disease now. Is has been a concern of the parents and primary care physician that, although this patient seems to be in remission, he has failed to increase his activity and has poor dietary habits, and as such he is beginning to develop other potential chronic health issues. Mr. ST’s latest physical exam and lab work has noted that body weight status is in the 95th percentile, with elevated resting blood glucose and triglycerides. The parents are concerned that if these poor health indicators continue, their son will have to deal with more than his JIA. The family physician wants the boy to begin a structured exercise program as well as to begin following the DASH diet plan.

Objective and Laboratory Data

Exercise testing was not requested.

Assessment and Plan

Diagnosis

JIA with overweight/obese weight status and prediabetes

Exercise Prescription

Mr. ST was referred to Exercise Medical Clinic to meet with an exercise physiologist. In consultation with the child’s parents it was determined that the child would begin with a programmed exercise routine developed by the exercise physiologist and would be administered here at the clinic. The patient will come to the clinic 3 d per week for the first 4 wk. At week 5 the child will move to completing his exercise program from home. At week 8 the child will come to the clinic to be assessed on his ability to maintain his at-home exercise program. If the child is compliant then adjustments will be made to the program for intensity, duration, frequency, and mode. If the child is struggling then it may be appropriate to have him exercise in the structured environment for 2 wk to help him get back on track.

Finally, it would be beneficial to have the child’s parents begin an exercise program as well. This will help them but would also provide positive role models for their child. Additionally, the parents and child should be referred to a dietitian to help them with their meal planning and diet plans.

Discussion

A patient such as this, with JIA, is often in poor physical condition due to the adoption of a sedentary lifestyle, possibly due to the discomfort accompanying the disease. Although drug therapy has improved the quality of life for children with JIA, increasing physical activity may help to enhance it further.

Case Study Discussion Questions

1. What would your initial exercise prescription look like for this patient? Include the mode, intensity, and duration (or volume) you would prescribe. Include your rationale for your choices.
2. What modifications to your program would you make at week 5 when the patient starts a home based exercise program? Explain.
3. Assuming the patient is making progress at week 8, how would you progress your program. Explain.

Case Study

Case History

Abioye Akachi, a 5 y.o. boy, recently arrived in Australia from East Africa. Brought to the Emergency Dept. by his worried parents, who state that he has frequent infections, a poor appetite, appears to be in pain, is pale and lethargic.

On examination the clinician finds an irritable child with jaundice, splenomegaly and failure to thrive. The clinician requests an FBE, ESR, CRP, Haptoglobin, Blood film, Malaria screen, Renal and Liver function tests and to crossmatch one unit of blood.

FBE Results

Blood film & other results

1. Define ‘signs’ & ‘symptoms’. Discuss the clinical findings of the case and correlate to any physiological or pathophysiological processes.
2. Discuss the laboratory results in detail and discuss and correlate to any physiological or pathophysiological processes.
3. State your Provisional Diagnosis.
4. State your Differential Diagnosis/es.
5. Discuss your chosen Provisional Diagnosis and Differential Diagnosis/es with justifications for your selections?
6. List all the Further Tests and Results for the PD and DDs? Tabulate your result.
7. Describe the aetiology & pathophysiology for the chosen PD.

Listed below is the net sales in $ million for Home Depot Inc. and its subsidiaries from 1993 to 2015. Remember to code the years starting at 1 for year 1993. Year Net Sales 1993 $ 9,854 1994 12,629 1995 16,212 1996 19,085 1997 23,642 1998 31,934 1999 40,035 2000 46,621 2001 55,432 2002 58,246 2003 64,438 2004 73,664 2005 80,767 2006 89,476 2007 78,442 2008 73,135 2009 64,853 2010 67,223 2011 70,034 2012 75,408 2013 78,117 2014 82,730 2015 88,658 Click here for the Excel Data File Determine the least squares equation. On the basis of this information, what are the estimated sales for 2016 and 2017? (Round your final answers to 2 decimal places.)

The mortality rate from disease X in city A is 60/100,000 in persons 50+ years old. The mortality rate from the same disease in city B is 120/100,000 in persons 50+ years old.

1.  Is the inference correct that disease X is two times more prevalent in persons 50+ years old in city B than it is in persons 50+ years old in city A? Why or why not?

In 2000, there were 65,000 deaths due to lung disease in cigarette smokers aged 20-64 years. The expected number of deaths among cigarette smokers based on age-specific death rates from lung diseases in all females aged 20-64 years was 15,000 during 1995.

1. What was the standardized mortality ratio (SMR) for lung diseases in cigarette smokers?