NP III: Pediatric Case Study Grading Sheet
NP III Pediatric Case Study Grading Sheet Each question is worth 1 point
1.__________
2.__________
3.__________
4.__________
5.__________
6. __________
7.__________
8.__________
9.__________
10._________
Student Name: __________________________________ Date ______
Hillsborough Community College
NPIII: Pediatric Unit 1
Case Study INSTRUCTIONS: Complete case study individually. Show work with all math problems.
CASE Ivana Alexandrovich, 8 yr old
Admitted 18 hours ago with fracture R femur & R clavicle, open wound on R foot, chest & abdominal bruising.
Presented in ER 24 hours ago after motor vehicle accident, restrained …show more content…
in back seat. R leg placed in traction in ER.
NURSING ASSESSMENT / MORNING REPORT T 101.5 P 118 RR 28 BP 130/74 Weight: 19.5 kg Height: 116 cm Allergies: NKDA, Immunizations up-to-date Neuro: alert and oriented, speaks few words of English, primarily Russian
Skin: warm to touch, pink, Peripheral IV # 22 in L hand, Wound on R foot with dressing intact, bruising noted on chest and abdomen from seatbelt. Eyes: PERLA, clear, no drainage Mouth: Lips & mucous membranes: dry, not cracked
Respiratory: Breath sounds are clear, equal bilaterally, easy respiratory effort
Cardiac: regular rate & rhythm, radial & pedal pulses equal & strong, cap refill – less than 3 sec.
Abdomen: soft & tender, bowel sounds present all four quadrants, BM last 48 hrs. ago, nausea present, 2 episodes of emesis during evening shift, moderate amount of clear yellow fluid
GU: perineal area clear, voiding in toilet with hat, voided 3 times during evening shift small to moderate amount of clear amber urine
Musculo-skeletal: R leg in traction with pins at distal end of leg, moves R arm with some pain, moves L leg & L arm with no pain.
Social: lives with mom, dad, 2 yr old sister, & grandmother. Family moved to Tampa 6 months ago from Russia. Dad is a chemical engineer and is working at USF. Father speaks fluent English & Russian, mom & grandmother speak no English.
Doctors Orders: Dx: MVA, Fracture R femur & R clavicle Activity: bedrest Diet: clear liquids Labs: CBC, sed rate & BMP in am
IVF: D5 ½ NS w 20 KCL meq/l at 40 ml/hr; Heparin lock IV when able to eat regular diet Medications: Claforan 500 mg IV q 6 hrs Tylenol 200 mg po q 4 hrs prn for fever or pain Morphine 1 mg – 1.5 mg IV q 2 hrs for pain Pin care bid Normal Saline wet-to-dry dressing change bid Traction with 20 lb weight
1. List 3 topics that should be taught to the family specific to this hospital admission?
a) Orient the family to the hospitalization process and resources available to them – the assigned room, interpreter, call light, bed controls, television, toys etc
b) Ensure that the parents are prepared for hospital experiences, allowed to participate in care activities, and kept informed regarding the child’s response to treatment.
c) Provide the family with information about the child’s condition, treatment, and support systems.
2. List 3 teaching strategies the nurse would utilize when teaching this family?
a) In the U.S., children in households where English is not the primary language have been shown to receive lower quality healthcare services then children in English speaking households. Use of a medical interpreter may be effective in improving care for these children. b) The nurse will explain, demonstrate, and then request a return demonstration by the parents (and child- if age appropriate) of any treatment or procedures that will be done at home.
c) Educate parents about proper medication administration, including dosing amounts, time and routes.
3. Calculate the minimum fluid intake requirement and minimum urine output for this patient?
First 10kg- 100ml/kg Second 10kg- 50ml/kg >20kg- 20ml/kg
10 X 100= 1000ml
9.5 X 50= 475ml
=1475ml/24hr
Minimum Urine Output= 2ml/kg/hr
2ml X 19.5kg
=39ml/hr
4. Ivana is not tolerating liquids, what data would indicate that she may have a fluid deficient? (List 4)
a) Monitor Ivanas input/output.
b) Assess for dry mucous membranes
c) Assess for decreased skin turgor
d) Monitor daily weights. Sudden weight loss/change.
5. What is this patients weight and height percentiles. What are the nursing implications for this data?
a) Weight- 3rd Height- less than 3rd
b) Nursing implications – Ivana’s percentiles indicate she is below the fifth percent which is suggesting she is failure to thrive. Continue to monitor Ivana’s daily weights, diet/ caloric intake, food preferences and any other changes related to growth and development that could potentially delay her growth.
6. How would you assess pain in Ivana and why utilize these measures?
a) Oucher pain scale - A poster 0-100 scale for school age children, such as Ivana, with no pain starting at 0 , maximum pain at 100
b) Wong-Baker FACES Pain Rating Scale -6 cartoon faces with neutral to gradually increasing painful expressions- Good for Ivana to express her pain.
7. After peripheral IV and IV fluids are started, the nurse is ready to start the Claforan IV. Is the ordered dose a safe dose? According to a pediatric drug book the safe dose range for Claforan is 100 mg – 200 mg/kg/24 …show more content…
hrs.
100 X 19.5= 1950
200 X 19.5= 3900
Ivana’s Range
1950-3900mg/24hr
500 X 4= 2000/24hr yes it is a safe dose.
8. Later in the day when the nurse returns to re-take the temperature, the nurse notices the dad changing the wound dressing using and applying a white pasty substance to the wound which he states his mother sent him made from herbs in her garden. What are the nursing/medical and cultural considerations when discussing the father’s use of this herbal remedy?
First, the nurse must consider how diversity affects patients and patient care.
As nurses, medical diversity is something that we will undoubtedly encounter and has a large influence on health management. Alternative medicine is not only prevalent for those outside of the medical profession but is a rising practice among health care professionals. In this case, a nurse should inquire about the substance and seek to identify its origins. This should also be discussed with physician. The nurse and the entire health care team should familiarize themselves with the family’s beliefs and practices. The health care team should then use this knowledge to design a comprehensive and inclusive health care plan. Culturally, the nurse must be sensitive to the family structure, religious values, and cultural preferences. In this case, the nurse should respect the families Russian cultural
values.
9. List a priority physical and social diagnosis for this patient.
Physical: Physical-altered nutrition: less than body weight requirement R/T body weight less than normal AEB patient’s height and weight percentiles.
Social: Impaired Verbal Communication R/T language barriers AEB the inability to speak English fluently, primary language is Russian
10. List a priority physical and social diagnosis for the family
Physical: Caregiver Role strain R/T Caregiver has multiple competing roles AEB his job at USF as an engineer, taking care of his daughter Ivana, and will serve as an interpreter to the mother and grandmother while at the hospital.
Social: Interrupted Family Process R/T the child’s hospitalization and illness AEB changes in assigned tasks.
Fall 2013
1.__________
2.__________
3.__________
4.__________
5.__________
6. __________
7.__________
8.__________
9.__________
10._________
Student Name: __________________________________ Date ______
Hillsborough Community College
NPIII: Pediatric Unit 1
Case Study INSTRUCTIONS: Complete case study individually. Show work with all math problems.
CASE Ivana Alexandrovich, 8 yr old
Admitted 18 hours ago with fracture R femur & R clavicle, open wound on R foot, chest & abdominal bruising.
Presented in ER 24 hours ago after motor vehicle accident, restrained …show more content…
in back seat. R leg placed in traction in ER.
NURSING ASSESSMENT / MORNING REPORT T 101.5 P 118 RR 28 BP 130/74 Weight: 19.5 kg Height: 116 cm Allergies: NKDA, Immunizations up-to-date Neuro: alert and oriented, speaks few words of English, primarily Russian
Skin: warm to touch, pink, Peripheral IV # 22 in L hand, Wound on R foot with dressing intact, bruising noted on chest and abdomen from seatbelt. Eyes: PERLA, clear, no drainage Mouth: Lips & mucous membranes: dry, not cracked
Respiratory: Breath sounds are clear, equal bilaterally, easy respiratory effort
Cardiac: regular rate & rhythm, radial & pedal pulses equal & strong, cap refill – less than 3 sec.
Abdomen: soft & tender, bowel sounds present all four quadrants, BM last 48 hrs. ago, nausea present, 2 episodes of emesis during evening shift, moderate amount of clear yellow fluid
GU: perineal area clear, voiding in toilet with hat, voided 3 times during evening shift small to moderate amount of clear amber urine
Musculo-skeletal: R leg in traction with pins at distal end of leg, moves R arm with some pain, moves L leg & L arm with no pain.
Social: lives with mom, dad, 2 yr old sister, & grandmother. Family moved to Tampa 6 months ago from Russia. Dad is a chemical engineer and is working at USF. Father speaks fluent English & Russian, mom & grandmother speak no English.
Doctors Orders: Dx: MVA, Fracture R femur & R clavicle Activity: bedrest Diet: clear liquids Labs: CBC, sed rate & BMP in am
IVF: D5 ½ NS w 20 KCL meq/l at 40 ml/hr; Heparin lock IV when able to eat regular diet Medications: Claforan 500 mg IV q 6 hrs Tylenol 200 mg po q 4 hrs prn for fever or pain Morphine 1 mg – 1.5 mg IV q 2 hrs for pain Pin care bid Normal Saline wet-to-dry dressing change bid Traction with 20 lb weight
1. List 3 topics that should be taught to the family specific to this hospital admission?
a) Orient the family to the hospitalization process and resources available to them – the assigned room, interpreter, call light, bed controls, television, toys etc
b) Ensure that the parents are prepared for hospital experiences, allowed to participate in care activities, and kept informed regarding the child’s response to treatment.
c) Provide the family with information about the child’s condition, treatment, and support systems.
2. List 3 teaching strategies the nurse would utilize when teaching this family?
a) In the U.S., children in households where English is not the primary language have been shown to receive lower quality healthcare services then children in English speaking households. Use of a medical interpreter may be effective in improving care for these children. b) The nurse will explain, demonstrate, and then request a return demonstration by the parents (and child- if age appropriate) of any treatment or procedures that will be done at home.
c) Educate parents about proper medication administration, including dosing amounts, time and routes.
3. Calculate the minimum fluid intake requirement and minimum urine output for this patient?
First 10kg- 100ml/kg Second 10kg- 50ml/kg >20kg- 20ml/kg
10 X 100= 1000ml
9.5 X 50= 475ml
=1475ml/24hr
Minimum Urine Output= 2ml/kg/hr
2ml X 19.5kg
=39ml/hr
4. Ivana is not tolerating liquids, what data would indicate that she may have a fluid deficient? (List 4)
a) Monitor Ivanas input/output.
b) Assess for dry mucous membranes
c) Assess for decreased skin turgor
d) Monitor daily weights. Sudden weight loss/change.
5. What is this patients weight and height percentiles. What are the nursing implications for this data?
a) Weight- 3rd Height- less than 3rd
b) Nursing implications – Ivana’s percentiles indicate she is below the fifth percent which is suggesting she is failure to thrive. Continue to monitor Ivana’s daily weights, diet/ caloric intake, food preferences and any other changes related to growth and development that could potentially delay her growth.
6. How would you assess pain in Ivana and why utilize these measures?
a) Oucher pain scale - A poster 0-100 scale for school age children, such as Ivana, with no pain starting at 0 , maximum pain at 100
b) Wong-Baker FACES Pain Rating Scale -6 cartoon faces with neutral to gradually increasing painful expressions- Good for Ivana to express her pain.
7. After peripheral IV and IV fluids are started, the nurse is ready to start the Claforan IV. Is the ordered dose a safe dose? According to a pediatric drug book the safe dose range for Claforan is 100 mg – 200 mg/kg/24 …show more content…
hrs.
100 X 19.5= 1950
200 X 19.5= 3900
Ivana’s Range
1950-3900mg/24hr
500 X 4= 2000/24hr yes it is a safe dose.
8. Later in the day when the nurse returns to re-take the temperature, the nurse notices the dad changing the wound dressing using and applying a white pasty substance to the wound which he states his mother sent him made from herbs in her garden. What are the nursing/medical and cultural considerations when discussing the father’s use of this herbal remedy?
First, the nurse must consider how diversity affects patients and patient care.
As nurses, medical diversity is something that we will undoubtedly encounter and has a large influence on health management. Alternative medicine is not only prevalent for those outside of the medical profession but is a rising practice among health care professionals. In this case, a nurse should inquire about the substance and seek to identify its origins. This should also be discussed with physician. The nurse and the entire health care team should familiarize themselves with the family’s beliefs and practices. The health care team should then use this knowledge to design a comprehensive and inclusive health care plan. Culturally, the nurse must be sensitive to the family structure, religious values, and cultural preferences. In this case, the nurse should respect the families Russian cultural
values.
9. List a priority physical and social diagnosis for this patient.
Physical: Physical-altered nutrition: less than body weight requirement R/T body weight less than normal AEB patient’s height and weight percentiles.
Social: Impaired Verbal Communication R/T language barriers AEB the inability to speak English fluently, primary language is Russian
10. List a priority physical and social diagnosis for the family
Physical: Caregiver Role strain R/T Caregiver has multiple competing roles AEB his job at USF as an engineer, taking care of his daughter Ivana, and will serve as an interpreter to the mother and grandmother while at the hospital.
Social: Interrupted Family Process R/T the child’s hospitalization and illness AEB changes in assigned tasks.
Fall 2013