MAISHA1995
Pediatric Inflammation and Infection Unfolding Case Study—MEDICAL…
Pediatric Inflammation and Infection Unfolding Case Study—MEDICAL SURGICAL NURSING
Read the initial patient description about Clark Kent and continue to learn more about him and answer questions along the way.
Clark Kent is a 6-year-old child being seen for a routine well-visit as a new patient whose family recently moved to the rural desert southwest from the eastern United States. As the nurse obtain the health history from Clark’s parents, it is apparent that Clark’s childhood has not been a healthy one.
Patient Name: Clark Kent. Age: 6 years
Health Care Provider: B. Wayne M. D. Allergies: PCN, sulfa, latex, dairy, gluten, eggs, pet dander, nuts
Code Status: Full
Medical History:
Multiple allergies: Intolerance to gluten, dairy, and eggs since age 9 months-cause severe diarrhea, nausea and vomiting.
Nut allergy- since age 2 years- cause difficulty breathing. Also reactive to nut “dust”
Penicillin (PCN) and sulfa- causes severe rash
Latex allergy- “mild” anaphylactic reaction at age 3 years
Seasonal allergies to certain tree blossoms and pet dander-itching eyes, running nose, coughing
Asthma- since age 1
Reoccurring strep throat since age 2- typically once each winter
Fracture right arm and clavicle from a bicycle accident at age 5
Surgical History:
Surgical Repair of right arm fracture age 5 (outpatient)
Mental Health History:
Treated for attention-deficit/hyperactive disorder (ADHD) since age 3-treated with cognitive-behavioral therapy and methylphenidate orally since starting school.
Hospitalizations:
Ages 9 months, 3-years, and 5-years for severe diarrhea and weight loss. Ages 2 and 4 for asthma.
Developmental Level:
Meets physical developmental milestones. Height 40 inches (101.6 cm) and Weight 30 lbs (13.6 kg).
“slow” in school and parents are considering “special classes” or homeschooling with tutoring
Immunization History:
Received routine immunizations at 12 months. Parents have refused all immunizations since due to severe allergy history. “We are afraid of what could happen and wonder if the immunizations could have caused all of this.”
*Hint: You might want to take notes, so you have it to refer to later on. Think of this as your patent report to take notes.
As the nurse reviews the health record, what condition is the priority concern?
1. As the nurse reviews the health record, what condition is the priority concern?
A. Delay in school
B. ADHD
C. previous repaired fracture
D. Allergies
2. Given Clark’s history, what do you think is the nurse’s priority teaching topic?
A. Gluten free diet
B. Grades in school
C. Lack of immunization
D. ADHD Diagnosis
3. The clinic is not a latex-free zone. As the nurse prepares for Clark’s physical assessment, which item(s) require special attention? Select all that apply:
Ballons that mom brought to keep him calm
Blood pressure cuff
Adhesive tape
Gloves
Clark’s temperature and SpO2 results
4. As the nurse is speaking with Clark’s parents and examining him, he becomes very fidgety and won’t stay on the examination table. What action should the nurse take?
A. Tell him to sit still and he can have candy after the visit.
B. Ignore the behavior.
C. Give Clark a small age-appropriate toy.
D.Ask the parents to address the situation.
5.The nurse is concerned about Clark’s lack of immunizations. Although she wants to be respectful of the parent’s personal decision, she feels it is in Clark’s best interest to pursue the topic. Relying on the recommendations of the American Academy of Pediatrics (AAP), how should the nurse begin the conversation with the parents?
A.”Do you know that the AAP fully supports the delivery of routine immunizations for children?”
B.”Can you tell me more about your concerns about Clark receiving immunizations?”
C.”It seems that you are placing Clark in danger by not getting him vaccinated?”
D.”Are you afraid that Clark will get sick from the other kids at school since he is not immunized?”
6.After a conversation with the nurse and health care provider, Clark’s parents provide consent for immunizations, if an antihistamine is given beforehand. The nurse delivers the antihistamine, diphenhydramine (Benadryl), then gathers latex-free equipment for the injections and two automatic epinephrine injectors, to be safe. She then reviews the Center for Disease Control (CDC) immunization record and education sheets with the parents and administrations needed vaccines.
A. Difficulty breathing
B. Itchy skin
C. Rash
D. Eye Swelling
E. Sleepiness
7. Two weeks after the immunizations, Clark gets home from school, telling his mother that he feels “yucky.” He has a low-grade fever and says his tummy hurts. His mom feeds him a snack, thinking he may just be hungry. She also gives him some ibuprofen for his fever. She lays him down for a nap while watching cartoons. Clark wakes up crying with pain. He says, “my tummy hurts, my tummy hurts!!!” He cannot identify where the pain is located. His mother takes him to urgent care. They completed an assessment and find his pain is worse in the right lower quadrant. They decide to send Clark to the emergency room for diagnostic tests.
Clark reports to the ER and the nurse documents this admission note:
6-year old boy with stomach pain was sent to this emergency department by the urgent care team. History of asthma and multiple allergies. Gluten intolerant but mother states, “he never had a stomach ache like this before.” T 101 (38.3), respirations 28, HR 128, BP 100/60, O2 95%. Neurological status A&O X3 and normal for developmental age, irritable. Lung fields are clear bilaterally. Tenderness noted in the right lower quadrant, hypoactive bowl sounds. Some nausea, no vomiting. Last bowl movement yesterday, which looked normal and voided dark yellow urine at the urgent clinic.
The lab that were drawn in the ED have returned.
Lab Results:
WBC: 15,000
Hemoglobin: 11.1
Hematocrit: 45
RBC: 3.9
Platelets: 245,000
Calcium: 9.1
Chloride: 98
Magnesium: 2.0
Phosphorus: 3.1
Potassium: 3.8
Sodium: 139
Glucose: 80
BUN: 20
Creatinine: 1.0
What hypothesis can the nurse make, given this information?
Two weeks after the immunizations, Clark gets home from school, telling his mother that he feels “yucky.” He has a low-grade fever and says his tummy hurts. His mom feeds him a snack, thinking he may just be hungry. She also gives him some ibuprofen for his fever. She lays him down for a nap while watching cartoons. Clark wakes up crying with pain. He says, “my tummy hurts, my tummy hurts!!!” He cannot identify where the pain is located. His mother takes him to urgent care. They completed an assessment and find his pain is worse in the right lower quadrant. They decide to send Clark to the emergency room for diagnostic tests.
Clark reports to the ER and the nurse documents this admission note:
6-year old boy with stomach pain was sent to this emergency department by the urgent care team. History of asthma and multiple allergies. Gluten intolerant but mother states, “he never had a stomach ache like this before.” T 101 (38.3), respirations 28, HR 128, BP 100/60, O2 95%. Neurological status A&O X3 and normal for developmental age, irritable. Lung fields are clear bilaterally. Tenderness noted in the right lower quadrant, hypoactive bowl sounds. Some nausea, no vomiting. Last bowl movement yesterday, which looked normal and voided dark yellow urine at the urgent clinic.
The lab that were drawn in the ED have returned.
Lab Results:
WBC: 15,000
Hemoglobin: 11.1
Hematocrit: 45
RBC: 3.9
Platelets: 245,000
Calcium: 9.1
Chloride: 98
Magnesium: 2.0
Phosphorus: 3.1
Potassium: 3.8
Sodium: 139
Glucose: 80
BUN: 20
Creatinine: 1.0
7. What hypothesis can the nurse make, given this information?
A. Clark has a delayed reaction to his immunizations.
B. It is possible that Clark has developed appendicitis.
C. Clark ate a food to which he is allergic.
D. He is having a difficult time at school and wants to stay home.
8. Clark says, “Wow, I feel so much better; I do not have any pain anymore!! 🙂 Can I go home?”
The nurse enters Clark’s room. What observation is most concerning?
A.No pain
B.He wants to go home
C.Arms are in the air
D. Arms are closed
9.Clark has a ruptured appendix and surgery is scheduled within the hour. Match the category chart below pertaining to the preoperative care.
Match one of the below to each task:
Indicated
Contraindicated
IV Fluids for NPO status
Delivery of IV antibiotics
Verbal hand-off to operating room nurses and anesthesiologist about allergies
Preoperative teaching with family
Confirmation that IV is patent
Confirmation of correct ID band
Parental signature on consent
Preoperative medical play on his Batman doll prior to surgery
Instruction of postoperative pain management options
Oral pain medication such as Tylenol or Ibuprofen
10.The nurse reflects on the assessment over the last 6 hours since surgery. Below are 4 findings, which one requires requires additional action?
A. Pain was worse before surgery.
B. Bowl sounds are absent.
C. Abdominal incision with a dime-sized drop of dried blood.
D. Lung sounds with wheezes throughout.
11. With further assessment, the nurse discovers that Clark’s oxygen saturation is 92%, his breathing is mildly labored, and his eyes are puffy. The nurse places Clark on 2L of O2 via NC and decides to call the health care provider.
The nurse gathers a full set of vital signs and begins to prepare SBAR for the health care provider. write an “essay” using SBAR (What will you report to the HCP when you call?)
Situation:
Background:
Assessment:
Recommendation:
WRITE YOUR ANSWER IN THE BOX BELOW.
12. The nurse receives an order for epinephrine 0.01 mg/kg (1:1,000 solution) subcutaneous X1 dose. Available in 1ml/mg (1:1,000 solution). Remember, he weighs 13.6kg.
How many mLs will you draw up and administer to Clark? Just write the number; DO NOT WRITE the mLs after the number and round to the nearest hundredths.
TYPE YOUR ANSWER
13.How does the nurse know the epinephrine worked?
A. Hypotension and Tachycardia with tachypnea
B. Open airway and stable vital signs for being given Epi
C. Hypertension and Bradycardia with tachypnea
D. Reduced pain and nausea
14. After Clark’s appendicitis, the MD places orders for new medications. Clark’s Medication Administration Record (MAR):
1. Pipercillin 100mg/tazobactam 12.5mg per kg IV Q8HR
2. Vancomycin 10mg/kg IV Q6HR
3. Morphine Sulfate 0.15-0.3mg/kg Q4HR PRN pain
4. Acetaminophen 15mg/kg/dose Q6HR PRN for mild pain or temperature greater than 100.5 (38).
Which medication from the MAR is most concerning?
After Clark’s appendicitis, the MD places orders for new medications. Clark’s Medication Administration Record (MAR):
1. Pipercillin 100mg/tazobactam 12.5mg per kg IV Q8HR
2. Vancomycin 10mg/kg IV Q6HR
3. Morphine Sulfate 0.15-0.3mg/kg Q4HR PRN pain
4. Acetaminophen 15mg/kg/dose Q6HR PRN for mild pain or temperature greater than 100.5 (38).
Which medication from the MAR is most concerning?
Morphine Sulfate
Acetaminophen
Piperacillin/tazobactam
Vancomycin
15.Clark’s mom receives a call that his cousin, Robin’s who is 3.5 years old, suddenly feels lethargic, doesn’t have as wet of diapers, and his mom notices that his face, hands, and feet are swollen and urine looks bubbly in the toilet. Robin’s mom is bringing her to the hospital.
You suspect Robin is experiencing nephrotic syndrome. Place the pathophysiology for what is happening inside Robin’s body from the start- step 1 to step 4.
1.Hypercholesterolemia, hypovolemia and with that,edema occurs
2. Hypoalbuminemia
3.Protuinuria
4.Insult to kidney.
16. What are the anticipated orders for nephrotic syndrome (hint: there are 8 correct answers)? Drag your answer choices to the “ordered for this patient” and drag the other choices to the “not ordered for this patient”
These questions will help guide you to what 8 orders you anticipate being ordered for Robin:
What PRN medication with Robin have onboard during his hospitalization for nephrotic syndrome? Robin will be prescribed what medication to pull off fluid What medication is used to reduce inflammation in Robin’s body? If Robin’s labs and symptoms do not improve, what medication might the doctor prescribe? What diet modifications might be included in the orders?
CHOOSE WHAT BELONGS TO EACH CATEGORY
Ordered for the patient
Not ordered for the patient : Click to change selection.
Metoprolol
IVFs wide open
Daily Weights
Lisinopril
Daily weights
High Carbohydrate Diet
Albumin
Prednisone
Fluid Restriction
Phosphorus
Lasix
Minimum Fluid Goal of 1500mLs
Ibuprofen
Potassium Chloride
Hydralazine
Na Restriction
