Pediatric Nursing: Nursing Care of the Child with an Infection

1. Mrs Acton, the mother of 6-year-old Christina, calls the physician’s office to speak to the
   nurse. Mrs Acton is concerned because Christina went to a birthday party eight days ago and was
   exposed to chickenpox.
   a. What information would be appropriate to give to Mrs Acton?
   • Because it’s contagious, Christiana should stay away from any immunocompromised family members or tiny children.
   • Have Christiana wear a mask since chickenpox spreads by coughing and sneezing. If she has not been vaccinated, I would recommend getting the vaccination to prevent chickenpox from recurring.
   • Recommend calamine lotion as an over-the-counter treatment for itching.
   • Oatmeal baths and cold packs are recommended for alleviating soreness.
   • To avoid scratching, cut your fingernails and use gloves.
   b. What data would be important for the nurse to gather when speaking with Mrs Acton?
   • How long have you been experiencing symptoms?
   • Have the symptoms gotten any worse?
   • Has your daughter been vaccinated against varicella?
   • Has your daughter received the second dosage of the vaccine if she received the first?
   • Has she been sick with a fever?
   • Do her rashes look like bug bites, or do they have blisters and bumps on them?
   • Does she seem to be having problems breathing or has sores in her mouth?
   • Do her rashes appear red, heated, swollen, or pus-filled? (signs of infection)

Pediatric Nursing Case Studies: Nursing Care of the Child with an Alteration in Gas Exchange/Respiratory Disorder

1.  Gloria is an 8-year-old girl admitted to the pediatric unit with a history of cystic
   fibrosis and difficulty breathing.
   a. What would the nurse know to include in the health history?
   • Has your daughter experienced any stomach ache or difficulty passing a stool?
   • How does your stool appear? Is it oily and bulky?
   • Has she lost her appetite? Does it appear like she is gaining weight as a result of the amount of food she is consuming?
   • Has she experienced a recent respiratory infection or cough?
   • Can you tell me about her sputum production? Is it now higher?
   • Can you tell me how she’s doing with her breathing? Does it appear like she is increasing her workload in order to take a break?
   • How well does she cope with day-to-day tasks? Is she prone to exhaustion?
   • Does she take pulmonary or pancreatic drugs on a regular basis? Has she have a sudden desire for more in the last few days?
   • Has she been sick with a fever? If that’s the case, what was the highest temperature you experienced?
   • Has she experienced pain in bones?
   b. When conducting a physical assessment on Gloria, what will the nurse do in relation to the
   child’s cystic fibrosis?
   • Look for polys in the nasal passages.
   • Determine your respiratory rate.
   • Evaluate the work of breathing
   • Consider the use of any accessory muscles.
   • Determine the frequency and severity of coughing.
   • Assess the quality (productive/non-productive) and quantity of sputum production.
   • Does she appear to be endowed with a barrel chest?
   • Check your nails for clubbing.
   • Does she have a swollen abdomen?
   • Do her extremities appear thin due to the reduced amount of subQ fat?
   • Does she have any oedema, which could indicate cardiac or liver failure?
   • Auscultation: does she have crackles, wheezing, or diminished breath sounds; is she tachycardic or has a gallop; and does she have bowel sounds?
   • Does she experience dullness over her liver during percussion, indicating intestinal obstruction?
   • Does she have reduced tactile fremitus during palpation or an asymmetric chest?
   c. What tests would the nurse expect to be ordered for Gloria?
   2. Jimmy Jones, age 6, is diagnosed with asthma. He has been hospitalized for three days for an
   acute exacerbation and is scheduled to go home tomorrow. (Learning Objectives 9 and 10)
   a. What would the nurse know to include in a child/family teaching plan?
   b. How can asthma affect a child’s self-esteem?

Pediatric Nursing Case Studies: Nursing Care of the Child with an Alteration in Perfusion/Cardiovascular Disorder

1. Baby boy Ellis, 2 hours old, is being evaluated in the newborn nursery by the nursing staff. Findings include T 37°C; apical heart rate 140 bpm; respirations 58 breaths per minute; BP (arms) 70/47, (calves) 62/39; head circumference 34 cm; chest circumference 31 cm; length 48 cm; weight 2,700 g. The infant is crying. (Learning Objectives 1, 2, 3, 4, and 8)
a. Based on the physical findings, what should be the nurse’s priority?
b. What assessments/tests should the nurse expect to be done on this infant?
c. What should the nurse include in the teaching plan for the parents of this infant?
2. Jennifer Collins, 13 years old, is admitted to the pediatric floor with a diagnosis of probable acute rheumatic fever. (Learning Objectives 2, 4, 6, 7, and 8)
a. What would the nurse include when performing an initial assessment?
b. What tests would the nurse expect to be done on Jennifer? The diagnosis of acute rheumatic fever is confirmed.
c. What would the nurse be sure to include in the discharge teaching plan for Jennifer and her family?

Pediatric Nursing Case Studies: Nursing Care of the Child with an Alteration in Bowel Elimination/Gastrointestinal Disorder

1. Ghalib Moghadam, three years old, and his family are recent immigrants from Somalia. He has been referred to the local children’s hospital to be seen at the craniofacial clinic for an unrepaired cleft lip and palate. Ghalib’s parents do not have a good understanding of the English language. (Learning Objectives 2, 5, 6, 7, 8, and 10)
a. What would the nurse know to include in the health history of Ghalib?
b. What would the nurse include in the teaching plan for Ghalib and his parents?
c. What resources could the nurse give the parents to help with emotional support?
d. What would be a major challenge in the nursing care of Ghalib and his family?

Pediatric Nursing Case Studies: Nursing Care of the Child with an Alteration in Urinary Elimination/Genitourinary Disorder

1. Jon Allen, 14 months old, is admitted to the pediatric unit of the local children’s hospital for repair of his hypospadias. (Learning Objectives 1, 3, 4, 6, and 8)
a. What information should be gathered in the nursing assessment of Jon’s genitourinary system?
b. What would the nurse know to include in Jon’s postoperative management?
c. When planning postoperative and discharge teaching, what would the nurse include?

Pediatric Nursing Case Studies: Nursing Care of the Child with an Alteration in Immunity or Immunologic Disorder

1. Bryce Morris, five years old, has been brought to the physician’s office by his mother for a yearly check-up. During the nursing assessment, the nurse notes the following: height 40.5 in, weight 40 lb, BP 108/67, pulse 72, R 22, T 37.0°C. When documenting Bryce’s vital signs, the nurse recognizes Bryce has dropped from the 50th percentile in height and weight one year ago to the 5th percentile now.
Bryce’s mother reports that she is concerned because Bryce seems to have lost his appetite, and she wants to know if this is normal for a five-year-old. She also states that she is “a bit” concerned because Bryce doesn’t seem to want to play anymore and has become very irritable. (Learning Objectives 2, 3, 4, and 8)
a. What further assessments should the nurse make?
b. What diagnostic testing should the nurse expect to be ordered?
Bryce is diagnosed with pauciarticular juvenile idiopathic arthritis.
c. What would the nurse know to include in a teaching plan for Bryce and his family