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Pediatric Cancer - Case Study

CASE STUDIES

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Case Study 1: Care of the Child in Inpatient and Outpatient Settings

Question 1: When should the discharge teaching begin for Jordan and his family?

Answer: The discharge teaching should begin after 48 hours to the Jordan and his family. (Canavan and Arant, 2009).

Question 2: What is the best way to approach Jordan regarding the IV that has been ordered.

Answer: IV infusion of 20ml/kg isotonic fluids (normal saline) with 0.9% Sodium chloride for 1-2 hours will manage the loss of fluids until oral rehydration therapy is tolerated by Jordan (Holliday et al, 2007).

Question 3: What would be good distractions for a child of Jordan's age?

Answer: Watching Kids TV shows would be good distraction for child of Jordan's age while being admitted in the hospital.

Case Study 2: Pediatric Cancer

Question 1: Which of Mario's presenting symptoms must be treated and stabilized before chemotherapy induction?

Answer: Fever is the most important presenting symptom which should be treated immediately as it could be a sign of chronic infection (Allmon et al, 2018).

Question 2: What testing is required for a definitive diagnosis of meningitis?

Answer: Lumbar puncture or Spinal tap is widely required for the definitive diagnosis of meningitis. Cerebrospinal Fluid (CSF) is collected during spinal tap. Patients with meningitis often have low glucose, low protein and increase WBC count in CSF analysis (Mayo clinic, n.d).

Question 3: What should the nurse do in this clinical situation? Prioritize actions.

Answer: Nursing actions for pediatric meningitis include

• Placing Patient droplet isolation

• Administration of analgesics

• Administration of antimicrobials

• Assessment of neurological status and LOC every 1-2 hours

• Implementing effective precautions for seizures

• Patient family education (Alcosar et al, 2013)

Case Study 3: Pediatric Respiratory System

Question 1: What risk factors does Will have for contracting bronchiolitis?

Answer: Inadequate prenatal and neonatal care, delivery due to elective cesarean before 37 weeks of gestation, less birth weight are the common risk factors Will possess for contracting bronchiolitis (Aceves et al, 2018)

Question 2: What is the first priority for Will's treatment?

Answer: Diagnosis for Bronchiolitis after physical examination

Administration of alpha or beta adrenergic drugs for management of bronchiolitis

Question 3: What should the nurse do in this clinical situation? Prioritize actions.

Answer: Nursing actions include

1. Routine respiratory assessment for every 1-2 hours

2. Administration of oral feeds

3. Performing pulse oximetry and documenting the findings

4. Minimal handling

5. Performing gentle nasal suctions to clear nasal passages

6. Administration of oxygen to retain saturation rate 90%

7. Administration of effective analgesics (RCH, 2016)

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Case Study 4: Pediatric Gastrointestinal System

Question 1: What test will be used to diagnose pyloric stenosis?

Answer: Abdominal ultrasound examination is commonly used to identify enlarged pylorus.

Question 2: What should the nurse do in this clinical situation? Using the case study above, the first prioritization step the nurse would take is ____.

Answer: Administration of IV fluids to restore fluid and electrolyte balance.

Question 3: The second prioritization step the nurse would take is ____.

Answer: Preparing neonate for surgical procedures by cardiovascular assessments.

Question 4: The third prioritization step the nurse would take is ____.

Answer: Assessment of blood and biochemical parameters after surgical treatment.

Question 5: The fourth prioritization step the nurse would take is ____.

Answer: Administration of 10% dextrose.

Question 6: The fifth prioritization step the nurse would take is ____.

Answer: Administration of replacement fluid 0.9%.

Question 7: The sixth prioritization step the nurse would take is ____.

Answer: Repeating the fluid treatment for every 24 hours.

Question 8: The seventh prioritization step the nurse would take is ____.

Answer: Cardiovascular assessments after 6 hours of surgery and starting the baby fed.

Question 9: The eighth prioritization step the nurse would take is ____.

Answer: Administration of analgesics and discharge teaching (RCH, 2018).

Case Study 5: Pediatric Cardiovascular System

Question 1: What is the treatment for an unstable patient with SVT?

Answer: Intubation and assistive ventilation support

Administration of adenosine starting from 0.05mg/kg body weight to the infant

Question 2: Decreased cardiac output from prolonged SVT will produce what complication?

Answer: Defibrillation.

Question 3: In this clinical situation what should the nurse do? Prioritize actions.

Answer: Nursing actions include

For ventricular defibrillation, connecting the defibrillator to ECG leads frequent monitoring of QRS complex

Administration of Beta Blockers in extreme conditions (Auckland Health Board, 2010)

Case Study 6: Hematologic System

Question 1: How should the nurse respond when Liam's father explains that they watched and waited to see if Liam needed treatment after his injury?

Answer: Nurse should explain that pain management drugs are harmful for his hemophilia and could worsen the elbow injury. However, acute blood thinning medications like warfarin can be prescribed for pain management of elbow for the kid with hemophilia.

Question 2: Why are neuro checks an important part of Liam's physical exam?

Answer: Neurological assessments are important to assess the extreme chronic condition of the injury of Liam. It helps to assess CNS bleeding in Liam due to injury.

Question 3: What should the nurse do in this clinical situation? Prioritize actions.

Answer: The prophylactic actions for Liam include

1. Gathering history of onset of the symptoms

2. Observation of patient for Neurological and CVD symptoms

3. Administration of IV and pain medication

4. Evaluation of physical and motor response

5. Assessment of cranial nerve function and pressure

6. Reassessment of cranial nerve pressure after raising the bed 30 degrees upward (Riley et al, 2013)

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Case Study 7: Common Disorders of the Red Blood Cells

Question 1: What is the nursing priority at this time?

Answer: Nursing priority is to manage type 2 diabetes is to determine the glucose levels using Oral Glucose Tolerance Test. (Desisto et al, 2014).

Question 2: What should Susan be taught about insulin needs during pregnancy?

Answer: The need for insulin changes based on the hormone production and weight gain during the pregnancy and Susan should be provided with an insulin chart by the nurse about the recommended levels. (Desisto et al, 2014).

Question 3: What additional risk factor does Susan have?

Answer: High BMI, High blood pressure and hormonal disorders are other additional risk factors exposed by Susan (Desisto et al, 2014).

Question 4: How should Susan be counseled regarding weight gain in pregnancy?

Answer: Susan should be counseled privately by nurse and dietician privately regarding the weight management. She should be advised about the risk of overweight during pregnancy could affect the child birth. (Desisto et al, 2014).

Question 5: What advice can be given to Susan regarding exercise?

Answer: Regular exercises can be suggested to Susan for weight management.

Case Study 8: Pediatric Genitourinary System

Question 1: What risk factors does Lilly have for UTI?

Answer: Frequent urination, wetting pants regularly, lower abdominal pain.

Question 2: What might prevent Lilly from a recurring UTI?

Answer: Management of drugs for UTI tract infections could prevent her from recurring UTI.

Question 3: What should the nurse do in this situation? Prioritize actions.

Answer: Administration of antibiotics in IV fluids for 48 hours till five days and followed by oral antibiotics will eliminate the current infection and reduce the redundancies of future UTI infections (Riberio, 2015).

Case Study 9: Pediatric Neurologic System

Question 1: How should the nurse respond to Abby's mother when she asks if Abby has epilepsy?

Answer: Nurse should educate Abby's mother about the current clinical condition that could be possibly lead to epilepsy condition of the kid.

Question 2: How should the nurse respond to Abby's mothers question about brain damage?

Answer: Nurse should respond the Abby's mother with good quality of information about the brain damage might occur possibly with proper communication tool.

Question 3: In this clinical situation what should the nurse do?

Answer: The aim of the nurse is to treat and establish seizure control using anti-epilectic drugs and ketogenic diet (Cassidy, 2016)

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