CASE STUDIES
I- Case Study: Care of the Child in Inpatient and Outpatient Settings
Jordan is 9-year-old male who is a direct admit for observation. He has a history of vomiting and diarrhea for 48 hours.
Subjective Data
- Nausea and vomiting for 24 hours
- Has not voided today
- Unable to tolerate oral fluids
Objective Data
- Vital signs: T 37.8° C, P 120, R24, BP 110/60
- Weight: 34 kg
- Hyperactive bowel sounds to auscultation
1. Question 1
When should the discharge teaching begin for Jordan and his family?
2. Question 2
What is the best way to approach Jordan regarding the IV that has been ordered.
3. Question 3
What would be good distractions for a child of Jordan’s age?
II- Case Study: Pediatric Cancer
Mario is a 7-year-old male who presents with a 1-week history of body aches and pallor. He has a 2-day history of fever to 103° F and a 1-day history of bruising and lethargy.
Subjective Data
- Complains of hurting all over
- States he feels very tired
- States he feels dizzy when he stands up
Objective Data
- Weight 26.1 kg
- Vital signs: T 38.9° C, P 140, R 40, BP 108/54, O2 sat 100%
- Purpural rash on extremities
- WBC 0.7
- HGB 3.1
- Hct 8.5
- Plt .08
- ANC 0.1
4. Question 1
Which of Mario’s presenting symptoms must be treated and stabilized before chemotherapy induction?
5. Question 2
What testing is required for a definitive diagnosis of meningitis?
6. Question 3
What should the nurse do in this clinical situation? Prioritize actions.
III- Case Study: Pediatric Respiratory System
Will is a 4-month-old infant born at 34 weeks of gestation. Will’s mother states that he has not been able to go to day care because he has been coughing with a fever for the past 3 days. She states today he is unable to feed well from the bottle because of nasal secretions.
Subjective Data
- Mother complains that infant has had cough for 3 days
- Mother states that infant is having trouble sleeping
- Not voided in past 6 hours
Objective Data
- Birth Weight: 1.9 kg
- Today’s Weight: 5.5 kg
- Vital Signs: T 38° C, P 186, R 60, BP 90/52, Pulse Oximetry 93%
- Thick yellow nasal secretions
- Nasal flaring with moderate intercostal retractions
- Breath sounds decreased with crackles bilaterally to auscultation
7. Question 1
What risk factors does Will have for contracting bronchiolitis?
8. Question 2
What is the first priority for Will’s treatment?
9. Question 3
What should the nurse do in this clinical situation? Prioritize actions.
IV- Case Study: Pediatric Gastrointestinal System
Lucy is a 44-day-old formula-fed infant who presents with a 4-day history of vomiting.
Subjective Data
- Mother states infant has been vomiting undigested formula after feedings
- Mother states that infant has not had fever or diarrhea
- Mother states that infant has had 8 wet diapers in the past 24 hours
Objective Data
- Weight 4.8 kg (birth weight 3.5 kg)
- Vital signs: T 37.1° C (rectal), P 130, R 30, BP 92/52
- Mucous membranes moist, anterior fontanel flat and soft
- Awake and alert, lusty cry
- Good muscle tone
- Olive-sized mass palpated at epigastrium
10. Question 1
What test will be used to diagnose pyloric stenosis?
11. 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 ____.
12. Question 3
The second prioritization step the nurse would take is ____.
13. Question 4
The third prioritization step the nurse would take is ____.
14. Question 5
The fourth prioritization step the nurse would take is ____.
15. Question 6
The fifth prioritization step the nurse would take is ____.
16. Question 7
The sixth prioritization step the nurse would take is ____.
17. Question 8
The seventh prioritization step the nurse would take is ____.
18. Question 9
The eighth prioritization step the nurse would take is ____.
V- Case Study: Pediatric Cardiovascular System
Michael is a 7-week-old breastfed infant who presents with a 2-day history of irritability and poor feeding.
Subjective Data
- Mom states patient has been “fussy” for past 2 days
- Only feeds for a “few” minutes at a time
- Breathing heavily and fast for 2 days
Objective Data
- Weight: 4.8 kg
- Vital Signs: T 36.8° C, P 250, R 65, BP 84/58
- Breath sounds clear to auscultation
- Oxygen Saturation 95%
- Central capillary refill 4 sec
19. Question 1
What is the treatment for an unstable patient with SVT?
20. Question 2
Decreased cardiac output from prolonged SVT will produce what complication?
21. Question 3
In this clinical situation what should the nurse do? Prioritize actions.
VI- Case Study: Hematologic System
Liam is an 8-year-old male with a history of hemophilia. Liam presents today with a 1-day history of right elbow pain.
Subjective Data
- Right elbow pain for 1 day
- Patient states he hit his right elbow on desk yesterday
- Patient complains that he cannot move his elbow
Objective Data
- Weight 31.6 kg
- Vital sighs: T 37.4° C, P 82, R 20, BP 108/68
- Rates pain 6 on scale of 10
22. 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?
23. Question 2
Why are neuro checks an important part of Liam’s physical exam?
24. Question 3
What should the nurse do in this clinical situation? Prioritize actions.
VII- Case Study: Common Disorders of the Red Blood Cells
Susan is a 26-year-old G1P0 at 6 weeks of gestation with type 2 diabetes. Her BMI is 32. Her hemoglobin A1C is 9. She uses glyburide 10 mg PO daily. The physician has switched her to insulin at this time.
1. Question 1
What is the nursing priority at this time?
2. Question 2
What should Susan be taught about insulin needs during pregnancy?
3. Question 3
What additional risk factor does Susan have?
4. Question 4
How should Susan be counseled regarding weight gain in pregnancy?
5. Question 5
What advice can be given to Susan regarding exercise?
VIII- Case Study: Pediatric Genitourinary System
Lilly is a 3-year-old female who presents with complaints of abdominal pain and fever since yesterday.
Subjective Data
- Complains of lower abdominal pain
- Fever for 24 hours
- Lilly has ‘wet her pants’ despite being recently potty trained
Objective Data
- Vital signs: T38.5° C, P 114, R 32, BP 104/62
- Urine positive for WBCs, nitrites, blood
6. Question 1
What risk factors does Lilly have for UTI?
7. Question 2
What might prevent Lilly from a recurring UTI?
8. Question 3
What should the nurse do in this situation? Prioritize actions.
IX- Case Study: Pediatric Neurologic System
Abby is a 1-year-old female who presents after a reported seizure at day care.
Subjective Data
- Fever for 1 hour
- Eating and drinking normally per mother
Objective Data
- Vital signs: T 40° C, HR 160, R 44, BP 104/68
- Awake and alert
- Skin hot to touch, otherwise normal physical examination
9. Question 1
How should the nurse respond to Abby’s mother when she asks if Abby has epilepsy?
10. Question 2
How should the nurse respond to Abby’s mothers question about brain damage?
11. Question 3
In this clinical situation what should the nurse do?
