Developmental Level

Please answer the questions related to the case study below. 

Case Study 

Claire is a previously healthy, unvaccinated 3 year old child who is admitted to your nursing unit at the children’s hospital. Claire’s parents report that she had a cough and runny nose last week, and was taken to see the physician. Claire’s admitting diagnosis is seizures and further workup is to be done to determine the cause. Claire presented to the emergency department by ambulance after she started seizing in her home. EMS reported a 3 minute long tonic-clonic seizure and the emergency room nurse reports to you that another tonic-clonic seizure occurred that lasted 2 minutes in the ER. Post-ictal period lasted approximately 5-10 minutes both times and vital signs were within normal range in the ER. Claire is now on the unit, and vital signs are as follows: Temp- 38.7, Pulse- 134 BP- 88/62 Resp- 32/min and Sp02 90% on room air.  On your initial assessment Claire is lying in the bed staring at her mother, she appears listless and does not fuss when you take her vital signs. Claire’s mother is frantic and reports to you that Claire vomited just prior to you entering the room.

  1. Please identify three communication techniques that could be utilized to build the therapeutic relationship with Claire and her mother.  (3)
  2. Discuss three safety concerns related to Claire’s age group and hospital admission (3)
  3. Discuss your concerns from the above assessment. Which pieces of assessment data concern you and why? (3)
  4. Using the data you’ve mentioned above, identify what pathological process could be occurring with Claire. Please provide evidence and rationale for your answer (3)
  5. Please describe your next three nursing actions, and provide rationale for why you would choose to perform them (3)
  6. Please identify any health history information that would concern you (3)

The physician requests that a second IV be placed to administer medications. When you enter later in the shift to start the IV, Claire starts to cry and kick and you are not able to even look for a vein as she will not keep still.

  1. Discuss the legalities of restraining a 3 year old child to complete medically necessary treatment (3)
  2. Describe how you would approach Claire’s mother to bring up the topic of restraint, what teaching points would be essential to include (3)
  3. Identify the type of restraint that would be most appropriate in this patient, and discuss what you would need prior to restraining Claire (3)

Four days later you return to your next shift and when entering the room Claire is sitting up in her cot and waving. She laughs when you approach and say hello to her, and shows you her stuffed elephant. When you are assessing you notice that she is favouring her left arm, and her right arm appears red and is warm to touch at the elbow.

  1. Describe how you would perform a pain assessment on Claire, taking into account her age (3)
  2. Identify three appropriate activities or toys for Claire given her suspected diagnoses above and her developmental level (3)

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