Difficult SAMPLE ASSIGNMENT FOR A PEDIATRIC CASE STUDY All students read Nicole. Nicole. Answ Answer er the questions. One group of students will research research support suppo rt gro groups ups for pare parents nts of child children ren with cancer cancer.. One group will suggest specific specific recommendations to assist Nicole in developing coping mechanisms that are age appropriate appro priate for her. The third group will iden identify tify what the possible signs and sympto symptoms ms might have presented presented related to the CVAD CVAD line infec infection. tion. Each group will present and lead a discussion on their topics in post conference.
Additional cases provide the opportunity to introduce cultural diversity, diversity, economic hardship hard ship and other variables variables into the situations. Stude Students nts are able to experience enriched enrich ed clinical experiences, experiences, ev even en in those situations situations where time is very limited. The cases are interesting, interesting, easy to read and reme remember mber.. The student has the questi questions ons and answers available to provide a knowledge foundation prior to going to the clinical clini cal area. Instructo Instructors rs can expand the cases and students can relate them to what they are seein seeing. g. The cases become the basis for teaching teaching critical thinking.
C a l l 1 . 8 0 0 . 3 5 4 . 9 7 0 6 t o o r d e r t o d a y • J o i n u s a t w w w . c e n g a g e. e . c o m /n /n u r s i n g / c a s e s t u d i e s
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Case Studies in Pediatrics: Frontmatter
CONTENTS
Contents Reviewers Preface
vii ix
Comprehensive Table of Variables
Part 1
Part 2
Part 3
Part 4
xiii
The Digestive and Urinary Systems . . . . . . . . . . . . . . . . . . . . . . .
...
1
Case Study
1
Shelly
3
Case Study
2
Justin
5
Case Study
3
Beth
7
Case Study
4
Jesus
9
Case Study
5
Jamal
13
Case Study
6
Kurt
15
Case Study
7
Nathan
17
Case Study
8
Marissa
19
Case Study
9
Sandra
21
Case Study
10
Cammie
23
The Respiratory System . . . . . . . .
..
27
Case Study
1
Case Study
2
Caleb
33
Case Study
3
Cara
35
Case Study
4
Erin
39
Case Study
5
Anna
41
Case Study
6
Dwight
45
Case Study
7
Helen
49
Sara and Mary
29
The Cardiovascular System and the Blood . . . . . . . . . . . . . . . . . . . . . . . . 51 Case Study
1
Nisha
53
Case Study
2
Brandon
55
Case Study
3
Ryan
59
Case Study
4
Sean
61
Case Study
5
Cassie
63
The Skeletal, Muscular, and Integumentary Systems . . . . . . . . . . 67 Case Study
1
Julie
69
Case Study
2
Lauren
73
Case Study
3
Jason
75
v
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Case Studies in Pediatrics: Frontmatter
CONTENTS
Part 5
Part 6
Part 7
Case Study
4
Kimberli
79
Case Study
5
Ilya
81
The Nervous and Endocrine Systems . . . . . . . . . . . . . . . . . . . . . . . . . 85 Case Study
1
Andrea
87
Case Study
2
Brent
89
Case Study
3
Jessica
91
Case Study
4
Melanie
93
Case Study
5
Andrew
97
The Lymphatic System . . . . . . . .
..
101
Case Study
1
David
103
Case Study
2
Jerome
107
Case Study
3
Chad
109
Case Study
4
Ashlee
113
Case Study
5
Nicole
117
Case Study
6
Katie
121
The Reproductive System . . . . . . . 123 Case Study
Reviewers Jane H. Barnsteiner RN, PhD, FAAN Professor of Pediatric Nursing University of Pennsylvania School of Nursing Philadelphia, Pennsylvania Diana Jacobson MS, RN, CPNO Faculty Associate Arizona State University, College of Nursing Tempe, Arizona Nancy Oldenburg RN, MS, CPNP Clinical Instructor Northern Illinois University DeKalb, Illinois Deborah J. Persell MSN, RN, CPNP Assistant Professor Arkansas State University Jonesboro, Arkansas JoAnne Solchany RN, ARNP, PhD, CS Assistant Professor, Family & Child Nursing University of Washington Seattle, Washington
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Case Studies in Pediatrics
C O M P R E H E N S I V E TA B L E O F V A R I A B L E S
Comprehensive Table of Variables
Case Studies
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Case Studies in Pediatrics
C O M P R E H E N S I V E TA B L E O F V A R I A B L E S
N O I T A G E L E D N O I T A Z I T I R O I R P
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Y P A R E H T E V I T A N R E T L A
x
L A C I H T E
x
L A G E L L A I C O S O H C Y S P C I G O L O C A M R A H P
x x
x x x x x x x x x x
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x x
x x
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x x x x x x x x x
L A U T I R I P S C I M O N O C E O I C O S
x x x
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N O I T A C I N U M M O C
x x x
x
x
S N O I T I D N O C G N I T S I X E O C
S N O I T A R E D I S N O C L A R U T L U C
x
x
Y R O T S I H T N A C I F I N G I S
S N O I T I D N O C G N I T S I X E E R P
x x
Y T I L I B A S I D
x
x
x x x x
x
x x x x
x
c i n a p s i H n n a a n n c n n n i n n n i r a a a c a a a a a c i c c e c i c c r c i c e i i i r m i r r r i r r m e r e e e A r e e e e m m m n m m m A m m A A A a A A A h A s A c k t e t e t e i e k i e t e t t n i i i x c i c a i i h h h e l h h h a a p l W W W M B W B S W W
n n n n n n n n n n n n a a a a a a a a a a i c a c i c i c i c i c c i c i c a i i c c c i i r i r r r r r r r r e e r e r e e e e r e e e e e m m m m m m m m m m m m A A A A A A A A A A A e e e A e e e t e e e t t t i k i t i i d k i t i t i k i i t c c t c h l a h h h h h o l a h h h l a Y T I C I N H T E W B W W W W W l o B W W W B B e h s t l m a d t e i t n p s a s y o l S m h a e / t y t i c c r i i s p a n y n s l l l n i l l l l l l i l l m l l l l l l i S l o a a a e r l c c a a a a a a a a a a a a a a h t r / / t t t t t t t t t t t t t t / i c t i t i t i U e i c i i i i i e i s i i i i i i c l a i p p p p p p y p p p p p p i u p i p p p d m p s s s s s s m s s s s s s s s s s n n n S i o o o o o o o i c o l i o o s G N I T T E S n o o l o o o o o o l o a H H C H H H H H H H y H H H H H H C s H C H H H r a e o v t v o i a t s r s i s d s i s s s h h h h e p h t t r t h h a e e s g t t t t n s t n C n t i e n n a n a o y o e o n D R o o o n o n m a m m m e h o o e m E G A h e m 8 d e 4 4 h m T 4 0 1 2 6 9 8 4 4 1 : T e 1 8 1 1 9 : 4 n 4 4 1 2 6 n 1 1 T : e e o r R E D N E G n w F M F F F M F h F M M M F O F M F M M M M F F F T T t t t r r Y D U T S E S A C r a a a 0 P 1 2 3 4 5 6 7 8 9 1 P 1 2 3 4 5 6 7 P 1 2 3 4 5
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Case Studies in Pediatrics
C O M P R E H E N S I V E TA B L E O F V A R I A B L E S
x x x x x
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t n a r g i m m i n a i s s u R t n e c e R n a n n c n n n n n n n n n n n n i a a a a a a a a a a a r a c i c i c c i c i c i c c a c i c r c i e i i s i c i c e i i r r r r r r r r r t r r r m s m e e e e e e e e e r e e e e a e m m m m A t m m m m m m m E m m s A A A A h n A A A A A A A y s e A A e e l a i i e e e e e e e e S n t k t t t n s i t i i t i t i t i i k i t i d a i c t a s y d c h h h h h h h h l a a h h i r i s p l u a A W W W R S W W W W W B W W M B t n e t s n ’ m s s ’ m ’ e s u r r e r g t e e m e e t s d d t r d i i i y n a v v I S v l t p o l o i a e r r e r a d e o c d t n i i p p p n n t m u i n p i a i y e p r e e o s l c , c r r r i c c h r o l r l / / a s a a o n l l l l l l l a t h o c l a a e c h a d c / a a a a a a a l m t i t t t t t t t t u n / i g h i E h i t e i i e i i h o i c i h t r t t e e e p p l p l p p p p p p l o s c s s s s m s s a i s s s e a i c c h c a i y u o o m e f y o o o o o e f f s f f o d e o o c f s S M H H E H o H n a H o S H P H c H H H H H H o l , i s t a u t a o e h l v p e r e k t e m a S y N n L e e o h e 3 3 6 0 e 0 1 0 3 4 h T 5 n 1 1 1 1 T 9 1 1 1 h 2 1 1 4 1 1 1 : : 7 T r : e u x v i i o F F F M F M F F M F F M S M M M F F F t t t r r r a a a P 1 2 3 4 5 P 1 2 3 4 5 P 1 2 3 4 5 6
x
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c i m n e i t l s c y l S a t e e a v n i t m c o e r u H P d o r p e s R k e e h e T : w 6 n 3 1 e v e S F F t r a P 1 2
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ANSWERS
must realize that the time of administration for medications is part of the seven rights of medication administration—Right Time. Some nurses do not want to use this schedule because of the 0700 dose being at the time of morning change of shifts, and on units where nurses work 12-hour shifts, it affects both shift times; however, nurses should first consider what is best for the client. In most health facilities, a 30-minute window for administration is policy (drugs can be administered 30 minutes prior to or after the scheduled time) so if the aforementioned schedule cannot be changed, the nurse should administer the cefoxitin sodium before the gentamicin because it infuses in 15 minutes versus the 30-minute administration time for gentamicin; thus both could be administered within the 30-minute window. 12. Calculate
the rates of administration via a volumetric intravenous infusion pump for the following: Gentamicin sulfate 100 mg in 100 mL of 5% dextrose in water to infuse over 30 minutes Vancomycin hydrochloride 500 mg in 250 mL of 0.9% normal saline Cefoxitin sodium 1 g in 50 mL of 5% dextrose in water to infuse over 15 minutes Using the formula of Time Volume
�
Time Volume
The hourly rate for gentamicin is 200 mg/hour 30 minutes 100 mL
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60 minutes X
The hourly rate for vancomycin is not stated in the prescription because the nurse should note that to prevent renal adverse effects, it must be administered over a minimum of 60 minutes (250 mL/hour). Common practice in pediatrics is infusing it over 2 hours so the rate should be 125 mL/hour. The hourly rate for cefoxitin is 200 mL/hour. References Broyles, B.E. (2005). Medical-surgical clinical companion . Durham, NC: Carolina Academic Press, pp. 183–186. Centers for Disease Control and Prevention. http://www.cdc.gov Daniels, R. (2002). Delmar’s manual of laboratory and diagnostic tests. Clifton Park, NY: Thomson Delmar Learning. Gahart, B.L. and Nazareno, A.R. (2005). 2005 Intravenous medications . (21st ed.). St. Louis: Mosby. Intravenous Therapy. http://www.nursewise.com Josephson, D.L. (2004). Intravenous infusion therapy for nurses: Principles & practice (2nd ed.). Clifton Park, NY: Thomson Delmar Learning. North American Nursing Diagnosis Association. (2005). Nursing diagnoses: Definitions & classifications, 2005–2006 . Philadelphia: NANDA.
Potts, N. and Mandleco, B. (2002). Pediatric nursing: Caring for children and their families . Clifton Park, NY: Thomson Delmar Learning. Reiss, B.S., Evans, M.E. and Broyles, B.E. (2002). Pharmacological aspects of nursing care. (6th ed.). Clifton Park, NY: Thomson Delmar Learning, pp. 760–797. Wong, D.L., Perry, S.E., and Hockenberry, M.J. (2002). Maternal child nursing care (2nd ed.). St. Louis: Mosby, p. 1376.