Case Studies (peds)

NUR114

Week 8

Case Studies (peds)

Complete the following two (2) case studies. Thoroughly answer the questions regarding the scenario with supporting data. Title each case study on your paper. Submit to Blackboard.

Nursing Care of the Child With a Neoplastic Disorder

1. Tiffany Mikles, 4 years old, has been newly diagnosed with leukemia. She is the youngest of three children. This is her first admission to the hospital. 

a. Write a psychosocial assessment of Tiffany and her family.

b. What should the nurse include in child and family education?

2. Jacob Espinoza, 14 years old, is admitted to the pediatric oncology ward with Ewing sarcoma located at the midshaft of the right femur. CT scan shows a 2.5-cm area on the pelvis that is believed to be an area of metastasis. Jacob asks the nurse what his treatment will be like. 

a. Describe how you would explain to Jacob his expected treatment. 

b. What laboratory tests would the nurse expect to be ordered for Jacob?

c. Describe the nursing management you would use for Jacob.

Associate Degree in NursingNURS 114 – MATERNITY Week 8

Case Studies

1. Sarah works in the labor and delivery unit as a transition nurse. Her department has instituted a new bedside transition period where newborns make the transition to extrauterine life in their mother’s recovery room about an hour after birth. Sarah’s next assignment is a new baby boy with Apgar scores of 8 and 9, born by cesarean about 1 hour ago to Lindsay, a 28-year-old G1. Sarah’s assessment findings of the new baby boy are:

• Vital signs: axillary temperature 37.0° C, heart rate 145, respiratory rate 75
• Observations: color pink, respirations rapid and unlabored, good muscle tone, good arm and leg movement
• Auscultation: breath sounds clear and equal bilaterally, strong heart sounds with a soft murmur, active bowel sounds in all four quadrants
• Physical assessment: fontanels soft and flat, eyes clear with red reflex in both, ears normal shape and placement, soft and hard palate intact, strong suck, both nares patent, capillary refill less than 2 seconds, both testes descended
• Measurements: weight 8 pounds 6 ounces, length 20 inches, head circumference 36.2 cm, chest circumference 36.0 cm

As Sarah is charting her findings, Lindsay asks Sarah if everything is OK with her baby.

1. Which assessment findings for this newborn are abnormal? What is the most likely cause of these abnormal findings?
2. How would Sarah explain these abnormal findings to Lindsay?
3. Describe the nursing interventions that Sarah would implement based on these findings. 

2. Brenda is a nurse in a special care nursery. A 16-year-old girl had been admitted to the emergency department earlier that morning with complaints of excruciating back pain and nausea. She was diagnosed as being in labor and transferred to the labor and delivery unit. She was apparently unaware of the pregnancy. She received no prenatal care and cannot remember the exact date of her last menstrual period. An ultrasound determined the infant to be approximately 5 lb. All attempts to stop labor are unsuccessful, and a baby girl is delivered. The newborn is placed on the open bed warmer for the team to assess.

They observe decreased muscle tone, spontaneous respirations, heart rate 120. The infant is crying softly. The infant receives stimulation by drying with a warm blanket and oxygen blow-by via bag and mask per the respiratory therapist at just prior to 1 minute of age. The infant’s color is blue at 1 minute of age and her Apgar score is 7. The infant’s tone improves, and she begins to pull her arms and legs to midline. Her color improves quickly with blow-by oxygen and the respiratory therapist slowly backs off the oxygen. The infant receives an Apgar score of 9 at 5 minutes of age.

The baby’s physical appearance includes the following: head a little larger than body size, numerous veins visible under skin, plantar creases on half of foot sole, ears are formed and soft with little cartilage, nipples aren’t well defined, labia majora smaller than labia minora.)

1. What equipment would Brenda check to ensure that it was present and working properly for the delivery? Why might she need this equipment? 

2. Based on the physical assessment and response to resuscitation, what would you determine this infant to be: preterm, term, or postterm? Why?

3. Once the infant is stable, what course of action should Brenda take next? Why? What problems should she anticipate?

4. On the evening shift in the special care nursery, you are paged to delivery room 5. When you arrive, the labor nurse says the baby has been stuck in the birth canal for a while, and the fetal heart tones are down. They use the vacuum suction to assist delivery. The doctor gets the baby out and places the infant on the radiant warmer. You are the resuscitating nurse for the infant, and you observe the following: the infant is limp, pale, gasping, has poor tone, and the heart rate is 101. 

1. What are your first actions to aid in this infant’s recovery?
2. What Apgar score would you assign at 1 minute with these results? Explain the score for each category.

5. Tammi is an 18-year-old single mother who delivered a full-term infant 3 days ago. The father is not involved, and Tammi’s aunt is her support person. The infant is very fussy in the nursery, with mild tremors noted. Tammi is having a hard time feeding her baby, the baby spits up a lot and he does not console easily. The physician has been called to assess the infant. 

1. What is the probable cause of the infant’s symptoms, and what questions do you need to ask the mother?
2. What is the acronym of the tool used in assessing the infant’s condition, and what are the top three substances used that can cause this condition?
3. Name what measures are used to test for this condition and on whom you perform the test.

3. You are the newborn nursery nurse and have been called to the labor and delivery suite to attend the delivery of a G5P4 mother whose pregnancy was complicated by gestational diabetes. At 2032 a male infant weighing 8 pounds 2 ounces was delivered vaginally with the assistance of a vacuum extractor. You have assigned Apgar scores of 7 and 9. (Learning Objectives 2, 3, 5, 6, and 8) 

1. Relate the assessments you need to carry out in this immediate postdelivery time period.
2. Describe the nursing interventions you will perform before the baby is taken to the newborn nursery.
3. After taking the baby to the newborn nursery, you notice that the baby has developed diffuse swelling and bruising on the occiput of his head from the vacuum extractor use. Discuss how you would differentiate between a cephalhematoma formation and caput succedaneum development. Which one is more serious?