Tiffany Mike Leukemia

Case Study

Student’s Name

Institutional Affiliation

Case Study

Psychosocial Assessment of Tiffany and Her Family

Since Tiffany is the first child with this condition in the family, the assessment should involve a few aspects of their social lives. One of the things to consider would be their reaction to the health of Tiffany. With the diagnosis, Tiffany is likely to have different thoughts about it. The psychosocial assessment here would determine how well Tiffany and her family would respond to the treatment and care. On the basic information part, the age of Tiffany would be filled in. The hospital that referred Tiffany or the one where she could potentially be referred to would follow.  The background information of Tiffany, her siblings and her parents was gathered. This includes their work, their religion and their social lives. Other factors that could be of use here include their occupation, level of education and the income they have. Determining this could help determine whether or not they can afford treatment for Tiffany. It could also determine whether or not they accept the treatment. These factors help to determine what will be necessary in the case of treatment for Tiffany (Conducting a Psychosocial Assessment, n.d). Finally, a summary of the clinical conditions and in the case of Tiffany, this means how far the Leukemia has spread, and any other ailments that she may have. The psychosocial assessment for Tiffany and her parents would be performed by asking them oral questions and filling in the required spaces. Some of the questions could also be answered using the documents that they provide.

What Should the Nurse Include In the Child and Family Education?

The nurse should include information about the nature of the disease that Tiffany has. This information provided should be detailed, yet simplified so that the parents can understand what they are dealing with. In addition to that, the nurse should include some of the treatment procedures and the schedules for each. This will help the family of Tiffany with planning. Another thing to include would be the care that her family can give her, during the process, and also during future instances in life. Some tips could also include what to do during an emergency. Another thing to include in the information would be the places where the family can get healthcare providers. Information on diet, and medication, including supplements should also be provided to the family. In general, the nurse should give education and information on some of the ways in which the family can take care of their daughter without the help of the hospital. However, this information should also include what to do during emergencies and the role of the hospitals. Some hardships that are likely to be encountered that the family should be prepared on. These hardships should also be included in the education that the nurse would offer. The means for coping with some of the issues that come with Leukemia should also be provided. This would make sure that the parents of Tiffany are well informed about the nature of Tiffany’s condition.

Case 2

a) To explain the treatment to Jacob, I would first start by explaining the nature of his condition to him. This would involve accurate descriptions of what the observations were made on his conditions. I would use some terms that he understands to make sure that he accurately knew exactly what was happening to him during treatment. Some of the procedures that are likely to be involved include radiotherapy and chemotherapy, alongside surgery. I would explain to him the importance of each of these treatments, and the reasons why he had to be brave for all of them. In addition to all this, I would give him explanations on consent and since he was too young, I would make him know that some of the decisions that would affect him medically in this case would be made by the parents. These explanations would help him to become more confident and comfortable.

b)  Some of the tests that would be performed would involve trying to find out the extent to which the tumor had spread. The surest way to know about the condition of the tumor would be a biopsy. A biopsy involves the removal of a small tissue from the area for further testing. If it is not possible to carry out a biopsy, other tests would be carried out. 

Another test in this case would be an X-Ray. The X-Ray in this case would be used to create an accurate structure of the body organs especially the bones. The tumor could then be observed from this structure   (How is bone cancer diagnosed, n.d). 

Another method would be to check a computed tomography, CAT or CT scan. This usually creates a 3D image of the body, or part of the body using images that are taken from the X-ray at different angles. In this case, it would be a useful test and procedure that would help in determining what the condition was, and thus what the treatment would look like.

c) The Nursing management for Jacob would involve a number of things. I would aim to make sure that Jacob was comfortable and also that he wasn’t in pain. This would mean regularly giving him painkillers depending on the level of pain he was in. I would also make sure that Jacob had the best nurses catering for him. This would mean nurses that were competent in their work and well trained. It would be helpful to make sure that the people who served Jacob were mainly not exhausted. In addition to all this, it would also be helpful to make sure that whatever was done for his care made sure that the tests and treatments were in mind as some of them would lead to pain. Generally, the nursing management should involve total respect for the autonomy and the consent of the patient. It should also involve making sure that all the actions that are carried out are the best for the patient in all the situations. 

Associate degree case study

Case Study one

a) One of the abnormal signs is that the respiratory rate is 75 breathes instead of the normal 30-60 breaths. Another abnormal sign was the color pink and the rapid respiration.

b) The nurse would explain the signs to the mother by telling her what the findings were. In my opinion, she should start by telling the mother what the good signs were that were observed from this. From here, she could then explain what the issue was with the pink skin and the fast respiration. If any of them needed medical attention, she would then tell the mother and inform her on how to talk to the doctors

Nursing interventions

Some of the nursing interventions that would be used based on the findings here include direct care for the baby who had some of the issues. This includes holding her the right way and advising the mother on how to do the same. Another intervention would be indirect care for the patient. This means making sure that the mother can take care of her. In addition, there would be attempts to make sure that the medications were all given on time and that the breathing rate and the skin color were monitored accordingly. In summary, the nursing interventions included the assessment and monitoring, the performance and care which is mainly a therapeutic action, and finally, referring or managing to a person who would have done better. The last one was unlikely to happen as in this case, the symptoms were not major.

Question 2

a) One of the equipment that Brenda would use to make sure that everything was ok would be would be a stethoscope and an ultrasound. Using these, the heart rates can be monitored and the conditions of the baby while still in the womb.

b) In this case, the baby was preterm. The main reason for this is that most of the organs were not fully developed. In addition, the symptoms that the baby had were typical of a preterm baby. This includes the lack of well-formed nipples, differences in size of the labia majora and the labia minora when compared to term babies, a very high heart rate, the side of the head in comparison to the rest of the body and the softness of the cries that the baby had

c) Once the baby is stable, the best action to take would be to attempt to keep it warm, or to feed it. The main reason for this is that the baby is most likely cold or hungry. Some problems that could be expected include the inability of the baby to feed perfectly. Another thing that would be done was check for any medical conditions and examines the baby for any issue. This would make sure that the baby was healthy and would continue to be. A problem that would be expected here is that there may be some conditions present and that the baby would require medication

Question 3 

1. the common characteristics of the child during assessment includes, poor motor skills, difficulty to regulate behavioral states, proportional increase in body size and large body, plump, full faced (Williams & Wilkins, 2013). According to the Apgar score, the baby will only need frequent post-delivery care. The weight of the baby is greater than 8 pounds and the mother had gestational diabetes increasing the likelihood of the condition. 
2. The nursing interventions to conduct before taking the child to a neonatal nursery include the following. Monitoring the vital signs of the baby and hydration. Psychotherapy should also be performed to check the bilirubin levels. Another intervention is monitoring the level of blood glucose which will determine if oral feeding with IV glucose supplementation will be administered. 
3. A caput succedaneum is an edema found in a neonate scalp the vertex of the newborn’s head. It occurs during labor due to pressures against the mother’s cervix. The oedema is soft and crosses the suture lines. Cephalhematoma on the other hand is the collection of between skull bone periosteum and the bone itself (Antipuesto, 2011). The differential factor between Cephalhematoma and caput succedaneum is that cephalhematoma occurs hours after birth- 24-48 hours forming an occipital bone. This is the condition that our neonate in the case study is suffering. 

Question 4

The one minute APGAR assessment delivers essential information about the physical health of the baby and assists the nurse or physician to determine if treatment is required either then or later in life (Mediline Plus, 2016). This baby in our case study requires life saving measures because the score is below four. The cause of very low APGAR is due to difficult birthing, and the baby requires physical stimulating to assist health heart rate. Another remedy would be oxygen and clearing out the airway to assist the newborn in breathing.

APGAR scoring; 

• Appearance- Skin color is pale giving a score of 0
• Pulse- Heart rate score is 2 point because the rate is greater than 100. This is an indication that the baby is vigorous. 
• Grimace – 0 score there was no response after airways were stimulated.
• Activity- Muscle tone score is 0appearance (color) this is an indication that the baby’s muscles were limp. 
• Respiratory – Respiratory effort score is 1. Due to our score, the baby had a weak cry or whimpering or grunting sound.

Question 5 

1. The probable cause of these symptoms could be- fussy in the nursery, with mild tremors noted,  hard time feeding, the baby spits up a lot and does not console easily- is exposure to opioids. This may cause Neonatal Abstinence Syndrome or (NAS) caused by mothers who use opioids. The mother should be asked a question that probes if they were using any drugs and which drugs during pregnancy. The next question should concern if she was stressed during pregnancy, her financial status and her diet. The most probable cause of the opioids would be stress as she was left by the baby’s father while pregnant, and she might be having financial problems.
2. According to Jannson, Velez and Harrow (2009), the acronym used in assessing the condition will be Finnegan Neonatal Abstinence Scoring System. This type of condition is mostly caused by use of opioids like Heroine, codeine. Morphine and methadone.
3. Infants with opioids signs are evaluated from birth using the vital signs of Finnegan neonatal Abstinence Scoring System. The infants suffering from this condition should have continuous monitoring, via pulse oximetry or cardiorespiratory monitor due to respiratory depression potential that is secondary to seizures and medications due to NAS. The infants should be scored every three hours during their hospital stay information from mothers is obtained while caring mother-infant dyads in a rooming-in fashion.

References

Antipuesto, D. (2011). Difference between Caput Succedaneum and Cephalhematoma. Nursing Crib. Retrieved 1 November 2016, from http://nursingcrib.com/nursing-notes-reviewer/maternal-child-health/difference-between-caput-succedaneum-and-cephalhematoma/

Conducting a Psychosocial Experiment. (n.d) Retrieved October 29, 2016 from http//www.himh.org.au/_data/assets/pdf_file/0015/10374/MIND-Essential-Psuchosocial-Assesment.pdf  

How is Bone Cancer Diagnosed? (n.d). Retrieved October 29 from https://www.cancer.org/cancer/bonecancer/detailguide/bone-cancer-diagnosis

Jannson, L., Velez, M., & Harrow, C. (2009). The Opioid Exposed Newborn: Assessment and Pharmacologic Management. PubMed Central (PMC). Retrieved 1 November 2016, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729086/

Mediline Plus,. (2016). Apgar score: MedlinePlus Medical Encyclopedia. Medlineplus.gov. Retrieved 1 November 2016, from https://medlineplus.gov/ency/article/003402.htm

Williams, & Wilkins,. (2013). Essentials of Maternity, Newborn, and Women’s Health Nursing. Wolters Kluwer, chapter 23.