Question

Case Studies Chapter 49: Nursing Care of the Child With an Endocrine Disorder 1. Jalissa Twyman, 8 years old, was admitted to the pediatric intensive care unit with a closed head trauma after being involved in a bicycle/motor vehicle accident. Jalissa is unconscious. The nurses caring for Jalissa document a weight loss of 1.82 kg over a 24-hour period, decreased skin turgor, and dry mucous membranes. Urine output for the same 24-hour period is 3.5 L/m2. (Learning Objectives 1, 2, 3, 4, 5, and 7)

a. What further assessments should the nurse perform on Jalissa?

b. What laboratory tests would the nurse expect to be performed on Jalissa?

c. What nursing interventions should be done for Jalissa?

2. Aellai Gianopoulos, 13 years old, is brought to the clinic by her mother, who states that Aellai is losing her hair. Vital signs are as follows: T 98.4°F, HR 85, R 15, BP 121/78. Height is 64 in., and weight is 81.5 kg. Aellai has an olive complexion marred by acne, large brown eyes, and long black hair that is very thin on the top of her head. Her breasts are small and she has an abundance of hair on her arms and legs. She reached puberty approximately 6 months ago. (Learning Objective 1, 2, 3, 4, 5, 7, and 8)

a. What other information should the nurse gather in the health history?

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

c. What should the nurse include in the teaching plan for Aellai and her family?

Answer 1

Jalissa

a.The further assessment which has to be performed on Jalissa are

• Central venous pressure to asses intracranial pressure ()injury to brain can elevate this
• Assessing for the presence of reflexes and motor movements
• Glasgow coma scale
• Monitor vitals (blood pressure ,temperature, respiration alters after an injury)
• Assess the urine for any hematuria
• Assess for organ damage by palpation

b.The following laboratory test can be expected to be performed are

• CBC :basic to assess for hemoglobin for blood loss,infection
• Chrst X ray to assess injury in chest
• CT scan or MRI brain to rule out any edema,hemorrhage, clots
• Serum electrolytes (sodium ,potassium imbalance can occur leading to acid base imbalance)
• Renal profile

c.The following nursing intervention has to be done

• Place patient in supine position with 30 ° head elevation
• Apply cervical collar if injury is suspected in neck region
• Monitor vital signs continuously
• Assess for papillary reactions
• Administer mannitol as it prevents cerebral edema after an head injury
• Administer antibiotics to prevent infection, analgesics to relieve pain

2.a.The other information which can be gathered in health history are

• Family history or any heriditary history
• Complaints of back pain ,fatigue,muscle weakness ,insomnia , menstrual cycle to rule out any link with hirsutism
• Weight (excessive weight can sometimes trigger hormone imbalance)