Question

Jordan is a 9-year-old boy who is a direct admit for observation. He has had a history of vomiting and diarrhea for 48 hours.

Subjective Data

Has a history of nausea and vomiting for 24 hours.

Has not voided today.

Is unable to tolerate oral fluids.

Objective Data

Vital signs: temp, 37.8º C; pulse, 120 bpm; resp, 24 breaths/min; blood pressure, 110/60 mm Hg

Weight: 34 kg

Hyperactive bowel sounds to auscultation

Questions:

When should the discharge teaching begin for Jordan and his family?

What is the best way to approach Jordan regarding the intravenous (IV) line that has been ordered?

What would be good distractions for a child of Jordan’s age?

Case Study #2

Susan is a 4-year-old girl with a 7-day history of fever and lethargy. Susan’s physician has ordered laboratory work that includes a blood culture.

Subjective Data

Susan has had fever for 1 week.

Her mother has noticed a decreased activity level.

Susan states she is “afraid” of needles.

Objective Data

Weight: 26.1 kg

Vital signs: temp, 39.3º C; pulse, 110 bpm; resp, 40 breaths/min; blood pressure, 108/54 mm Hg; oxygen saturation (O₂ sat) 100%

No abnormal findings on physical examination

Questions:

When should Susan’s nurse explain the procedure to her?

To give Susan some control over this situation, what choices could be given to her?

What actions should the nurse take in this clinical situation? Prioritize

Answer 1

1. The discharge teaching should begin soon after the admission to the hospital and at least several days before the planned discharge.

2. Keep the child calm and make sure that you yourself is calm in front of the child

• try soothing the hand before the start of the procedure.
• insert on non dominant hand
• use an immobilser and use scalp veins
• try to change the attention of the kid by nursery rhymes or communicating with him
• try to develop a good interpersonal relationship with the child and make them sure that as far as possible you will do it at ease.

3.for this child, we can provide some play materials, so that he focus on that

• allow him to watch his favourite show in the televison.
• or play those rhymes which is very interesting for him.

4.The Susan's nurse should explain about the procedure before hand itself.

• develop a good interpersonal relationship and make her understand in her language itself in a very simple language before the procedure that she has to take blood for investigations and will take by pricking with needle which will make only a slight pain.

5.The parents especially her mother can be instructed to be along with her during the procdure.

• she can be given some play items or games which are interesting for her. This would help her to engage in those activities.
• can advise the parents to involve themselves in the playing, so that child will not think about this this procedure.
• can play television and make her to watch her favorite music or cartoon.
• 6. the nurse should first develop a good interperosnal relationship with the child
• be friendly with the child
• develop a trust from the childthat you are there to help not to harm her
• distract the child as per her interst
• put the glkoves
• provide all the equipment needed for blood collectionn
• give a small prick and take the blood needed for the investigations.