Jordan is a 9-year-old male admitted for observation due to vomiting and diarrhea for 48 hours. Discharge teaching should begin once Jordan is stabilized. The nurse should approach discussing the ordered IV with distraction and reassurance. Lucy is a 44-day-old infant presenting with 4 days of vomiting undigested formula. The nurse's first steps are to obtain vital signs, assess the infant's appearance and hydration status, place an IV line, and perform a physical exam including abdominal palpation to check for a mass. Abby is a 1-year-old female presenting after a reported seizure at daycare with a fever of 40°C. The nurse should reassure the mother

1. CASE STUDIES
I-
Case Study: Care of the Child in Inpatient and Outpatient
Settings
Jordan is 9-year-old male who is a direct admit for observation.
He has a history of vomiting and diarrhea for 48 hours.
Subjective Data
Nausea and vomiting for 24 hours
Has not voided today
Unable to tolerate oral fluids
Objective Data
Vital signs: T 37.8° C, P 120, R24, BP 110/60
Weight: 34 kg
Hyperactive bowel sounds to auscultation
1.
Question 1
When should the discharge teaching begin for Jordan and his

2. family?
2.
Question 2
What is the best way to approach Jordan regarding the IV that
has been ordered.
3.
Question 3
What would be good distractions for a child of Jordan’s age?
II-
Case Study: Pediatric Cancer
Mario is a 7-year-old male who presents with a 1-week history
of body aches and pallor. He has a 2-day history of fever to
103° F and a 1-day history of bruising and lethargy.
Subjective Data
Complains of hurting all over
States he feels very tired
States he feels dizzy when he stands up
Objective Data

3. Weight 26.1 kg
Vital signs: T 38.9° C, P 140, R 40, BP 108/54, O2 sat 100%
Purpural rash on extremities
WBC 0.7
HGB 3.1
Hct 8.5
Plt .08
ANC 0.1
4.
Question 1
Which of Mario’s presenting symptoms must be treated and
stabilized before chemotherapy induction?
5.
Question 2
What testing is required for a definitive diagnosis of
meningitis?
6.
Question 3
What should the nurse do in this clinical situation? Prioritize

4. actions.
III-
Case Study: Pediatric Respiratory System
Will is a 4-month-old infant born at 34 weeks of gestation.
Will’s mother states that he has not been able to go to day care
because he has been coughing with a fever for the past 3 days.
She states today he is unable to feed well from the bottle
because of nasal secretions.
Subjective Data
Mother complains that infant has had cough for 3 days
Mother states that infant is having trouble sleeping
Not voided in past 6 hours
Objective Data
Birth Weight: 1.9 kg
Today’s Weight: 5.5 kg
Vital Signs: T 38° C, P 186, R 60, BP 90/52, Pulse Oximetry
93%
Thick yellow nasal secretions
Nasal flaring with moderate intercostal retractions

5. Breath sounds decreased with crackles bilaterally to
auscultation
7.
Question 1
What risk factors does Will have for contracting bronchiolitis?
8.
Question 2
What is the first priority for Will’s treatment?
9.
Question 3
What should the nurse do in this clinical situation? Prioritize
actions.
IV-
Case Study: Pediatric Gastrointestinal System
Lucy is a 44-day-old formula-fed infant who presents with a 4-
day history of vomiting.
Subjective Data
Mother states infant has been vomiting undigested formula after
feedings

6. Mother states that infant has not had fever or diarrhea
Mother states that infant has had 8 wet diapers in the past 24
hours
Objective Data
Weight 4.8 kg (birth weight 3.5 kg)
Vital signs: T 37.1° C (rectal), P 130, R 30, BP 92/52
Mucous membranes moist, anterior fontanel flat and soft
Awake and alert, lusty cry
Good muscle tone
Olive-sized mass palpated at epigastrium
10.
Question 1
What test will be used to diagnose pyloric stenosis?
11.
Question 2
What should the nurse do in this clinical situation? Using the
case study above, the first prioritization step the nurse would
take is ____.

7. 12.
Question 3
The second prioritization step the nurse would take is ____.
13.
Question 4
The third prioritization step the nurse would take is ____.
14.
Question 5
The fourth prioritization step the nurse would take is ____.
15.
Question 6
The fifth prioritization step the nurse would take is ____.
16.
Question 7
The sixth prioritization step the nurse would take is ____.
17.
Question 8
The seventh prioritization step the nurse would take is ____.

8. 18.
Question 9
The eighth prioritization step the nurse would take is ____.
V-
Case Study: Pediatric Cardiovascular System
Michael is a 7-week-old breastfed infant who presents with a 2-
day history of irritability and poor feeding.
Subjective Data
Mom states patient has been “fussy” for past 2 days
Only feeds for a “few” minutes at a time
Breathing heavily and fast for 2 days
Objective Data
Weight: 4.8 kg
Vital Signs: T 36.8° C, P 250, R 65, BP 84/58
Breath sounds clear to auscultation
Oxygen Saturation 95%
Central capillary refill 4 sec

9. 19.
Question 1
What is the treatment for an unstable patient with SVT?
20.
Question 2
Decreased cardiac output from prolonged SVT will produce
what complication?
21.
Question 3
In this clinical situation what should the nurse do? Prioritize
actions.
VI-
Case Study: Hematologic System
Liam is an 8-year-old male with a history of hemophilia. Liam
presents today with a 1-day history of right elbow pain.
Subjective Data
Right elbow pain for 1 day
Patient states he hit his right elbow on desk yesterday
Patient complains that he cannot move his elbow

10. Objective Data
Weight 31.6 kg
Vital sighs: T 37.4° C, P 82, R 20, BP 108/68
Rates pain 6 on scale of 10
22.
Question 1
How should the nurse respond when Liam’s father explains that
they watched and waited to see if Liam needed treatment after
his injury?
23.
Question 2
Why are neuro checks an important part of Liam’s physical
exam?
24.
Question 3
What should the nurse do in this clinical situation? Prioritize
actions.
VII-

11. Case Study: Common Disorders of the Red Blood Cells
Susan is a 26-year-old G1P0 at 6 weeks of gestation with type 2
diabetes. Her BMI is 32. Her hemoglobin A1C is 9. She uses
glyburide 10 mg PO daily. The physician has switched her to
insulin at this time.
1.
Question 1
What is the nursing priority at this time?
2.
Question 2
What should Susan be taught about insulin needs during
pregnancy?
3.
Question 3
What additional risk factor does Susan have?
4.
Question 4
How should Susan be counseled regarding weight gain in
pregnancy?
5.
Question 5

12. What advice can be given to Susan regarding exercise?
VIII-
Case Study: Pediatric Genitourinary System
Lilly is a 3-year-old female who presents with complaints of
abdominal pain and fever since yesterday.
Subjective Data
Complains of lower abdominal pain
Fever for 24 hours
Lilly has ‘wet her pants’ despite being recently potty trained
Objective Data
Vital signs: T38.5° C, P 114, R 32, BP 104/62
Urine positive for WBCs, nitrites, blood
6.
Question 1
What risk factors does Lilly have for UTI?
7.

13. Question 2
What might prevent Lilly from a recurring UTI?
8.
Question 3
What should the nurse do in this situation? Prioritize actions.
IX-
Case Study: Pediatric Neurologic System
Abby is a 1-year-old female who presents after a reported
seizure at day care.
Subjective Data
Fever for 1 hour
Eating and drinking normally per mother
Objective Data
Vital signs: T 40° C, HR 160, R 44, BP 104/68
Awake and alert
Skin hot to touch, otherwise normal physical examination
9.

14. Question 1
How should the nurse respond to Abby’s mother when she asks
if Abby has epilepsy?
10.
Question 2
How should the nurse respond to Abby’s mothers question about
brain damage?
11.
Question 3
In this clinical situation what should the nurse do?