course material

1. cases study
CASE STUDIESI- Case Study: Care of the Child in Inpatient and Outpatient SettingsJordan is
9-year-old male who is a direct admit for observation. He has a history of vomiting and
diarrhea for 48 hours.Subjective DataNausea and vomiting for 24 hoursHas not voided
todayUnable to tolerate oral fluidsObjective DataVital signs: T 37.8° C, P 120, R24, BP
110/60Weight: 34 kgHyperactive bowel sounds to auscultation1. Question 1When should
the discharge teaching begin for Jordan and his family?2. Question 2What is the best way to
approach Jordan regarding the IV that has been ordered.3. Question 3What would be good
distractions for a child of Jordan’s age?II- Case Study: Pediatric CancerMario 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 DataComplains of
hurting all overStates he feels very tiredStates he feels dizzy when he stands upObjective
DataWeight 26.1 kgVital signs: T 38.9° C, P 140, R 40, BP 108/54, O2 sat 100%Purpural rash
on extremitiesWBC 0.7HGB 3.1Hct 8.5Plt .08ANC 0.14. Question 1Which of Mario’s
presenting symptoms must be treated and stabilized before chemotherapy induction?5.
Question 2What testing is required for a definitive diagnosis of meningitis?6. Question
3What should the nurse do in this clinical situation? Prioritize actions.III- Case Study:
Pediatric Respiratory SystemWill 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 DataMother complains that infant has had
cough for 3 daysMother states that infant is having trouble sleepingNot voided in past 6
hoursObjective DataBirth Weight: 1.9 kgToday’s Weight: 5.5 kgVital Signs: T 38° C, P 186, R
60, BP 90/52, Pulse Oximetry 93%Thick yellow nasal secretionsNasal flaring with moderate
intercostal retractionsBreath sounds decreased with crackles bilaterally to auscultation7.
Question 1What risk factors does Will have for contracting bronchiolitis?8. Question 2What
is the first priority for Will’s treatment?9. Question 3What should the nurse do in this
clinical situation? Prioritize actions.IV- Case Study: Pediatric Gastrointestinal SystemLucy is
a 44-day-old formula-fed infant who presents with a 4-day history of vomiting.Subjective
DataMother states infant has been vomiting undigested formula after feedingsMother states
that infant has not had fever or diarrheaMother states that infant has had 8 wet diapers in
the past 24 hoursObjective DataWeight 4.8 kg (birth weight 3.5 kg)Vital signs: T 37.1° C
(rectal), P 130, R 30, BP 92/52Mucous membranes moist, anterior fontanel flat and
softAwake and alert, lusty cryGood muscle toneOlive-sized mass palpated at epigastrium10.

2. Question 1What test will be used to diagnose pyloric stenosis?11. Question 2What should
the nurse do in this clinical situation? Using the case study above, the first prioritization
step the nurse would take is ____.12. Question 3The second prioritization step the nurse
would take is ____.13. Question 4The third prioritization step the nurse would take is ____.14.
Question 5The fourth prioritization step the nurse would take is ____.15. Question 6The fifth
prioritization step the nurse would take is ____.16. Question 7The sixth prioritization step
the nurse would take is ____.17. Question 8The seventh prioritization step the nurse would
take is ____.18. Question 9The eighth prioritization step the nurse would take is ____.V- Case
Study: Pediatric Cardiovascular SystemMichael is a 7-week-old breastfed infant who
presents with a 2-day history of irritability and poor feeding.Subjective DataMom states
patient has been “fussy” for past 2 daysOnly feeds for a “few” minutes at a timeBreathing
heavily and fast for 2 daysObjective DataWeight: 4.8 kgVital Signs: T 36.8° C, P 250, R 65, BP
84/58Breath sounds clear to auscultationOxygen Saturation 95%Central capillary refill 4
sec19. Question 1What is the treatment for an unstable patient with SVT?20. Question
2Decreased cardiac output from prolonged SVT will produce what complication?21.
Question 3In this clinical situation what should the nurse do? Prioritize actions.VI- Case
Study: Hematologic SystemLiam is an 8-year-old male with a history of hemophilia. Liam
presents today with a 1-day history of right elbow pain.Subjective DataRight elbow pain for
1 dayPatient states he hit his right elbow on desk yesterdayPatient complains that he
cannot move his elbowObjective DataWeight 31.6 kgVital sighs: T 37.4° C, P 82, R 20, BP
108/68Rates pain 6 on scale of 1022. Question 1How 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 2Why are neuro checks an important part of Liam’s physical
exam?24. Question 3What should the nurse do in this clinical situation? Prioritize
actions.VII- Case Study: Common Disorders of the Red Blood CellsSusan 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 1What is the nursing priority at this time?2. Question 2What should Susan be
taught about insulin needs during pregnancy?3. Question 3What additional risk factor does
Susan have?4. Question 4How should Susan be counseled regarding weight gain in
pregnancy?5. Question 5What advice can be given to Susan regarding exercise?VIII- Case
Study: Pediatric Genitourinary SystemLilly is a 3-year-old female who presents with
complaints of abdominal pain and fever since yesterday.Subjective DataComplains of lower
abdominal painFever for 24 hoursLilly has ‘wet her pants’ despite being recently potty
trainedObjective DataVital signs: T38.5° C, P 114, R 32, BP 104/62Urine positive for WBCs,
nitrites, blood6. Question 1What risk factors does Lilly have for UTI?7. Question 2What
might prevent Lilly from a recurring UTI?8. Question 3What should the nurse do in this
situation? Prioritize actions.IX- Case Study: Pediatric Neurologic SystemAbby is a 1-year-
old female who presents after a reported seizure at day care.Subjective DataFever for 1
hourEating and drinking normally per motherObjective DataVital signs: T 40° C, HR 160, R
44, BP 104/68Awake and alertSkin hot to touch, otherwise normal physical examination9.
Question 1How should the nurse respond to Abby’s mother when she asks if Abby has

3. epilepsy?10. Question 2How should the nurse respond to Abby’s mothers question about
brain damage?11. Question 3In this clinical situation what should the nurse do?