Critical Appraisal of a Pediatric Case Study: Adolescents’ Health Assessment and Nursing Care

QUESTION

Care of Children and Adolescents (CCA206) T2 2023 Torrens University Australia (TUA) CCA206_Assessment_3_ Critical Appraisal of a Case Study © Torrens University Australia 2023 Page 1 of 2 Assessment 3 – Case study/ scenario Visualise yourself in the role of the newly graduated Registered Nurse (RN), working in a busy Paediatric Emergency Department (PED) allocated to provide care for the following patient on an afternoon shift. Patient information Name: Irene Smith Age / Sex: 16 years 10 months / female Accompanied by: Taylor Smith (Brother, 20 years/Male) Present Medical History Irene presented to the PED with her brother Taylor, following a fall around 3 hours ago. Irene was riding a bike in in the street in front of her home and bumped into a parked car on the street, fell and hit her head. She was not wearing a helmet during the incident. There was no loss of consciousness noted at the time. However, she started having headache after half an hour of injury. There were multiple abrasions on elbow and knee and swelling on her left forehead. Past Medical/ Surgical History Acne Vulgaris, Depression, Anxiety, and attempts of self-harm multiple times Current medications: Roaccutane, Olanzapine (poor concordance- she misses to take medications regularly as prescribed) Allergies: Pea nuts (Anaphylaxis) Perinatal history Vaginal birth, other details are not available Immunisation history ? Incomplete. Irene does not remember receiving any vaccination.

Family and Social history Irene’s parents are divorced, and she lives with her father. Irene is enrolled to TAFE for a vocational course. However, her engagement with the course has been poor with sporadic attendance for classes. She works in a local grocery store two days in a week. Irene mentioned that she does not have many friends and she has been bullied at school because of her looks and feels very depressed about it. Physical Examination Irene appears very tired, is crying, looks anxious and distressed, pain 6/10 Anthropometry Height: 160 cm Weight: 40 kg Vital signs Respiratory rate: 20 breaths per minute Oxygen saturation: 96 % on room air Heart rate: 98 beats per minute Blood Pressure: 108/65 mm of Hg Temperature: 37.6°C Neurological assessment Glasgow Coma Scale – E3 V4 M6 13/15, Pupils – B/L 4mm and reactive

Head and Neck Swelling (3×3 cm) and bruising on right forehead, neck feeling stiff and has limited mobility Respiratory B/L air entry equal on auscultation, No increased work of breathing Cardiac Nil issues noted Abdomen/ GIT Nausea (since an hour), abdomen soft and non-tender, last oral intake – food (3 hours ago), fluid (sips of water 2 hours ago) Musculoskeletal Limited range of motion and pain right upper and lower limbs, Swelling on right elbow Skin and mucous membranes Dry skin and lips, Abrasion on forehead right side (2×2 cm) on Right elbow (3x2cm), Laceration on right knee (2X1 cm) Multiple small scars noticed on both thighs (anterior and medial aspects). Irene mentioned the scars have resulted from previous injuries from self-harm attempts. Medical/ Clinical diagnosis Head injury for evaluation Treatment plan Admission Neurosurgeon/ team to review (regarding further management) Vital signs monitoring and neurological assessment every 30 minutes, continuous SPO2 monitoring Spinal immobilisation Nil by mouth IV cannulation Bloods – FBE (Full Blood Evaluation), Urea and Electrolytes

Wound dressing Urgent CT scan – Head and Spine IV fluids – 0.9% sodium chloride (normal saline) and 5% Glucose as continuous infusion IV Paracetamol STAT, IV Metoclopramide STAT IV Morphine PRN IV Antibiotics Additional Information Irene’s father is on the way to hospital. Irene does not want her mother to be notified as they do not get along and thinks that mother is non-sympathetic

Critical Appraisal of a Case Study

In this assessment task, you will be required to critically evaluate the information provided in the case study scenario and demonstrate an in-depth understanding of common adolescent pathologies, and the role of the nurse in the assessment, planning and delivery of care.Consider using the Clinical Reasoning Cycle to guide your case study appraisal.

To complete this assessment task, you must: 1. Read the case study document found in Assessment 3 resources folder on Blackboard 2. Critically evaluate the information provided in the case scenario 3. Address the following questions pertaining to the case study • Outline and describe the aetiology and pathophysiology of the clinical diagnosis. • Identify and briefly describe the signs and symptoms of the clinical presentation and how they relate to and/or support the clinical diagnosis. • Discuss any psychosocial, emotional and/or cultural needs which should be factored into nursing care and care planning. • Consider the growth and development milestones for the age of the case study character and how this will influence nursing assessment and the planning of care. • Identify the child protection responsibilities of an RN in a clinical setting and discuss the collaborative processes with a multidisciplinary team. • Discuss whether the adolescent in the scenario can provide informed consent, and make independent medical decisions, based on your knowledge of Gillick competence, and legislation in your state and territory. • Outline and discuss the Registered Nurses role in the safe administration and management of medications for the adolescents.

ANSWER

Critical Appraisal of a Pediatric Case Study: Adolescents’ Health Assessment and Nursing Care

Introduction

This essay critically evaluates a pediatric case study scenario involving a 16-year-old female named Irene Smith who presents with a head injury and various psychosocial issues. By applying the Clinical Reasoning Cycle, this analysis will address various aspects of Irene’s health condition, highlighting nursing responsibilities, assessment, and care planning strategies.

Aetiology and Pathophysiology of Clinical Diagnosis

Irene’s clinical diagnosis is a head injury resulting from a bike accident. The impact of the collision led to a traumatic injury to her forehead and a potential neck injury due to stiffness and limited mobility. The head injury can cause brain trauma, hemorrhages, and intracranial pressure elevation, possibly affecting neurological function and well-being.

Signs and Symptoms Relating to Clinical Presentation

Irene exhibits signs such as headache, vomiting, limited neck mobility, and altered level of consciousness (Glasgow Coma Scale score of 13/15). These symptoms are indicative of potential brain injury and warrant thorough assessment and intervention. The abrasions and lacerations are visual evidence of her injury.

Psychosocial, Emotional, and Cultural Needs

Irene’s history of depression, anxiety, self-harm attempts, and being bullied highlights her vulnerable mental health state. Nurses must prioritize her psychological well-being and consider a holistic approach that addresses emotional distress, potentially necessitating counseling and mental health support.

Growth and Development Milestones

At 16 years and 10 months old, Irene is in the adolescent developmental stage. This phase is marked by identity formation, autonomy-seeking, and self-discovery. Nurses must respect her autonomy, involve her in decision-making, and provide developmentally appropriate communication.

Child Protection and Multidisciplinary Collaboration

Nurses have a crucial role in identifying signs of abuse or neglect. In Irene’s case, her history of self-harm raises concerns. Collaborative teamwork with social workers and psychologists is essential to address her psychosocial needs and safety.

Informed Consent and Medical Decision-Making

Assessing Irene’s capacity to provide informed consent requires an understanding of Gillick competence and applicable state legislation. If Irene demonstrates the maturity to understand her condition and the proposed treatment, she may provide informed consent for her care.

Safe Medication Administration and Management

Irene’s incomplete medication concordance, combined with her psychological state, poses challenges in medication management. Nurses must ensure accurate administration, educate Irene on medication importance, and involve her in decisions regarding her treatment plan.

Conclusion

This critical appraisal of Irene’s case study underscores the complexity of pediatric nursing, especially when dealing with adolescents who face health challenges intertwined with psychosocial issues. Utilizing the Clinical Reasoning Cycle, nurses can ensure comprehensive assessment, effective care planning, and collaborative interventions, prioritizing the physical, mental, and emotional well-being of the patient.