CNA342 - Clinical Scenario - Case Study - Nursing Assignment

Internal Code: MAS5044

Clinical Scenario - Nursing Assignment:

Scenario 1:  Rohan (9 years) – Care provided by a RN in a community and primary health care setting You are a community health nurse working within a rural suburban neighbourhood. One day, when you are at one of the schools in your catchment area a teacher shares her concern for Rohan an 9- year-old boy in her class. Rohan has diagnosed with type 1 diabetes mellitus a few months ago, and since has had many absences from school. The teacher has tried to provide extra support for Rohan while he is at school, and checks in with him about his meals and blood sugar checks, which he does independently. She tells you that she knows a little bit about diabetes because her father is diabetic and that Rohan’s blood sugars are “all over the place”. She frequently provides him more food than is sent from home. Rohan is not following the diabetic diet plan he was given from the diabetes clinic because he and his family are vegetarian but the plan includes meat. Rohan lives at home with his three younger sisters and parents. His mother is ill with nephrotic syndrome and has developed depression since the family immigrated to Australia two years ago. The teacher has talked to Rohan’s mother about these concerns but nothing seems to change for Rohan. The teacher is also concerned because Rohan has told her that he does his own insulin in the morning because his father goes to work early and his mother is not up yet. She also notes that his little sisters have had as many absences from school as Rohan but they are healthy as far as she knows. She asks what you can do to help Rohan? Scenario 2: Elsa (17 years) – Care provided by a RN in an outpatient care setting You are a nurse working in the outpatient Gastro-Intestinal (GI) clinic, you have just started in this role, taking over for a colleague’s maternity leave. You receive a call from the mother of Elsa, a 17- year-old girl who was diagnosed with ulcerative colitis 4 years ago. Elsa has had multiple acute episodes of colitis and has been in hospital at least once a year. Last week, Elsa had a flare of her colitis but when she came to emergency at the children’s hospital, she was sent to the adult hospital. Her mother calls you upset about the care at the adult hospital, and worried that Elsa is going to leave against medical advice. She tells you that on admission she dropped Elsa off at emergency and had a difficult time finding a parking spot. When she returned, the staff told her to wait in the waiting room until the physician was finished his assessment. She waited over an hour and when she was finally allowed to see Elsa, she was quiet and withdrawn. She told her mother that “they asked me all kinds of questions and I didn’t know the answers, and they made me change into this gown, which I never had to wear in the other hospital”. Elsa mother says that it felt strange to be excluded from Elsa’s care, and because she is a single parent she’s always responsible. They had done some preparation for transition to adult services with the previous clinic nurse. She had booked an appointment at the adult clinic, but because the wait list was so long it was scheduled next month and they had not had the opportunity to meet the adult GI team until now. Elsa’s mother tells you that Elsa is feeling a little better today but team are not planning to discharge her. She thinks that Elsa is still too unwell to leave, she has lost quite a bit of weight this time, and although Elsa has been asking to go home, she has refused to take her. Her mother tells you that she doesn’t think Elsa will stay in the hospital another day because she overheard Elsa telling her boyfriend that “she hates this place” and planning to leave with him against medical advice. She asks what you can do to help Esla Scenario 3: Petra (9 months) – Care provided by a new grad in an Emergency care setting You are a new graduate nurse working in rotation in a very busy emergency department (ED) in a primary referral centre of a major city, Australia. You are allocated to the paediatric area along with a more senior nurse who is ED staff who has a full load of patients. In the 2-cot isolation area where you are assigned, you receive a rushed patient handover from the waiting room triage nurse that includes an “unwell” infant who has been in the waiting room for 1 hour with her father (Ben). Ben is the primary carer and Petra’s parents are separated. Petra’s mother (Aline) works full time as a lawyer and shares the care with Ben. It is unclear whether Aline has been contacted by Ben to inform her that Petra is unwell. Petra is 9 months old, she was born premature at 35 weeks’ gestation, and was 1900 grams at birth. She is the only child, of an IVF pregnancy. You assess the triage notes and see that today Petra is febrile (39.5C) and has a blotchy rash on her abdomen. The triage nurse gave Petra Panadol ½ hour ago in the waiting room while waiting for a bed. Ben tells you Petra is drinking about ½ of her usual amount, refusing all solid intake, has had 5 wet diapers and has been irritable for 24 hours. Neither of them have had much sleep. Ben shows you the bottle of expressed breastmilk and water that he has bought from home. Petra is clinging to her father and appears little for her age, flushed and possibly dehydrated. Petra has never been fed infant formula and the parents are opposed to her receiving any other fluids except breastmilk or water. She goes to day care two days per week. Before you can do any observations and clinical assessment, Aline is ushered into the room and is visibly distressed. Petra begins to cry. Her cry is weak and short lasting and she falls back into her father’s chest. The nurse you are working with pulls you aside and asks you what your plan of care is for the family. How do you respond? Questions: Part I – Description and Analysis • Consider the situation and review the information given for the infant, child or youth and family in ONE of the clinical scenarios provided. • Identify three priorities (problems/issues) for nursing care based on your analysis of the clinical scenario. Part II –Application and Synthesis • Establish goals related to one of your priorities (problem/issue) identified in Part I. • Describe what strategies (interventions) you would take (course of action) to engage with the infant, child or youth and family to develop a trusting relationship. You may choose from a variety of concepts to support your approach (rationale), for example: o relational/interpersonal/communication theory o family-centred care theory o child rights theory o cultural safety theory o developmental theory • Drawing on relevant literature related to concepts you have selected, articulate your plan of care to address ONE of the priorities identified in Part I. Include at least two interventions and how you would evaluate the effectiveness of your care against your goals. Assessment Criteria 1. Describes the physical, social, cultural needs of the infant, child or youth and family. Identifies three priorities for nursing care relevant to the clinical scenario. 2. Develops strategies to engage with the infant, child or youth and family that are feasible and supported by relevant theoretical perspectives. 3. Synthesises and applies the best available literature to develop a plan of care tailored to ONE specific need of the infant, child or youth and family. Articulates clear, logical, practical and evidence-based interventions and evaluation. 4. Demonstrates and applies expected academic writing skills including accurately adhering to the Harvard referring style