NUR373 - Pediatric Patient Case Study & Nightshift Nurse Report Writing Along With Hematology/Oncology - Nursing Assignment Help

Assignment Task

Pediatric Patient Case 1- Oncology 

You are a nursing student working on the Hematology/Oncology floor (8A) at SickKids. You begin your shift at 0715 and the nightshift nurse gives you report on the following patient: 

• A.B is a 16-year-old male, current weight (measured in the ER) is 61kg. Previous clinic visit weight 3 days ago was 64kg.  Height 170cm. No known allergies.  

• A.B was readmitted to 8A from the ER at 0230 for chemotherapy induced nausea and vomiting, and mucositis pain following the completion of his 2nd cycle of high dose methotrexate to treat his osteosarcoma last week. 

• A.B’s father reports they were using the prescribed antiemetics as ordered but A.B keeps throwing them up.

• Health History: 

• Appendectomy at 13 years old 
• Admitted to 8A 4 weeks ago for febrile neutropenia
• Diagnosed with Osteosarcoma 6 months ago 
• Subcutaneous port inserted at SickKids 4 months ago 
• Due to nausea and vomiting, A.B has been placed on droplet/contact precautions 

His last set of vital signs at 0400 were: 

• HR: 120
• RR: 20
• BP: 115/78
• Temperature: 36.9 PO 
• SpO2: 98% on room air
• Pain: 7/10 in mouth and abdomen, he received morphine1.5mg IV for pain at 0415
• A.B’s port was accessed, and bloodwork drawn in the ER. Labs are as follows:

CBC 

• WBC: 2.8 × 109/L
• Neutrophils: 1.0 x 109/L
• Hemoglobin: 86g/L
• Hematocrit: 0.6 
• Platelets: 65 x109/L

Chemistry

• Sodium: 147 mmol/L
• Chloride: 100 mmol/L 
• Potassium: 5.3 mmol/L
• Magnesium: 0.7 mmol/L 
• Phosphate: 1.20 mmol/L 
• Glucose: 4.0 mmol/L 
• Creatinine: 94 µmol/L

Home medications: 

• Trimethoprim/Sulfamethoxazole 160mg PO Daily on Friday, Saturday, Sunday for PCP prophylaxis 
• Ondansetron 8mg PO Q8H PRN for nausea/vomiting 
• Lorazepam 1mg S/L Q6H PRN for nausea/vomiting
• COVID swab completed in the ER; result pending 
• A.B has a subcutaneous port that was accessed in the ER, they started NaCl 0.9% @150mL/hr
• The RN in the ER gave A.B a dose of ondansetron 8mg IV at 0000 for vomiting
• A.B has two younger siblings (age 8 and 12). His father is staying with him in the hospital and is very attentive, appropriately concerned, and tired looking. 
• A.B attends high school; he is a good student and very social. 
• A.B’s father is a mechanic, his mother is a dietician, and the family lives in Richmond Hill. His mother has been calling the father for updates, she is staying home with the other siblings. A.B’s grandmother is at their home to help. 

Your 0800 assessment of A.B: 

• A.B is asleep but is alert when you began your assessment. He is pleasant and cooperative but reports that he is in pain again and feeling like he is going to throw up.
• The inside of his mouth has white patches that are reddened around the borders, there are 4-5 spots dispersed around his mouth (including the roof and his cheeks). 
• A.B is pink, warm, capillary refill of <2 seconds. Radial and posterior tibial pulses are 2+. 
• A.B’s chest is clear with good air entry throughout all lobes, no work of breathing noted. 
• Abdomen is soft, non-distended and non-tender upon palpation, hypoactive bowel sounds. 
• Skin is dry and intact, A.B’s lips are dry and cracked. 
• A.B has voided one since his arrival to 8A. The urine specific gravity was 1.030. His last BM was yesterday, it was normal.
• Vital signs on your assessment are: 
• HR: 118
• RR: 16
• BP: 118/70
• Temperature: 37 PO 
• SpO2: 99% 
• Pain: 8/10 in mouth and abdomen
• A.B’s port is infusing well, and the dressing is dry and intact.
• A.B can ambulate independently to the washroom with a crutch to support his leg that is affected with cancer. He allows his father to help him with the IV pole but seems hesitant to accept assistance. 
• A.B reports that he has not had anything to eat or drink since yesterday morning. His father says his oral intake has been poor for the last 3 days. 
• The 8A Dietician and Social Work are following A.B in addition to the medical team. 

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