CCA206 Care of Children And Adolescents Assignment 3 -Laureate International University AU.

Subject Code and Title CCA206 Care of Children and Adolescents
Assessment Critical Appraisal of a Case Study
Individual/Group Individual
Length 1500 words (+/- 10%)
Weighting 35%
Learning Outcomes: The Subject Learning Outcomes demonstrated by successful completion of the task below include:
a) Define and apply the key concepts related to the growth and development of children and adolescents to nursing assessment and
care planning.
CCA206 Care of Children And Adolescents Assignment 3 -Laureate International University AU.

CCA206 Care of Children And Adolescents Assignment 3 -Laureate International University AU.

b) Explain the theoretical underpinnings of a range of childhood
health issues and apply this knowledge when using skills in
simulated practice.
c) Critically evaluate the psychosocial and cultural needs, the
ramifications of illness and hospital admission use this knowledge in
care-planning and professional practice.
d) Explore the complexities of medication management with
children and adolescents and interpret and apply to care planning.
e) Recognise child protection responsibilities and collaborative
processes with a multidisciplinary team.

Task Summary:
In this assessment task, you will be required to
 Select one (1) case study to explore.
 Critically evaluate the information provided in your case study scenario.
 Demonstrate an in depth understanding of common adolescent pathologies, and the role of the nurse in the assessment, planning and delivery of care.
 The word limit for this task is 1500 words (+/- 10%). This is an individual task.
 Please refer to the Task Instructions for more details.

As adolescents mature and develop their independence, they will at times present on their own to seek health care services. Adolescents will also commonly present with their parents(s), requiring the nurse to practice family centred care.

When planning, delivering, and evaluating nursing care for adolescents who present without a parent in the emergency department setting, the nurse needs to build and sustain a therapeutic relationship with the adolescent, and advocate for their rights and needs.

In clinical scenarios where adolescents present on their own, and do not wish to include their family in their care, the nurse and medical team can be faced with moral and ethical dilemmas as to whether the family should be involved, despite the patient’s refusal. Adolescents should be viewed
as individuals, and a determination should be made as to whether they are Gillick competent, whilst ensuring local legislation and policy is upheld. The determination as to whether an adolescent can be deemed Gillick competent, should also be made when an adolescent presents with parent(s) or a guardian, as it is essential to include the adolescent in decision making practices.

The case scenarios provided below, will test your knowledge of different pathologies and your understanding of the role of the Registered Nurse (RN) when caring for adolescents.

CCA206 Care of Children And Adolescents Assignment 3 -Laureate International University AU.

CCA206 Care of Children And Adolescents Assignment 3 -Laureate International University AU.

Task Instructions:
To complete this assessment task, you must:
1.Visualise yourself in the role of the newly graduated Registered Nurse (RN), working in a busy metropolitan emergency department (ED). Your patient has been seen by a medical officer who has commenced assessment and they have handed the patient over to you for nursing care.
2.Choose one case study from the four presented.
3.Write a 1500-word (+/- 10%) essay using the suggested structure below.
4.Incorporate current evidence-based literature into the critical appraisal.
5.Respond to each of the points listed below pertaining to the selected case study:

  • Outline and describe the 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.
  • 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.
  • Discuss whether the adolescent in the scenario can provide informed consent, and make independent medical decisions based on your knowledge of Gillick competence, considering the clinical diagnosis.
  • Identify the child protection responsibilities of the case study character whilst in the hospital setting and collaborative processes with a multidisciplinary team.
  • Outline any psychosocial and/or cultural needs which should be factored into nursing care and care planning.
  • Explain how the nurse can create and sustain a safe and emotionally supportive environment for the adolescent in the case study.
  • Outline and discuss the Registered Nurses role in the safe administration and management of medications for the adolescent.

Suggested Structure:
1.Page numbers should be included in the footer along with student ID number
2.A brief succinct introduction should be written to introduce the case study and intention of the critical appraisal
3.A conclusion should be written which sums up any significant findings and concludes the critical appraisal in an engaging way. No new information should be introduced in the conclusion
4.Use Headings and Subheadings where appropriate to indicate which question is being addressed.

Submission Instructions:
Please submit ‘Critical Appraisal of a Case Study via the Assessment 3 link in the main navigation menu in CCA206 Care of Children and Adolescents Blackboard site. The learning facilitator will provide feedback via the Grade Centre in the LMS portal. Feedback can be viewed in My Grades.

Case Scenarios:
Please select one (1) scenario to critically appraise, all case scenarios are balanced with equal complexity.

Clinical Scenario 1
Name: William (Bill) Giovanni
Age: 16 years and 11 months
NOK: Brother Owen Giovanni (20 years old)
Allergies: lactose, fructose
Medical past History: asthma, lactose intolerance, fructose intolerance, smoker (10-15 a day)
Medications: Salbutamol prn

Reason for presenting to hospital: 1/7 of mild bilateral lower abdominal pain, localised to the R) side in the last 2 hours with associated rebound tenderness, nausea, hot flushes and diaphoresis.

Diagnosis: Acute appendicitis.
Vital Signs: HR: 90, BP: 109/65, RR: 22, Spo02: 99% RA, Temp: 38.5
Glasgow Coma Scale (GCS): 15

 Abdominal U/S: Positive for appendicitis
 Bloods: FBE (WBC = elevated), U&E and Blood cross match.
 Urinalysis: NAD

Treatment Plan:
 Admission: requires surgical removal of appendix
 Diet: Fasting for theatre
 Vital signs: 30/60
 Medications:
o IV Morphine 2mg PRN
o IV Maxalon 10mg PRN
o IV Metronidazole 500mg in 100ml N/Saline stat
o IV Amoxicillin 500mg IV stat
o IVT N/saline 0.9% 8/24
 Ani-emboli stockings

You have been asked to take over nursing care of Bill in the ED, until a bed is ready in theatre. Bill requires pharmacological management of his pain, intravenous antibiotics (IV a/bs), to remain fasting and be prepared for theatre.When approaching the cubicle, you see Bill lying in bed, knees bent, guarding his abdomen, and grimacing in discomfort. His brother is with him who looks stressed and waves you over. Owen (the patient’s brother and next of kin (NOK)) talks to you outside the cubicle, stating that his
brother Bill, has a low pain tolerance, and always gets freaked out in hospitals since their father passed away in a hospital when they were children.

Owen states that both he and Bill are estranged from their mother, who is an IV drug user. Owen also states that Bill is afraid of having IV medications as he is fearful of ending up like his mother. Owen asks if he can stay with his brother until he goes to theatre, as he is the only one looking out
for his brother, and thinks he can help keep him calm.

Clinical Scenario 2
Name: Jess Dutch
Age: 16 years and 7 months
NOK: Sister Kelly Dutch (19 years old)
Allergies: Peanuts (anaphylaxis)
Medical past History: Acne vulgaris, depression, anxiety and self-harm.
Medications: Roaccutane once daily

Reason for presenting to hospital: Self-inflicted laceration 7x2cm (LxW) to L) wrist with tendon visible on view. Sustained 2/24 prior with a knife, patient states feeling depressed and anxious.

Diagnosis: Laceration
Vital Signs: HR: 95, BP: 1015/65, RR: 24, Spo02: 99% RA, Temp: 37.5
Glasgow Coma Scale (GCS): 15

 Bloods: FBE, U&E and Group and Hold.

Treatment Plan:
 Admission: requires surgical washout and repair of laceration
 Diet: light meal for dinner then fasting for theatre in the morning
 Vital signs: Every 30 minutes
 Neurovascular observations every 30 minutes for 4/24 then 1/24.
 Saline soaked gauze dressing with combine to wound.
 Medications:
o IV Ceftriaxone 1g stat
o IM ADT Booster 0.5ml stat
o Oral Panadiene forte x1 PRN

You have been asked to take over nursing care of Jess in the ED, until a bed is ready on the children’s ward, she will then be sent to theatre the following morning.Jess requires an admission for surgical washout and repair of a laceration with an exposed tendon by a Plastic Surgeon.

Jess is visibly crying and has her hands over her face. She tells you she has been bullied online by girls from school because of how she looks and that she has been feeling very depressed and having panic attacks when she reads mean posts about herself on social media. Jess tells you she is picked
on because she has acne and because she is bigger than the other girls at school.Jess says she has self-harmed secretly before, but this is the first time she has ever required medical assistance as a result.

Jess’s parents are divorced, she lives with her father and has called him, leaving a voicemail as he is at work. Jess’s older sister is on her way to the hospital, and she doesn’t want her mother to be notified as they don’t get along, and she thinks her mother is unsympathetic. Jess tells you she has a
close relationship with her father and sister, Jess tells you her wound doesn’t hurt, but that she feels chest tightness and panicked, she is worried
kids at school will find out about what she did and bully her even more.

Clinical Scenario 3
Name: Jackie Damien
Age: 15 years and 2 months
NOK: Mother Selena Damien (36 years old)
Allergies: Shellfish (hives)
Medical past History: Asthma, Anorexia Nervosa, anxiety
Medications: Potassium orally BD

Reason for presenting to hospital: Known anorexia nervosa patient who experienced a syncopal episode during exercise, presenting anorexic, lethargic and frail. Currently managed at home as an outpatient.

Diagnosis: Hypokalaemia secondary to Anorexia nervosa
Vital Signs: HR: 44 (irregular), BP: 90/59, RR: 16, Spo02: 99% RA, Temp: 36.7
Glasgow Coma Scale (GCS): 14 (eyes closed)

 Bloods: FBE, U&E (K+ 3.3 mmol/L).
 ECG: Bradycardia (irregular) with T wave inversion in V4 and V5
Treatment Plan:
 Admission: requires cardiac and electrolyte monitoring
 Diet: Vegan (patients dietary preference) Regular intake encouraged and observed by
nursing staff
 Vital signs: Every 30 minutes including cardiac monitoring via 3 lead ECG.
 Venous Blood Gas 4/24 to monitor K+ and Mg+
 1/24 Fluid balance
 Medications:
o Oral Chlorvescent (28mmol/L K+) dissolved in 100-150ml H2O TDS
o IVT N/saline 0.9% 1L, 8/24

CCA206 Care of Children And Adolescents Assignment 3 -Laureate International University AU.

CCA206 Care of Children And Adolescents Assignment 3 -Laureate International University AU.

You have been asked to take over the nursing care of Jackie, who is to be admitted for 2/7 for rehydration and monitoring of electrolyte levels. She will be transferred to a Short Stay Unit (SSU) when a bed is available.

When you go to assess Jackie, you are greeted by her mother Selena. Selena tells you that she thought Jackie had turned a corner and was managing well at home, but today’s syncopal episode demonstrated Jackie was still over exercising, to the point of physical exhaustion. Selena tells you Jackie has weekly appointments with a private psychiatrist, and attends a twice weekly support group with other young people diagnosed with Anorexia. Selena becomes teary, and tells you she and her husband (Jackie’s father) both take turns working from home to help monitor Jackie, and
that Jackie has a supportive group of friends who visit her regularly. Jackie tells you that she is feeling cold and asks you if you could bring her a warmed blanket. Upon inspection Jackie looks very frail and underweight, she smiles and is politely spoken, she tells you she wants to be a Veterinary
nurse one day and loves animals. Jackie has adopted a vegan diet and asks you to make sure her medicine and meals do not contain any animal products.

CCA206 Care of Children And Adolescents Assignment 3 -Laureate International University AU.

Clinical Scenario 4
Name: Adam Carlson
Age: 14 years and 6 months
NOK: Mother Dorothy Carlson (48 years old)
Allergies: NKA
Medical past History: Autism and tonsillectomy
Medications: NAD

Reason for presenting to hospital: Jumped off a 2m high fence landing on L) lower leg, whilst playing with his friends. Obvious deformity to L) lower leg with bone on view. Distressed ++

Diagnosis: Open L) tibial plafond fracture #
Vital Signs: HR: 74, BP: 129/78, RR: 14, Spo02: 98% RA, Temp: 36.9
Glasgow Coma Scale (GCS): 15

 Bloods: FBE, U&E, Group and Hold.
 Xray: L) Open tibia plafond fracture (#)
Treatment Plan:
 Admission: requires open reduction internal fixation (ORIF) in theatre
 Diet: Fasting for theatre
 Saline soaked gauze dressing to fracture site
 Vital signs: Every 30 minutes
 Continuous sp02 monitoring via Elastoplast sp02 monitor on L) great toe
 Neurovascular observations: Every 15 minutes
 Medications:
o IV Ceftriaxone 1g stat
o IVT N/saline 0.9% 1L, 12/24

CCA206 Care of Children And Adolescents Assignment 3 -Laureate International University AU.

CCA206 Care of Children And Adolescents Assignment 3 -Laureate International University AU.

You have been asked to take over the nursing care of Adam, who requires an ORIF for a L) Open tibial plafond fracture (#). Adam has already received pain relief (Penthrane) via an inhaler device, which was given to him by the ambulance on the way to the hospital. Adam is lying in bed playing a game on a phone smiling, and does not appear distressed, he has the Penthrnae inhaler device in his mouth.

Adam’s mother Dorothy introduces herself to you, she tells you that Adam doesn’t appear to be in pain, but that he often has difficulty communicating his emotions. Dorothy tells you that Adam has the mentality of an 8-year-old, and he would not have realised jumping off the fence was dangerous.
Dorothy tells you that Adam can be wary of new people and has become very frightened and almost hysterical in hospital before, as he associates hospitals with needles, which he doesn’t like. Adam noticed you talking to his mother and states “No needles I don’t want any”.

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