Case Study 1

Case Study
Care of Infants and Children Practicum NURS 3051P
Submitted by: Jessy Soliz
Submitted to: Mrs. Cynthia Guild
Submitted on: March 20, 2015

Case Study 2
Table of Contents
Page #
Introduction
Preface
Data collection/Complete Health History.
-

Bio data
Chief complaints
History of present illness
Medical history
Family history
Lifestyle
Socioeconomic history
Environmental history
Psychological
Complete Physical Assessment

Analysis of Data Collected-

-

Gordons Typology of 11 Functional Health Patterns

-Health perception/Health Management
-Nutritional/Metabolic
-Elimination
-Activity/Exercise
-Cognitive/Perceptual
-Roles/Relationships
-Self-Perception/Self concept
-Coping/Stress
-Value/Belief
-Sleep/Rest
-Sexuality/reproduction

Comparing the data.

Actual and potential problems.

Implementation/Evaluation
-

Nursing Care Plan

Teaching Plan

Recommendations

Case Study 3
Appendix A..
References..

Introduction

Case Study 4
Neonates are new born human beings who are just a few days to a month old. Their
immune system and over all body systems are still underdeveloped therefore making them prone
to infections and other diseases. This is referred to as neonatal sepsis. It is an invasive infection ,
usually caused by bacteria which can occur intrauterine or extra uterine. Neonates who have low
birth weight, depressed function at birth, congenial anomaly that disrupted the skin, birth
asphyxia or any invasive procedure have a higher risk of developing neonatal sepsis. Sepsis is
the commonest cause of neonatal mortality; it is responsible for about 30 - 50% of the total
neonatal deaths in developing countries (Stoll B.J. 1997). This condition encompasses of various
systemic infections such as septicemia, meningitis, pneumonia, arthritis, osteomyelitis and
urinary tract infections. The onset of neonatal can be either early or late. In the early onset the
bacteria is usually acquired in the mother's womb or during labor and delivery. The symptoms
will usually show during the first 4-6 hours of life. In late onset the infection is acquired from the
environment and the symptoms will show after a few days of life. The overall symptoms do not
show clearly therefore the mother or guardian has to be alert for any changes in the child's
behavior. One of the most common signs is a disruption in the baby's feeding pattern. The baby
will refuse to suckle the breast and will become lethargic and sleep more often. Also shortness of
breath or difficulty breathing can be another common sign and the parent should seek medical
help immediately since the infection can speared faster in an infant than in an adult. Sepsis
related mortality can be largely prevented with the prevention of the sepsis itself with timely
recognition, antimicrobial therapy and aggressive supportive care.

Preface

Case Study 5
I would like to thank the mother of G.E.L for letting me do a case study based on her
son's condition 'neonatal(abdominal) sepsis'. I would also like to extend my gratitude to the
nurses of Karl Heusner Memorial Hospital in specific those at the Pediatric Ward for being
committed to providing tender loving care to their young patients and for the knowledge they
shared with me about pediatric care. I would like to thank Mrs. Cynthia Guild for being a patient
and understanding along with Ms. Elliot who helped me to further understand the importance of
developing care and teaching plans. This over all experience has helped me open my mind more
about the several health conditions that children can suffer and how to give the proper care to
each one in order to make them get well soon. I'm looking forward to being a nurse and giving
the best care to the people of Belize.

Data Collection/ Complete Health History

Case Study 6
i.

Biodata:

G.E.L is a 16 day old male baby residing with both his mother and father in Manatee drive in
Belize city. Both parents migrated to Belize 6 years ago from Guatemala. Both speak only
Spanish which according to the mother has been a bit difficult getting around in a city where the
main language is English. The family is Christian and attend a church in the area where they live.
According to the mother she works at a super market and her husband works in a gas station and
both cover the bills at home including medical care. The mother sought medical help referred by
a female doctor ,who is a close friend to her, after she mentioned the changes she noticed in her
baby three days before hospitalization.
Chief complaint
G.E.L's reason for hospitalization is because he refused to breast feed and if he did feed a bit he
would vomit from both the mouth and the nose.
History of Present illness
Mother of baby G.E.L described that on three days ago she noticed that her baby refused to
suckle her breast as before. The baby would sleep most of the day and she noticed he was
looking weak. A few days later the baby also started passing watery stool and she would hear
abnormal sounds in the baby's abdomen is she got him to feed him a bit of breast milk. The
mother states she got scared after she saw how her baby as getting and mentioned it to her friend
who is a doctor at Karl Heusner Memorial hospital. The doctor recommended the mother to take
the child to the hospital immediately for medical evaluation and attention, since the sing and
symptoms pointed out the baby had an infection in the abdomen. During the hospital stay the
baby started with shortness of breath and abnormal breathing patterns and is being treated for

Case Study 7
pneumonia as well. Presently the baby is doing much better the breathing pattern is returning to
normal and the baby tolerates breast milk as before.
ii.

Medical history

Patient G.E.L has no past medical history. He was delivered via vaginal delivery at the Karl
Heusner Memorial Hospital. There were no complications during the delivery. The baby left the
following day along with the mother who was in good health as well. So far the mother says the
bay suffers from n allergies since the only thing the feed him with is breast milk.
iii.

Family history

The mother of baby G.E.L states neither she nor her husband suffer from any illness and none of
them has been previously hospitalized. As far as she knows no other member of the family has
suffered from an infection. Only she and her husband are here in Belize and they have no close
or distant relative they know of that is living in Belize.
iv.

Lifestyle

On a typical day baby G.E.L would normally wake up and breast feed and would doze off the
sleep. A few hours later he would wake up again and feed more breast milk and go back to sleep
again. Sometimes he would stay awake and the mother would talk to him or sing to him and the
baby would gurgle and move his legs and hands. The baby would pass stool like 9 to 10 times a
day and the color would be a dark green color and thick in consistency. The mother says she
drinks a lot 'atole de masa' a porridge made of grind corn and says in her country mothers drink
that in order to produce enough breast milk to full the baby. She states that she would normally
cook lunch for both herself and her husband since its healthier and more cheaper than buying

Case Study 8
food in the streets. She would buy groceries at the supermarket she works in since the employees
get a small discount in all their purchases. After the baby was born she took some days off work
and they were planning on paying a lady who lives close by to babysit baby G.E.L so that she
can return to work since the family depends on both salaries to cover the bills at home.
v.

Socioeconomic history

Mother of baby G.E.L sates that she believes that God is the sole provider and that as soon as her
baby is discharged she will take him to church and give thanks to God for taking care of her baby
and allowing him to get better and return home safe and sound. The family live in a rented one
story cement house with two rooms, a kitchen, a small living room and a front porch. The
bathroom is separate from the main house but it is a flush toilet they have. They have a regular
size back yard they normally use it to hang cloths only once they are both not often at home. She
also states that their neighborhood is safe and the security is ok. She has not heard of any
robberies in the neighbor hood since they moved in and no cases of murder happening in the area
as well. She states if the baby gets sick again after returning home she would not think twice
before bringing him back to the hospital for medical help.
vi.

Environmental history

The mother states that in the areas where they live there is potable water but the just use it to
bath, wash cloths and wash dishes. Purified water from the shop is what they normally use for
drinking and cooking. There are shops close by, the supermarket where she works is close to
their home too. There is a 'tortilleria' in the vicinity as well where they normally buy since from
small they got costumed to eating tortilla rather than rice. There is a primary school within
walking distance as well and she states that first Good if all goes well and they are still living

Case Study 9
there that is the school where baby G.E.L will attend school as well. There are no noise or air
pollution cases in the area so far. She hasn't seen no rats or roaches in the house but they have a
lot of lizards but her husband chases them with a broom whenever they see one.
vii.

Psychological

Neither the mother nor the father have any relatives in the country to provide metal and physical
help to the parents. The mother is the only one staying with the baby during his hospitalization.
The mother has to wait for the father to come off work so he can bring her clothes and food and
stay a while with the baby while she takes a bath and cleans up. She states that since the day her
baby was admitted to the hospital she has not rested well but she doesn't mind staying awake to
take care of her baby. Her friend, the doctor who referred her to the hospital, is the only other
person that comes to visit her and the baby at the ward and often brings her juice or food because
she encourages the mother that she has to take care of her health as well. The mother states that it
was very hard living in a foreign country with no support from a family member nearby, but that
with time they have gotten used to it and she and her husband are doing ok by themselves and
now that they have a baby they will try even harder to give him a happy and safe home to grow
in.
viii.

Physical assessment of the client (Patients mother answered the questions

regarding the subjective data)

Baby G.E.L has a normal boy weight in relation to his age. The mother noticed the baby getting a
bit thinner since he was not feeding for some days. She states that upon birth he has not gotten
any fever or has any complications before the present illness. The baby appears to be asleep in
supine position. Baby's overall skin is smooth and warm to touch with even pigmentation, it is

Case Study 10
clear in color. There is sight redness in both cheeks. The baby's head circumference is 30 cm and
is proportional to the rest of the body. There is little hair noted, black in color, smooth and clean
with even pigmentation. The scalp is free of lesions and scars. The fontanel is soft upon
palpation. The eyes appear normal and are same size not bulging. The eye brow is evenly
distributed. Both ears are proportional to each other and in line with the eyes. The mother states
the baby has no discharge from the ears, and the baby responds by moving hands and legs when
she talks to him. The baby's nose is small and round with no obstructions noted. The lips and
gums are pink in color and moist. He has no teeth yet. His neck is not swollen or enlarged and
the baby cannot hold his head up which is normal due to his age. The mother states that the
baby's breathing was normal on his first days of life, only got agitated when crying. After
hospitalization the baby stared with rapid breathing even when sleeping. The mother was
instructed to slightly elevate the baby's head and to not over cloth him or cover him with thick
blankets. There are no wheezes or crackles heard upon auscultation of the chest and lung areas.
The heart sounds are rhythmic with no murmurs. The baby makes no face grimaces indicating he
has pain when palpating the abdomen. Same is soft and non-tender with no bulges or masses.
The baby's limbs are developing well and no abnormalities were noted. He has no sign of
cyanosis in the hands and feet and capillary refill on fingers and toes return to normal pink color
within 3 seconds. The baby breast fed normally in his first days of life then started refusing to
suckle the mothers breast. He has 9 to 10 bowel movements per day, which recently have been
watery.

ANALYSIS OF DATA COLLECTED

Case Study 11
ORGANIZING THE DATA
1.

Gordons Typology of 11 Functional Health Patterns

I.

Health Perception/Health Management

Patient had generally good health prior to injury. From the information gathered from
the mother during the interview she states that the patient does not suffer from
allergies from medications being given, it is too soon to determine if the patient is
allergic to any type of foods since the baby only breast feeds. Their living
environment is stable free from pests and infestations, only the lizards which are
present but the father chases them away. There is no air pollution near the home
which may cause breathing problems in the infant and the rest of the family. The
family only drinks purified water and the mom states she maintains the house as clean
as possible and washes any vegetables that will be cooked. There is a loving
relationship between her and her husband. She states they try to talk over any issues

II.

they have since they only have each other here for support.
Nutritional/Metabolic
Patient had a decrease in intake of nutrients since he stopped sucking breast for a few
days and an abnormal abdominal sound was heard by the mother when the baby did
take in some milk. The baby also presented with diarrhea and this along with the
insufficient intake of milk can lead to dehydration of the infant. The baby appears to
have an infection in the gastro intestinal tract which interferes with his normal routine
of feeding. Since he is still a 16 day old baby his defenses are low and he need the
breast milk which boosts his immune system in fighting infections.

III.

Elimination
Bowel movements started regular in the first days of life. 9 to 10 bowel movements
per day consisting of thick dark green stool. This is normal since the baby is passing

Case Study 12
the meconium which was building up in the baby's intestine during the pregnancy and
need to be eliminated. The baby wets the pampers as well which indicates he is
passing urine as well. Recently the baby presented with watery stool which may be
cause by the infection and the inability to digest the breast milk. Mother changes
pampers whenever soiled and cleans with wipes and applies cream to prevent rashes
IV.

on the baby's buttocks due to the pampers.

Activity/Exercise
Baby G.E.L is a 16 day old baby therefore he requires full assistance when feeding
and changing cloths and pampers. He is able to move his legs and hands up and down
and turn the head from side to side when spoken too as well. He sleeps after breast
feeding and wakes up after a few hours. The mother stated that he appears lethargic as

V.

well due to his present illness.

Cognitive/Perceptual
Baby G.E.L due to his age is unable to comprehend when spoken too but he reponds
when stimulated by moving his limbs. The mother states that when he cries she would
give him breast and he would become calm again. She stimulates him by talking to
him in loving words and singing to him so he falls asleep.

VI.

Roles/Relationships
Baby G.E.L is attached to his mother since she states that he doesn't not fall asleep
unless she is with him. That is also one of the reasons why only she stays with the
baby most of the time in the hospital. The baby doesn't cry when other people hold
him, this may be because he is still unaware of his surroundings and is unable to

VII.

identify people by face.

Self-Perception/Self concept

Case Study 13
The patient is still unable to show signs of self esteem and self assurance. The baby
seems content most of the time does not cry all of the time and is calm in the mother
VIII.

arms.
Coping/Stress
Patient shows no signs of stress this may be due to the fact that the patient is not
aware he is in a hospital setting. When mother talks to him he gurgle in response and
sometimes opens his eyes. The mother on the other hand says she tries not to stress
herself other than just taking care of her baby. She gets full support from her husband

IX.

as well.
Value/Belief
The mother states she will grow her child to fear and to believe in God just like how
she was grown. She believes that if she asks with a clean heart God will help her son
be ok again. She says a prayer while holding her son asking for his health every night
before putting him to sleep. She doesn't have any other customs or believes she
follows. She covers him whenever it gets chilly in the room and places a hand mitten

X.

on the baby's hands to prevent himself from scratching his face with his finger nails.
sleep/ rest
The mother states that her baby sleep most of the day. He only wakes up to breast
feed and goes back to sleep. Sometimes he will remain awake for a while and she will
talk to him in order to bond with him. Due to his illness he has been sleeping more
often and appears lethargic. He is not a baby that bothers much at night he will only
wake up and cry if he is hungry where she will breast feed him and he will go back to
sleep. The mother on the other hand has not been sleeping well since she doesn't want
to leave her baby unattended. She states she doesn't mind once her baby is ok and that

XI.

she will get rest after her baby is doing better and out of the hospital.
sexuality and reproduction

Case Study 14
The patient is still unable to identify himself with his gender. Since he is a little boy
the mother dresses him in blue clothes and most of his bottles and other baby things
are blue. She says she named him after his father and her father's names.

COMPARING THE DATA

Table 1: Timeline of events in baby G.E.L's illness
Patient has been showing gradual reduced levels of pain from initial admission and assessment
up to the present. Patient scored a 5 on Wong-Bakers FACES pain assessment tool initially,
scored a 3 last week and is presently scoring a 1. There is definite improvement in the patients
ability to sit up in bed and assist in changing clothes and pampers.
Vital signs have been consistent and without presence of an infection. Patient is seen and
evaluated by Dr. Roberts and Dr. Parham on a daily basis to assess condition. X-rays have been
taken of the initial injury and how it has been aligning with the help of the skin traction with
weights. Last x-ray taken indicated femur is well aligned but must still be kept of traction to keep
promoting callus formation. Since patient is 4 years old, bone healing is characteristically rapid
because of the thickened periosteum and generous blood supply. In early childhood, healing
times for a femoral fracture can take up to 4 weeks (Hockenberry & Wilson, 2011). LS has been

Case Study 15
at the ward for 18 days still and Dr. Roberts has ordered 2 more weeks of being in traction. Bone
healing in any age group is greatly influenced by the patients general health. LS does not have
any other illness presently to hinder her healing. Mother should be educated on the importance of
a balanced diet to promote stronger bones and good development of childs body.
Strengths of LSs family include having a good support system in terms of taking the time out to
take care of LS and father staying at home to take care of the other children and to keep their
business running. Her grandmother is also helping take care of the other children. Weaknesses
could be that there is only communication through the phone to the rest of the family in Benque.
No other family members have come to relieve LP of taking care of her daughter. In another of
point of view, LSs injury is an opportunity for the family to grow closer when they help each
other out. LS will become closer to her mother, and vice versa. Father will have the opportunity
to see what it feels to take care of the rest of the family on his own, and he could be more
understanding to his wife. Financial strain of LSs injury may decrease the familys resources,
other siblings could feel neglected since attention is on LS for the moment, and both parents can
be feeling guilt over having failed to protect their child. Other opportunities to educate other
members of the community on fractures and timeframe of bone healing could come to LSs
family so that they could educate other families to supervise when their children are playing and
try to prevent injuries to their childrens bones.

Case Study 16

Table 2: Nursing
interventions related to data
gathered
Risk for disuse
syndrome
-Patient's
muscles are
not being
used, can lead
to decreased
muscle
strength

Risk for impaired

skin integrity
-Right leg is dry
so mother is
putting lotion to
keep skin
hydrated and
giving liquids

Impaired
Physical
Mobility
-R leg is on
traction with
weights

Acute pain
-voices pain
when
moved

Closed
fracture
to right
femur

Caregiver role
strain
-mother voices
anxiety that her
youngest child is
still breastfeeding
but she cannot
breastfeed while
being with LS in
Bze City

Bathing self-care
deficit
-requires
assistance of
mother to
perform self care
(bathing,
dressing etc.)

Sleep
deprivation
-patient
awakens
crying from
nightmares
related to
injury

Case Study 17
ACTUAL AND POTENTIAL PROBLEMS
In order of priority
Actual: a. Impaired physical mobility- LS is unable to move the right femur and whole right
leg because of the skin traction with weights to the foot of bed. She is able to move her toes but
has impaired physical mobility to change positions on the bed. She is kept in a supine position,
but she is able to sit up in bed now that she is not experiencing as much pain as before. She needs
assistance in bathing herself and changing clothes. She requires the assistance of her mother. The
nurse helps in changing the bed linens without disturbing the traction.
b. Acute pain- LS is not having as much pain as she had at the beginning of the injury
however there is still pain present whenever she moves the leg suddenly or when she is being
changed and bed linens are being changed. The right leg is still tender to touch and edematous.
Patient is being given 7.5cc of Tylenol for pain management. Patient starts complaining and
crying that it hurts whenever she feels the pain.
Potential: c. Risk for disuse syndrome- Patient is at risk for disuse syndrome since she is not
ambulating and not able to do range of motion exercises to affected leg. Patient is limited to
staying in bed, so muscle strength is at risk to be reduced. Inactive muscle loses strength at a rate
of 3% per day (Hockenberry & Wilson, 2011). Immobility can also affect the circulation to the
skin during inactivity and can cause edema. Friction from the straps and bandages could cause
skin breakdown.

Case Study 18
IMPLEMENTATION/EVALUATION

Nursing Care Plan 14/03/2014

Assessment

Nursing Diagnosis

Objective data:
-Patient lying in supine
position in bed
-respiratory
effort
adequate
-skin warm to touch and
hydrated
-oral mucosa pink and
hydrated
-Abdomen soft and
palpable, non-tender
-Extremities
well
perfused, capillary refill
less than 3 seconds.
-right leg on skin
traction with weights,
immobilized with sand
bags
around
leg,
edematous and tender
Subjective Data:
-patient cries when
moved when bed linens
are being changed and
when she wakes up from
a bad dream, and voices

Actual:
Impaired physical mobility
related to bone injury to
right femur as evidenced
by inability to move out of
bed to bathe due to skin
traction with weights to
right leg

Acute pain related to bone

injury to right femur as
evidenced by client voicing
pain felt to right leg and
being tender to touch
Potential
Risk for disuse syndrome
related to bone injury to
right femur

Goals/Objectives

Interventions/Rationale

Long term goal:

I. Impaired Physical Mobility
At the end of 3 days, 1.Assist in changing pampers and
patient will be able to:
bed linens-helps patient since she
cannot move much without
1.Pull herself up to feeling pain (collaborative-nurse
assist mother during and mother)
bathing and when bed 2.Do range of motion exerciseslinens are being changed helps strengthens muscles of legs
according to level of and arms (independent-nurse)
tolerance
3.Provide books, and toys within
reach-keeps patient entertained
Short term goal:
and not feel bored of staying in
At the end of the 8 hour bed (collaborative-nurse and
shift, patient will be mother)
able to:
4.Keep right leg in tractionpromotes correct alignment and
2.Voice that she feels healing of bone (collaborativelittle pain or is free of doctor and nurse)
pain to right leg when 5.Provide skin care by keeping
she moves
skin clean and dry-helps maintain
skin integrity and reduces risk of a
break in the skin (independent3.Move
unaffected nurse)
limbs to do range of
motion exercises to
I.
Acute pain

Outcomes
At the end of 3 days,
patient was able to:
1.Pull herself up in bed to
assist during bed baths and
changing
of
linens
according to level of
tolerance

At the end of the 8 hour

shift, patient was able to:
2.Voice that she felt little or
no pain to right leg when
she moved
3.move unaffected limbs
and do range of motion
exercises and therefore
reduced the risk of disuse
syndrome

Case Study 19
pain
-Patient cannot bathe on
her own, requires help of
mother to be sponged in
bed
-Patient is quiet and
calm when she has
books to read and TV to
watch.

reduce risk of disuse 1. Assess level of pain using

syndrome
Wong-Bakers pain assessment
tool-helps to see level of pain
patient is feeling (independent)
2. Administer Tylenol every 8
hours or when needed-analgesics
help control pain (Dependent on
doctors orders)
3.Monitor vital signs for increase
in pulse which would indicate
pain (independent)
4.keep toys and books within
reach so patients focus will be on
the stimuli and not on the pain
(independent-mother)
5.Provide comfort to child by
talking soothingly so she can
relax when she is having pain
(collaborative-nurse and mother)
II.

Risk for disuse

syndrome
1.Initiate range of motion
exercises to encourage adequate
circulation (independent)
2.Massage pressure area points to
prevent bed sores (collaborativenurse and mother)
3.Encourage patient to wiggle

Case Study 20
toes, sit up, and stretch as
tolerated
(collaborative-doctor,
nurse and mother)
4.Educate mother on disuse
syndrome so she can move childs
limbs when nurse is not around
(independent-nurse)

Case Study 21
TEACHING PLAN
TOPIC: Fractures and traction
VENUE: Patients bedside AUDIENCE: Mother and
patient
DATE: March 14, 2014
DURATION: 30 minutes
THE PURPOSE: To educate the patient and mother on impaired physical mobility, pain
management and how to do range of motion exercises
STATEMENT OF OVERALL GOAL: Patient and mother will understand the reasons why
traction is placed, and how to manage patient in traction
OBJECTIVES

CONTENT
OUTLINE

At the end of the

discussion, patient
and mother will be
able to:
1.Describe what is a
fracture and the
types of fractures
and how traction
therapy works

1.What is a
fracture?

2.Identify type of
fracture patient
suffered by looking
at patients x-rays
3.Adapt to patient
having to stay on
traction for 2 more
weeks and how to
manage pain
4. Describe disuse
syndrome and how
to do range of
motion exercises to
prevent it

METHOD
OF
INSTRUCTIO
N

DiscussionExplain traction
care-understand
2. What are the the therapy,
different types
maintain
of fractures that traction,
can occur?
maintain
alignment
3. treatment of
(check after
fractures-cast or patient moves),
traction
and prevent
skin breakdown
4.Medications
available:
go in depth by
Tylenol,
demonstrating
Voltaren,
the correct
Pethidine-for
ways of doing
pain
range of motion
management
exercises and
have mother
5.Disuse
perform a
syndrome
return
demonstration
6.Questions and
answers at end
of presentation

TIME
ALLOTED
FOR EACH
OBJECTIVE

5 minutes for
each objective
and time left
will be for
demonstration
and questions
& answers

RESOURCES/
TEACHING
AIDS

METHOD OF
EVALUATION

Visual aids:

When the nurse

finishes
discussion,
patient and
mother are able
to identify type
of fracture
patient
sustained,
understand
which pain
medications are
given and how
they work, and
how to initiate
range of motion
exercises to
prevent disuse
syndrome.

Pictures of the
types of
fractures
Patients X-ray
Demonstration

Case Study 22

Recommendations
After evaluating the data compiled, some recommendations to patient and family can be
given. Possible ways to improve the situation of the family could be that other family members
should come and help the mother of taking care of the child. Undoubtedly, LP is having difficulty
being the only one who has to stay with the child because she voices that her baby is still
breastfeeding and her breasts are getting tender from not breastfeeding. In the meantime also, she
is also worried about her other children and how things are at home. It would be recommended to
have someone else come to help her at least for 2 or 3 days so she can go back home. LS is doing
very well in the past days. All that is left to do is wait 2 more weeks so the skin traction can be
discontinued. Dr. Roberts could then put on a cast or transfer her to the San Ignacio Community
Hospital so she can be closer to home. LS also needs more books and toys so that she does not
get bored about having to stay immobilized.
Interventions from the nursing care plan were met and the patients needs were prioritized
according to the needs that were most outstanding. Range-of motion exercises are still being
done and client is able to sit up in bed and move other limbs to promote circulation. Patients
right leg is still in traction and care is done to see that the leg is always aligned and that the
weights are hanging freely. If patient is in pain, Tylenol is given to help alleviate it.
When patient is discharged and taken back home, bed rest and care should be taken so
that leg does not become injured again. The child must not strain the right leg with excessive
running or other physical activities. Follow up care with the doctor should be done as scheduled
for x-rays to see that the bone continues healing. If there is any vomiting or shortness of breath

Case Study 23
after being discharged, parents should be advised to seek immediate medical help at the nearest
health center. Patient should keep taking her pain medications as prescribed by the doctor as
well. The mother should be encouraged to freely ask any questions she might have regarding
future appointments or how to better take care of her child once she is back home. At the same
time the nurse should provide accurate and understandable information on all topics related to
the injury. The teaching plan for this patient should help minimize the lack of knowledge on the
patients injury.

Case Study 24

Fig 2.1 Wong-Bakers FACES pain assessment tool).

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