Pediatrics Case Studies

Bryce Morris

1. Bryce Morris, 5 years old, has been brought to the physician’s office by his mother for a yearly check-up. During the nursing assessment the nurse notes the following: height 40.5 inches, weight 40 pounds, BP 108/67, pulse 72, R 22, T 37.0°C. When documenting Bryce’s vital signs the nurse recognizes Bryce has dropped from the 50th percentile in height and weight 1 year ago to the 5th percentile now. Bryce’s mother reports that she is concerned because Bryce seems to have lost his appetite and she wants to know if this is normal for a 5-year-old. She also states that she is “a bit” concerned because Bryce doesn’t seem to want to play anymore and that he has become very irritable. (Learning Objectives 2, 3, 4, and 8) a. What further assessments should the nurse make? b. What diagnostic testing should the nurse expect to be ordered? Bryce is diagnosed with pauciarticular juvenile idiopathic arthritis. c. What would the nurse know to include in a teaching plan for Bryce and his family? 2. LaWanda Green, 9 months old, is brought to the emergency department by her grandparents. She has red, raised bumps on her chest and back. Her grandmother states that LaWanda became very fussy and that is when they noticed the bumps. (Learning Objectives 1, 3, 4, and 8) a. What would be the emergency department nurse’s priority assessments? What other assessments should be made? b. What information would be important to include in the health history? c. What discharge teaching should be done with LaWanda and her grandparents? 3. Miguel Souza, 14 years old, comes to the free clinic complaining of a prolonged course of diarrhea. The health history reveals that Miguel’s family has recently emigrated from South America; that Miguel has had seven incidences of “bad sore throats” in the past 12 months; when he injures himself it “almost always” gets infected; and he has diarrhea lasting several days at least monthly. Miguel states that he sometimes earns money as a male prostitute. Peds Quiz 4-B Case Study Vital signs include the following: T 100°F, HR 85, R 18, BP 125/78. Height and weight measurements are in the 5th percentile for age. No developmental delays are noted. (Learning Objectives 1, 2, 3, 4, 6, and 7) a. What other information would be important to include in Miguel’s health history? b. What diagnostic tests would the nurse expect to be ordered? c. What should be included in a nutritional plan for Miguel? d. What might the psychosocial impact of HIV infection be on Miguel?