Critical Appraisal of Childhood/Adolescence Clinical Presentation: Case Study Analysis Task

The Subject Learning Outcomes demonstrated by successful completion of the task below include:

c) Critically analyse the psychosocial and cultural needs of the child or adolescent and their significant other and essential support in relation to acute illness in child and adolescent primary health care.

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.

f) Identify and determine suitable risk assessment tools for use within children’s health care (as outlined in the National Safety and Quality Health Services (NSQHS) Standards). 

Choose one (1) case study detailing a common clinical presentation in childhood/adolescence; and

Research and write a critical appraisal on your chosen case study.

The word limit for this task is 1800 words (+/- 10%). This is an individual task.

Please refer to the Task Instructions for details on how to complete this task.

This assessment provides an opportunity for you to use the theoretical knowledge you have acquired so far in CCA206 Care of Children and Adolescents. You are encouraged to question the  information presented to you in the case study, recommend appropriate courses of action and provide rationale supported by references to theory and evidence. When making recommendations, keep in mind the philosophy of patient-and family-centred care.

Read the two case studies presented.

Choose one (1) case study to critically appraise.

Please ensure you consider the following points as you complete your case study report (subheaders are not required):

1. Outline and describe the pathophysiology of the clinical diagnosis.

2. Outline, describe and analyse the signs and symptoms of the clinical presentation.

3. Describe and interpret the growth and development of the child/adolescent in your case study and any important concepts relating to this.

4. Identify the child protection responsibilities of a Registered Nurse in your state/territory and apply it to your case study.

5. Describe and analyse the multidisciplinary processes for handling complex safeguarding issues for your chosen case study.

6. Identify and explore medication management complexities in your chosen case study, to include the interpretation and application to care planning.

7. Complete an appropriate risk assessment for chosen case study, to include identifying and appraising suitable risk assessment tools, applying one tool, and determining risk management measures to be integrated into patient care plan.

Write your case study report in the 3rd person.

Task Summary

Present your own original work using multiple academic references from academic books, peer reviewed scientific journal articles and other credible sources (.edu, .gov and .org webpages).

Familiarise yourself with the rubric to ensure you are addressing the relevant elements within your critical appraisal.
Present your academic references on a separate page using APA (6th ed.) guidelines.

Submit your report as a word document and not in protected view.

Present your assessment in 12-point font, Arial or Times New Roman, 1.5 line spaced and a minimum of 2.5cm margins.

Mrs Sooma, attends the Emergency Department (ED) with her 5-month-old son Amar.

She is concerned that her son has had a cough, runny nose and congestion for three days, and is gradually getting worse. Overnight, he coughed very forcefully until he vomited, and this morning, his mother noticed he was breathing faster, feels like he has a fever and is taking in less formula.

He has not had a wet nappy in four hours. His 4-year-old sister has a cold and Amar attends a local day care centre. Mrs Sooma has four children under six years of age, which she brings up alone after her husband died recently in car accident. You are Amar’s admitting nurse.

Amar was born at 32 weeks gestation measuring 38.1cm and weighing 1421grams.

He remained in hospital until six weeks of age. Since discharge, he has been weighed/measured regularly and you perform an admission weight/length and plot Amar’s growth on the World Health Organisation (WHO) growth charts. His mother is concerned that he is not growing well as he is much smaller than children of a similar age.

When you are weighting Amar, you notice that he has several small bruises on his left lateral upper arm, which are on the bicep and tricep region. Further observation notes a non-blanching petechiae on his neck, jaw line and upper chest.

Mrs Sooma openly explains that her 4-year-old toddler has begun to bite with her temper tantrums. Mrs Sooma recounts events relating to the bruise/bite mark and becomes quite emotional, she sheds some tears. She explains Amar’s 4-year-old sister had bitten him on the left arm which she thinks looks more like a bruise now almost a week later. She explained how she noticed the ‘little pinpoint spots’ on his chest this morning when she bathed him. You clearly document and report to the senior nurse on duty and the attending Doctor your findings whilst weighing Amar.

Context

Temperature: 38.4°C

Heart rate:150 beats per minute

Respiratory rate: 60 breaths per minute

Blood pressure:90/50 mmHg.

Oxygen saturation: 91% on room air.

He appears alert and smiles sometimes but is clearly tachypnoeic and has a moist cough. You note moderate subcostal and intercostal retractions, with mild nose flaring.

On auscultation of his chest, there are widespread crackles audible throughout both lung fields, which have a “wet” quality. There is equal air entry bilaterally with a faint lower bibasal wheeze evident on expiration only.

The admitting Doctor reviews Amar and documents a clinical diagnosis of moderate viral bronchiolitis. He informs Amar’s mother that he will need admission to hospital.

Intravenous fluids

Intravenous antibiotics

Insertion of an IV cannula

Oral liquid paracetamol

30/24 vital signs

Continuous Sp02 monitoring

4/24 nebulised Salbutamol

Review by a doctor in four hours unless further deterioration is noted by nursing staff.

You are aware of the hospital guideline for the management of Bronchiolitis and note a Paediatric Medical review and consultation is expected, when bronchiolitis is assessed as being moderate or severe.

Mrs Hawkins attends the Emergency Department (ED), with her 6-year-old daughter Lucy. She is concerned that Lucy has developed a rash, her cough is worsening, and her fever continues despite treatment from her General Practitioner (GP). Mrs Hawkins first brought her daughter to see the GP three days beforehand, when she developed a fever for 48hrs, had a troublesome cough, itchy watery eyes, and a runny nose and complained of a sore ear.

The GP diagnosed conjunctivitis with otitis media and prescribed oral antibiotics. Since then, Lucy has deteriorated, and earlier today she developed a facial rash that proceeded to spread to her torso.

Weight 15kg

Height 115cm

On first impressions, you are very concerned that Lucy looks extremely underweight, as you can see the bones in her rib cage. Her skin is smudged with dirt and her clothes stained and smelly. She also has a visible red rash on her face which has progressed to her back. She is quiet and somewhat unresponsive with inconsistencies between her responses and her mother’s.

You observe that Mrs Hawkins does not comfort Lucy when she becomes upset and appears to be rough and impatient when instructing her to re-dress.

Lucy was a born 3.4kg at f39.4 weeks and born via vaginal delivery. She has no medical or surgical history, or previous hospitalisations. She does not take any medication, other than the oral antibiotics prescribed the GP. She has no known drug allergies. Lucy has no siblings and her Father is reported to be healthy.

Mrs Hawkins has Type 1 diabetes. No other diseases noted paternally or maternally. Mrs Hawkins explains to you that her daughter has not had any of the recommended immunisations as she (the Mother) has refused consent. Lucy is also home schooled.

Meanwhile, you become increasingly concerned that Lucy appears to be deteriorating clinically (changes to her vital signs) and you escalate your reporting to an immediate assessment and treatment by the Paediatrician in the Emergency Department.

Temperature: 39.6°C

Heart rate: 130 beats per minute

Respiratory rate: 52 breaths per minute

No blood pressure was recordable.

Oxygen saturation: 90% on room air

You commence supplemental oxygen via nasal prongs at 2L/min. Lucy has bilateral conjunctivitis, a normal oral pharynx, decreased breath sounds with fine crepitation throughout, moderate subcostal retractions and a generalised erythematous macular-papular rash to her face, trunk and upper extremities.

The Paediatrician is working on a clinical diagnosis of measles with moderate to severe pneumonia. She informs Lucy’s mother that admission is required and recommends close monitoring in an isolation room.

Oxygen to maintain saturations >92% with continuous Sp02 monitoring

Continuous cardiac monitoring via a 3 lead ECG

Regular reassessment for possible further respiratory support.

Urgent chest x-ray

Nose & throat swabs

IV cannula

IVT Normal saline 1000ml 12/24

Oral liquid paracetamol

Blood cultures

Full blood count

Electrolytes

C-reactive protein and

Measles serology