Describe the care of children and adolescents
Case Study (Option 1)
• Mrs Sooma attends the Emergency Department with her 5-month-old baby 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. 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.
Age Corrected Age Weight (kg) Length (cm)
3 months 1 month 3.0 50.9
5 months 3 months 4.5 55.9
• When you are weighting Amar, you notice that he has one small bruise on his left lateral upper
arm. 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
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temper tantrums. Mrs Sooma recounts events relating to the bruise/bite mark and becomes
quite emotional. 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 nursing clinician on duty and the attending Doctor your findings whilst weighing
Amar.
• Further physical examination shows Amar’s temperature is 38.4°C, heart rate is 150 beats per
minute, respiratory rate is 60 breaths per minute, and blood pressure is 90/50 mmHg. His
oxygen saturation is 92% 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.
On auscultation, there are widespread crackles audible throughout both lung fields, which
have a “wet” quality. There is equal air entry bilaterally with no audible wheeze evident.
• 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. The plan of
care includes intravenous fluids and antibiotics, with 2/24 vital signs. He also prescribes 4/24
nebulised Salbutamol with review in six 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.
Case Study (Option 2)
• Mrs Hawkins attends the Emergency Department 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 antibiotics. Since then, Lucy has deteriorated
and earlier today, she developed a facial rash that proceeded to spread to her torso.
• You are Lucy’s admitting nurse. You undress Lucy to take a weight and height (Weight 15kg;
Height 115cm) and begin your assessment. On first impressions, you are very concerned that
Lucy looks extremely underweight. Her skin is smudged with dirt and her clothes stained and
smelly. 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 when instructing her to re-dress. 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.
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• 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 that you aware
of. 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.
• On physical examination, Lucy is febrile 39.6°C, heart rate is 130 beats per minute, respiratory
rate is 62 breaths per minute, and no blood pressure was recordable. Oxygen saturation is
90% on room air and 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, mild 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. The plan of care includes oxygen to maintain saturations
>92% with continuous monitoring and assessment for possible further respiratory support.
Orders for an urgent chest x-ray; nose & throat swabs; blood cultures, full blood count,
electrolytes, C-reactive protein and measles serology as a priority.
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