Case Study 02 - delmarlearning.com

1 2-1 case Study 2:InfantTHE INTEGUMENTARY SYSTEMO verview:This case requires knowledge of burns, child abuse, as well as an understandingof the client s background, personal situation, and mother-child attachment from Thomson Delmar Learning s case Study Series: Pediatrics, by Bonita E. Broyles, RN, BSN,MA, PhD. Copyright 2006 Thomson Delmar Learning, Clifton Park, NY. All rights months oldSETTING HospitalETHNICITY White AmericanPSYCHOSOCIAL Single teenage mother Family history of abuseLEGAL Mandatory reportingETHICAL Suspected abuseCase Study 3/30/06 3:36 PM Page 2-12-2 Client ProfileKylais an 8-month-old infant who lives with her mother, grandmother,and great grandmother in Cincinnati, Ohio. Her mother, Sierra, is a 16-year-old who stopped going to school after she became pregnant by her on-again, off-again 18-year-old boyfriend, Kyle, who visits Sierra but showsno interest in Kyla.

2 He frequently becomes annoyed and leaves when Kylaneeds to be fed or have her diapers changed. Sierra s father was very abu-sive to both Sierra and her mother as Sierra was growing up. He died 6 months ago as a result of a knife wound that occurred during a fight at alocal tavern. He and Sierra s mother lived together with their five childrenand when he worked, he worked for a minimum wage that barely fed hisfamily. Kyla s aunts and uncles (Sierra s three sisters and one brother) keepin contact with their mother and sister, but are busy with their own lives andfamilies. Although Sierra participates in Kyla s care, her mother is the sta-ble caregiver when she is not working. The relationship between Sierra andher mother has been strained since Sierra became pregnant and frequentlythe two engage in heated arguments over the increased financial stressrelated to Kyla s needs and Sierra s refusal to seek employment.

3 Sierra sgrandmother is in poor health and requires frequent visits to the emer-gency room as a result of unstable StudyAt 2135 hours, Kyla is brought wrapped in a bath towel by her grandmotherto the emergency department at the local hospital. The admitting nurseobserves that Kyla is crying vigorously and is unable to be consoled. She isin no apparent respiratory distress. According to the grandmother, Kylecame over to see Sierra while Kyla s grandmother was out at the grocerystore. When she returned, Kyla was screaming. Sierra said that she and Kylewere talking and Kyla got real fussy, so we decided to give her a bath to gether to quiet down, but she just kept screaming. Kyla s grandmotherwrapped Kyla in a bath towel and brought her to the hospital because shethought that she was sick because she was so red.

4 On further assessmentthe nurse notes that Kyla has blisters on her feet, lower legs, and buttocks,and bruises on her upper arms. The health care provider examines Kylaand arranges for her to be transferred by AirFlight to Cincinnati Shriners Hospital to be admitted with second-degree burns of her buttocks, geni-talia, legs, and feet. Health care providers at the burn center estimate Kyla sburns as 34% of her total body surface area (TBSA) using the Estimationof the Extent of Burns in Children chart. Although Sierra calls every otherday to ask about Kyla s condition, she doesn t visit her daughter. Kyla sgrandmother stays at the hospital with 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc.

5 Permission to reproduce for classroom use Study 3/30/06 3:36 PM Page 2-2 case Study 2: INFANT2-3 Copyright 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. Permission to reproduce for classroom use your impressions about theabove the factors in this situation thatwould place Kyla at risk for child developmental theory, discussSierra s level of growth and health care providers determinedthat Kyla s development was appropriatefor an 8-month-old infant . Discuss whatyou would expect when assessing Kyla sgrowth and how the health care providersarrived at 34% of Kyla s TBSA experienc-ing second-degree the characteristics of second-degree the 4:2:1 rule for calculatingmaintenance rate of intravenous fluids forKyla, who weighed kg (7 lb) at birthand has experienced a weight gain withinnormal limits for her age, calculate herhourly IV Kyla s priority nursingdiagnoses on admission to the burn cen-ter, discussing why each is a your impressions about whySierra doesn t visit Kyla at the what members of the healthcare team should be involved in Kyla scare and your feelings about childabuse and how you would feel if you werea nurse caring for Kyla in this and Suggested your impressions about the above is a normal 8-month-old infant who is the victim of child abuse.

6 The primary concernof the health care team is to treat her injuries with a minimum of compli-cations and report their suspicions to the legal authorities. Kyla was borninto an environment where she added to the financial stress already pres-ent in this family. Her mother is an adolescent who was a victim of childabuse as well as being in a situation in which her mother also was her father was abusive, Sierra also has had to deal with his violentdeath. She has dropped out of school so she doesn t have daily contact withpeers, who provide the primary sense of belonging and self-esteem for anadolescent. Her teen development has been arrested by all of these addition, she may blame Kyla for her not being with her friends partici-pating in normal adolescent activities.

7 Sierra s grandmother also poses astressor in this situation as Sierra must care not only for Kyla but also forher grandmother while her mother is at work. She has most likely experi-enced feelings of wanting to escape from this situation. Kyla still requires agreat deal of care, and it is difficult for an adolescent who by normalgrowth and development is focused on her self and establishing her ownidentity to focus on the care of an infant . Kyle s presence in her life doesnot appear to be a healthy Study 3/30/06 3:36 PM Page the factors in this situation that would place Kyla at risk forchild was born into an environment in which abuse is thenorm. Many abusers were abused themselves, as was Kyla s mother.

8 Kylaposed additional financial stress on the family which is a characteristic of achild who is abused. Kyla s mother does not seem involved in her care, asone would expect. Another characteristic of an abused child is that he orshe is the product of an unwanted pregnancy. Her mother s level of growthand development also contributes to this situation because having aninfant does not promote normal adolescent growth and development,which can result in resentment and anger. Kyla s father and his behaviortoward Kyla also presents a potential developmental theory, discuss Sierra s level of growth and is an adolescent (13 20 years of age) and according toErikson s theory, she is involved in identity versus role confusion.

9 Duringadolescence, children see themselves as distinct individuals who are uniqueand different from everyone else. During this time, the adolescent tends torebel against persons she sees as authority figures. The adolescent some-times has a confrontational relationship with the same-sex parent and isespecially close to the opposite-sex parent. Risk-taking behavior (unpro-tected sex, smoking, drug use, speeding, etc.) is very common as the ado-lescent rebels against established social rules and mores. In their attemptto develop their own identity, adolescents rely primarily on peers for asense of belonging. Consequently, behaviors are frequently the result ofpeer pressure. Adolescents growing up in a dysfunctional environment may run away as an attempt to escape this environment.

10 According to Piaget,the adolescent is involved in formal operational thinking, allowing him orher to not only practice concrete thinking but also think about what is possible. The adolescent is very concerned about how he or she is seenby others, especially peers. Most of the adolescent s time is spent in schooland participating in school activities. Hormonal and growth changes alsoimpact the adolescent, with this level of growth and development being thesecond and final growth spurt during the lifespan. Sex hormones aresecreted by the ovaries, testes, and adrenals. Menstruation begins andmood swings frequently affect adolescent personalities. Breast develop-ment occurs as well as fat deposits to fill out and contour the body, prepar-ing it for childbearing.