Case Study 04 - DelmarLearning.com

1 4-1 case Study 4:PreschoolerTHE RESPIRATORY SYSTEMO verview:This case requires knowledge of foreign body aspiration (FBA), growth anddevelopmental risks for FBA, as well as an understanding of the client s background, personalsituation, and family-child Emergency roomETHNICITY Asian AmericanCOMMUNICATION English/ChinesePHARMACOLOGIC Cetazolin (Ancef)PSYCHOSOCIAL AnxietyPRIORITIZATION Emergency situationDELEGATION Nurse assistant Client teachingAdapted 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 Study 3/30/06 4:18 PM Page 4-14-2 Copyright 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. Permission to reproduce for classroom use ProfileSok Wu Yangis a preschooler who is celebrating his fourth birthdaytoday.

2 He lives with his mother, aunt, siblings, and grandparents. His fatherwas killed in a construction accident when Sok Wu was an infant. He has a6-year-old sister and an 8-year-old brother. His mother and aunt are fluentin both Chinese and English, although his grandparents speak onlyChinese. He and his siblings also are fluent in both languages, speakingtheir native language when conversing with their grandparents and Englishwith their mother and aunt. Sok Wu, nicknamed Scotty by his family tofacilitate his integration into preschool, enjoys preschool and playing withhis friends there. The family has been planning a birthday party for Sok Wuand has invited his preschool class to attend as well as one of his sister sfriends and his brother s best friend from school. Sok Wu is very excitedabout the party and wants to help in all of the StudyTwo hours before his party begins, Sok Wu is brought to the emergencydepartment of the hospital located two blocks from his home by his motherand aunt.

3 His mother is very upset and tells the nurse Sok Wu had swal-lowed a party balloon that he found on the table at home. He is in respi-ratory distress when his mother and aunt bring him to the hospital. As thenurse assesses the client s airway, she asks the nursing assistant to take SokWu s vital signs with the following results:Temperature: 36 C ( F)Pulse: 140 beats/minuteBlood pressure: 70/40 Respirations: irregularThe child s pulse oximetry reading is 78% on admission. The nurse s assess-ment reveals barely audible and diminished breath sounds bilaterally; stri-dor and use of accessory muscles; heart sounds weak and irregular; cool,clammy skin; and decreased your impressions about theabove are the nurse s priority interven-tions as the child enters the emergencydepartment? is the significance of Sok Wu svital signs, oxygen saturation reading, andthe nurse s assessment findings?

4 Are the nursing priorities for thissituation? how you think Sok Wu smother and aunt are feeling at this health care provider prescribesthe following for Sok Wu:Order stat chest PIV of 5% Dextrose and Study 3/30/06 4:18 PM Page 4-2 case Study 4: PRESCHOOLER4-3 Copyright 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. Permission to reproduce for classroom use and Suggested your impressions about the above Wu has proba-bly aspirated the balloon and it is blocking his airway. Because balloons arepliable, they are difficult to expel from the airway using the Heimlichmaneuver, usually requiring procedural removal. Because of the otherinformation, including his vital signs and the fact that he is still conscious,although barely, the blockage may be partial rather than are the nurse s priority interventions as the child enters the emer-gency department?

5 The nurse s priorities in this situation include assessingthe child s airway, breathing, and circulation. Depending on these find-ings, actions must address maintaining a patent airway, effective respira-tions, and tissue is the significance of Sok Wu s vital signs, oxygen saturation, andthe nurse s assessment findings?The normal temperature for a 4-year-oldis C ( F) so Sok Wu s temperature is below normal,probably the result of decreased tissue perfusion secondary to reducedoxygen intake. The normal pulse rate for a 3- to 5-year-old is 75 125beats/minute. His pulse is elevated probably due to a combination of fac-tors including anxiety, and increased cardiac output to compensate fordecreasing tissue perfusion. His blood pressure is below the normal of102/62. This also is the result of decreasing tissue perfusion caused byhypoxia.

6 His oxygen saturation is 78%, significantly below the normalnormal saline to infuse at 70 oxygen saturation via nothing by mouth (NPO).Monitor continuous vital the chest X-ray which reveals aforeign body in his trachea, Sok Wu isscheduled for an emergencybronchoscopy. What is the rationale forthis procedure in this case ? the successfulbronchoscopy, what assessments shouldthe nurse perform on Sok Wu? health care provider prescribescefazolin 160 mg IV q6h 3 doses withthe first dose to be administered stat. Youasked the nursing assistant to weigh SokWu on the scales on his hospital bed asyou communicate the medication order topharmacy. The nursing assistant reportsthat Sok Wu weighs kg ( lb). Didthe nurse act appropriately when shedelegated obtaining Sok Wu s weight tothe nursing assistant? process does the nurse use whenadministering medications to this child?

7 Your feelings about this situa-tion, considering Sok Wu s level of growthand hours following his admis-sion to the hospital, Sok Wu is dischargedwith no complications associated with hisFBA. He is sent home with his mother andaunt. What would be the nurse s focus indischarge teaching for Sok Wu s motherand aunt? case Study 3/30/06 4:18 PM Page 4-34-4range of 95% to 100%. The barely audible and diminished breath soundsindicate obstruction of the air entering and leaving the lungs, which wouldbe expected in the presence of airway obstruction. The absence of crack-les, rales, and rhonchi indicate that infection is probably not is a high-pitched sound made in the presence of air attempting tomove through an obstruction of the trachea or larynx. The use of accessorymuscles for breathing represents severe respiratory distress. The presenceof weak and irregular heart sounds indicates that the heart is having diffi-culty compensating for decreased tissue perfusion.

8 Cool and clammy skinmay be a sign of impending shock as the body shunts blood from theextremities to redirect it to maintain perfusion of the vital organs of theheart and brain. His decreasing responsiveness probably is an indication ofdecreased tissue perfusion to the brain. All of these are consistentlyresponses to foreign body aspiration resulting in decreased tissue are the nursing priorities for this situation?a. Ineffective airway clearance related to the presence of a foreignbody. The patency of the airway must be established and Risk for impaired gas exchange related to inability to inhale oxygenand exhale carbon dioxide secondary to foreign body aspirationc. Risk for ineffective tissue perfusion related to impaired gasexchange secondary to FBAd. Anxiety related to seriousness of child s condition and unfamiliarhospital surroundingse.

9 Deficient knowledge related to child s condition, normal growthand development activities of preschooler, accident how you think Sok Wu s mother and aunt are feeling at are both very anxious and worried about Sok Wu and whetherhe can be successfully treated. They probably fear that he will die or sufferirreparable brain damage if he survives. They also are probably feelingguilty about leaving the uninflated balloons on the table where Sok Wucould pick one up. They are concerned about the other children at an afterthought, they may be concerned about letting the parents of theother children who were invited to the party know that the party has beencanceled. This concern undoubtedly would be a fleeting one until SokWu s condition The health care provider prescribes the following for Sok Wu:Stat chest 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc.

10 Permission to reproduce for classroom use Study 3/30/06 4:18 PM Page 4-4 case Study 4: PRESCHOOLER4-5 Initiate PIV of 5% Dextrose and normal saline to infuse at70 oxygen saturation via pulse nothing by mouth (NPO).Monitor continuous vital the chest X-ray which reveals a foreign body in his trachea, SokWu is scheduled for an emergency bronchoscopy. What is the rationale forthis procedure in this case ?Performing a bronchoscopy is a standard of care for a client with foreignbody obstruction. It is performed to both positively identify the object andto remove the successful bronchoscopy, what assessments should thenurse perform on Sok Wu?The nurse needs to monitor and maintain apatent airway; monitor vital signs hourly for at least 4 hours; monitor forreturn of the child s gag reflex which is anesthetized during the bron-choscopy; monitor the neurological status, breath sounds, heart sounds,skin temperature, and condition hourly; and monitor oxygen saturation viapulse oximetry continuously.