#1.  The mother of a 10-year-old girl has brought her to the clinic based on concerns expressed by the school nurse.  The teacher has noted times when the girl appears to be daydreaming; however, after the nurse witnessed a few of these incidents, she has recommended the child be evaluated for absence seizures.  The mother is not totally convinced that is true, however, is willing to find out. A.  How would you respond to this mother? B.  What patient centered care will be appropriate here? C.  What safety measures should the parents be encouraged to follow? #2. You are assessing a child’s vision and notice the child is unable to correctly answer her questions when shown the Ishihara color plates.  When questioning the mother, you discover that the child has not understood the colors but the mother has just assumed the child was slow. A.  How would you proceed? B.  What care would you provide in this case? C.  How will you know the nursing care plan was effective for this child? #3.  The parents have brought their 3-year-old son to the clinic for an evaluation.  They are concerned something is wrong because he cannot seem to move like he used to and is having difficulty climbing up and down the stairs. A.  How would you respond? B.  What patient-centered care should you develop? C.  You recognize that this patient will need assistance from other departments.  Which additional team members will be able to assist this patient and his family? #4.  A mother has brought her 4-year-old daughter to the emergency department.  She didn’t realize her husband had sprayed the lawn with a pesticide and allowed their daughter to play in the yard.  She now comes in with complaints of nausea, vomiting, difficulty breathing, and confusion. A.  How would you respond?  What are you initial interventions? B.  How can you help the family? C.  What are some nursing diagnoses that would be appropriate for this situation? #5.  The parents are in denial demanding a second opinion.  The physician has just informed them their 2-year-old son has a glioblastoma.  Devastated, they ask the nurse, “How can this happen to us?” A.  How would you respond? B.  What are some nursing diagnoses you would identify in this situation (more than 1 please) C.  What are some expected outcomes related to your nursing diagnoses? (should have an outcome for every diagnoses)

Question #1:

A. In response to the mother’s concerns about her daughter’s daydreaming episodes, it is important to acknowledge her worries and empathize with her. Start by reassuring the mother that you understand her hesitation and that you are there to help identify the underlying cause of her daughter’s symptoms. Explain that absence seizures can present as moments of being unresponsive or “zoning out,” and it is necessary to consider this as a potential cause given the school nurse’s observations.

B. Patient-centered care for this case would involve taking an individualized approach to understanding the child’s symptoms and concerns. Begin by conducting a thorough evaluation, including a detailed medical history and physical examination. Consult with a neurologist to further assess the possibility of absence seizures. In addition, communicate with the school nurse and teacher to gather more information about the frequency and duration of the episodes.

C. Safety measures should be emphasized to the parents to ensure the well-being of their daughter. Educate them about the potential risks associated with absence seizures, such as accidents during moments of unresponsiveness. Encourage them to create a safe environment by removing potential hazards and supervising the child during activities that carry a higher risk, such as swimming or climbing. Discuss the importance of informing other caregivers, such as teachers or family members, about the possibility of absence seizures and the appropriate actions to take if an episode occurs.

Question #2:

A. In response to the child’s difficulties with color recognition and the assumption by the mother that the child is slow, it is important to address the situation tactfully. Start by gently informing the mother that color recognition is a developmental milestone and can vary among children. Express that it is essential to conduct a thorough visual assessment to determine the underlying cause of the child’s difficulties.

B. Care for this case should involve a comprehensive vision assessment by a qualified professional, such as an optometrist or ophthalmologist, to assess all aspects of the child’s visual capabilities. This may include testing for color blindness, visual acuity, and other visual functions. Depending on the results, appropriate interventions, such as vision therapy or corrective lenses, can be considered.

C. To determine the effectiveness of the nursing care plan for this child, regular follow-up assessments should be conducted to evaluate any improvements in the child’s color recognition and overall visual capabilities. This can be done through repeated administration of color identification tests, monitoring the child’s ability to correctly identify colors in daily activities, and gathering feedback from the parents regarding any changes they have noticed. The care plan should aim to improve the child’s overall visual functioning and enhance their ability to participate fully in daily activities requiring color recognition and differentiation.

Question #3:

A. Respond to the parents’ concerns about their son’s difficulties with movement and stair climbing by acknowledging their worries and assuring them that their son’s symptoms warrant further evaluation. Express empathy and communicate that you are there to help identify the cause of his difficulties.

B. Patient-centered care should focus on establishing a comprehensive assessment plan to evaluate the child’s motor skills and determine the underlying cause of his difficulties. This may involve collaborating with a pediatric physical therapist or occupational therapist to conduct a thorough evaluation of his motor development, balance, and coordination. Additionally, involving the parents in goal-setting and care planning will ensure their active participation and understanding of the steps being taken.

C. This patient may benefit from assistance from multiple departments or professionals. In addition to involving a pediatric physical therapist or occupational therapist, other team members who can help include a pediatrician for medical evaluation and ongoing management, a developmental psychologist to assess and support the child’s cognitive and emotional development, and a social worker or counselor to provide support for the family and help navigate resources and services in the community. Collaborating with these team members will ensure a holistic approach to care and address the complex needs of the child and his family.

Question #4:

A. In response to the mother’s concerns about her daughter’s symptoms following exposure to a pesticide, it is crucial to act swiftly and prioritize her safety. In a calm and reassuring manner, explain that her daughter may be experiencing symptoms of pesticide poisoning and swift medical intervention is necessary.

B. To help the family navigate this challenging situation, provide support and reassurance. Address their concerns and fears by explaining the steps that will be taken to evaluate and treat their daughter. Provide information on the potential effects of pesticide exposure and reassure them that prompt medical care is critical in managing the situation. Offer resources and contact information for support groups or organizations that specialize in pesticide safety and exposure.

C. In this situation, some nursing diagnoses that would be appropriate include “Risk for Impaired Gas Exchange related to respiratory distress,” “Risk for Fluid Volume Deficit related to vomiting and nausea,” and “Confusion related to pesticide poisoning.”

To determine if the nursing care plan was effective, regular monitoring of the child’s vital signs, respiratory status, hydration levels, mental status, and symptom progression should be conducted. The child should show improvement in respiratory distress, maintenance of hydration, and resolution of confusion as the nursing interventions are implemented and the medical treatment progresses. Regular communication with the medical team and the family will aid in evaluating the effectiveness of the nursing care provided.