CCA206 Care of Children and Adolescents Case Study Assessment

Visualise yourself in the role of a second year BN (Bachelor of Nursing) student on the last week clinical placement in a busy Paediatric Emergency Department (PED) providing care for the following patient in the afternoon shift along with your mentor RN (Registered Nurses).

Patient information

Age: 4 years

Sex: Male

Name: Oscar Wilson

Accompanied by: Meghan Wilson (mother) and Patricia Foster (Grandmother)

Present Medical History:

Oscar presented to Paediatric Emergency Department (PED) at 1400. Chief complaints included lethargy, fever (very high temperatures), runny nose, and productive cough for the past three to four days. Oscar appeared to be very sleepy and stayed in bed all the time over the past two days. His oral intake was poor during the past week. Oscar has complained of nausea, refused oral food/fluids and had two episodes of vomiting since this morning. He also had one episode of seizures (generalised toni clonic seizures) this morning @ around 1000.

Past Medical History

History of recurrent cold and cough, latest occurrence approximately 4-6 weeks ago Hospital admission X 5 days for Acute gastroenteritis 2 years ago Allergies: Nil known

Perinatal History

First baby, Antenatal period was uneventful Vaginal birth at 38 weeks, Birth weight: 3.5 Kg. Length & Head circumference: data not available Postnatal: Developed neonatal jaundice, received phototherapy

Developmental History

Summary based on family report Oscar can walk around in the house and lawn, have started to run around for short distances, however, is not confident to use stairs. Oscar is not toilet trained by day and need diapers. Oscar can scribble on paper or a board, however, is not able to draw lines or circles. Oscar can put words together to communicate, however his speech is difficult to understand

Immunisation History

Unvaccinated due to cultural reasons

Nutritional history

Predominantly bottle-fed in infancy, semi-solid food started at 4 months of age, mealtime is usually extended due to poor acceptance (need coercion/distraction), prefers finger foods

Family History

Meghan (Oscar's mother) has a history of depression, management has been irregular in the past one year, Oscar's Dad has history of asthma, diabetes

Social History

Oscar has not been enrolled to childcare/ Early Learning Centre. Meghan does not work, Oscar's Dad works as a truck driver and will be home only for a few days in a month Meghan's mum lives close by and was summoned for help when Oscar had the seizure episode this morning

Physical Examination

General appearance

Oscar appears very tired, drowsy and unsettled.

He also appears underweight, skin is smudged with dirt, and clothes are smelly

Anthropometry

Length: 98.0

Weight: 12.2 kg

Vital signs

Respiratory rate: 34-38 breaths per minute Heart rate: 150-160 beats per minute Capillary refill time: 3 seconds

Oxygen saturation: 95-97 % on room air

Blood Pressure: 90/58 mm of Hg

Temperature: 39.1°C

Neurological

GCS 13/15 (E3V4M6), Neck stiffness++, Pain, associated involuntary effort to reduce meningeal stretching (Brudzinski sign+, Kernig sign+), Pupils bilaterally equal and reactive, History of one episode of seizure

Respiratory

Rhinorrhoea and occasional productive enough

Mild increased work of breathing

Cardiac/Abdomen/Musculoskeletal:

Nil issues noted, abdomen soft, non-tender

Renal:

last diaper change was 14 hours ago (small amount of urine, yellow)

Skin and mucous membranes

Dry lips and mouth

Few petechial spots on trunk

Medical diagnosis

?Acute Bacterial Meningitis

Treatment plan

Admission
Contact and Droplet precautions
Continuous monitoring of RR, HR, SPO,
Hourly (and PRN) monitoring for full neurological observations, seizures, blood pressure, temperature and Fluid Balance Chart (FBC)
Blood sample for Venous gas, Full Blood Evaluation (FBE),
Biochemistry, Culture Nil by Mouth until review Lumbar puncture-Cerebrospinal Fluid (CSF) for biochemistry, microscopy, and culture (before commencing antibiotics) IV cannulation, IV fluids-0.9% sodium chloride 5% glucose for maintenance (consider 2/3 of maintenance volume.
To be revised based on hydration status, Na levels,
and acid-base status) IV Antibiotics, steroids, paracetamol Seizure management Paediatric
Medical team to review Consider CT/MRI (Magnetx Resonance imaging) and further management after Paediatric Medical Consultant's review

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