Case: Introduction

Case:

Introduction

You are a 1st year nursing student and working a ​night shift in the paediatric section of the Emergency Department (ED) at Canberra Hospital. It is now 0030hrs on the 27th of November 2022 and you are caring for a 10-year-old girl Isabelle Williams in the paediatric area of the ED after she has returned from radiology.

Situation

The treating medical officer has arrived and advises Isabelle and her mother Donna, that the X-ray shows a displaced fractured radius and ulna, the Orthopaedic surgery team has been called for a consultation.

Background

During the previous evening shift ​Isabelle was brought into the ED by Donna. Donna told the triage nurse that Isabelle tried to jump off a moving swing while it was swinging quite high.

Isabelle’s left arm was very swollen and appears deformed, and Isabelle says her arm is ok if she keeps it completely still.

The triage nurse observed Isabelle grimacing with any movement of her arm and upper body and administered weight-based doses (Isabelle weighs 31kg) of paracetamol and ibuprofen STAT at 1500Hrs.

Isabelle was promptly reviewed by one of the senior medical staff who immobilised the limb with a back slab and ordered another STAT weight-based dose of intranasal fentanyl. Which was administered by ED senior nursing staff at 1515Hrs.

Assessment

You have completed a set of vital signs which are documented on the PEWS chart in Isabelle’s bedside chart.

Recommendation

The treating medical officer asks you to keep Isabelle nil by mouth until seen by the Orthopaedic surgery team in case Isabelle requires surgery for an open reduction and internal fixation of her fractures.

Questions

1. Summarize Isabelle’s circumstances. Consider the patient situation and summarize Isabelle’s current circumstances identifying the key issues, including cues within the case, from a nursing perspective.

2. Identify two (2) assessments required to care for Isabelle. Identify two (2) person centred (physical and non-physical) assessments required during your shift to care holistically for Isabelle.

3. Identify two (2) focused clinical problems/issues for the care of Isabelle.

4. Identify goals of care related to the two clinical priorities.

5. Plan of care outlines nursing interventions to address the two (2) identified clinical priorities, showing how you have used the information from your assessment to make care decisions.

6.Explain how you will evaluate the effectiveness of the plan of care and interventions.

7. Using Borton’s model of reflection, briefly outline approaches/ considerations relevant to the assessment/care of a hospitalised child and their family.