Directions:
- Please read the case studies and answer the questions.
- Bold each question as a heading and then provide your response
- Follow the rubrics provided for 1st Case & 2nd Case
- Document the sources you use for the Pathophysiology (and any nursing dx, labs, etc.) in APA style.
1st Case
Scenario: An 8 year old female presented to the ED on Monday with R-side abdominal swelling, fever, hematuria, hypertension, and fatigue. The physician palpated a mass and sent the child for an US.
Labs: Glucose 151 (high), BUN 23 (High), Creatine 1.53 (High)
Na 141 Cl 105 K3.4 Ca 8.6 (low)
CBC with Diff: WBC 9.02 RBC 3.69 (Low)
HCT 29.6 (Low) PLT 237 Neutrophils 80.1 (High)
Diagnosis: R Wilm’s Tumor – surgery scheduled for Tuesday.
Questions:
1. What is the pathophysiology of a Wilm’s Tumor?
2. What is your priority nursing diagnosis pre-op?
Scenario: Wednesday s/p R nephrectomy. HR 92 RR 20 BP 111/63 Temp 37.2C O2 99%
Pain 4/10 on the Faces scale. Alert & oriented x4. No nausea or vomiting. Lungs clear bilaterally. Normal bowel sounds. Surgical Wound – dressing clean, dry, intact; no redness, warmth or edema. Orders: renal diet, fluid limit 750 ml; medications: acetaminophen 500mg prn, ondansetron 2.8mg IV prn
Questions:
1. List one nursing diagnosis with interventions & goals.
2. Any medications you would give now? If so, what & why?
3. What discharge teaching will you plan?
2nd Case
Scenario: Alex is a 6 year old boy who arrives to his primary care office with a 3-day temperature of 102-103F axillary and L leg pain. Today he started with red pinpoint rash and has been unusually sleep. Alex is up-to-date on his vaccines. His vitals today are RR 28
HR 120 T102.5F BP 90/60 O298% on room air. Weight 21.8 kg Height 3.5 feet
On exam the NP finds that Alex has not only cervical lymphadenopathy but also enlarged lymph nodes in the axillae and groin. Yet, Alex is not complaining of a sore throat, headache, ear pain, or trouble urinating. UA, rapid strep, and rapid flu test are all negative. Alex hasn’t had any recent injury to his leg. The NP draws blood to run a CBC and comprehensive metabolic panel.
The CBC shows a WBC 42,000 (very high) RBC (normal) Hbg 10 (low) Hct 31% (low) Platelets 90,000 (low) Neutrophils-bands – (high) Neutrophils-segmented (low) Lymphoblasts at 38% (very high). The NP admits Alex to the local children’s hospital and orders an oncology consult for suspected leukemia.
1. What in the above scenario could lead to a diagnosis of leukemia?
2. What additional tests would you expect to be done in hospital?
3. What pain scale would you use for Alex?
4. Who else in the hospital could you ask to help prepare Alex for the various tests and procedures?
5. List one nursing diagnosis with interventions & goals.
6. Would advance directives be appropriate here? Why or why not?
References
