Z.O. is a 3-year-old boy with no significant medical history. He is brought into the emergency department (ED) by the em
Posted: Wed Jul 06, 2022 10:22 am
Z.O. is a 3-year-old boy with no significant medicalhistory. He is brought into the emergency department (ED) by theemergency medical technicians after experiencing a seizure lasting3 minutes. His parents report no previous history that mightcontribute to the seizure. Upon questioning, they state that theyhave noticed that he has been irritable, has had a poor appetite,and has been clumsier than usual over the past 2 to 3 weeks. Z.O.and his family are admitted for diagnosis and treatment for asuspected brain tumor. A CT scan of the brain shows a 1-cm mass inthe posterior fossa region of the brain, and Z.O. is diagnosed witha cerebellar astrocytoma. The tumor is contained, and the treatmentplan will consist of a surgical resection followed bychemotherapy.
1). What are the most common presenting symptoms of a braintumor?
2). Outline a plan of care for Z.O., describing at least twonursing interventions that would be appropriate for managing fluidstatus, providing preoperative teaching, facilitating familycoping, and preparing Z.O. and his family for surgery.
Z.O. returns to the unit after surgery. He is arousableand answers questions appropriately. His pupils are equal andreactive to light. He has a dressing to his head with small amountof serosanguineous drainage. His IV is intact and infusing to a newcentral venous line as ordered. His breath sounds are equal andclear, and O2 saturations are 98% on room air. The nurse gets himsettled in his bed and leaves the room.
3). The nurse check the postop orders, which are listed below.Which orders are appropriate, and which should the nurse question?State rationales.
Postoperative Orders
1). Vital signs every 15 minutes × 4, then every hour ×4, then every 4 hours
2). Contact MD for temperature less than 36° C or over38.5° C (96.8° F to 101.3° F)
3). Maintain NPO until fully awake. May offer clearliquids as tolerated
4). Maintain Trendelenburg's position
5). Reinforce bandage as needed
6). Neuro checks every 8 hours
4). The nurse returns to the room later in the shift to check onZ.O. Which of these assessment findings would cause concern?(Select all that apply.)
a). BP 90/55 mm Hg
b). Increased clear drainage to dressing
c). Increased choking while sipping water
d). Photophobia
e). HR 130 beats/min
Z.O.'s wound and neurologic status are monitored, and hecontinues to improve. Z.O. is transferred to the Oncology Serviceon postoperative day 7 for initiation of chemotherapy.
5). Outline a plan of care that addresses common risks secondaryto chemotherapy, describing at least two nursing interventions thatwould be appropriate for managing risks for infection, bleeding,dehydration, altered growth and nutrition, altered skin integrity,and body image.
6). The nursing assistive personnel (NAP) is in the room caringfor Z.O. Which of these safety observations would you need toaddress? Explain your answer.
a). NAP encourages Z.O. to use a softtoothbrush for oral care
b). NAP applies the disposable probe coverto the rectal thermometer
c). NAP applies hand gel before and afterassisting Z.O. to the restroom.
d). NAP assists Z.O. out of bed to prevent afall
On Day 10 after initiation of chemotherapy, you receivethe following laboratory results:
Laboratory Test Results: Hemoglobin (Hgb) 12.5g/dL
Hematocrit (Hct) 36%
White blood cells (WBCs)7.5/mm3
Red blood cells (RBCs) 4.0million/mm3
Platelets 80,000/mm3
Albumin 2.8 mg/dL
Absolute neutrophil count (ANC)75
7). Which of the lab results would the nurse be concerned about,and why?
8). Discuss some of the emotional issues Z.O.'s parents willexperience during the immediate postoperative period.
9). Z.O. has a 5-year-old sister. She has been afraid ofvisiting at the hospital because her “brother might die.” Discuss apreschooler's concept of death and strategies to help cope with theillness of a sibling.
Postoperatively, Z.O. completed his initial course ofchemotherapy. Now, 4 months later, he is experiencing new symptoms,including behavior changes and regression in speech and mobility.His tumor has recurred. The physician suggests hospice care toZ.O.'s parents.
10). List some of the goals of hospice care for this client andfamily.
1). What are the most common presenting symptoms of a braintumor?
2). Outline a plan of care for Z.O., describing at least twonursing interventions that would be appropriate for managing fluidstatus, providing preoperative teaching, facilitating familycoping, and preparing Z.O. and his family for surgery.
Z.O. returns to the unit after surgery. He is arousableand answers questions appropriately. His pupils are equal andreactive to light. He has a dressing to his head with small amountof serosanguineous drainage. His IV is intact and infusing to a newcentral venous line as ordered. His breath sounds are equal andclear, and O2 saturations are 98% on room air. The nurse gets himsettled in his bed and leaves the room.
3). The nurse check the postop orders, which are listed below.Which orders are appropriate, and which should the nurse question?State rationales.
Postoperative Orders
1). Vital signs every 15 minutes × 4, then every hour ×4, then every 4 hours
2). Contact MD for temperature less than 36° C or over38.5° C (96.8° F to 101.3° F)
3). Maintain NPO until fully awake. May offer clearliquids as tolerated
4). Maintain Trendelenburg's position
5). Reinforce bandage as needed
6). Neuro checks every 8 hours
4). The nurse returns to the room later in the shift to check onZ.O. Which of these assessment findings would cause concern?(Select all that apply.)
a). BP 90/55 mm Hg
b). Increased clear drainage to dressing
c). Increased choking while sipping water
d). Photophobia
e). HR 130 beats/min
Z.O.'s wound and neurologic status are monitored, and hecontinues to improve. Z.O. is transferred to the Oncology Serviceon postoperative day 7 for initiation of chemotherapy.
5). Outline a plan of care that addresses common risks secondaryto chemotherapy, describing at least two nursing interventions thatwould be appropriate for managing risks for infection, bleeding,dehydration, altered growth and nutrition, altered skin integrity,and body image.
6). The nursing assistive personnel (NAP) is in the room caringfor Z.O. Which of these safety observations would you need toaddress? Explain your answer.
a). NAP encourages Z.O. to use a softtoothbrush for oral care
b). NAP applies the disposable probe coverto the rectal thermometer
c). NAP applies hand gel before and afterassisting Z.O. to the restroom.
d). NAP assists Z.O. out of bed to prevent afall
On Day 10 after initiation of chemotherapy, you receivethe following laboratory results:
Laboratory Test Results: Hemoglobin (Hgb) 12.5g/dL
Hematocrit (Hct) 36%
White blood cells (WBCs)7.5/mm3
Red blood cells (RBCs) 4.0million/mm3
Platelets 80,000/mm3
Albumin 2.8 mg/dL
Absolute neutrophil count (ANC)75
7). Which of the lab results would the nurse be concerned about,and why?
8). Discuss some of the emotional issues Z.O.'s parents willexperience during the immediate postoperative period.
9). Z.O. has a 5-year-old sister. She has been afraid ofvisiting at the hospital because her “brother might die.” Discuss apreschooler's concept of death and strategies to help cope with theillness of a sibling.
Postoperatively, Z.O. completed his initial course ofchemotherapy. Now, 4 months later, he is experiencing new symptoms,including behavior changes and regression in speech and mobility.His tumor has recurred. The physician suggests hospice care toZ.O.'s parents.
10). List some of the goals of hospice care for this client andfamily.