Case Study: All questions apply to the following case study. You should answer each question completely. When asked to
Posted: Wed Jul 06, 2022 10:22 am
Case Study: All questions apply to thefollowing case study. You should answer each question completely. When asked to provide several answers, list them in order ofpriority or significance. Do not assume information that is notprovided.
Z.O. is a 3-year-old boy with no significant medical history. Heis brought into the emergency department (ED) by the emergencymedical technicians after experiencing a seizure lasting 3 minutes.His parents report no previous history that might contribute to theseizure. Upon questioning, they state that they have noticed thathe has been irritable, has had a poor appetite, and has beenclumsier than usual over the past 2 to 3 weeks. Z.O. and his familyare admitted for diagnosis and treatment for a suspected braintumor. A CT scan of the brain shows a 1-cm mass in the posteriorfossa region of the brain, and Z.O. is diagnosed with a cerebellarastrocytoma. The tumor is contained, and the treatment plan willconsist of a surgical resection followed by chemotherapy.
1). What are the most common presenting symptoms of abrain tumor?
2). Outline a plan of care for Z.O., describing at leasttwo nursing interventions that would be appropriate for managingfluid status, providing preoperative teaching, facilitating familycoping, and preparing Z.O. and his family for surgery.
Z.O. returns to the unit after surgery. He is arousable andanswers questions appropriately. His pupils are equal and reactiveto light. He has a dressing to his head with small amount ofserosanguineous 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 listedbelow. Which orders are appropriate, and which should the nursequestion? State rationales.
Postoperative Orders 1). Vital signs every 15 minutes × 4, thenevery hour × 4, then every 4 hours 2). Contact MD for temperatureless than 36° C or over 38.5° C (96.8° F to 101.3° F) 3). MaintainNPO until fully awake. May offer clear liquids as tolerated 4).Maintain Trendelenburg's position 5). Reinforce bandage as needed6). Neuro checks every 8 hours
4). The nurse returns to the room later in the shift tocheck on Z.O. Which of these assessment findings would causeconcern? (Select all that apply.) a). BP 90/55 mm Hg b). Increasedclear drainage to dressing c). Increased choking while sippingwater 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 riskssecondary to chemotherapy, describing at least two nursinginterventions that would be appropriate for managing risks forinfection, bleeding, dehydration, altered growth and nutrition,altered skin integrity, and body image.
6). The nursing assistive personnel (NAP) is in the roomcaring for Z.O. Which of these safety observations would you needto address? Explain your answer. a). NAP encourages Z.O. to use asoft toothbrush for oral care b). NAP applies the disposable probecover to the rectal thermometer c). NAP applies hand gel before andafter assisting Z.O. to the restroom. d). NAP assists Z.O. out ofbed to prevent a fall
On Day 10 after initiation of chemotherapy, you receive thefollowing laboratory results:
Laboratory Test Results: Hemoglobin (Hgb) 12.5 g/dL Hematocrit(Hct) 36% White blood cells (WBCs) 7.5/mm3 Red blood cells (RBCs)4.0 million/mm3 Platelets 80,000/mm3 Albumin 2.8 mg/dL Absoluteneutrophil count (ANC) 75
7). Which of the lab results would the nurse beconcerned about, and why?
8). Discuss some of the emotional issues Z.O.'s parentswill experience during the immediate postoperativeperiod.
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 thisclient and family.
Z.O. is a 3-year-old boy with no significant medical history. Heis brought into the emergency department (ED) by the emergencymedical technicians after experiencing a seizure lasting 3 minutes.His parents report no previous history that might contribute to theseizure. Upon questioning, they state that they have noticed thathe has been irritable, has had a poor appetite, and has beenclumsier than usual over the past 2 to 3 weeks. Z.O. and his familyare admitted for diagnosis and treatment for a suspected braintumor. A CT scan of the brain shows a 1-cm mass in the posteriorfossa region of the brain, and Z.O. is diagnosed with a cerebellarastrocytoma. The tumor is contained, and the treatment plan willconsist of a surgical resection followed by chemotherapy.
1). What are the most common presenting symptoms of abrain tumor?
2). Outline a plan of care for Z.O., describing at leasttwo nursing interventions that would be appropriate for managingfluid status, providing preoperative teaching, facilitating familycoping, and preparing Z.O. and his family for surgery.
Z.O. returns to the unit after surgery. He is arousable andanswers questions appropriately. His pupils are equal and reactiveto light. He has a dressing to his head with small amount ofserosanguineous 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 listedbelow. Which orders are appropriate, and which should the nursequestion? State rationales.
Postoperative Orders 1). Vital signs every 15 minutes × 4, thenevery hour × 4, then every 4 hours 2). Contact MD for temperatureless than 36° C or over 38.5° C (96.8° F to 101.3° F) 3). MaintainNPO until fully awake. May offer clear liquids as tolerated 4).Maintain Trendelenburg's position 5). Reinforce bandage as needed6). Neuro checks every 8 hours
4). The nurse returns to the room later in the shift tocheck on Z.O. Which of these assessment findings would causeconcern? (Select all that apply.) a). BP 90/55 mm Hg b). Increasedclear drainage to dressing c). Increased choking while sippingwater 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 riskssecondary to chemotherapy, describing at least two nursinginterventions that would be appropriate for managing risks forinfection, bleeding, dehydration, altered growth and nutrition,altered skin integrity, and body image.
6). The nursing assistive personnel (NAP) is in the roomcaring for Z.O. Which of these safety observations would you needto address? Explain your answer. a). NAP encourages Z.O. to use asoft toothbrush for oral care b). NAP applies the disposable probecover to the rectal thermometer c). NAP applies hand gel before andafter assisting Z.O. to the restroom. d). NAP assists Z.O. out ofbed to prevent a fall
On Day 10 after initiation of chemotherapy, you receive thefollowing laboratory results:
Laboratory Test Results: Hemoglobin (Hgb) 12.5 g/dL Hematocrit(Hct) 36% White blood cells (WBCs) 7.5/mm3 Red blood cells (RBCs)4.0 million/mm3 Platelets 80,000/mm3 Albumin 2.8 mg/dL Absoluteneutrophil count (ANC) 75
7). Which of the lab results would the nurse beconcerned about, and why?
8). Discuss some of the emotional issues Z.O.'s parentswill experience during the immediate postoperativeperiod.
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 thisclient and family.