Running head: CASE STUDY AND CARE PLAN 1

Pediatric Child Case Study and Care Plan

Julie Mumbi

Northern Lakes College

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Introduction

Kate is an 18-month-old toddler who has been admitted to hospital for fever, pallor,

bruising, lethargy, and anorexia. Kate’s parents are anxious regarding her admission and the

diagnosis of leukemia. At 18 months, Kate is in Erickson’s development theory, autonomy

versus shame and doubt (1 to 3 years).

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Case Study

Preparation of client

The assessment order should be done with ‘traumatic procedures last’ (Perry et al., 2020,

p.920). ‘At the beginning of the visit, to establish rapport, children should be included in the

interaction by asking them their name, age, grade, and favourite activities’ (Perry et al., 2020,

p.897). Kate ‘should not be excluded during the interview period; infants and younger children

can be observed through play; Occasionally, younger children can answer questions or respond

to remarks. In communication with children of all ages, the nonverbal components of

communication process convey the most significant messages. It is difficult to disguise feelings,

attitudes, and anxiety when relating to children. During the health assessment, they should be

allowed to touch and examine articles that will come in contact with them…Toddlers might not

have yet acquired sufficient language skills to express their feelings and wants; toddlers are able

to communicate effectively with their hands to transmit ideas without words’ (Perry et al., p.900-

901). Explain the x-ray is like taking a picture, apply EMLA patch before a blood draw to reduce

pain.

Teaching on admission and discharge teaching

‘Caregivers must listen to children so that they are aware of children’s fears and

concerns. They need to let children know that they are important and that what they say matters.

Physical contact is usually comforting and reassuring to children. Simply holding, touching and

facilitate communication. Spending unhurried time with children and exposing children to

positive influences can help build children’s strength and security.’ (Potter et al., 2020, p. 891).

Parents educated on the importance of ‘proper level of nutrition and hydration…alkalizing the

urine by ingesting antacids may help prevent the formation of uric acid kidney stones' ‘Some
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types of leukemia such as ALL (Acute lymphatic leukemia) respond well to drugs, and the

prognosis is excellent, with many children enjoying a cure. The best prognosis is for children

between the ages of 1 and 9 years of age’ (Hubert & VanMeter, 2018, Gould’s Pathophysiology

for Health Professions, p. 210). The family was educated on the importance of discontinuing

vaccines until Kates's immune system has recovered. ‘Live or attenuated viral vaccines are

contraindicated in immunosuppressed children and should be deferred until the child's immune

system function has returned to normal ... Siblings and other family members can receive all

routine age-appropriate vaccines except oral polio’ (Perry et al., p.1519). During this stressful

time for Kate and her family, it is vital to recognize that Kate will likely experience regression as

well as she may not develop at pace with her peer group. ‘The retreat from one’s present pattern

of functioning to past levels of behaviour is referred to as regression. It usually occurs in

instances of discomfort or stress when one attempts to conserve psychic energy by reverting to

patterns of behaviour that were successful in earlier stages of development. Regression is

common in toddlers because almost any additional stress hinders their ability to master present

developmental tasks. Any threat to their autonomy, such as illness, hospitalization, separation

from parents, our adjustment to a new sibling, present a need to revert to earlier forms of

behaviour, such as increased dependencies; refusal to use the potty chair; temper tantrums;

demand for the bottle, stroller, or crib; and loss of newly learned motor, language, social, and

cognitive skills’ ( Perry et al., p.1056).

Parental involvement

Describe the process, and get parents to participate in the procedure, when possible, to

hold Kate in their arms. ‘Children need support during procedures, and for young children, the

greatest source of support is the parents. They represent security, safety, protection, and comfort.
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A British research study found that children who had their parents present during invasive

procedures had lowered respiration and heart rate levels, felt less pain, and were in less

distressed…Explain the procedure in relation to what the child will see, hear, taste, smell, and

feel. Emphasize those aspects of procedures that require cooperation, such as lying still.’ (Perry

et al., p. 1281).

Supports

‘Ronald McDonald House Charities® Alberta supports families seeking vital medical

treatment for their seriously ill or injured child. Our warm, compassionate Houses provide a

home-away-from-home for families who need to travel for medical reasons. When those families

are experiencing one of life’s most difficult times – we offer them the gift of togetherness’

(Ronald Mcdonald House Charities Alberta, https://rmhcalberta.org/). Kate's parents were

informed to retain all receipts, including travel expenses, for appointments for completing taxes

and that hotels offer a discounted rate for medical stays. (https://www.canada.ca/en/revenue-

agency). Indigenous health liaison was requested and provided.

Cultural and spiritual care

Kates parents requested their traditional healer visit Kate; traditional healers are often

respected and influential people in indigenous communities. Working together can help to create

a successful environment that is conducive to the management of Kate. ‘Furthermore, they

exhibit a sincere interest in the family and their problem.’ It is crucial to keep in mind that

‘Practices that do no harm should be respected.’ Also, while conversing with Kate’s parents, it is

essential to recognize that many indigenous peoples practice ‘non-verbal communication and are

highly sensitive to body language.’ While providing care for Kate, the nurse will be mindful of
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body language, keeping a low voice and taking time to speak. ‘Indigenous people may consult a

variety of traditional healers with specific skills and knowledge. The truth and reconciliation

Commission (2015) has recommended that health care providers work with traditional healers

when caring for indigenous peoples’ (Perry et al., 2020, p. 863)

Safety precautions

Safety precautions necessary to keep the patient safe include keeping Kate away from

infectious patients on the unit, reverse isolation, PPE, limiting nursing staff and visitors and

proper hand hygiene with an antiseptic solution. (Perry et al., p1519) ‘Practice good

hygiene. Wash your hands often with warm water and soap. Keep your home clean. Avoid large

crowds. Stay away from people you know may be sick. Be vigilant. Watch out for warning signs

such as fever, fatigue, cough or diarrhea. Keep cuts, scrapes or surgical scars clean and beware of

swelling or redness.’ (Cancer Treatment Center of America, September 2016).

Kate’s bed will be in the lowest position with bed rails up. (Perry et al., 1276)

Play

The three toys suggested for Kate would be:

1. Plastic building (Duplo) blocks: ‘Because they can be used in a variety of ways, raw

materials allow children to exercise their own creativity and imagination and are sometimes

superior to ready-made items. For example, building blocks can be used to construct a variety of

structures to count and to learn shapes and sizes’ (Perry et al., 2020, p.887).

2. Nesting boxes or a rainbow stacker: ‘They want to do things for themselves, using

their newly acquired motor skills of walking, climbing and manipulating and their mental powers

of selecting and decision making’ (Perry et al., 2020, p. 880).

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3. Snappy sticks by EduShape: ‘Toys that require pushing, pulling, rolling, and

manipulating teach them about physical properties of the items and help develop muscle muscles

and coordination…For infants, toddlers, and all children who still mouth objects, avoid toys with

small parts that may pose a fatal choking or aspiration hazard’ (Perry et al., p.887). ‘Toys should

be appropriate to the child’s age, conditions, and treatment. For example, if the child receiving

oxygen, electrical or friction toys are not safe since sparks can cause oxygen to ignite. The nurse

needs to inspect toys to ensure they are nonallergenic, washable, and unbreakable and have no

small, removable parts that can be aspirated or swallowed or, in other ways, injure a child’.

(Perry et al., 2020, p.1294).

Nursing care plan

Nursing Diagnosis Expected Outcome Interventions Rationale

Ineffective The child will Measure and record To monitor and
thermoregulation r/t maintain a the client’s maintain an average
infectious process temperature below 38 temperature every 1 temperature below 38
(leukemia), exhibited degrees during the to 4 hours To reduce the
by a fever of 39.2 nurse's shift. Monitor and temperature when it
intervene to provide rises above 38
comfort during fever: To maintain a fluid
obtaining vital signs intake of 1090 mL
and accurate intake per day based on
and output, daily maintenance of
administer fluid requirements
acetaminophen when
the temperature is
above 38
Encourage fluid and
nutrition of
approximately 70 mL
every waking hour
(Ackley et al., p.918)

Pathophysiology

‘Leukemia is a cancer of the white blood cells. White blood cells (also called leukocytes

or WBCs) fight infections and other diseases.

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In leukemia, the bone marrow (spongy material inside the bones) makes many white blood cells

that aren’t normal. These abnormal WBCs crowd the bone, marrow and get into the bloodstream.

Unlike healthy white blood cells, they can’t protect the body from infections. Sometimes

leukemia (loo-KEE-mee-uh) spreads from the bone marrow to other parts of the body, like the

chest, brain, or liver. Leukemia is the most common type of cancer in children. But most kids

and teens treated for leukemia are cured of the disease’ (Jonathan L. Powell, MD. September

2019. Leukemia. Retrieved from KidsHealth.org) & (Hubert & VanMeter, 2020, p.209).

Alteration in health status

‘Children ages 2 through 12 years have less stable regulatory responses to imbalances,

and in childhood illnesses tend to have less tolerance for large changes. Children frequently

respond to illnesses with fevers of higher temperatures and longer duration than those of adults,

increasing their insensible water loss’ (Potter & Perry, Fundamentals of Nursing, 2017, p. 1028).

Priority nursing action is to administer more acetaminophen; secondly would be to increase

Kates fluid intake. ‘In all children with high temperature, attention to adequate hydration is

essential. Most children’s needs can be met through the ingestion of additional oral fluids’ (Perry

et a., p.1274).

Medication administration

Acetaminophen liquid (Tylenol) 15 mg/kg q6h prn for fever, the pharmacy stocks liquid

acetaminophen 160mg/5ml strength. 15 x 11.8= 177/160 x 5= 5.5mL per dose.

Conclusion

Kate’s family was in obvious shock at receiving cancer diagnosis; they were open and

receptive to working together with their healer in creating a calming, healing environment for
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Kate. In addition to the above education, the family was provided with the following resources to

review:

1. https://www.albertahealthservices.ca/findhealth/Service.aspx?id=1069856&serviceAtFac

ilityID=1109903

2. https://myhealth.alberta.ca/alberta/indigenous-cancer-care

3. https://myhealth.alberta.ca/Alberta/AlbertaDocuments/guide-to-cancer-care-in-alberta-

for-newly-diagnosed-indigenous-people.pdf

4. https://www.albertahealthservices.ca/assets/info/cca/if-cca-sources-of-help-in-alberta-for-

people-with-cancer.pdf

5. https://www.llscanada.org/sites/default/files/CA-Chapters/Prairies%20Region-

Calgary/Pdf/Alberta%20Blood%20Cancer%20Resource%20Guide.pdf

6. https://www.albertahealthservices.ca/info/Page11949.aspx

7. https://www.cancer.ca/en/cancer-information/cancer-type/childhood-cancer-

information/your-child-has-cancer/?region=on
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References

About. (n.d.). Retrieved October 18, 2020, from https://rmhcalberta.org/about/

Ackley, B. J., Ladwig, G. B., Beth, M. F., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing

diagnosis handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.

Alberta Blood Cancer Resource Guide. (n.d.). Retrieved October 17, 2020, from

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Calgary/Pdf/Alberta%20Blood%20Cancer%20Resource%20Guide.pdf

Alberta Health Services. (n.d.). Indigenous Health Liaison Services. Retrieved October 18, 2020,

from https://www.albertahealthservices.ca/findhealth/Service.aspx?id=1069856

Alberta Health Services. (n.d.). Indigenous Health. Retrieved October 18, 2020, from

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Astle, B. J., Duggleby, W., & Potter, P. A. (2019). Canadian fundamentals of nursing. Milton,

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PDF Guide to Cancer Care in Alberta for Newly Diagnosed Indigenous Peoples. (n.d.).

Retrieved October 17, 2020, from

https://myhealth.alberta.ca/Alberta/AlbertaDocuments/guide-to-cancer-care-in-alberta-for-

newly-diagnosed-indigenous-people.pdf
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Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., Wilson, D., Keenan-Lindsay, L. .., & Sams,

C. (2018). Maternal child nursing care in Canada. Vancouver, BC: Langara College.

Powell, J. (Ed.). (2019, September). Leukemia (for Parents) - Nemours KidsHealth. Retrieved

October 18, 2020, from https://kidshealth.org/en/parents/cancer-leukemia.html

Sources of Help in Alberta for People with Cancer. (n.d.). Retrieved 2020, from

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people-with-cancer.pdf

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Your child has cancer - Canadian Cancer Society. (n.d.). Retrieved October 18, 2020, from

https://www.cancer.ca/en/cancer-information/cancer-type/childhood-cancer-

information/your-child-has-cancer/?region=on