NSG 212: Specialized Populations - Pediatrics
Continuing Case Study: On the way out of the pediatric clinic, Hannah trips and falls down,
striking her forehead on the bottom leg of a chair. She cries instantly and is bleeding from a
laceration to her forehead. Her mother frantically picks her up and the nurse immediately applies
pressure with a gauze to stop the bleeding. After a few minutes of applying pressure, Hannah is
still crying and the nurse notices she is holding her wrist. After re-examination by the
pediatrician, it is decided Hannah needs to be transferred to the hospital for repair of the
laceration and x-ray of the wrist. On the way to the hospital, Hannah’s mother is making various
phone calls to every member of the family to tell them what happened. After arriving in the
emergency department (ED) and being examined by the physician, the nurse informs Hannah’s
mother that she has been ordered Dermabond to the head, x-ray of the wrist, and a cat scan
(CT) of the head. Hannah’s mother steps out of the room during application of the Dermabond
and states, “I can’t be in there; I feel woozy.” Hannah screams and cries when her mother leaves
the room. She is then taken to receive a CT of the head, and after reading results, the physician
decides to keep Hannah overnight in pediatric observation. The mother states she must go home
to care for her other child so her spouse can go to work, so she will wait until Hannah falls asleep
and sneak out. When she returns the next morning, she arrives with Hannah’s brother, Kyle, who
is 9 years old. She tells the nurse she had to bring him because she couldn’t leave him home
alone and her spouse was still at work. The nurse informs the mother that Hannah wet the bed
last night, woke up crying, and refused to eat breakfast. When the mother walks into the room,
Hannah begins to cry. The nurse notices the sibling, Kyle, standing quiet in the corner. The
mother is asking the nurse repeatedly when they can be discharged, stating she had to rearrange
her whole day. While waiting, she wants to know if they have a playroom or any toys for Hannah
to keep her occupied.
Instructions: As the primary nurse, create a nursing care plan to address the needs of Hannah
and her family. Use the clues in the scenario and the care plan to assist you.
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NURSING CARE PLAN
NURSING DIAGNOSIS
e.g. Acute pain related to (r/t) fall as evidenced by (AEB) crying and guarding of injured site.
1.
r/t separation from mother AEB _______________________________________
________________________________________________________________.
(pg. 788-789: Box 35.1)
2. _____________________ r/t ________________________________ AEB wetting the bed at night
despite being potty-trained.
3. ___________________________ r/t ____________________________ AEB refusing to eat breakfast.
(pg. 790)
4.____________________________ r/t unexpected hospital admission AEB ________________________
______________________________________________________________________________________.
5. ___________________________ r/t hospital admission of sibling AEB __________________________
_____________________________________________________________________________________.
DESIRED OUTCOME
e.g. Patient will rate pain as less than 3 on the FACES scale.
1.
2.
3.
4.
5.
2
NURSING INTERVENTIONS AND RATIONALES
e.g. Use a pain assessment tool appropriate for
age and developmental level to determine
intensity of pain.
3
e.g. Provides accurate assessment of pain level in
the pediatric patient.