Health Promotion Case Studies
Case Study #1
Alicia is an 8-week old infant admitted to peds with severe gastroenteritis. Alicia weighed 7
pounds at birth and now weighs 8 pounds 3 ounces. Normally, Alicia takes Similac formula, 3
ounces every 4 hours. She has been vomiting and has had diarrhea for the past 24 hours. Due to
this, she has been placed on NPO and has IV fluids for hydration. She is fretful and restless.
Alicia’s mom is an 18-year-old single parent, but does receive assistance and support from her
parents. All are present and very apprehensive about Alicia’s condition.
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1. Alicia’s weight is normal for her age.
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2. Alicia’s mother reports that Alicia normally sleeps through the night without waking.
This is normal for most infants this age.
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3. It is important to Alicia’s recovery for her mother or grandmother to remain at the
bedside as much as possible.
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4. Alicia is likely to respond positively to mobiles and bright colored objects from home.
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5. Alicia’s mother expresses concern about the tiny, yellow-white papules across her
nose. You reassure her that this is normal and that it will resolve soon.
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6. When Alicia is held upright, head control is absent. This is abnormal and should be
reported to the physician immediately.
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7. Alicia’s mom reports that she has been having 10 – 12 loose, green stools/day.
This is abnormal.
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8. It is normal for Alicia to exhibit the “rooting reflex” by turning her head toward
anything that touches her cheek.
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9. Alicia is listless with little movement of her arms and legs. This is normal for an
infant this age.
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10. You encourage Alicia’s family to hold, cuddle or rock her because infants this age
tend to be comforted by such actions.
Case Study #2
Gina is a 3-year-old patient in the intensive care unit with the diagnosis of status asthmaticus.
Gina was admitted yesterday through the emergency room in a respiratory arrest that occurred on
route to the emergency room. The attack began on the playground at pre-school and 911 was
called. Gina is intubated and on the ventilator. She has a history of asthma for years but this is
the first occurrence of this severity. Her mother, Ann, age 40, has been at the hospital since her
arrival and has not left. Her father, Bob, age 44, has also been here all night and went into work
for awhile this morning. Gina is an only child. Ann has been pregnant 6 months ago and
suffered a spontaneous abortion in the first trimester.
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1. Gina will be less apprehensive if one of her parents are allowed to stay with her as
much as possible.
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2. It would be less stressful to Gina if her caregivers could adhere to her routine activities
as much as possible.
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3. Since few of Gina’s teeth have come in, she will need baby food to be adequately
nourished.
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4. Gina’s environment needs to be safe because at this age it is difficult to differentiate
actions that may be dangerous.
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5. A good way to explain medical procedures to Gina is to use “play” to teach her and
allow her to express her fears.
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6. It would be abnormal for Gina to wet her bed at night since she has been potty-trained
since the age of 18 months.
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7. Since speech is very limited at this age, it would be very difficult for Gina to
communicate her needs.
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8. Temper tantrums and negative behavior are common for 3-4 years.
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9. Some acceptable forms of play for Gina would be…having a story read to her,
coloring, drawing, imitative play, etc.
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10. Gina’s mother is very concerned because she has only voided twice in the last 24
hours. This is normal and the nurse should reassure the mother that this is normal for
a child her age.
Case Study #3
Billy is a 5-year-old pre-schooler that comes to the pediatric unit for routine tonsillectomy. His
mother is present but his father is out of town on business. Billy has never been in the hospital
before and is very frightened. Lab is here to draw blood and Billy will not cooperate.
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1. Billy’s blood pressure is 84/50 on admission. This is abnormal and you phone the
physician immediately.
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2. Children Billy’s age are easily distracted.
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3. Children in this age group are very picky about food and are hard to get to eat.
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4. It would be good if you encouraged Billy to do certain things on his own since at this
age self-help skills are increasing.
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5. It would be normal for Billy to wake up during the night with fears of death.
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6. It would be best not to speak in terms of time, since Billy has no concept of time and
hours.
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7. Children in this age group enjoy action activities such as jumping rope, bicycle,
running, and building things.
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8. Billy would enjoy reading stories, board games, and imitative play during his
hospitalization.
Case Study #4
Seventeen-year-old Jonathan was admitted to ICU with injuries sustained in an MVA. He has a
chest tube, multiple broken bones, and severe lacerations to his face. Jonathan’s family recounts
that he was driving under the influence of alcohol and was not wearing his seat belt. His father
verbalizes, “How could he be so stupid?” His mother is very concerned because Jonathan
appears very depressed. He is eating very little, refuses to let someone bathe him and refuses all
visits by his friends.
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1. It is common for boys Jonathan’s age to experience mood changes and unpredictable
reactions.
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2. Jonathan’s decision to drink and drive and to not wear his safety belt was most likely
due to peer pressure.
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3. It is normal for adolescents to sleep 12-18 hours in a 24-hour period.
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4. Jonathan would most likely enjoy conversing about sports events, music, and hobbies.
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5. Since Jonathan is not eating anything, it would be important to determine any likes or
dislikes and preferences.
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6. It probably would help Jonathan’s parents understand his recent behavior if you
discussed the normal growth and development of an adolescent with them.
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7. It is best to force the adolescent to do the right things, i.e., eating, bathing, etc., than to
encourage them to make their own decisions.
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8. Normal blood pressure for an adolescent is 150/80.
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9. Jonathan’s reluctance to allow his friend to visit could be because he is embarrassed
for them to see his physical appearance.
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10. It is important for the adolescent to be afforded as much privacy as possible during
procedures as bathing, dressing changes, etc.
Case Study #5
Mary, a 25-year-old female, is admitted to OB/GYN with the diagnosis of pre-eclampsia. She
has 4+ pitting edema of her extremities and her B/P is 200/100. She and her husband have 2
other children, ages 3 and 18 months, who are staying with her best friend, Debbie. She begins
crying during the admission process and verbalizes fear for her unborn child as well as for her
other children. Her parents live 13 hours away and are unable to make the trip to be with her.
She begs the physician to let her go home. She is employed as a legal secretary for the District
Attorney.
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1. Establishing parental independence is a major developmental task for this age group.
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2. Vehicular accidents, suicide, and homicide are the leading causes of death in this age
group.
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3. Self concepts and a positive body image are not really that important to the early
adult.
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4. Mary and her husband’s personal set of values and their philosophy of life are
important aspects in planning her care.
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5. Mary’s insistence to go home is common in this age group because one of the
developmental tasks for the early adult is establishing and maintaining a residence.
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6. Mary should be discouraged from verbalizing her fears and feelings since this makes
her condition worse.
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7. Mary’s concern for her job and career are normal since this provides personal
satisfaction and economic security for the early life.
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8. Mary will need discharge teaching on developing healthy lifestyle habits, weight
control, exercise, family planning, child care, and home management.
Case Study #6
Mr. Jackson, age 62, has been admitted to the hospital with a tentative diagnosis of R/O
myocardial infarction. He has a history of smoking for 20 years then quit for 10 years prior to
resuming 1-1/2 years ago and currently smokes 2 packs a day. He was married 4 years ago to
Marcie, age 31, after he had been divorced for 5 years. Marcie is currently 8 months pregnant
with their first child. All of his family is here at the hospital, he has 2 sons, ages 28 and 31 and a
daughter age 37 from his first marriage. He is depressed about the possibility that he may have
heart disease. He has always watched his weight and exercised 3-4 times a week. Recently the
company where he has worked for 30 years merged with a larger company. He is currently the
director of finance.
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1. It is an important task for the health care provider to assist Mr. Jackson in prolonging
the period of optimal physical, mental, and social activity throughout this illness.
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2. Developing a personal view of death is too stressful for Mr. Jackson and any
references to such should be avoided.
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3. Patients in this age group need routine physical exams every six months.
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4. It will be a major source of stress for Mr. Jackson to accept his life with its physical
limitations.
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5. Mr. Jackson and his wife have the same developmental tasks in common which will
make his illness easier to accept.
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6. Physical changes that accompany cardiovascular disease will be a major source of
stress for Mr. Jackson.
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7. It is important to assist Mr. Jackson in redirecting his energy and talents as he adjusts
to his chronic condition.
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8. Mr. Jackson and his wife will need discharge teaching in regard to a diet high in fiber,
low sodium, sugars, and calories.
Case Study #7
Mrs. Smith is a 77-year-old female admitted to the hospital with a diagnosis of bronchitis and
dehydration. She has a history of diabetes and coronary artery disease. She is a non-smoker and
has recently lost her husband of 55 years to cancer. She has two daughters that live in town and
visit her daily. Mrs. Smith is disoriented to place and time and is refusing to take her
medications or eat her meals. Mrs. Smith is able to ambulate with the assistance of a walker.
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1. It is not important to re-orient Mrs. Smith to her environment.
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2. It would be appropriate for the nurse to begin a discharge plan on Mrs. Smith at the
time of admission.
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3. The greatest fear of the geriatric patient is often the fear of becoming incapable of
self-care.
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4. It is established that geriatric patients are considered to be 65 years of age or older.
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5. It is not necessary to encourage Mrs. Smith to participate in self-care activities
because she is considered to have a short life expectancy.
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6. The nurse should encourage visiting from family and/or significant others during her
hospitalization.
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7. Instituting measures to prevent physical injuries due to the unfamiliar environment is
not a nursing function.
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8. Poor vision, inadequate instructions, and confusion may be factors which adversely
affect her compliance with taking medications at home.
N:Syllabus\Fresh\Fall\RNSG 1523 Health Promotion Case Studies
Reviewed 06/11
Reviewed 06/12
Reviewed 03/13