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Case Study Anna
Client profile
Anna is a 4-year-old autistic preschooler who lives at home with her
parents and three older siblings. Ann is nonverbal, although she intermittently
cries out while playing and can be disruptive at home. She attends a Head Start
educational program in town and, according to her teacher, her behavior at
school has gradually become less disruptive. Over the past year, she has
experienced three episodes of tonsillitis. With each episode she was treated with
antibiotics that seemed to effectively treat the problem until the next episode
occurred. Following treatment for her last episode a month ago, her pediatrician
recommended a tonsillectomy. Her parents are quite anxious at the thought of
Anna having surgery and being hospitalized. The surgery is scheduled for the
following week.
Case Study
During her preoperative visit Anna is very quiet and clings to her mother. Her
parents speak and understand sufficient English to communicate with the nurse.
They express their concerns about Anna having surgery and state that they have
given her daily vitamins since she was just a baby to help prevent her from getting
“these kinds of infections.” Further they have avoided talking about Anna’s
situation at home because they don’t want to increase the child’s anxiety. They
state she would she would be very afraid if surrounded by strangers. They explain
to the nurse that Anna has autism and express their concern about the child’s
response to hospitalization because her behavior worsens when she is in an
unfamiliar environment. Anna weighs 35lbs.
Questions
1. What is autism and what is its incidence and etiology?
2. Discuss the potential impact Anna’s autism may have on her hospital
experience.
3. Discuss the parents’ comment about giving Anna vitamins to prevent
“these kinds of infections”
4. How can the nurse interact to address the family’s anxiety?
5. Discuss the incidence and causes of tonsillitis.
6. What diagnostic studies should be performed prior to Anna’s surgery?
7. Anna is admitted to the same-day surgical unit and is accompanied by her
parents. When approached, her parents verbalize that Anna is afraid that
the “people are going to hurt her” How should the nurse respond to Anna
and her parents?
8. What are the nursing priorities for Anna’s postoperative care?
9. Discuss the appropriate priority nursing interventions for Anna.
10.Anna refuses to take fluids following her surgery and her urine output has
decreased. She is then transferred to the pediatric surgical unit for an
overnight stay. What is the rationale for this action? What is the expected
urine output for Anna, who weighs 15.9 Kg (35 lb.)?
11.Anna cries and becomes withdrawn when visiting hours on the unit are
over as her parents prepare to go home to check on their other children.
12.Discuss Anna’s reaction, relating it to her growth and development and the
impact hospitalization has on a child Anna’s age.
13.Anna’s mother spends the night with her, and the following morning Anna
is drinking, and her urine output is within normal limits, so she is to be
discharged. Discuss the discharge teaching for Anna and her parents.

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