Jimmy’s mother, Clara, took him to the

Jimmy’s mother, Clara, took him to the emergency room close to the end of the afternoon shift. She was rather annoyed at the thought of taking him to the hospital as she saw no need to get medical treatment. As she entered, she could be heard shouting, “I’m only here to get a prescription for this little rash on my baby’s hands. I don’t need nobody telling me how to be a mother so can one of you nurses just call the doctor so I can get what I need and go? No need to have me take up your time when someone more ill needs your attention.” Three hours earlier, Jimmy’s mother was visited by two Community Health Aides. The Health Centre was half a mile from the house (and the hospital a little less than three-quarters of a mile in the opposite direction). The visit was unexpected and unwelcomed but she allowed them in after they explained it was simply to help her out if she needed any assistance. The Aides detected a pungent odour on entering the yard and saw five-year-old Jimmy sitting on the ground looking dirty with numerous lesions all over his skin. They insisted that the child needed medical attention and informed Clara that if she did not get help for Jimmy, they would have to call the police. Page 2 of 5 Clara is a single mother and Jimmy is her only child. She sells sweets and coal to get by as no one will hire her due to her bad employment history and psychiatric condition (bipolar disorder). She takes her meds but has been finding it exceptionally difficult of late to take care of herself and Jimmy. On examination, Jimmy’s scalp was covered in crusts from healing and infected wounds due to deep and vigorous scratching. His hair was dirty and there was evidence of pediculosis. His arms, legs, torso and groin had numerous circular rashes with raised edges and grey, scaly skin inside the circles. His nails were dirty and dental caries marred his innocent smile. Questions A) Jimmy’s mother identifies you as the nurse she wants to help her son. Describe in three paragraphs how you would professionally handle the situation. (15marks) B) What is the most likely skin condition Jimmy is having? Give a rationale for your response. (2marks) C) What referrals would be necessary in this situation? (3marks) D) What are the possible reasons for the time lapse between the visit from the Aides and Clara’s arrival at the hospital? Why was she in such a hurry to leave? Why did she choose you to look after her son? (5marks) *************************************************************************** Page 3 of 5 Scenario 2 It is world cup season and 12-year-old Marcus loves watching the game. He cannot participate in any form of sports due to his haemophilia. He was often sad when his friends forgot about his condition and invited him to play football after school. Although they quickly remembered and apologized most times, Marcus never forgot. Today is the date for Marcus’ routine follow-up visit with the haematologist. Marcus and his mom are in the waiting room. You are the nurse in the office and you notice Marcus is not his usual cheerful self and he did not bother to join the conversations of the other children in the office who came for review as well. Questions A) Explain the pathophysiology of haemophilia. (7marks) B) How is the condition diagnosed and treated? (3marks) C) What would you say to Marcus’ mom who confides in you that she no longer knows what to say to him when he is sad because he cannot join his friends? (7marks) D) What would you say to Marcus? Would you make any referrals? (3marks) *************************************************************************** Page 4 of 5 Scenario 3 Judith is a ten-year-old who has asthma. She was diagnosed six months ago. Her dad smokes and although he does it outside or in another room in the house, Judith is always affected. Today, Judith was rushed to the emergency room with severe shortness of breath due to chest tightness and inspiratory as well as expiratory wheezing. The inhalers she uses were of no help. Her father held her in his arms and reluctantly released her so she could be placed on a stretcher. Being the nurse to place the child on the stretcher, you cannot help but notice the strong smell of cigarette smoke on the father’s clothes. Questions A) Explain the pathophysiology of asthma. (7marks) B) Describe the treatment of the condition. (4marks) C) What would be the contents of your teaching session with Judith and her father after Judith was stabilized? (9marks) *************************************************************************** Scenario 4 One-year-old Missy is diagnosed with Kawasaki Disease. Her parents, being from a 90s childhood, found the name of the condition almost hilarious. They associated the name Kawasaki with huge two-mufflered motor bikes. Page 5 of 5 Questions A) Explain to Missy’s parents what is Kawasaki Disease. Include its symptoms and treatment. (10marks) B) Formulate three nursing diagnoses for this family. (3marks) C) Missy is for admission. Explain the admission process. (2marks) *************************************************************************** Scenario 5 Fifteen-year-old Zach was infected with HIV from his mother who did not take her ARVs during pregnancy. Up to this point, Zach has taken his meds and was always on time for follow-up visits. Of late, Zach has become somewhat depressed. There is this girl in his class whom he really likes. In the office today, as you prepare to take a blood sample for a CD4 count, he confides in you that he is wondering what is the point of living with HIV when he will not be able to even get married and have children. He knows about his condition but fears rejection from the girl he likes and possibly from who he wants to marry when he becomes an adult. Questions A) Formulate four nursing diagnoses for this scenario. (4marks) B) Describe the trends in HIV management and reproduction. (You may need to do some research) (6marks) SCIENCE HEALTH SCIENCE NURSING NURSING RN NUR315

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