Bobby was hospitalized 6 days ago for appendicitis. After an appendectomy following a perforated appendix, he now has an open incision requiring BID dressing changes and contact isolation due to a hospital acquired MRSA infection. It is anticipated that he will be here for 5-10 more days for long term antibiotic therapy and wound care. He is 13 years old. He has been afebrile for 24 hours. The wound is open with minimal serous drainage. He is withdrawn and relates “just tired” when you inquire about how he is this morning. Last week he shared his interest in school. Gets A’s in math, computer science and was supposed to be competing in the school science fair this week. What do you know about the adolescent and the appropriate developmental level? Keeping his diagnosis in mind, what about visitation? Is socialization a need? What other questions should you ask? Group B Response It is 10 pm and you make assessment rounds and find Bobby crying. You ask him what his pain level is. What pain scale are you using? He says he misses his family and wonders when they are going to come to get him and take him home? He relates his dad told him to be brave but he couldn’t stay with him since Bobby was going to be in the hospital for such a long time and his dad had to work. He has 2 other brothers older than him. You also notice that his tray is untouched. In addition to Erikson’s theory of development, children have fear of loss. What is Bobby’s fear? (do not forget the interdisciplinary team members) Video: Pre-operative teaching Discussion B: Group B will complete the initial post, Group A will respond to the post. Tina is 5 years old, lives with her mother and grandmother. Mother works 2 jobs to help support her mother and her daughter. Tina is well cared for but is now admitted for a cardiac catheterization due to the Ventricular Septal Defect (VSD) that was noted at birth. Tina has an extensive history of respiratory infections and a nursing diagnosis of ‘activity intolerance’. Her mother relates that she does not allow her to play organized or competitive games due to her health. Tina smiles broadly when you come in the room to begin the pre-operative checklist. She starts to ask you a question when her grandmother tells her she must stay in the bed. “The nurse knows what she is doing and you will just be in the way.” Tina continues to smile at you but moves back to the bed. You have identified some unique family dynamics, please relate. What is the Erikson developmental level that Tina should exhibit? And where do you think she is? How can you assist in the developmental growth? What education can you give to Tina and her grandmother pre operatively? What will she expect post operatively? Group A Response You begin to explain that the first thing you will need to get done is an I.V. Tina’s grandmother doesn’t give you a chance to ask her to help. She excuses herself and says she can’t watch. She will go to the cafeteria and return later. Tina starts to cry and begins to suck her thumb. What tools have you brought with you? How can you comfort Tina? What methods of communication might you use to help relieve anxiety? Can you give Tina choices? How can you successfully get the IV in? Do only Part B include in-text citation with 3-4 references
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