|ASSESSMENT 3 BRIEF|
In this assessment task, you will be required to
As adolescents mature and develop their independence, they will at times present on their own to seek health care services. Adolescents will also commonly present with their parents(s), requiring the nurse to practice family centred care. When planning, delivering, and evaluating nursing care for adolescents who present without a parent in the emergency department setting, the nurse needs to build and sustain a therapeutic relationship with the adolescent, and advocate for their rights and needs.
In clinical scenarios where adolescents present on their own, and do not wish to include their family in their care, the nurse and medical team can be faced with moral and ethical dilemmas as to whether the family should be involved, despite the patient’s refusal. Adolescents should be viewed as individuals, and a determination should be made as to whether they are Gillick competent, whilst ensuring local legislation and policy is upheld. The determination as to whether an adolescent can be deemed Gillick competent, should also be made when an adolescent presents with parent(s) or a guardian, as it is essential to include the adolescent in decision making practices.
The case scenarios provided below, will test your knowledge of different pathologies and your understanding of the role of the Registered Nurse (RN) when caring for adolescents.
To complete this assessment task, you must:
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Marking of this assessment will be conducted using the attached rubric below.
Please submit ‘Critical Appraisal of a Case Study via the Assessment 3 link in the main navigation menu in CCA206 Care of Children and Adolescents Blackboard site. The learning facilitator will provide feedback via the Grade Centre in the LMS portal. Feedback can be viewed in My Grades.
Please select one (1) scenario to critically appraise, all case scenarios are balanced with equal complexity.
Clinical Scenario 1
Name: William (Bill) Giovanni
Age: 16 years and 11 months
NOK: Brother Owen Giovanni (20 years old)
Allergies: lactose, fructose
Medical past History: asthma, lactose intolerance, fructose intolerance, smoker (10-15 a day)
Medications: Salbutamol prn
Reason for presenting to hospital: 1/7 of mild bilateral lower abdominal pain, localised to the R) side in the last 2 hours with associated rebound tenderness, nausea, hot flushes and diaphoresis.
Diagnosis: Acute appendicitis.
Vital Signs: HR: 90, BP: 109/65, RR: 22, Spo02: 99% RA, Temp: 38.5
Glasgow Coma Scale (GCS): 15
You have been asked to take over nursing care of Bill in the ED, until a bed is ready in theatre.
Bill requires pharmacological management of his pain, intravenous antibiotics (IV a/bs), to remain fasting and be prepared for theatre.
When approaching the cubicle, you see Bill lying in bed, knees bent, guarding his abdomen, and grimacing in discomfort. His brother is with him who looks stressed and waves you over.
Owen (the patient’s brother and next of kin (NOK)) talks to you outside the cubicle, stating that his brother Bill, has a low pain tolerance, and always gets freaked out in hospitals since their father passed away in a hospital when they were children.
Owen states that both he and Bill are estranged from their mother, who is an IV drug user. Owen also states that Bill is afraid of having IV medications as he is fearful of ending up like his mother. Owen asks if he can stay with his brother until he goes to theatre, as he is the only one looking out for his brother, and thinks he can help keep him calm.
Clinical Scenario 2
Name: Jess Dutch
Age: 16 years and 7 months
NOK: Sister Kelly Dutch (19 years old)
Allergies: Peanuts (anaphylaxis)
Medical past History: Acne vulgaris, depression, anxiety and self-harm.
Medications: Roaccutane once daily
Reason for presenting to hospital: Self-inflicted laceration 7x2cm (LxW) to L) wrist with tendon visible on view. Sustained 2/24 prior with a knife, patient states feeling depressed and anxious.
Vital Signs: HR: 95, BP: 1015/65, RR: 24, Spo02: 99% RA, Temp: 37.5
Glasgow Coma Scale (GCS): 15
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