Child Life Case Studies.

 

 


An’Iah, a 5-year-old female, was admitted to the pediatric oncology unit with a diagnosis of acute lymphoblastic leukemia (ALL). She presented with symptoms of fatigue, fever, and bruising, which led to the diagnosis after comprehensive diagnostic workup. An’Iah’s parents, Christopher and Melanie, were devastated by the news but remained hopeful for their daughter's recovery.
Initial Assessment: Upon admission, An’Iah appeared withdrawn and anxious. She expressed fear of needles and medical procedures and was quite tearful. The nursing team conducted a thorough assessment, including physical examination, vital signs monitoring, and psychosocial evaluation. It was evident that An’Iah’s emotional well-being was as crucial as her medical treatment.

Zy’air, a 3-month-old baby boy, was brought to the ER by his fathers, Brandon and Tyrell. Zy’air was born full-term via surrogacy and was in good health. However, his fathers expressed concerns about his feeding patterns and sleep habits, seeking guidance from the pediatric nursing team. Fathers reported that Zy’air often chokes and gags while taking his bottles.
Initial Assessment: Upon arrival at the clinic, Zy’air appeared alert and responsive. The nursing team conducted a comprehensive assessment, including monitoring vital signs, evaluating feeding techniques, and assessing Alex's growth and development. It was noted that Zy’air has a phlegmy cough which could be a sign of aspiration and concerns of possible pneumonia were discussed. It was evident that Brandon and Tyrell were actively involved in Zy’air’s care and were committed to providing him with the best possible upbringing. Scheduled a swallow study and occupational therapy evaluation to assess Zy’air’s suck, swallow, breathe patterns. Both Brandon and Tyrell appeared anxious as they were pacing and crying.

Lily, a 9-year-old female, was placed in foster care due to neglect and parental substance abuse. She was admitted to the pediatric clinic for a routine health checkup mandated by child protective services. Lily was accompanied by her foster parent, Tatiana, who expressed concerns about Lily's emotional health and adjustment to her new living situation.
Initial Assessment: During the initial assessment, Lily appeared withdrawn and hesitant to engage with the nursing staff. She expressed fear of medical procedures and reluctance to discuss her feelings or experiences. The nursing team recognized the importance of building trust and rapport with Lily to provide comprehensive care tailored to her needs.

Sanjay, a 16-year-old male, presented to the adolescent health clinic for a routine check-up. He appeared healthy and active but expressed concerns about his weight and body image. Sanjay’s parents were supportive but busy with work, and he often felt overwhelmed by academic pressures and peer expectations.
Initial Assessment: During the initial assessment, Sanjay appeared apprehensive but willing to engage with the nursing staff. He disclosed feelings of stress, anxiety, and self-consciousness about his appearance. The nursing team recognized the need to address Sanjay’s physical and emotional health concerns in a supportive and non-judgmental manner.
 
Maria, a 16-year-old female, was admitted to the pediatric hematology unit with a vaso-occlusive crisis secondary to sickle cell disease. Maria presented with severe pain in her lower back and legs, along with fatigue and shortness of breath. She had a history of recurrent pain crises and had been managing her condition with regular medications and supportive care.
Initial Assessment: Upon admission, Maria appeared in distress due to the intensity of her pain. The nursing team conducted a thorough assessment, including monitoring vital signs, assessing pain intensity using a pain scale, and evaluating oxygen saturation levels. They also reviewed Maria's medical history, including her previous treatments and management strategies for sickle cell disease.

Cheng, a 4-year-old male, was admitted to the pediatric rehabilitation unit following a spinal cord injury resulting in paraplegia. Cheng’s parents, Aki and Mira, were devastated by his diagnosis but remained committed to supporting Cheng’s recovery and rehabilitation. Cheng presented with limited mobility, muscle weakness, and altered sensation in his lower extremities.
Initial Assessment: Upon admission, Cheng appeared apprehensive but curious about his new environment. The nursing team conducted a thorough assessment, including neurological evaluation, assessment of skin integrity, and identification of Cheng’s developmental needs and abilities. It was evident that Cheng’s parents played a crucial role in his care and rehabilitation journey.

Emma, a 2-year-old female, was admitted to the pediatric emergency department with burns to her hands and arms after accidentally touching a hot stove. Emma's dad, Joe, brought her to the hospital for treatment. Paternal grandma, Alice, was also present. However, healthcare providers observed additional concerning factors, including delayed presentation to medical care and inconsistent explanations of the injury mechanism.
Initial Assessment: Upon admission, Emma was assessed by the pediatric nursing team. Her burns were classified as partial-thickness burns, with redness, blistering, and pain present on her hands and arms. Nursing staff also noted signs of neglect, including poor hygiene, inadequate clothing, and failure to seek medical care promptly. Suspecting child maltreatment, the nursing team-initiated communication with Child Protective Services (CPS).
 

 

Strict Hand Hygiene and Aseptic Technique: Enforce meticulous handwashing for all staff, visitors, and An’Iah. Monitor vital signs (especially fever) every 4 hours.An’Iah is critically neutropenic due to her disease and treatment. Infection is the leading cause of morbidity and mortality in pediatric oncology. A fever (≥38∘C) is a medical emergency requiring immediate workup.
Limit Exposure: Restrict visitors who show signs of illness and ensure An’Iah avoids contact with known sources of infection (e.g., standing water, fresh flowers).Reduces the pathogen load in the immediate environment, protecting the severely immunocompromised child.
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Case Study 2: Zy’air (3-month-old with Feeding Concerns)

 

 

Primary Medical/Nursing Diagnoses

 

Medical Concern: Rule out Aspiration Pneumonia; Swallowing Dysfunction (to be confirmed by swallow study).

Priority Nursing Diagnosis: Risk for Aspiration related to uncoordinated suck, swallow, and breathe patterns, and potential gastroesophageal reflux (GERD), as evidenced by choking, gagging, and a phlegmy cough during feedings.

Secondary Nursing Diagnosis: Compromised Family Coping related to crisis and chronic health problem (feeding difficulty) as evidenced by the fathers' anxiety (pacing, crying) and seeking guidance

 

Nursing DiagnosisPriority Nursing InterventionsRationale
Risk for AspirationImplement Safe Feeding Techniques: Recommend thickened feeds (if ordered post-swallow study), pace feeds with frequent burping, and hold the infant in an upright position during and for at least 30 minutes after feeding.Maintaining an upright position uses gravity to reduce reflux and keep the airway clear. Pacing ensures the infant can coordinate the suck-swallow-breathe cycle without overwhelming the airway.
Monitor Respiratory Status: Assess and document respiratory effort, rate, and breath sounds frequently, especially post-feed. Use pulse oximetry to monitor SpO2​.Early identification of aspiration pneumonia (e.g., crackles, wheezes, SpO2​ decline) is critical for timely intervention and preventing severe respiratory distress.
Compromised Family CopingProvide Emotional Support and Education: Acknowledge the fathers' anxiety and validate their concerns. Provide clear, step-by-step education on proper feeding and care before discharge.Validation helps build trust and rapport. Clear education empowers the fathers with the knowledge and skills necessary to manage their infant's condition, reducing anxiety associated with the unknown and improving compliance.
Collaborate with Multidisciplinary Team: Ensure the fathers understand the roles of the occupational therapist (OT) and the need for the swallow study. Facilitate communication between the family and the OT.Integrating services provides a comprehensive plan of care and reinforces that their concerns are being taken seriously, which supports the family's ability to cope with a potential chronic condition.

Sample Solution

 

 

 

 

Based on the scenarios provided, I will select An’Iah, the 5-year-old with ALL, and Zy’air, the 3-month-old baby with feeding concerns, to identify their primary medical/nursing diagnoses and explain the priority nursing interventions for each.

 

Case Study 1: An’Iah (5-year-old with ALL)

 

 

Primary Medical/Nursing Diagnoses

 

Medical Diagnosis: Acute Lymphoblastic Leukemia (ALL).

Priority Nursing Diagnosis: Anxiety related to diagnosis, fear of invasive procedures (needles), and separation from familiar surroundings, as evidenced by withdrawn behavior, tearfulness, and verbalizing fear.

Secondary Nursing Diagnosis: Risk for Infection related to compromised immune system secondary to leukemia and subsequent myelosuppressive treatment (chemotherapy).

 

Priority Nursing Interventions

 

Nursing DiagnosisPriority Nursing InterventionsRationale
AnxietyTherapeutic Play and Diversion: Use age-appropriate play (e.g., medical play with dolls, bubbles, storytelling) during non-invasive procedures and downtime. Provide clear, simple explanations for procedures immediately before they occur.Play is the primary mode of expression and coping for a 5-year-old. It helps them master overwhelming events and reduces anxiety by promoting a sense of control and predictability (Wong's principle).
Establish Trust and Predictability: Assign consistent nursing staff when possible, and allow An’Iah to make simple choices (e.g., which arm for blood pressure, what color band-aid).Consistent personnel and control over minor events increase rapport and reduce fear in the pediatric patient, making them more compliant and les

 

 

 

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