Description
Case Study 1
The Child With Cardiovascular Dysfunction
Supra Ventricular Tachycardia (SVT)
Michael is a 7-week-old breastfed infant with a 2-day history of irritability and poor feeding.
Subjective Data
Mom states that her infant has been âfussyâ for the last 2 days.
He feeds for only a âfewâ minutes at a time.
He is breathing heavily and fast for 2 days.
Objective Data
Weight: 4.8 kg
Vital signs: temp, 36.8º C; pulse, 250 bpm; resp, 65 breaths/min; blood pressure, 84/58 mm Hg
Breath sounds clear to auscultation
Oxygen saturation: 95%
Central capillary refill: 4 seconds
QUESTIONS:
- 1. What is the treatment for an unstable patient with supraventricular tachycardia (SVT)?
- Decreased cardiac output from prolonged SVT would produce what complication?
- In this clinical situation, what actions should the nurse take? Prioritize the actions.
Case Study 2
Pyloric Stenosis
Lucy is a 44-day-old formula-fed infant with a 4-day history of vomiting.
Subjective Data
Mother states that the infant has:
Been vomiting undigested formula after feedings.
Has not had fever or diarrhea.
Has had eight wet diapers in the last 24 hours.
Objective Data
Weight: 4.8 kg
Birth weight: 3.5 kg
Vital signs: temp, 37.1º C (rectal); pulse, 130 bpm; resp, 30 breaths/min; blood pressure,
92/52 mm Hg
Moist mucous membranes; flat and soft anterior fontanel
Awake and alert, lusty cry
Good muscle tone
Olive-sized mass palpated at epigastrium
Questions:
- What test will be used to diagnose pyloric stenosis?
- What actions should the nurse take in this clinical situation? Prioritize the actions.
Case Study 3
Schizophrenia Spectrum Disorder
As part of his internship, Trey is working night intake at a psychiatric hospital in a medium-sized college town. Itâs been pretty quiet all evening until a little after 1 am, when he hears shouting in the outer hallway.
Trey looks at Lisa, his fellow student intern, who says, âWhatâs going on out there?â
A moment later the doors burst open, and a young man, who looks about 18 years old, is escorted in to the intake desk. He is agitated and has tears on his face, but he is not showing signs of violence or aggression, beyond the brief shouting he did out in the hallway.
He plunks himself down in the chair across from the intake desk and buries his face in his hands, rocking slightly and moaning. He has a slight body odor and is perspiring heavily.
âHeâs all yours,â Lisa whispers.
Trey ignores her and moves quickly to the intake desk. Lisa runs off to find the supervising nurse, who has gone on break.
âHey there,â Trey says calmly, bending over to look into the patientâs eyes. âIâm Trey. Whatâs up?â
He is almost surprised when the patient stops rocking, sits up, and lowers his hands. âHey,â he says quietly. âIâm Matt, and this is hell, dude.â
âNot quite,â Trey smiles. âIâm here to help. Can you tell me whatâs happened?â
âIâm going all to pieces,â Matt says, âlittle screws and bolts and debris flying off everywhere.â
Trey says nothing; he just waits.
âI had kind of a breakdown in my dorm,â Matt says. âI threw my laptop out the window.â
âOoh, thatâs rough. Bad night, huh?â
âBad week, bad month, bad year, bad bad life. Bad bad bad bad bad bad bad bad BA-A-A-AD.â
âWhat happened?â
âWhere you wanna start?â
In fits and starts, Matt conveys small clues that hint at his story.
Matt has always been a ânerd,â he says, according to his older brothers. As a child he often withdrew from play groups at school to play on his own. In isolation, he has always managed to perform well academically, but in group work or group assignments, he has tended to resort to outbursts and a refusal to participate. He says that he has always been awkward in social situations and has always found it hard to carry on âa good, rewarding conversation.â
âAnd Iâm freakinâ clumsy. Klutzy. A klutz,â he says, looking everywhere but at Trey. âIâm the opposite of an athlete, the opposite of my brothers.â
Although his speech is frequently eccentric, Matt manages to convey a very brief picture of how, because of his withdrawal, negative thoughts, and social awkwardness, people tend to leave him on his own, both at large extended family gatherings or social functions in his familyâs community and place of worship.
In his senior year of high school, Mattâs grades and SAT scores gained him entrance to a leading Midwest universityâdespite his disruptive problems.
Matt had been looking forward to going away to school, hoping that part of his problems âfitting inâ had to do with his familyâs âobscenely proper prominenceâ in the community, and his older brothersâ âsuper-dude images, which,â he says, âI will never live up to.â
âAt the same time,â he says during intake, âI was also pretty nervous, pretty stressed, pretty freaked out, pretty freaky.â
In his first week of college, Matt found orientation week âdisorienting,â he jokes with a slight smile. âOrientation disoriented me. It dissed me. I got dissed. There were people everywhere, like climbing-the-walls-and-on-top-of-you everywhere.â
Except when Trey first initiated conversation, Matt, for the most part, has worked to avoid eye contact and continually bounces his left leg nervously. He is gripping the arms of his chair and looks as if heâs about to fly right out of it.
âMy roommate is a jock,â he says. âJocular jock. Oh, Jocularity, wouldnât you know theyâd put me with a jocularânot-so-very-jocularâjock. They plan that stuff, you know. Just to keep me from escaping, from making a fresh start. Guyâs a jerk, and now, here I am.â He grins and expands his arms, gesturing the psychiatric ward around him.
âAnd now here I am, just 8 weeks into my first semester away from home, and Iâve just been admitted for totally breaking down, shooting laptop missiles from the second freakinâ floor. They win.â
QUESTIONS:
- If Matt is truly suspected of having newly diagnosed or recent-onset schizophrenia, should Trey be letting the conversation focus so much on Mattâs childhood? Where might intake or assessment be best focused?
- Based on this initial phase of Mattâs intake interview alone, what symptoms are already suggested in his behavior that would be significant in terms of potential psychosis or schizophrenia?