THE NERVOUS SYSTEMOverview: This case requires knowledge of hydrocephalus,spina bifida, growth and d

THE NERVOUS SYSTEMOverview: This case requires knowledge of hydrocephalus,spina bifida, growth and development, as well as an understanding of the client’s background, personal situation, and parent-child attachment relationship.Client Profile Jerod is the name Joanna and Jim chose for their first child. Jim accompanied Joanna to all of her prenatal visits. When the routine ultrasound was performed at 32 weeks’ gestation, Jerod wasdiagnosed with hydrocephalus and a myelomeningocele. His parents were initially devastated, but remained very excited about their son’s birth. Joanna was scheduled for a caesarean section at 38 weeks’ gestation and the couple were anxious about Jerod’s condition and his treatment following birth.Case Study Jerod is delivered by caesarean section and transferred to the pediatric intensive care unit(PICU). On admission to the nursery he weighs 3.4 kg (7.5 lb) and is 8 cm (20 in.) in length. His vital signs are: Temperature: 37° C (98.6° F) Pulse: 144 beats/minute Respirations: 40 breaths/minute He hasbulging fontanels and a high-pitched cry. His head circumference is 40 cm (15.8 in.) and his chest circumference is 34 cm (13.4 in.). In the lumbar region of his spine, the nurse notes a sac-like projection. When Joanna and Jim visit the nursery, they stroke Jerod and caress his fingers and toes. Joanna begins to cry and comments to the nurse, “I so wanted to breastfeed Jerod, but now I guess I can’t.”Questions1. Discuss the reason for Jerod being delivered by caesarean section.2. Discuss the significance of Jerod’s clinical manifestations.3. What is hydrocephalus?4. What is a myelomeningocele and how is it related to hydrocephalus?5. Discuss the incidence and etiology of hydrocephalus and myelomeningocele.6. Discuss the complications associated with Jerod’s myelomeningocele.7. What are the priorities of care for Jerod on admission?8. Discuss Jerod’s parents’ actions when visiting Jerod in the nursery and how the nurse should respond to Joanna’s concern about breastfeeding.9. Discuss the priority nursing interventions when caring for Jerod’s myelomeningocele prior to surgery.10. Jerod’s myelomeningocele is surgically repaired and a shunt is placed for his hydrocephalus. Discuss the two types of shunts used to treat hydrocephalus and which is most commonTHE INTEGUMENTARY SYSTEMOverview: This case requires knowledge of burns, child abuse, as well as an understanding of the client’s background, personal situation, and mother-child attachment relationship.Client Profile Kyla is an 8-month-old infant who lives with her mother, grandmother, and great grandmother in Cincinnati, Ohio. Her mother, Sierra, is a 16-year-old who stopped going to school after she became pregnant by her on-again, off-again 18-year-old boyfriend, Kyle, who visits Sierra but shows no interest in Kyla. He frequently becomes annoyed and leaves when Kyla needs to be fed or have her diapers changed. Sierra’s father was very abusive to both Sierra and her mother as Sierra was growing up. He died 6 months ago as a result of a knife wound that occurred during a fight at a local tavern. He and Sierra’s mother lived together with their five children and when he worked, he worked for a minimum wage that barely fed his family. Kyla’s aunts and uncles (Sierra’s three sisters and one brother) keep in contact with their mother and sister, but are busy with their own lives and families. Although Sierra participates in Kyla’s care, her mother is the stable caregiver when she is not working. The relationship between Sierra and her mother has been strained since Sierra became pregnant and frequently the two engage in heated arguments over the increased financial stress related to Kyla’s needs and Sierra’s refusal to seek employment. Sierra’s grandmother is in poor health and requires frequent visits to the emergency room as a result of unstable angina.Case Study At 2135 hours, Kyla is brought wrapped in a bath towel by her grandmother to the emergency department at the local hospital. The admitting nurse observes that Kyla is crying vigorously and is unable to be consoled. She is in no apparent respiratory distress. According to the grandmother, Kyle came over to see Sierra while Kyla’s grandmother was out at the grocery store. When she returned, Kyla was screaming. Sierra said that she and Kyle were talking and Kyla “got real fussy, so we decided to give her a bath to get her to quiet down, but she just kept screaming.” Kyla’s grandmother wrapped Kyla in a bath towel and brought her to the hospital because she thought that she was sick because “she was so red.” On further assessment the nurse notes that Kyla has blisters on her feet, lower legs, and buttocks, and bruises on her upper arms. The health care provider examines Kyla and arranges for her to be transferred by AirFlight to Cincinnati Shriners’ Hospital to be admitted with second-degree burns of her buttocks, genitalia, legs, and feet. Health care providers at the burn center estimate Kyla’s burns as 34% of her total body surface area (TBSA) using the “Estimation of the Extent of Burns in Children” chart. Although Sierra calls every other day to ask about Kyla’s condition, she doesn’t visit her daughter. Kyla’s grandmother stays at the hospital with Kyla.Questions1. Discuss what is the impressions about the above situation.2. Discuss the factors in this situation that would place Kyla at risk for child abuse. 3. Using developmental theory, discuss Sierra’s level of growth and development.4. The health care providers determined that Kyla’s development was appropriate for an 8-month-old infant. Discuss what you would expect when assessing Kyla’s growth and development.5. Discuss how the health care providers arrived at 34% of Kyla’s TBSA experiencing second-degree burns. 6. Describe the characteristics of second-degree burns.7. Using the 4:2:1 rule for calculating maintenance rate of intravenous fluids for Kyla, who weighed 3.18 kg (7 lb) at birth and has experienced a weight gain within normal limits for her age, calculate her hourly IV rate.8. Determine Kyla’s priority nursing diagnoses on admission to the burn center, discussing why each is a priority.9. Discuss your impressions about why Sierra doesn’t visit Kyla at the hospital.10. Discuss what members of the health care team should be involved in Kyla’s care and recovery.11. Discuss what out come about child abuse and how you would feel if you were a nurse caring for Kyla inHealth ScienceScienceNursing NURSING 207 Share QuestionEmailCopy linkComments (0)

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