DISEASES OF THE CARDIOVASCULAR SYSTEM

Problem No. 33

You work as a ward nurse in the pediatric cardiology department. Under your supervision is a 12-year-old girl with a diagnosis of Rheumatism, active phase, chorea minor.

Nursing examination revealed the following data: the girl is conscious, but reluctant to make contact, lethargic, whining, most of the time she lies with her face turned to the wall, does not communicate with her peers. The patient is worried about the outcome of the disease. Complains of being tired. On examination: general weakness, slowness. The temperature is 36.9 degrees C. The skin is pale, blue under the eyes, the pharynx is clean. Respiratory rate 22 per minute, pulse 112 per minute, blood pressure 120/70 mm Hg. There is a twitching of facial muscles (grimacing) and muscles of the upper limbs, which increases if attention is paid to the girl. Sheds food while eating. Muscular hypotension.

From the anamnesis: He considers himself ill for 14 days, when he first complained of causeless irritability, poor sleep, change in handwriting. He often suffers from acute respiratory viral infections, recently – frequent tonsillitis.

Tasks

  1. Find out what needs are being met.
  2. State the patient’s actual and potential problems.
  3. Set a goal and create a nursing intervention plan with motivation.

Problem No. 34

You are a ward nurse at a children’s hospital. A 10-year-old boy is hospitalized with a diagnosis of rheumatism, active phase, polyarthritis

During a nursing examination, the following data were obtained: the boy complains of pain in the left knee joint, because of the pain he does not get up, he cannot change the position of his leg in bed. Prior to that (3-4 days ago) I was worried about pain in the right ankle joint. In the anamnesis: three weeks ago he had a sore throat, was treated for three days with home remedies and went to school, did not go to the doctor.

Objectively: Position in bed is passive. Contact boy. Appetite is reduced. The dream is disturbing. The temperature is 37.8 degrees C. The skin is pale, clean, blue shadows under the eyes. The left knee joint is hot to the touch, round in shape, enlarged in size, painful movements. Reduced nutrition. Pulse – 100 beats per minute, NPV – 22 per minute. Stool with a tendency to constipation.

Medical appointments:

– strict bed rest

– aspirin 0.5 x 4 times a day after meals

– ampioks intramuscularly 500 thousand units. x 4 times a day,

Tasks

1. Reveal which needs are violated.

2. Identify the patient’s problems.

3. Set goals and create a nursing intervention plan with motivation.

Problem No. 35

You are a ward nurse in the pediatric department of a hospital. You are treating an 8-year-old girl with a diagnosis of rheumatic chorea.

During a nursing examination: she fell ill 3 weeks ago, the disease developed gradually, the girl became sloppy, her handwriting changed, she began to get tired, cry for no reason. On examination, the child is irritable, sometimes aggressive, emotionally unstable (sometimes crying, sometimes laughing). Movements are uncoordinated, cannot eat by herself, fasten buttons. Grimace on the face. Appetite is reduced. Sleep is restless. The skin is clean, pale. Pulse 100 beats per minute, rhythmic. AD 105/60. Physiological functions are normal.

Tasks

1. Satisfaction of what needs of the patient is violated.

2. Identify the patient’s actual and potential problems.

3. Make a sound nursing intervention plan.

Problem No. 36

You are a ward nurse at a children’s hospital. An 8-year-old child was hospitalized to the department with a diagnosis of Rheumatism I, active phase, endomyocarditis, polyarthritis.

During the examination, the nurse received the following data: complaints of pain in the right knee joint, weakness, shortness of breath and palpitations during exercise, loss of appetite. On examination: T – 37.6 degrees C. The boy is pale, shadows under the eyes. The right knee joint is enlarged, hot to the touch, with the slightest movement pain appears in it. Ps 120 per min. BP 110/70 mm Hg NPV 20 min. Physiological functions are normal.

Tasks

  1. Find out what needs the child is experiencing.
  2. Identify the patient’s problems.
  3. Define goals and create a nursing intervention plan with motivation.

Problem No. 37

You are a ward nurse at a children’s hospital. A 3-year-old child was admitted to the thoracic department for inpatient treatment with a diagnosis of “Congenital heart disease, tetralogy of Fallot, NK I-II st.”

During the examination, the nurse received the following data: while playing with a visiting cousin, the child’s shortness of breath increased, cyanosis of the whole body appeared, which did not decrease for half an hour. An ambulance was called to take the child to the hospital. Congenital heart disease in a child was diagnosed from birth. She is in the dispensary, on the waiting list for surgical treatment. With physical exertion, the child had shortness of breath before, and cyanosis intensified. The child has reduced appetite, poorly gaining weight.

On examination: the boy’s condition is serious. The position in the bed is forced. Frightened expression. The child lags behind in physical development. The skin is pale, pronounced acrocyanosis. Respiratory rate – 60 per minute, pulse 160 beats / min. Heart sounds are sonorous, a rough systolic murmur is heard over the entire region of the heart. The abdomen is soft. Physiological functions are normal.

Tasks

  1. Find out what needs the child is experiencing.
  2. Identify the patient’s problems.
  3. Define goals and create a nursing intervention plan with motivation.

Problem No. 38

You are a ward nurse in the pediatric department of a hospital. You are treating a 10-year-old boy with a diagnosis of Rheumatism I, active phase, endomyocarditis, arthralgia

During a nursing examination: he fell ill acutely, 2 weeks ago he had ARVI. Complains of pain in the left knee joint, weakness, shortness of breath on exertion, intermittent pain in the left half of the chest of moderate intensity. He misses home, misses his parents. Appetite is reduced. On examination – body temperature 37.2 degrees. The skin is pale, blue under the eyes. The food is satisfactory. There are no pathological changes in the area of the joints. NPV – 20 per minute. Pulse 120 beats per minute. BP 110/60 mm Hg Physiological functions are normal.

Tasks

1. Satisfaction of what needs of the patient is violated.

2. Identify the patient’s actual and potential problems.

3. Make a sound nursing intervention plan.

Problem No. 39

You work as a district nurse in a children’s clinic. A 10-year-old child observed at your site was discharged from the cardio-rheumatology department of the children’s hospital in a state of clinical and laboratory remission. Clinical diagnosis: Rheumatism, active phase, primary endomyocarditis, polyarthritis.

Tasks

  1. Make a follow-up plan for the coming year.
  2. What kind of conversations do you have with your parents?

BLOOD DISEASES

Problem No. 40

You are a ward nurse at a children’s hospital. A 12-month-old child is hospitalized with a diagnosis of iron deficiency anemia. Rickets”.

During the nursing examination, the following data were obtained: the child quickly gets tired, is not active, has a poor appetite (feeds by force). The diet of the child is monotonous, mainly dairy food, cereals; fruits, vegetables are rarely given to a child, since. afraid of indigestion. Vitamin D was given irregularly. He holds his head from 2 months, sits from 7 months, walks from 11 months. At the age of 6 months, he suffered from acute respiratory viral infections in a non-severe form.

The child is from the first pregnancy, the first childbirth, the mother is young. The father does not live with his family. The child is rarely on the street, the mother works, the great-grandmother helps in caring for the child. My mother has chronic tonsillitis and works as a technologist.

Objectively: The skin is pale. Reduced nutrition. Tissue turgor is somewhat reduced. Mucous membranes are pale. Cracks in the corners of the mouth (“jamming”). The head is slightly enlarged with protrusion of the frontal tubercles, a large fontanelle 2×2 cm, the edges are dense. There are rosaries on the chest. Respiratory rate 32 per minute, pulse 120 bpm. Teeth-6 (4/2) The abdomen is soft. Stool with a tendency to constipation.

Tasks

  1. Identify what needs are being violated. Identify the patient’s problems.
  2. What additional research methods need to be done? What changes are characteristic in these studies?
  3. Define goals and create a nursing intervention plan with motivation.

Problem No. 41

You work as a district nurse in a children’s clinic. During the next visit to the clinic by a 1.6-year-old child, the nurse noticed a sharp pallor of the patient’s skin and mucous membranes. The mother reported that the child quickly gets tired, irritable, noted a decrease in appetite, eats clay and chalk on the street. When questioning the mother, it was possible to establish that the child’s diet is monotonous: dairy food, dairy products, the child does not like cottage cheese, meat products. The mother gives fruits and vegetables irregularly, fearing to disrupt digestion. The child in the first year of life 3 times had ARVI.

Objectively: body weight – 10700 g, height – 80 cm. The skin and visible mucous membranes are pale. Reduced nutrition Muscle tone is somewhat reduced. The large spring is closed. Teeth – 8. In the blood test: Hb-98 g / l, Er-3.0×10 12 , c.p. – 0.8

Medical diagnosis: iron deficiency anemia.

Tasks

  1. Identify needs that are not met.
  2. Rate the blood test.
  3. State the patient’s concerns.
  4. Set goals and plan nursing interventions with motivation.

Problem No. 42

You are a ward nurse in the pediatric hematology department. A 10-year-old boy with a diagnosis of thrombocytopenic purpura is hospitalized.

During the nursing examination, the following data were obtained: Ill for 2 years, deterioration occurred during the last week (had ARVI), hemorrhages appeared on the skin and oral mucosa. Complaints about a nosebleed that appeared a few minutes ago (during the game). Objectively: conscious, oriented, communicative, but anxious. The skin is pale, multiple hemorrhages in the form of spots of various sizes and shapes, randomly located, of various colors (crimson, blue, green, yellow). Respiratory rate 22 per minute, pulse 112 per minute, blood pressure 100/60 mm Hg.

Tasks

  1. Find out what needs are being met.
  2. State the patient’s concerns.
  3. Define goals and draw up a nursing intervention plan with motivation.
  4. What are the causes of nosebleeds in this child?

Problem No. 43

You work as a ward nurse at a children’s hospital. A 9-month-old child was admitted to the clinic with a diagnosis of iron deficiency anemia, moderate form.

During the nursing examination, the following data were obtained: complaints of pallor of the skin, a sharp decrease in appetite, sleep disturbance. A child from 2 months of age is artificially fed with the “Baby” mixture, from 4 months he receives semolina porridge 2-3 times a day, vegetable puree is introduced at 5 months, but the child eats it reluctantly, therefore he receives it irregularly. Receives apple and carrot juices, but irregularly. The child receives meat broth, minced chicken, cottage cheese daily. In the second half of the year he had ARVI, bronchitis.

On examination: The child is not very active. The skin is dry, pale with a waxy tint, cyanosis around the mouth, aggravated by anxiety and crying. The hair on the head is sparse and thin. Reduced nutrition. Teeth 0/2. Heart rate 140 per minute. In the blood test: er. 3.6×10 12 /l, Hb 80 g/l, c.p. 0.7.

Tasks

1. What do you see as the reason for the development of anemia in a child?

2. Find out what needs the child is unable to meet.

3. State the patient’s problems.

4. Set goals and create a nursing intervention plan with motivation.

Task No. 44

You work as a ward nurse in the pediatric hematology department. A 7-year-old boy is admitted for inpatient treatment with a diagnosis of Hemophilia.

During the nursing examination, the nurse received the following data. From the age of 2, the boy has been experiencing prolonged (during a day or more) bleeding with the most minor injuries. With small bruises, extensive massive subcutaneous hematomas are often formed. At the age of 4 years, hemarthrosis of the left knee joint developed after a bruise. Periodically treated in a hospital, is on dispensary records.

Two days ago, the child accidentally cut his finger, a few hours after the injury, bleeding from the wound began, the bleeding from the cut does not stop. When examined in the blood: er. – 3.3×10 12 / l, Hb – 70 g / l, leukocytes – 7.2×10 9 / l.

Tasks

  1. Satisfaction of what needs is violated in the boy.
  2. State the patient’s concerns.
  3. Set goals and create a nursing intervention plan with motivation.

Problem No. 45

You are a ward nurse in the pediatric hematology department. A 5-year-old child with a diagnosis of “Hemorrhagic vasculitis, skin-abdominal-renal form” was admitted to inpatient treatment.

During the nursing examination, the following data were obtained: complaints of intense pain in the abdomen, nausea, and periodically vomiting after eating. Body temperature 37.8 degrees C. Symmetrically located hemorrhagic rash on the skin of the legs, itching, pinpoint hemorrhages on the oral mucosa. Multiple caries. The abdomen is not swollen, painful on palpation, especially in the navel. The stool is liquid, dark in color, without mucus. Urine red.

From the anamnesis: two days ago the boy was injected with gamma globulin. On the same evening, he developed abdominal pain, vomiting with blood, and a rash on his legs.

Tasks

  1. Find out what needs are being met.
  2. Identify the patient’s problems.
  3. Define goals and create a nursing intervention plan with motivation.

Problem No. 46

You are a pediatric ward nurse. A 6-month-old child is admitted for inpatient treatment with a diagnosis of Iron deficiency anemia, moderate form. Degeneration of the type of malnutrition of the 1st degree.

During the nursing examination, the following data were obtained: complaints of restless sleep, stools with a tendency to constipation, underweight, pallor of the skin and mucous membranes. The child was born with a weight of 3200 g. From 1 month. a child fed with unadapted mixtures receives complementary foods in the form of porridge 2-3 times a day. Receives juices and fruit puree irregularly. Objectively: The child is lethargic, capricious. Skin and mucous membranes are pale. The subcutaneous fat layer is thinned on the abdomen, chest, limbs.

For feeding eats 100 ml of food. Has a body weight deficit of 16%. Respiratory rate 46 per minute, pulse 140 bpm.

In the study of blood: er. 3.2 x 10 12 /l, Hb 84 g/l, c.p. – 0.65

Tasks

  1. Find out what needs are being met.
  2. Identify the patient’s problems.
  3. Explain to the mother the nutritional needs of the child. Make a menu for 1 day.

Problem No. 47

You are a kindergarten nurse. During a routine examination of a three-year-old child in the general blood test: erythrocytes 3.5 * 10 6 , Hb 90 g / l, color. p. 0.8. From the anamnesis: the boy visits the garden for 9 months. From a socially disadvantaged family. He often suffers from acute respiratory viral infections, in the first year of life he suffered an intestinal infection. From a nursing examination: a boy with poor appetite, does not like meat dishes, kefir. Little active, passive in games. The skin is dry, pale, jamming in the corners of the lips. Mucous membranes are pale pink. Reduced nutrition. The chest is compressed laterally. NPV – 20 per minute. Pulse 86 beats per minute.

Tasks

  1. What is the pathological condition of the child? What are its possible causes?
  2. What needs of the patient are not met?
  3. Identify actual and potential patient problems.
  4. Make a sound nursing intervention plan.

Problem No. 48

You are a pediatric hematology nurse. A 7-year-old girl comes to you with a preliminary diagnosis of acute leukemia.

From the anamnesis it is known that 2 weeks ago, after returning from the holiday camp, there were complaints of poor appetite, weakness, headaches, bone pain, many bruises appeared on the skin without a visible traumatic factor, and there was a prolonged fever. Nursing examination: sharp pallor of the skin and mucous membranes, bruises on the skin of the lower leg, buttocks. Enlarged submandibular, axillary, inguinal, cervical lymph nodes, dense on palpation. Pain in the bones when tapped. Increased bleeding gums. The girl is worried, afraid of examination.

Tasks

1. Satisfaction of what needs of the patient is violated.

2. Identify the patient’s actual and potential problems.

3. Make a sound nursing intervention plan.

Be First to Comment

Leave a Reply

Your email address will not be published.