Child abuse and maltreatment is not limited to a particular   age—it can occur in the infant, toddler, preschool, and   school-age years. Choose one of the four age groups and outline the   types of abuse most commonly seen among children of that age. Describe   warning signs and physical and emotional assessment findings the nurse   may see that could indicate child abuse. Discuss cultural variations   of health practices that can be misidentified as child abuse. Describe   the reporting mechanism in your state and nurse responsibilities   related to the reporting of suspected child abuse.

Case Study, Chapter 10, Principles and Practices of Rehabilitation

1. Mrs. Adams, 72 years of age, is admitted to the rehab unit with the diagnosis of stroke. The stroke affected the limbic area in the brain, which has caused the patient to have emotional labiality (her mood changes rapidly because she misinterprets situations). As a result of the emotional labiality, she sometimes refuses to be repositioned or to participate in physical or occupational therapy. She sometimes also refuses to eat and drink. The patient’s right side is paralyzed and flaccid. She has no feeling on her right side. She has reddened areas on her coccyx and both heels at least 1 cm in diameter that do not go away with repositioning. She is incontinent of urine and stool. She has problems with communication called global aphasia (difficulties understanding speech and the written word and difficulties with speaking and writing). She is 5 feet tall and weighs 178 pounds. She has a tendency to develop skin tears because her skin is thin, and she has several bandages on her arms. The family states they are concerned because the staff on the previous medical-surgical unit would drag their mother up in bed when she slid down. The staff would chart when their mother refused to be repositioned and then would not reposition her for hours.

1. Explain the pathophysiology of the risk factors that predispose Mrs. Adams to developing pressure ulcers?
2. What nursing measures need to be instituted for Mrs. Adams based on the information presented in the case study?

2. You are assigned to care for David Ramsey, a 22-year-old male patient who sustained a back injury secondary to being thrown from a motorcycle. He did not damage the spinal cord, but the computed tomography revealed a compression fracture at L-2 (lumbar area). David complains of severe lower back pain with numbness and tingling in the lower extremities. You identify the following nursing diagnosis: Impaired Physical Mobility.

1. What assessments are indicated based on this nursing diagnosis?
2. List other major nursing diagnoses based on David’s clinical presentation.

Case Study, Chapter 14, Shock and Multiple Organ Dysfunction Syndrome

1. Adam Smith, 77 years of age, is a male patient who was admitted from a nursing home to the intensive care unit with septic shock secondary to urosepsis. The patient has a Foley catheter in place from the nursing home with cloudy greenish, yellow-colored urine with sediments. The nurse removes the catheter after obtaining a urine culture and replaces it with a condom catheter attached to a drainage bag since the patient has a history of urinary and bowel incontinence. The patient is confused, afebrile, and hypotensive with a blood pressure of 82/44 mm Hg. His respiratory rate is 28 breaths/min and the pulse oximeter reading is at 88% room air, so the physician ordered 2 to 4 L of oxygen per nasal cannula titrated to keep SaO2 greater than 90%. The patient responded to 2 L of oxygen per nasal cannula with a SaO2 of 92%. The patient has diarrhea. His blood glucose level is elevated at 160 mg/dL. The white blood count is 15,000 and the C-reactive protein, a marker for inflammation, is elevated. The patient is being treated with broad-spectrum antibiotics and norepinephrine (Levophed) beginning at 2 mcg/min and titrated to keep systolic blood pressure greater than 100 mm Hg. A subclavian triple lumen catheter was inserted and verified by chest x-ray for correct placement. An arterial line was placed in the right radial artery to closely monitor the patient’s blood pressure during the usage of the vasopressor therapy.

1. What predisposed the patient to develop septic shock?
2. What potential findings would suggest that the patient’s septic shock is worsening from the point of admission?
3. The norepinephrine concentration is 16 mg in 250 mL of normal saline (NS). Explain how the nurse should administer the medication. What nursing implications are related to the usage of a vasoactive medication?
4. Explain why the effectiveness of a vasoactive medication decreases as the septic shock worsens. What treatment should the nurse anticipate to be obtained to help the patient?
5. Explain the importance for nutritional support for this patient and which type of nutritional support should be provided?

2. Carlos Adams was involved in a motor vehicle accident and suffered blunt trauma to his abdomen. Upon presentation to the emergency department, his vital signs are as follows: temperature, 100.9°F; heart rate, 120 bpm; respiratory rate, 20 breaths/min; and blood pressure, 90/54 mm Hg. His abdomen is firm, with bruising around the umbilicus. He is alert and oriented, but complains of dizziness when changing positions. The patient is admitted for management of suspected hypovolemic shock.

The following orders are written for the patient:

Place two large-bore IVs and infuse 0.9% NS at 125 mL/hr/line

Obtain complete blood count, serum electrolytes

Oxygen at 2 L/min via nasal cannula

Type and cross for 4 units of blood

Flat plate of the abdomen STAT

(Learning Objectives 1, 4, and5)

1. Describe the pathophysiologic sequence of events seen with hypovolemic shock.
2. What are the major goals of medical management in this patient?
3. What is the rationale for placing two large-bore IVs?
4. What are advantages of using 0.9% NS in this patient?
5. What is the rationale for placing the patient in a modified Trendelenburg position?