Care of Children and Adolescents (CCA206) T3 2023 Assessment 2 - Case study/ scenario Name: Oscar Wilson Age: 4 years Sex: Male Accompanied by: Meghan Wilson (mother) and Patricia Foster (Grandmother) Present Medical History Oscar presented to the Paediatric Emergency Department (PED) at 1400. Chief complaints included lethargy, fever (very high temperatures), runny nose, and productive cough for the past three to four days. Oscar appeared to be very sleepy and stayed in bed all the time over the past two days. His oral intake was poor during the past week. Oscar has complained of nausea, refused oral food/fluids and had two episodes of vomiting since this morning. He also had one episode of seizures (generalised tonic-clonic seizures) this morning @ around 1000. Past Medical History History of recurrent cold and cough, latest occurrence approximately 4-6 weeks ago Hospital admission X 5 days for Acute gastroenteritis 2 years ago Allergies: Nil known Perinatal History First baby, Antenatal period was uneventful Vaginal birth at 38 weeks, Birth weight: 3.5 Kg, Length & Head circumference: data not available Postnatal: Developed neonatal jaundice, and received phototherapy Developmental History Summary based on the family report: Oscar can walk around in the house and lawn, and has started to run around for short distances, however, is not confident to use stairs. Oscar is not toilet trained by day and needs diapers. Oscar can scribble on paper or a board, however, is not able to draw lines or circles. Oscar can put words together to communicate, however, his speech is difficult to understand. can Immunisation History Unvaccinated due to cultural reasons Nutritional History Predominantly bottle-fed in infancy, semi-solid food started at 4 months of age, mealtime is usually extended due to poor acceptance (need coercion/distraction), prefers finger foods. Family History Meghan (Oscar’s mother) has a history of depression, management has been irregular in the past year; Oscar’s Dad has a history of asthma and diabetes. Social History Oscar has not been enrolled on the childcare/ Early Learning Centre. Meghan does not work. Oscar’s Dad works as a truck driver and will be home only for a few days in a month. Meghan’s mum lives close by and was summoned for help when Oscar had the seizure episode this morning. General Appearance Oscar appears very Cred, drowsy and unsealed. He also appears underweight, his skin is smudged with dirt, and his clothes are smelly Anthropometry Length: 98.0 cm Weight: 12.2 kg Vital signs Respiratory rate: 34-38 breaths per minute Oxygen saturation: 95-97 % on room air Heart rate: 150-160 beats per minute Blood Pressure: 90/58 mm of Hg Capillary refill Cme: 3 seconds Temperature: 39.1°C Neurological GCS 13/15 (E3V4M6), Neck sCffness++, Pain, associated involuntary effort to reduce meningeal stretching (Brudzinski sign +, Kernig sign+), Pupils bilaterally equal and reactive, History of one episode of seizure Respiratory Rhinorrhoea and occasional productive cough Mild increased work of breathing Cardiac/Abdomen/Musculoskeletal: Nil issues noted, abdomen sop, non-tender Renal: last diaper change was 14 hours ago (small amount of urine, yellow) Skin and mucous membranes Dry lips and mouth Few petechial spots on the trunk Medical diagnosis ? Acute Bacterial MeningiIs Treatment plan Admission Contact and Droplet precauCons continuous monitoring of RR, HR, SpO2 Hourly (and PRN) monitoring for - full neurological observations, seizures, blood pressure, temperature and Fluid Balance Chart (FBC) Nil by Mouth until review Blood sample for Venous gas, Full Blood evaluation (FBE), Biochemistry, Culture Lumbar puncture – Cerebrospinal Fluid (CSF) for biochemistry, microscopy, and culture (before commencing anCbioCcs) IV cannulation, IV fluids - 0.9% sodium chloride + 5% glucose for maintenance (consider 2/3 of maintenance volume. To be revised based on hydration status, Na+ levels, and acid-base status) IV AnCbioCcs, steroids, paracetamol Seizure management Paediatric Medical team to review Consider CT /MRI (MagneCc Resonance Imaging) and further management after Paediatric Medical Consultant’s review 1. Describe the multidisciplinary processes for managing any complex safeguarding issues related to the child in the case study, based on the child protection responsibilities of a Registered Nurse in your State or Territory. 2. Identify and discuss the medication management complexities in the case study scenario and include in care planning. 3. Appraise suitable risk assessment tools, and apply one tool to determine the risk management measures to be integrated into the child’s care plan.