Kyle is a nine-year-old boy with a history of cystic fibrosis (CF) who for the past two days has had a fever of 101.9 F and has felt more tired. His cough has become more frequent, and he is bringing up thick yellow mucus. His mother brought Kyle to his CF clinic where he is diagnosed with a left lower lobe pneumonia. Kyle is admitted to the pediatric unit for IV antibiotics. Kyle has a Broviac line for vascular access since he frequently needs IV antibiotics for respiratory infections. Kyle is below the 5th percentile for his weight at 41 pounds (18.6 kg) and is at the 5th percentile for height at 44.5 inches (113 cm). He has a G-tube in place for night feedings. Kyle is in 4th grade and lives at home with both parents. His mother is a stay-at-home mom, and his father works as an IT tech. The family has health insurance through the father’s employer. He receives Medicaid because of his chronic illness. He has missed many days attending school due to CF. The kids at school tease because he is so small.

1. What patient history has clinical significance to the nurse and why?

The most recent vital signs were:

T: 102.6 F/39.2 C (oral)

P: 122 (reg)

R: 28 (reg)

BP: 108/58

O2 sat: 86% on room air

1. What patient vital signs have clinical significance to the nurse and why?

Current Assessment:

• GENERAL APPEARANCE: Slightly anxious appearing and very quiet. Skin is pale with dark circles under both eyes. Appears much younger than age due to slow growth. Does not speak except for nodding head “yes” “no.” Sitting between his parents.
• RESP: Respiratory efforts moderately labored with increased rate. Breath sounds coarse crackles and wheezing throughout lung fields bilaterally with fine crackles heard on inspiration at right base. Moderate subcostal retractions noted, nail beds have a bluish hue in color and have pronounced clubbing.
• CARDIAC: Pale, warm & moist forehead. No edema, heart sounds regular with elevated rate, no abnormal beats, and pulses strong, equal with palpation at radial/pedal/post-tibial landmarks, brisk cap refill noted at forehead Justin has an implanted Broviac line at the left upper chest. The site is clean and dry with a small scar at the insertion site.
• NEURO/MENTAL: Alert & oriented to person, place, time, and situation (x4). Appears to be moderately anxious, listening intently to provider and nurse but not speaking, holding on to Dad’s hand.
• GI: Abdomen soft/nontender, bowel sounds audible per auscultation in all four quadrants. Liver non-palpable, PEG tube in place with expected healing around tube/site
• GU: Voiding without difficulty, urine clear/yellow
• SKIN: Skin integrity intact, skin turgor elastic, no tenting present

1. What patient assessment findings have clinical significance to the nurse and why?
2. What is the nursing priority at this time?
3. What nursing interventions will the nurse initiate based on the priority at this time?

Susie is a 6-month-old female who was brought into the emergency department for diarrhea and vomiting over the past two days. She had two large loose stools the first day and now her mother reports that she has been less active, is not interested in playing, and has been sleepier today. She is unable to keep any feedings down today. She has had 5 loose, watery stools and emesis x4 this morning. She has not had a wet diaper since yesterday evening. Susie has not had any immunizations since birth. She is 26 inches in length and weighs 16 pounds, 4 ounces. She weighed 17 pounds, 2 ounces at her last office visit two weeks ago. Susie’s mother is 21 years old, a single mother, and this is her first child. Susie’s mom is not currently working and lives with her parents and she feels overwhelmed as a new mother.

1. What patient history has clinical significance to the nurse and why?

The most recent vital signs were:

T: 102.2 F/39.0 C (oral)

P: 158 (reg)

R: 36 (reg)

BP: 62/42

O2 sat: 95% on room air

2.What patient vital signs have clinical significance to the nurse and why?

Current Assessment:

• GENERAL APPEARANCE: Irritable when awake, alternates with lethargy once quiet. When awake and crying, tears are not present
• RESP: Breath sounds clear with equal aeration bilaterally, non-labored
• CARDIAC: Skin is pale, cool to touch, cap refill 3–4 seconds in both hands, brachial pulses palpable bilaterally
• NEURO: Lethargic, does not maintain eye contact with mom or caregiver
• GI: Abdomen soft with hyperactive BS x4 quadrants, no apparent tenderness to palpation
• GU: 5 mL dark amber, cloudy urine noted in urine collection bag-sent to lab
• SKIN: Anterior fontanel depressed, eyes slightly sunken, lips and tongue are dry with no shiny saliva present, when skin over abdomen is pinched, remains tented for 2–3 seconds
• 3.What patient assessment findings have clinical significance to the nurse and why?
• 4.What is the nursing priority at this time?
• 5.What nursing interventions will the nurse initiate based on the priority at this time?

Assignment:

Windshield Survey of Your Neighborhood

One way to understand your community is through a tool called “windshield surveys”. A Windshield Survey is simply a method for observing a neighborhood/community. It allows the observer to gain insight and understanding of a community and its people. Utilize the Windshield/Walking Survey to complete this assignment. The following elements are included in a typical windshield survey:

• Boundaries
• Housing and zoning
• Open space
• Commons
• Transportation
• Social service centers
• Stores
• Street people and animals
• Condition of the area
• Race and ethnicity
• Religion
• Health indicators
• Politics
• Media
• Business & industry

Write a 1200-1700-word essay exploring your own neighborhood (look within your zip code). Consider the list above when writing your assessment.

• What did you learn about your neighborhood?
• Did any of your findings surprise you?
• Based on the components of the windshield survey elements, how would you describe your neighborhood?
• Think about improvements to your community. Discuss how housing and zoning could be improved.
•  What would the impact of more open spaces mean for the community?
• How could transportation in your area be improved?
• Describe the services available and how to improve for all populations?

Assignment Expectations-

Rubric: This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again before submission to ensure you have addressed its criteria at the highest level.

Length: 1200 – 1700-word essay: title and reference page do not count towards the minimum word count.

Structure: While APA format is not required for the body of this assignment, academic writing is expected. Include a title page and reference page in APA style.

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (3) scholarly sources to support your claims.

Assignment:

Utilizing the Child Development and Health Promotion template, complete a table for each childhood stage (infant, toddler/ preschooler, school-age and adolescent) with the following information:

• Normal vital signs for this age
• Normal measurements for this age
• Cognitive abilities (Fine motor, gross motor, language, problem-solving)
• Psychosocial development theories
• Immunizations due
• Nutrition guidelines
• Health promotion activities
• Injury prevention education

APA formatting is not required. However, a title page and references should be included.

Assignment Expectations

Length: Complete four charts, one for each of the different stages:

Infant, Toddler/Preschooler, School Age, Adolescent.

Structure: Provide Sherpath and Text References with completed tables. Utilize the Child Development and Health Promotion Worksheet

to complete this project. APA formatting is not required for this assignment except for the references should be included in APA format.

References: Use the appropriate APA style in-text citations and references for all resources utilized.

Format: Save your assignment as a Microsoft Word document (.doc or .docx).