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URN: 9833360 |PATIENT: HERMIONE GRANGER DOB: 15 APRIL 2016 | PAEDS, USQ HOSPITAL SITUATION: Miss Hermione Granger, a 5-year old girl, was brought in by ambulance accompanied by her mother following a collision with a car whilst riding her bicycle. The collision was at low speed. The injuries she sustained include a suspected fracture of her left tibia and fibula, multiple grazes across her legs and feet, left hip, and shoulder. She has a 5cm laceration on her left elbow. Hermione was wearing her helmet but has sustained a small graze above her left eyebrow. BACKGROUND Miss Hermione Granger has no past medical and surgical histories. She lives at home with her parents and a younger brother. Miss Hermione Granger was born at 38 weeks gestation with no neonatal complications. Her immunisation is up to date. ASSESSMENT Her Glasgow Coma Scale (GCS) is 15, moving right upper and lower limbs with mild weakness, mild weakness in left upper limb and severe weakness in left lower limb. Both her pupils equal and reactive to light. Her vital signs are as follows: Heart Rate 130 bpm Respiration 30 bpm Blood Pressure 120/60 mmHg SaO2 99%. She was crying due to the injuries she sustained. All blood investigations were done, and results were unremarkable. CT Trauma done and was normal (Fig 1) including her left tibia and fibula (Fig 2). RECOMMENDATION Continue neurological observations. Miss Hermione Granger will be kept Nil by Mouth (NBM) until she is awake. She has had IN Fentanyl STAT administered prior to CT Trauma and a second dose during the procedure. Miss Hermione Granger has analgesia prescribed as well as intravenous therapy. Figure 1: Ct Head Figure 2: Left Tibia and Fibula Paediatric Neurological Observation Record: Glasgow Coma Scale NAME: HERMIONE GRANGER DATE OF BIRTH: 15 APRIL 2016 URN: 9833360 GENDER: Female A fall in GCS of 2 or more points requires review by Medical Officer Date Time< 1="" year=""> 1 year Eyes open Opens spontaneously Opens spontaneously 4 X X C= Eyes closed by swelling Opens to voice Opens to voice 3 Opens to pain Opens to pain 2 No response No response 1 Best verbal response Cues/babbles/cries appropriately Uses appropriate words/ phrases 5 X X T= Endotracheal Tube OR Tracheostomy Irritable cry/ grimace Uses inappropriate words/ phrases 4 Cries only to pain Persistent crying and/ or screaming 3 Grunts Moans to pain 2 No response No response 1 Best motor response Moves spontaneously Obeys commands 6 X X + Reactive - No reaction S Sluggish C Closed Withdraws to touch Localises to pain 5 Withdraws to pain Withdraws to pain 4 Abnormal flexion Abnormal flexion 3 Extension Extension 2 No response No response 1 Glasgow Coma Scale Score 15 15 15 Pupils Right Size 4 4 Reaction + + Left Size 4 4 Reaction + + Limb movement Arms Normal power Record (R) right (L) left Separately if there is a difference Mild weakness RL RL Severe weakness No response Legs Normal power Mild weakness R R Severe weakness L L No response Fontanelle Sunken Dehydrated C= Crying √ present Soft Normal X X Tense Raised ICP Bulging Raised ICP Initial LN LN WHAT YOU NEED TO DO — After reading the case study and reviewing all the charts in this workbook, respond to the task questions using the link below. PRESENTATIONS REQUIREMENTS — Question 1 to 5 must be written using formal academic sentence structure (compete paragraphs that are grammatically correct, with in-text referencing, and no dot-points, figures, or tables) — Question 1 to 5 must be written in third person — An introduction and conclusion paragraph are not required — Referencing: USQ APA 7th (https://usq.pressbooks.pub/apa7/ ) and references need to be current, the last 7 years Question 1 The initial assessment of the child’s overall condition is of crucial importance. The initial assessment of an unwell child includes the paediatric assessment triangle: appearance, breathing and circulation to skin; primary survey that focuses on basic life support, patient assessment and immediate management; secondary survey with a detailed history of the event and physical examination; and ongoing assessment. Discuss and justify with evidence-based literature one (1) reason for this (2 marks) Question 2 Intranasal delivery has been used for several different purposes including vaccinations. Discuss and justify with evidence-based literature two (2) reasons that contraindicate the use of this route in patients (4 marks) Question 3 Describe and justify using peer-reviewed evidence three (3) nursing interventions that should be implemented to reduce the risk of complications to this patient (9 marks) https://usq.pressbooks.pub/apa7/ Question 4 Identify and discuss one (1) priority problem for Miss Hermione Granger during her admission to the Paediatrics Ward. Justify the priority with peer-reviewed evidence (3 marks) Question 5 Coping with stress reactions is common after a serious illness, injury, or a hospital stay. Even though it is the child who is ill or injured, the whole family can be affected. It’s normal for the parents to feel overwhelmed trying to help the family and themself to cope. Discuss and justify with evidence-based literature three (3) nursing interventions that could help alleviate stress experienced by parents in this situation (9 marks) Reference LAB ASSESSMENT MARKING RUBRIC REMINDER: Each question on the case study has been allocated with individual marks- please refer to questions in case study Marks (1.5 mark) 1.5 marks 1.2 marks 0.9 mark 0.6 mark 0.3 mark 0 mark Academic writing High level of academic writing. Correct terminology and professional language. Skilful use of language that conveys meaning with clarity and fluency. No errors in tense, spelling, punctuation, or grammar. Good level of academic writing. Generally, uses Correct terminology and professional language. Uses language that effectively conveys meaning with clarity and fluency. Minimal errors (2-4) in tense, spelling, punctuation, or grammar. Satisfactory level of academic writing. Uses correct terminology and professional language for some of the responses (answers). Uses straightforward language that generally conveys meaning. Occasional errors in tense, spelling, punctuation, or grammar that reduce readability. Limited level of academic writing. Incorrect terminology and professional language frequently throughout the responses (answers). Language used means it is frequently difficult to determine meaning. Frequent errors in tense, spelling, punctuation, or grammar that reduce readability. Unsatisfactory level of academic writing. Uses incorrect terminology and professional language throughout the responses (answers). Uses language that often does not convey meaning or is difficult to determine meaning. Frequent errors in tense, spelling, punctuation, or grammar that interfere with effective communication. Serious problems with mechanics of language. No submission. Marks (1.5 mark) 1.5 marks 1.2 marks 0.9 mark 0.6 mark 0.3 mark 0 mark Referencing All aspects of APA referencing are technically correct in reference list and in-text referencing High level of academic sources used. Minimum of 10 peer reviewed journals accessed in addition to other sources to support work. Most aspects of APA referencing are technically correct in reference list and in-text referencing. Generally high level of academic sources used 8-10 peer reviewed journals accessed in addition to other sources to support work. Infrequent errors in APA referencing in reference list and/or in-text referencing. Mostly academic sources used with some non-academic sources. Some peer-reviewed journals accessed in addition to other sources to support work. Frequent errors consistent in APA. referencing in reference list and/or in-text referencing.