Chapter 48: Nursing Care of the Child With an Immunologic Disorder

1. Bryce Morris, 5 years old, has been brought to the physician’s office by his mother for a yearly check-up. During the nursing assessment the nurse notes the following: height 40.5 inches, weight 40 pounds, BP 108/67, pulse 72, R 22, T 37.0°C. When documenting Bryce’s vital signs the nurse recognizes Bryce has dropped from the 50th percentile in height and weight 1 year ago to the 5th percentile now.

Bryce’s mother reports that she is concerned because Bryce seems to have lost his appetite and she wants to know if this is normal for a 5-year-old. She also states that she is “a bit” concerned because Bryce doesn’t seem to want to play anymore and that he has become very irritable. (Learning Objectives 2, 3, 4, and 8)

a. What further assessments should the nurse make?

b. What diagnostic testing should the nurse expect to be ordered?

Bryce is diagnosed with pauciarticular juvenile idiopathic arthritis.

c. What would the nurse know to include in a teaching plan for Bryce and his family?

2. LaWanda Green, 9 months old, is brought to the emergency department by her grandparents. She has red, raised bumps on her chest and back. Her grandmother states that LaWanda became very fussy and that is when they noticed the bumps. (Learning Objectives 1, 3, 4, and 8)

a. What would be the emergency department nurse’s priority assessments? What other assessments should be made?

b. What information would be important to include in the health history?

c. What discharge teaching should be done with LaWanda and her grandparents?

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