PEDIATRIC ILLNESS AND CONDITIONS

Chapter 40: Nursing Care of the Child With a Respiratory Disorder

1. Gloria is an 8-year-old girl who is admitted to the pediatric unit with a history of cystic fibrosis and difficulty breathing. (Learning Objectives 3, 4, and 6)

a. What would the nurse know to include in the health history?

b. When conducting a physical assessment on Gloria, what will the nurse do in relation to the child’s cystic fibrosis?

c. What tests would the nurse expect to be ordered for Gloria?

2. Jimmy Jones, age 6, is diagnosed with asthma. He has been hospitalized for 3 days for an acute exacerbation and is scheduled to go home tomorrow. (Learning Objectives 9 and 10)

a. What would the nurse know to include in a child/family teaching plan?

b. How can asthma affect a child’s self esteem?

Chapter 41: Nursing Care of the Child With a Cardiovascular Disorder

1. Baby boy Ellis, 2 hours old, is being evaluated in the newborn nursery by the nursing staff. Findings include T 37°C; apical heart rate 140 bpm; respirations 58 breaths per minute; BP (arms) 70/47, (calves) 62/39; head circumference 34 cm; chest circumference 31 cm; length 48 cm; weight 2,700 g. The infant is crying. (Learning Objectives 1, 2, 3, 4, and 8)

a. Based on the physical findings, what should be the nurse’s priority?

b. What assessments/tests should the nurse expect to be done on this infant?

c. What should the nurse include in the teaching plan for the parents of this infant?

2. Jennifer Collins, 13 years old, is admitted to the pediatric floor with a diagnosis of probable acute rheumatic fever.

a. What would the nurse include when performing an initial assessment?

b. What tests would the nurse expect to be done on Jennifer?

The diagnosis of acute rheumatic fever is confirmed.

c. What would the nurse be sure to include in the discharge teaching plan for Jennifer and her family?

Chapter 44: Nursing Care of the Child With a Neuromuscular Disorder

1. Pamela Souza, 6 years old, was born with cerebral palsy. Pamela suffers from general spasticity, mental impairment, impaired vision and hearing, and hydrocephalus. She has been admitted to the pediatric unit for evaluation of intrathecal spasticity control. (Learning Objectives 2, 3, 4, and 6)

a. Identify medications that might be used to help control Pamela’s spasticity.

b. What information would the nurse include in the health history?

c. What nursing interventions would be important in Pamela’s care?

d. What information would be important to include in a teaching plan for Pamela and her family?

2. Kyle Stephens, 15 years old, is brought to the emergency department by ambulance after a diving accident at a local lake. (Learning Objectives 1, 2, 3, 4, and 7)

a. What nursing assessments would be important for Kyle?

b. What diagnostic tests would the nurse expect to be ordered for Kyle?

Kyle is found to have crushed vertebrae at the S4-5 level with a partially severed spinal cord.

c. What would be important teaching points for Kyle and his family?

Chapter 49: Nursing Care of the Child With an Endocrine Disorder

1. Jalissa Twyman, 8 years old, was admitted to the pediatric intensive care unit with a closed head trauma after being involved in a bicycle/motor vehicle accident. Jalissa is unconscious. The nurses caring for Jalissa document a weight loss of 1.82 kg over a 24-hour period, decreased skin turgor, and dry mucous membranes. Urine output for the same 24-hour period is 3.5 L/m2. (Learning Objectives 1, 2, 3, 4, 5, and 7)

a. What further assessments should the nurse perform on Jalissa?

b. What laboratory tests would the nurse expect to be performed on Jalissa?

c. What nursing interventions should be done for Jalissa?

2. Aellai Gianopoulos, 13 years old, is brought to the clinic by her mother, who states that Aellai is losing her hair. Vital signs are as follows: T 98.4°F, HR 85, R 15, BP 121/78. Height is 64 in., and weight is 81.5 kg.

Aellai has an olive complexion marred by acne, large brown eyes, and long black hair that is very thin on the top of her head. Her breasts are small and she has an abundance of hair on her arms and legs. She reached puberty approximately 6 months ago. (Learning Objective 1, 2, 3, 4, 5, 7, and 8)

a. What other information should the nurse gather in the health history?

b. What laboratory tests would the nurse expect to be ordered for Aellai?

c. What should the nurse include in the teaching plan for Aellai and her family?

Running head: NURSING MANAGEMENT OF THE NEWBORN

NURSING MANAGEMENT OF THE NEWBORN 8

NAME: Adebola Amoo Ross

As a postpartum nurse your next client is an LGA baby boy who was born at 37 weeks’ gestation. He had Apgar scores of 8 and 9. He was circumcised. The mother is breast-feeding. Your unit requires a full assessment, screenings, discharge instructions, and documentation. (Learning Objectives 4, 7, 8, and 10)

1. Describe what a normal head-to-toe assessment would be for an infant born at 37 weeks’ gestation. What test is used to determine this gestational age? What is the scale used to determine the Apgar score, and are this baby’s scores normal?

2. As the discharging nurse, you are responsible for what screenings in an infant in the first 24 to 48 hours? What immunizations would be required?

3. What discharge instructions would be pertinent to this mother? How would you educate her or the family?

4. How would you document your discharge teaching? Write a sample narrative of your teaching.

Definition of the Diagnosis

A new born baby usually undergoes several tests in order to detect any disorders that might need immediate medical attention (Susan, Terri & Susan, 2009). The test begins with physical examination which includes measurement of weight, length and head circumference. The heart rate, muscle tone, skin color, reflexes and breathing effort is also examined and scores of between 0 and 10 are given using the Apgar scale depending on the observed conditions. A baby with good health has an Apgar score above 7 whereas an Apgar score below 5 indicates that the baby may need immediate medical care. The gestation age is determined using the Ballard scale. It could either be small for gestation age (SGA), appropriate for gestation age (AGA) or large for gestation age (LGA). LGA’s refers to babies or infants whose age or gender is larger than expected or their birth weight greater than the 90th percentile. Some of the common risks in LGA infants include birth trauma, diabetes mellitus, metatarsus, adductus and hip subluxation (Angelica , Flaminia , Mania, Simona, Sara , & Cristina, 2014). Gestation diabetes is the common cause of LGA babies, other causes include, excessive maternal weight gain, fetal sex, increased gestation age and use of amoxicillin and pivambicillin antibiotics during pregnancy (Lawrence, 2017).

Common Signs and Symptoms

The common signs and symptoms for LGA babies are those that are related to the complications that may occur.

Potential Complications

Some of the potential complications associated with LGA newborns are birth injuries, perinatal asphyxia, difficult delivery, meconium aspiration, low Apgar score, lung problems, hypoglycemia, birth defects, and polycythemia (Cervellin, Comelli , Bonfanti, Numeroso , & Lippi, 2019).

Head to Toe Assessment

Vital Signs: Temperature, 98.6°F; blood pressure, 45/80 mm Hg; heartbeat, 160 beats/min; respiratory rate, 60 breaths/min, oxygen saturation 100% on room air

HEENT:

Head: the average head circumference of 33 to 35cm, overriding sutures, caput succedaneum

Eye: visual acuity 20/400, normal red reflex, no discharge, white sclera.

Ear: normal configuration that is a third angle of the eye and response to sound

Nose: symmetrical

Mouth: normal configuration; Epstein’s pearl, no cleft palate.

Neck: normal rotation.

Chest: average circumference of 30 to 33 cm, clear heart and lung sounds.

Abdomen: slight protrusion, cord drying, 3 umbilical vessels, liver 2 cm below costal margin, presence of bowel sounds.

Skin: pink skin, erythema toxicum, Mongolian spots, acrocynosis, milia

Genitalia: an open and properly placed urethra; presence of testes in the scrotum.

Limbs: presence of limbs, pink nails and no deformities.

NANDA Nursing Diagnosis

1. Birth injuries

2. Hypoglycemia

3. Lung problems

4. Heart diseases

5. Obesity

Infant screening

1. Otoacoustic emissions (OAE) test and auditory brain stem response (ABR)

The OAE tests is used to determine the response of some parts of the ear to sound while the ABR test is used to evaluate the auditory brain stem and brains response to sound (Angelica et al., 2014).

Desired outcome

Normal hearing

Interventions and rationale

1. Place a miniature earphone and a microphone on the baby’s ear and play a sound.

Rationale: Back reflection of an echo into the ear canal shows normal hearing

Place Band-Aid-electrodes on the baby’s head

Rationale: sound response indicates normal hearing

2. Pulse oximetry test

The pulse ox is a non-invasive test that measures the amount of oxygen in the blood.

Desired outcome

Normal oxygen levels.

Interventions and rationale

Place a pulse CO oximeter on the baby’s skin. The CO oximeter measures the fractional oxyhemoglobin.

Rationale: an oxygen saturation level of more than eighty-nine percent is an indication of healthy individual.

3. Bilirubin test

A jaundiced look on the baby would indicate bilirubin test is required.

Immunization Vaccines

· BCG vaccine

· Hepatitis B

· OPV

Discharge Instructions

· Keep the circumcision wound dry and clean and apply ointment daily.

· Breast feeding of the baby every two or three hours’ time

· Avoid any other food apart from the breast milk

· Wrap the baby to maintain normal temperatures

· Bathing the baby daily and take good care of the umbilical cord

· Contact the doctor in case of any abnormal signs and symptoms.

Documentation of the Discharge Teaching

The discharging teaching is done using the Focus, data, action, Response way. Mother of a circumcised LGA baby boy born at 37 weeks educated on wound care, baby care, breast feeding and follow up.

Documentation sample

Date	Time	focus	Notes
15/02/2020	12:57pm	Health education	The mother is able to follow the guidelines given and can handle the baby well.

References

Angelica D., Flaminia C., Mania G., Simona C., Sara C, & Cristina O. (2014). Investigation of the 1H-NMR based urine metabolomics profiles of IUGR, LGA and AGA newborns on the first day of life. The Journal of Maternal-Fetal & Neonatal Medicine: 27(2)

Cervellin G., Comelli I., Bonfanti L., Numeroso F., & Lippi G. (2019). Emergency diagnostic testing in pregnancy. Journal of laboratory and precision medicine: 5(2). doi: 10.21037/jlpm.2019.10.04

Lawrence E. (2017). A matter of size: Part 2. Evaluating the large-for-gestational-age neonate. PubMed journals

Susan S., Terri K., & Susan C. (2009). Maternity and Pediatric Nursing, 2nd ed. ISBN: 978-1-60913-747.

Child with a cardiovascular disorder

Chapter 41: Child with a cardiovascular disorder

Case 1: Baby boy Ellis, 2 hours old, is being evaluated in the newborn nursery by the nursing staff. Findings include T 37°C; apical heart rate 140 bpm; respirations 58 breaths per minute; BP (arms) 70/47, (calves) 62/39; head circumference 34 cm; chest circumference 31 cm; length 48 cm; weight 2,700 g. The infant is crying.

i. Based on the physical findings, what should be the nurse’s priority?

The nurse should first focus on the breathing rate and heartbeat of the child. The baby has a slightly high apical heart rate and temperature. Incorrect. Go review normal VS for a newborn,

Therefore, the baby’s temperature need to be reduced to normal and he also needs to be put on oxygen to help him with breathing until his breathing system has developed fully.

Look at the BPs again.. Why are UE BPs higher then LE? This is the question/

ii. What assessment /tests should the nurse expect to be done on this infant?

Cardiovascular magnetic resonance imaging,

fetal echocardiogram, the baby is born.. no longer a fetus

chest x-ray, pulse oximetry, cardiac catheterization, and electrocardiogram tests are expected to be done on the infant (Hockenberry & Wilson, 2018).

iii. What should the nurse include in the teaching plan for the parents of this infant?

c. Need to answer the above correctly first.

The nurse needs to inform the parents that the child is receiving intravenous (IV) fluids or having adjustments to make his breathing easier. He or she should also assure the parent that their baby is doing well. The nurse should teach the parents on how to care for their child once he is discharged. For example, they should always keep the baby warm to prevent cyanosis, observe the baby keenly and report to the doctor anytime the baby lacks enough oxygen and they should look out for symptoms like blue skin color and difficulty in breathing for this diagnosis, and also understand how to give medicine to the baby (Hockenberry & Wilson, 2018).

CASE 2: Jennifer Collins, 13 years old, is admitted to the pediatric floor with a diagnosis of probable acute rheumatic fever?

1. What would the nurse include when performing an initial assessment?

Nursing assessment for probable acute rheumatic fever include;

· History – the nurse will interview the caregiver to get an up to date history of the child. He or she will enquire about any recent respiratory infection or sore throat and also find out the time that the symptoms begun.

· Physical exam – the nurse will begin with a thorough review of all systems and note the physical condition of the child, look out for any signs and classify them as either major or minor manifestations, check temperature and pulse, examine swollen or painful joints, subcutaneous nodules, and look for any signs of chorea (Carapetis et al., 2005).

. History of recent streptococcal infection

. History of joint pain and/or fever

. Past history of ARF

. Observation for Sydenham chorea

. Observation for erythema marginatum

. Palpation of the surfaces of the wrist, elbows, and knees for firm, painless, subcutaneous nodules

. Presence or absence of heart murmur

0. What tests would the nurse expect to be done on Jeniffer? The diagnosis of acute rheumatic fever is confirmed.

The following tests are expected to be done on Jeniffer;

· Throat culture test

· Rapid antigen detection test – this is used to detect group A streptococci antigen which allows the diagnosis of streptococcal pharyngitis to be made.

· Antistreptococcal antibodies test – when antistreptococcal antibodies are at their peak that is when the features of rheumatic fever begin to show. This is the best test to confirm acute rheumatic fever for people who show chorea as the only diagnostic criterion.

· Heart reactive antibodies – this is a test to see if tropomyosin is elevated in persons with acute rheumatic fever.

· Rapid detection test for D8/17 – this is a immunofluorescence technique for identifying the B-cell marker D8/17 and see if it is positive.

· Other tests will be chest radiography and Echocardiography.

0. What would the nurse be sure to include in the discharge teaching plan for Jennifer and her family?

As the baby gets discharged, the nurse should include the following in the teaching plan for Jeniffer and her family; they should always be very keen on any symptoms of rheumatic fever and see the doctor immediately because there is no cure for rheumatic fever but the symptoms can be treated (Carapetis et al., 2005). Also, the child will need to be to be taken back to the hospital for follow ups with cardiology as symptoms of valve damage may not be detectable until later in the future. Also, matters hygiene should be included in the teaching plan. This is because many studies have shown that there are higher occurrences of rheumatic fever in places with poor sanitation and overcrowding.

References

Carapetis, J. R., McDonald, M., & Wilson, N. J. (2005). Acute rheumatic fever. The Lancet, 366(9480), 155-168.

Hockenberry, M. J., & Wilson, D. (2018). Wong’s nursing care of infants and children-E-book. Elsevier Health Sciences.

The child with a neuromuscular disorder

Chapter 44: The child with a neuromuscular disorder

Case 1: Pamela Souza, 6 years old, was born with cerebral palsy. Pamela suffers from general spasticity, mental impairment, impaired vision and hearing, and hydrocephalus. She has been admitted to the pediatric unit for evaluation of intrathecal spasticity control.

A. Identify medications that might be used to help control Pamela’s spasticity?

Medications that can be used to control Pamela’s spasticity include; Baclofen, Tizanidine, Dantrolene sodium, Diazepam, Clonazepam, and Gabapentin.

B. What information would the nurse include in the health history?

C. Gestational and perinatal events

D. History of head trauma

E. Feeding and weight loss

F. Seizure activity

G. Respiratory status: Has a cough, sputum production, or increased work of breathing developed?

H. Motor function: Has there been a change in muscle tone or increase in spasticity?

I. Presence of fever

J. Any other changes in physical state or medication regimen

The nurse will include the following in the health history of Pamela; mental retardation, Oromotor dysfunction, document if the patient has language and speech disorder, hearing and Ophthalmologic disorders (Perry et al., 2017).

K. What nursing interventions would be important in Pamela’s care?

The best nursing interventions that best suit Pamela’s case include;

You need to learn what this is to answer this question.

admitted to the pediatric unit for evaluation of intrathecal spasticity control.

· Ensuring therapeutic communication – the nurse should communicate with Pamela’s parents and family so that he or she can learn the child’s activities at home.

· Enhance self esteem – the nurse needs to assist Pamela to increase her her personal judgement on oneself because most of the time children with cerebral palsy have a low self esteem because they are not like their peers.

· Provide emotional support – reassure the patient that all is well and she is doing well

· Strengthen family support – teach the patient’s family on how to treat and interact with her at home so that she feels supported.

· The nurse should also prevent deformity, encourage mobility, increase oral intake of fluids, manage rest and sleep periods, enhance self care, and facilitate communication.

L. What information would be important to include in a teaching plan for Pamela and her family?

l. see above

After the baby will be discharge, care does not stop at that point. It still continues even at home. The following are some of the teaching aspects include teaching the family how to interact well with family, encourage her to play but also ensure that she is not in danger (Perry et al., 2017)

Case 2: Kyle Stephens, 15 years old, is brought to the emergency department by ambulance after a diving accident at a local lake.

1. What nursing assessments would be important to Kyle?

The nurse should assess if Kyle has any injuries in the body especially on the head, the spinal cord should also be assessed to find out if it is injured, she should be assessed for the amount of water taken, check if the airways are functioning well, and also assess the breathing rate and temperatures for any infections.

0. What diagnostic tests would the nurse expect to be ordered for Kyle?

An x-ray is expected to be ordered to confirm the crushed vertebrae and determine how severe it is and also check for any other damages around it. For the severed spinal cord, the nurse expects the following tests to be ordered; CT scan, MRI, or X-ray. All the above tests will enable the doctor to have a clear look at the abnormalities in the spinal cord (Chandy, D., & Weinhouse, 2019).

0. What would be important teaching points for Kyle and his family?

· Catheter care

· Bowel training

· Skin assessment

· Rehabilitation needs

· Sexual functioning

References

Chandy, D., & Weinhouse, G. L. (2019). Drowning (submersion injuries). UpToDate.

Perry, S. E., Hockenberry, M. J., Alden, K. R., Lowdermilk, D. L., Cashion, M. C., & Wilson, D. (2017). Maternal Child Nursing Care-E-Book. Mosby.

Chapter 49: The child with an endocrine disorder

Case 1: Jalissa Twyman, 8 years old, was admitted to the pediatric intensive care unit with a closed head trauma after being involved in a bicycle/motor vehicle accident. Jalissa is unconscious. The nurses caring for Jalissa document a weight loss of 1.82 kg over a 24-hour period, decreased skin turgor, and dry mucous membranes. Urine output for the same 24-hour period is 3.5 L/m2

I. What further assessments should the nurse perform on Jelissa?

The nurse should check if the child has a raised, swollen area from a bruise or a bump, any cuts in the scalp, sensitivity to light and noise, lightheadedness, confusion, and assess the functionality of the nerves, arterial blood pressure, intracranial pressure, heart rate and rhythm, central nervous pressure, and core temperature (Perry et al., 2017).

II. Tachycardia

III. Increased respiratory rate

IV. Urine concentration

VI. What laboratory tests should the nurse expect to be ordered for Jelissa?

A complete blood cell count especially if the child is suspected to have bleeding, CT scan, and MRI scan. Also, there is need to carry out a coagulation profile of the patient.

VII. UA

VIII. CT scan, MRI, or ultrasound of the skull and kidneys

IX. Serum osmolarity

X. Serum sodium

XI. Fluid deprivation test

XII. What nursing interventions should be done for Jelissa?

The nurse should ensure that the neck is positioned at a midline position to prevent jugular vein compression, ensure adequate sedation, ensure that there is no increased pressure on the intra-abdominal pressure, and also establish early enteral feeding because the child has lost weight in 24 hours and needs energy.

Case 2: Aellai Gianopoulos , 13 years old, is brought to the clinic by her mother, who states that Aellai is losing her hair. Vital signs are as follows: T 98.4°F, HR 85, R 15, BP 121/78. Height is 64 in., and weight is 81.5 kg.

She has classic s/s of a specific endocrine disorder.. a big clue is that this is a girl.

a. What other information should the nurse gather in the health history?

The nurse should note down if there are any history of endocrine disorder cases in the family, the age of the onset of the patient’s symptoms, the rate at which the symptoms are progressing, history of menstruation, any other medical history and any medications that the patient could be taking, or has taken before regarding the symptoms (Clare, 2019).

b. What laboratory tests would the nurse expect to be ordered for Aellai?

A twenty four hour urine collection test,

bone density test, For what she is 13yo?

ACTH stimulation test, CRH stimulation test, Incorrect

fine-needle aspiration Biopsy, of what?

oral glucose tolerance test, dexamethasone suppression test, Incorrect

five day glucose sensor test, and TSH blood test.

c. What should the nurse include in the teaching plan for Aellai and her family?

The nurse should develop a teaching plan for Aellai and her family to enable them to understand what is happening to Aellai and the care that she needs. The plan should include the following; it is important to first of all know that children are different and they grow at a different rate. However, their Aellai has endocrine disorder whereby the hormones responsible for the growth and development of her bone, reproductive organs, and secondary sex characteristics, and the hormones responsible for hair growth and skin pigmentation (Clare, 2019). Therefore, Aellai should visit an endocrinologist regularly for correction and monitoring.

References

Clare, C. (2019). Endocrine Disorders. Learning to Care E-Book: The Nurse Associate, 455.

Perry, S. E., Hockenberry, M. J., Alden, K. R., Lowdermilk, D. L., Cashion, M. C., & Wilson, D. (2017). Maternal Child Nursing Care-E-Book. Mosby.

Chapter 44: The child with a neuromuscular disorder

A. Identify medications that might be used to help control Pamela’s spasticity?

Medications that can be used to control Pamela’s spasticity include; Baclofen, Tizanidine, Dantrolene sodium, Diazepam, Clonazepam, and Gabapentin.

B. What information would the nurse include in the health history?

C. Gestational and perinatal events

D. History of head trauma

E. Feeding and weight loss

F. Seizure activity

G. Respiratory status: Has a cough, sputum production, or increased work of breathing developed?

H. Motor function: Has there been a change in muscle tone or increase in spasticity?

I. Presence of fever

J. Any other changes in physical state or medication regimen

The following is the information that the nurse is expected to include in the health history regarding Pamela; history of head trauma, gestational and perinatal events, find out if the baby is She is 6yo..not a baby

feeding well and also identify any weight loss, seizure activity, indicate the respiratory status of the child including any coughs, sputum production, or increased work of breathing development, presence of fever, any changes in physical state or medication regimen, and motor functions of the baby(Perry et al., 2017).

L. What nursing interventions would be important in Pamela’s care?

The best nursing interventions that best suit Pamela’s case include;

· Assisting with the administration of baclofen

· Assessment of spasticity before and after administration of medication

· Preoperative care and teaching

· Postoperative care and teaching

· Emotional support for Pamela and her family

· The nurse should teach the parents about the programmable delivery system, frequent checks and how to adjust dose and programming.

· If the patient is eligible for baclofen, the nurse should give it with caution to prevent hallucinations, possible psychosis, or any other serious effects and also bare in mind that abrupt discontinuation may lead to other serious reactions.

· Strengthen family support – teach the patient’s family on how to treat and interact with her at home so that she feels supported.

· The nurse should also prevent deformity, encourage mobility, increase oral intake of fluids, manage rest and sleep periods, enhance self care, and facilitate communication.

M. What information would be important to include in a teaching plan for Pamela and her family?

N. Information about the type of pump being inserted and how it works

O. Information and expectations about intrathecal baclofen treatment

P. Daily care of the surgical incisions

Q. Notify the physician or nurse practitioner if the child has a temperature greater than 101.5ºF, or if the child has persistent incision pain.

R. Avoid tub baths for 2 weeks.

S. Do not allow the child to sleep on the stomach for 4 weeks after pump insertion.

T. Discourage twisting at the waist, reaching high overhead, stretching, or bending forward or backward for 4 weeks.

U. When the incisions have healed, normal activity may be resumed.

V. Wear loose clothing to prevent irritation at the incision site.

W. Carry implanted device identification and emergency information cards at all times.

The nurse should include the following in the teaching plan; the drugs should be taken exactly as they have been prescribed and they should not stop giving Pamela the drugs without consulting the healthcare giver because abrupt discontinuation may lead to serious reactions. The family should also be aware that these drugs may have side effects like dizziness, confusion, drowsiness, nausea, insomnia, headache, frequent or painful urination but these side effects will go away after discontinuation of the drug. However, it is important to report if the side effects of the drug persist or become severe(Perry et al., 2017)

Case 2: Kyle Stephens, 15 years old, is brought to the emergency department by ambulance after a diving accident at a local lake.

1. What nursing assessments would be important to Kyle?

1. What diagnostic tests would the nurse expect to be ordered for Kyle?

1. What would be important teaching points for Kyle and his family?

Kyle should follow the exercises prescribed by the doctor with the help of the family members so that the spinal cord can heal faster, ensure to sleep in positions that do not harm the spinal cord further, avoid falls, and also ensure that Kyle is taken for follow up checks at the hospital so that his progress can be monitored. There is also a need for rehabilitation so that the child can function normal again. Kyle should be taken through bowel training, skin assessment, and also get assessed on sexual functioning.

References

Chandy, D., & Weinhouse, G. L. (2019). Drowning (submersion injuries). UpToDate.

Perry, S. E., Hockenberry, M. J., Alden, K. R., Lowdermilk, D. L., Cashion, M. C., & Wilson, D. (2017). Maternal Child Nursing Care-E-Book. Mosby.