UNIVERSITY OF EASTERN AFRICA, BARATON

SCHOOL OF NURSING AND HEALTH SCIENCES

DEPARTMENT OF NURSING

A CASE STUDY DONE IN PARTIAL FULFILMENT OF THE REQUIREMENTS OF THE

COUSE CHILD HEALTH NURSING

COURSE CODE: NRSG 338

PRESENTED BY:
GLORIA JEPKOECH- SJEPGL2313
KOGEI JOSEPH- SJOSKO2311
DAVID MUTUGI- SMUTMU2112

HAFSA RASHID-SHAFRA2311

DAVIS ONYANGO -SONYDA2211

INSTRUCTOR
MADAM CATHERINE

PLACEMENT UNIT:
PEDIATRIC MEDICAL WARD
Patient’s initials: M.A.O

IP NO: 411114

Gender: Female

Diagnosis: Severe Anemia

Date of Admission: 18/6/2025

Presenting Symptoms: Chest pain

Abdominal pain

Difficulty breathing

Past Medical and Surgical history

This is the patient’s second admission. She was first admitted at Kombewa sub-county hospital 2

weeks ago due to similar complains and she was discharged 3 days ago. The patient has no

significant surgical history. No history of transfusion.

Family history

The patient is a second born in a family of 3. Her eldest sister died last year due to sickle cell

anemia. Her mother died when she was 8 years old in a road accident. There is history of sickle

cell disease in the family. No history of diabetes or hypertension.

Social history
The patent’s father is a businessman and the mother a housewife. They live in a semi-permanent

house that is well ventilated. They have access to clean water and their environment is also clean.

The client comes from a middle social economic class. He has a health insurance as well.

Description of presenting signs and symptoms

The patient was well until 1 weeks before admission when she complained of chest pain and

abdominal pain. The pain is on the lower abdomen. The patient has been in pain for 1 week, and

the pain is stabbing in nature. The patient later developed difficulty in breathing. The patient is a

known sickler since 2014. The patient has been using hydroxyurea and folic acid.

Vital signs on admission

BP- 100/48mm/Hg

Pulse rate- 117 beats per minute

Respiratory rate- 27 breaths per minute

Oxygen saturation- 96%

Temperature- 36.4

Laboratory tests

Full hemogram:

WBC- high

Hemoglobin-low
RC number- low

Number of platelets- low

Biochemistry:

Bilirubin total- high

Total protein- high

Potassium indirect- low

Primary Diagnosis: Severe Anemia

Diagnostic tests and their rationale

Histopathology- gold standard

Core biopsy indicates “starry sky” appearance

Treatment

Analgesics like morphine to relieve pain

Chemotherapy

Rehydration therapy

Antiemetics like ondansetron

Nursing Assessment

(i) Respiratory

Inspection- No nasal flaring, no use of accessory muscles, no chest wall indrawing

Palpation- No tenderness, no masses, symmetrical chest expansion

Percussion- Resonance

Auscultation- Vesicular sound heard over the lung fields and bronchial sounds over the trachea

(ii) Cardiovascular

Inspection- pallor, capillary refill after 3 seconds, lifts or heaves, no peripheral edema, visible

pulsations

Palpation- Peripheral pulse palpable and regular

Auscultation- S1 and S2 heard, no murmurs

(iii) Gastrointestinal

Inspection- abdomen round, no visible peristalsis

Auscultation- active bowel sounds heard

Palpation- no palpable organ

(iv) Genitourinary

No lesions on the labia majora and minora

No vaginal discharge

(v) CNS

No seizures

No dizziness

(vi) ENT
Neck on inspection- no jugular vein distension

Nose- septum is at the midline, nostrils are symmetrical, sinuses are non-tender

Ear- symmetrical, no discharge, skin intact

Throat- oral mucosa pale, moist no thrush

Tonsils- no swelling, no exudate, uvula is at the midline

Throat- oral mucosa is pink with no thrush

Psychosocial assessment

Patient has fear and anxiety- he clings to the caregiver

Parents are stressed about their child’s condition

The child isolates himself from peers

Nutritional assessment

The patient is able to feed well. She takes normal diet: rice, beans, meat, cabbage and fruits. She

looks healthy.

Observations made during the shift

Vital signs were within normal

Patient had pain- administered morphine

Patient able to walk, but a short distance

Nursing Interventions
Encouraged the caregiver to give the patient soft food to prevent risk of choking

Administered morphine to relieve pain

Administered ondansetron to block 5-HT3 receptors to prevent vomiting

Encourage mother to perform oral hygiene to reduce bacterial load that could aspirate to lungs

Play therapy with the patient to distract him from the pain and his condition

How are the interventions aligned with pediatric nursing care standards

It is family centered- I ensure the caregiver is present while administering medications

Did safe medication administration and side effects mitigation

Provided age-appropriate therapeutic play and emotional support

Psychosocial and Emotional Support

Active listening and validation

Address acute anxiety with simple techniques

Involve hospital chaplains or elders for spiritual solace

Form support groups for parents who have children with similar conditions

Link the caregiver to well-wishers during long admissions

Education
Use simple terms when describing the condition

Guide them on their chemo dates

Clarify myths about cancer

Patient Education

Use simple definition to define the condition

Use visual aids to demonstrate how the cancer cells look like

Address myths

Explain to them in simple terms how chemotherapy works, tell them the side effects of the drugs

and how to manage them

During discharge, you tell them the warning signs

Teach then about hygiene practices to be done at home

Tell them the type of food the patients should aet

Encourage them to attend clinics

Pathophysiology

Severe anemia in sickle cell disease occurs due to a genetic mutation that causes red blood cells

to form an abnormal hemoglobin (HbS). Under stress like low oxygen or infection, these cells

become sickle-shaped, rigid and fragile. They break down quickly much faster than normal red

blood cells leading to chronic hemolysis. The bone marrow tries to compensate, but during

crises, production may fall short. This results in a persistent and sometimes sudden drop in

hemoglobin levels, causing severe anemia.

Most important concepts or skills learned through this case study

Pathophysiology of severe anemia

Hemolysis in sickle cell disease

Assessing pain severity and administering analgesics appropriately

Monitoring for transfusion reaction and understanding indications for blood transfusion

Infection control in patients with sickle cell disease

Challenges encountered

Challenges encountered and how you managed

Understanding complex pathophysiology- discussed with qualified staff

Prioritizing interventions- applied the ABC approach

Communication with patient and family- used simple language

Evidence-Based Practice

Administering analgesics during crisis

Transfusion to elevate hemoglobin levels

IV hydration done to prevent sickling of cells

FLACC scale to assess pediatric pain

Continuous monitoring to check oxygen saturation

Folic acid supplementation to increase red blood cell production

Nursing interventions that align with current best practices in pediatrics

Administered Normal saline IV for hydration to prevent sickling

Administering analgesics to ensure the patient is comfortable

Educate the caregivers about the condition in simple terms

Patient Outcomes

(i) Short-Term Outcome

Stabilization of vital signs

Effective pain management

Adequate hydration

Improved oxygenation

Patient and Family understanding

(ii) Long-Term Outcomes

Improved hemoglobin levels

Reduced frequency of crises

Prevention of infection

Improved quality of life

Empowerment and support

REFERENCES

Hockenberry, M.J., &Wilson, D. (2023). Wong’s Essentials of Pediatric Nursing (10th ed.).

Elsevier

Gupte, S. (2022). The Short Textbook of Pediatrics (13th ed.). Jaypee Brothers Medical

Publishers

Myron, Levin et. Al Current Diagnosis and Treatment of Pediatrics (9th ed.). Mc Graw-Hill

Education
 PNUEMONIA

History / Background

Biodata:

Name: T.O.O

Age: 3

Gender: female

D.O.A : 10/7/25

Chief complain

3-year-old male admitted with fever, cough, and difficulty in breathing (DIB).Symptoms began 2 days
prior to admission with a progressively worsening cough and fever.

Past medical and surgical history

No previous hospitalizations or known chronic respiratory conditions. No known allergies to food drug
or enviroment.No history of blood transfusion or surgical procedire done.

Family History:

No family history of asthma, tuberculosis, or immunodeficiency disorders. Parents are healthy and non-
smokers.One elder sibling.No history of chronic disease in the family like HTN or Diabetes.

Social History:

Lives in a one bedroom house with 3 family members. Poor ventilation and occasional use of charcoal
for cooking indoors. Attends a crowded daycare center.Middle-low income household.

2. Clinical Presentation

Signs and Symptoms:

 Cough with purulent sputum.
 Fever (38.9°C), nasal flaring, chest indrawing, and grunting.
 Difficulty feeding and lethargy.
 Audible wheeze and crackles on auscultation.

Vital Signs on Admission:

 Temperature: 38.9°C
 Respiratory Rate:58 breaths/min
  Heart Rate: 140 bpm
 SpO₂: 89% on room air

Diagnostic Results:

 CBC: WBC = 15.35 10^9/L Neutrophils16.65 10^9/L

3. Diagnosis and Clinical Pathway

Primary Diagnosis:

Severe Pneumonia

Differential Diagnoses:

Bronchiolitis

Diagnostic Rationale:

History of acute symptoms + physical exam findings (e.g., respiratory distress)

Treatment Plan:

 IV Antibiotics: Ceftriaxone 650mg OD

 Antipyretics:Paracetamol 195mg TDS
 Oxygen Therapy: Via nasal cannula at 2 L/min.
 Hydration:IV fluids with maintenance and correction for mild dehydration.
 NG feeding: Poor oral intake.

4. Nursing Assessment

Initial Physical Examination:

 Respiratory:Nasal flaring, subcostal/intercostal retractions, grunting, decreased breath sounds

with fine crackles.
 Cardiovascular- Tachycardia; Capillary refill< 2 seconds.
 Neurological: Alert but irritable.
 Nutritional: poor oral intake.
 General Appearance:Pale, fatigued, clingy to caregiver.

Psychosocial Assessment:

 Mother anxious; distressed by child’s condition.

 Strong parent-child bond noted.
 Family coping through faith and community support.
Ongoing Monitoring
 4 hourly respiratory and SpO₂ checks.
 Temperature and fluid intake every 4 hours.
 Monitored for respiratory fatigue and signs of deterioration.
 Noted improved activity and oxygen saturation by day 3.

5. Nursing Interventions
 Administered prescribed antibiotics to treat bacterial pneumonia effectively.
 Administered analgesics to manage fever and enhance comfort.
 Administer Oxygen therapy via nasal cannula to correct hypoxemia and support tissue
oxygenation.
 Proper positioning to mobilize secretions and improve lung ventilation.
 NG tube to ensure adequate nutrition and hydration during poor oral intake.
 Monitored vital signs and oxygen saturation closely early detection of clinical deterioration.
 Encouraged fluid intake orally as condition improved to prevent dehydration and support
recovery.

Psychosocial and Emotional Support:

 Provided emotional support and reassurance to mother.

 Engaged child in play (blowing bubbles, toys).
 Explained treatments in simple, child-friendly terms.
 Maintained therapeutic communication with family.

Patient Education:

 Taught mother about pneumonia, antibiotic use, and warning signs (e.g., fast breathing, fever,
poor feeding).
 Demonstrated home care: positioning, hydration, medication administration.
 Discharge education emphasized importance of follow-up and immunization.

6. Reflection on Learning

Pathophysiology:

Pneumonia involves inflammation of alveoli, often caused by bacterial pathogens. In children, it leads to
fluid-filled alveoli, impaired gas exchange, increased work of breathing, and systemic symptoms like
fever and lethargy.

Key Concepts & Skills Learned:

 Recognition of early and severe signs of pneumonia.

  Pediatric oxygen therapy management.
 Role of nutrition and hydration in pediatric illness.
 Age-specific communication with the child and caregivers.

Pediatric-Specific Knowledge Applied:

 Weight-based drug calculations and IV fluid management.

 IMCI pneumonia classification and treatment protocols.
 Child-friendly explanations and play therapy.

Challenges Encountered:

1. Anxiety and panic from caregiver- resolved by frequent updates and empathetic
communication
2. Difficulty maintaining oxygen saturation >90% -Adjusted nasal flow and reassessed lung sounds
3. Child refused oral feeds- NG tube used temporarily until oral intake resumed |

Evidence-Based Guidelines Followed:

 WHO IMCI guidelines for pneumonia classification and treatment.

 Pediatric pharmacology protocols for antibiotic dosing.
 Best practices for infection prevention and family-centered care.

7. Patient Outcomes
1. Short-Term Outcome:

After 72 hours:

 Fever subsided.
 Oxygen saturation stable on room air.
 Feeding improved; child active.
 Parents educated and confident in home care.
2. Long-Term Outcome:
 Complete resolution expected with full antibiotic course.
 Referred for nutritional counseling.
 Follow-up appointment scheduled in 7 days.
 Advised on good ventilation, hygiene, and immunization updates.
CEREBRAL PALSY
Patient’s Initials: A S
Age: 5years
Gender: Female
Diagnosis: Cerebral palsy
Date of Admission: 12th June 2025
Presenting Symptoms: Headache, convulsions, fever, general body malaise, loss of apetite.

History
Patient’s medical history
Client has had a history of hospital admission, the reason of the admission was malaria that was
diagnosed to the child in 2024. The client has had a history of malaria that made her to be admitted to the
hospital. Client has had no history of blood transfusion, no history of any chronic illness, no history of
accidents and no history of surgeries done to her. Client is not allergic to drugs environment or to
medication.
Family history
The is the first born in the family of the two where the 2nd born is a male of years. The mother and the
father are still alive. There is no history of chronic illness in the family like hypertension and diabetes
mellitus.
Social history
The client lives at their home in Rabuor with both the mother and the father are alive. The mother is a
business woman while the father is a bodaboda rider. The client is a SHA beneficiary.

Clinical Presentation
1.Motor Signs
Abnormalities of muscle tone, whether increased (hypertonia /spasticity) or decreased (hypotonia). Loss
of coordination and balance (ataxia), such as an unsteady walk, or difficulties with finer motor tasks.
Delays in motor milestones such as delayed head control, sitting, crawling and/or walking. Abnormal
postures, such as persisting primitive reflexes, scissoring of legs, and /or unusual body positions.
Involuntary movements such as writhing (athetosis), jerky (chorea), or sustained muscle contractions
(dystonia).
2. Musculoskeletal Signs
Contractures (the permanent shortening of muscles and joints). Joint deformities (e.g. the hip dislocated,
scoliosis (curved spine)). Gait abnormalities such as toe-walking, crouched gait, and/or dragging one side.
3. Cognitive and behavioural signs
Intellectual disability, in various degrees for some children. Learning difficulties, particularly with
attention and processing information. Behavioural problems or difficulties such as hyperactivity,
irritability, or socially withdrawn.
4. Seizures
Present in approximately 35-50% of children with CP, and particularly common in spastic quadriplegia.
Vital signs Bp 122/83mmhg, T 38.2 RR 26 b/m HR 97 b/m SPO2 100%
Lab tests: CBC, HB 10.7G/dl, RBC 4.9, PLT 455, Urea 2.1mmol, WBC 11.92
Diagnosis and Clinical Pathway
Primary diagnosis is cerebral palsy.
Diagnostic tests
1.Neuroimaging
a. Magnetic Resonance Imaging (MRI)
Expected Outcomes: Most common imaging technique.
Rationale: Identifies structural malformations and/or damage to the brain (e.g. periventricular
leukomalacia, hypoxic-ischemic damage).
b. Cranial Ultrasound
Used in: Preterm infants or neonates (through the fontanelles).
Rationale: Screens for intraventricular hemorrhage or periventricular leukomalacia.
c. Computed Tomography (CT) Scan
Rationale: Occasionally used if MRI options are entirely unavailable.
Treatment plan
Medications
Medications are used mostly to relieve some muscle rigidity, seizures, drooling, or pain. There are many
medications to include relaxants like baclofen and diazepam for the treatment of spasticity, botulinum
toxin (Botox) injections to relax tight muscles temporarily, anticonvulsants such as valproate or
levetiracetam for seizures, glycopyrrolate for drooling, and simple analgesics such as paracetamol or
NSAIDs for relief of pain in muscles or joints.

Therapies
Therapies will form the basis of the child's management of CP. Physical therapy aims to improve
movement, strength, and flexibility in children with CP. Occupational therapy supports children to
perform daily tasks such as dressing or feeding. Speech therapy aims to develop communication and
swallowing in those who also have speech or feeding problems. Recreational therapy enhances emotional
and social development. Sometimes, orthosis and braces can also help to improve posture and mobility.
Nursing interventions
1. Maintain a safe environment
Rationale: Children with CP may experience seizures and poor coordination and imbalance, thereby
increasing their chances of injury.
2. Assist with positioning and turning every 2 hours
Rationale: To avoid pressure ulcers while keeping the circulation moving and reducing the risk of
contractures.
3. Provide physiotherapy exercises as indicated
Rationale: To improve muscle strength, flexibility, and to avoid muscle shortening.
4. Assist with feeding and be on the lookout for aspiration
Rationale: Many children have issues with swallowing and aspiration may lead to pneumonia.
5. Provide adaptive feeding equipment if needed
Rationale: To help be independent and promote safe feeding practices.
6. Give prescribed medications (i.e., muscle relaxants, anticonvulsants)
Rationale: To manage spasticity and seizure activity which can deny comfort and quality of function.

How the interventions aligned with pediatric nursing care standards

1. The standards for pediatric nursing recognize injury prevention and keeping a safe environment, which
is especially important when caring for children with physical, cognitive and developmental conditions
2. These interventions support a child's growth and development, which is a major standard of pediatric
nursing. The interventions are based on the child's physical and cognitive development.
3Family-centered care supports family involvement in the planning and implementing of children's care;
families are the core of children's recovery and quality of life.
4. These interventions support the standard of providing holistic, as well as culturally sensitive care to
children with complex care needs, recognizing that children are influenced by their physical, emotional,
and psychosocial situation.
5. Nurses are advocates and educators and they assist families to care for their child safely and
independently in their own homes
6. Alignment: The standards of pediatric nursing support collaborative, interdisciplinary care between
professionals.
Psychosocial and Emotional Support:
Encourage Self-Worth and Confidence. Encourage participation in activities appropriate to the child's
individual abilities to foster a sense of value and competence.
Provide Emotional Support. Listen attentively, give reassurance, and be patient. Children with CP may
feel frustration, isolation, or anxiety as a result of their communication and physical challenges.
Promote Social Interaction. Encourage peer play, social interaction, and participation in school or
community events and activities to help alleviate feelings of loneliness.
Educate and Empower Families. Provide counseling, teach coping skills, and empower families to make
choices in quotidien care decisions. Families that feel empowered will have the confidence to manage day
to day stressors.
Refer to Support Services. Connect families to psychologists, counselors, social workers and support
groups for mental health and social support when needed.
Pathophysiology of Cerebral malaria
Cerebral malaria is caused by the Plasmodium falciparum. The red blood cells infected with the parasite
become sticky and adhere to small blood vessels in the brain (known as sequestration). It also stops blood
flow and causes inflammation, swelling (cerebral edema), and prevents oxygen and nutrients from
reaching proper brain tissue. Consequently, there is impaired consciousness, seizures, and the individual
can ultimately develop a coma or die if not promptly treated.
Important concepts
1. Insight into the Pathophysiology
Learned how an early brain injury can lead to a permanent movement dysfunction.
Gained insight into how each part of the brain (ex. motor cortex, cerebellum) affects movement, balance,
coordination, muscle tone.
2. Early Recognition and Assessment
Recognized the importance of identifying early signs of atypical development (ex. delays in milestones,
abnormally low/high tone, or poor coordination).
Reflected on the assessment process as I considered growth and development tasks including muscle tone,
reflexes in patients.
3. Nursing Interventions and Rationales
Understood the interventions (i.e. positioning, assist with feeds, medications) considered critical to
nursing care about children's developmental delays .Learned to generate critical thinking that informed
decisions and made sense for the particular condition of the child.
4. Family-centered care
Understood how to include families in all aspects of care, provide education, and emotional support.
Recognized quality of life from a family perspective and how to allow caregivers to feel empowered and
supported in their home environment.
5. Communication and psychosocial needs
Demonstrated understanding and support for children who face communication delays by utilizing
different methods of communication.
Developed emotional and psychosocial support techniques for both the child and family in enhance
coping and quality of life.
Challenges encountered during the study
1. Difficulty in Assessing the Child. Assessing the child was difficult due to a lack of cooperation from
the child and barriers to communication. Some children living with CP have a speech impairment, or
cognitive deficits, meaning it was difficult to elicit the child's needs/responses.
2. Limited Exposure to Neurological Disorders. As students we had limited exposure to
neurodevelopmental conditions such as cerebral palsy. This made it difficult to confidently identify types
of CP, and to assess the clinical information/ required action when symptoms appeared or the purpose of
therapy interventions.
3. Emotional Burden. Observing a child with physical and developmental limitations was emotionally
burdensome. There was a sense of helplessness that came along with seeing the child's needs and
managing our own emotions while remaining as professional and as helpful as possible.
4. Caregiver Communication. In some cases the caregivers were emotional, overwhelmed, or reluctant to
divulge information about the child's current status. Establishing rapport and obtaining information would
require patience and empathy to help the caregivers feel at ease providing complete information.
5. Multidisciplinary Care. Cerebral palsy care may involve many different professionals and specialties
(physicians, nurses, physiotherapists, speech-language pathologists, etc). It was sometimes overwhelming
and entirely confusing in terms of understanding the roles of each profession and how to coordinate care
amongst other professionals.
6. Limited Resources. Access to therapy equipment, and/or assistive devices, or getting updated medical
records, was limited in some situations. This constrained the completeness of the working case study, and
limited our ability to generate full assessment.

Evidence based practices

1. Early Identification and Developmental Surveillance
Guideline: Developmental screening is recommended by theAmerican Academy of Pediatrics AAP at 9,
18, and 24 or 30 months.
Relevance: This particular child had early identification for developmental concerns related to motor
delays, which led to access for timely physiotherapy and other therapies.
2. Multidisciplinary Team Approach
Guideline: The World Health Organisation (WHO) and National Institute for Health and Care Excellence
(NICE) guidelines address the necessity of interdisciplinary care (e.g., nurses, doctors, physiotherapists,
speech-language therapists, and occupational therapists).
Relevance: This particular child received interventions and recommendations from a team of
professionals, leading to better functional outcomes and quality of life.
3. Spasticity Management
Guideline: NICE recommends oral medications, such as baclofen, or botulinum toxin for focal spasticity.
Relevance: The nursing care ordered by the paediatrician was to deliver muscle relaxants, and it involved
evaluating the effectiveness and side effects.
4. Nutritional Support and Safe Feeding
Guideline: Segmental evidence-based pediatric protocols support the use of modified feeding techniques
and nutritional assessments for children who have swallowing difficulties.
Relevance: The nursing team supported feeding with adaptive feeding equipment and was vigilant for
signs of aspiration, under-nutrition, or failure to thrive.
5. Family-Centered care
Guideline: The AAP indicates the importance of involving parents in decision making, along with
education and support.
Relevance: We educated the family on completing daily routines for care, exercises, and the use of
medications. The family were trusting partners in caring for this child

Alignment of Nursing Interventions

The nursing interventions we implemented were well aligned with pediatric best practice at the time they
were provided to the patient, including:
Considering physical, emotional, and developmental needs in a holistic assessment.
Administering medications safely and monitoring for side effects.
Communicating positioning and skin care to prevent contractures and pressure ulcers.
Facilitating independence for communication and feeding with adaptive tools.
Educating and emotional support for caregivers to promote continuity of care in the home.

Patient outcomes
Short-Term Outcome
Improved Muscle Control and Mobility :
Regular physiotherapy and muscle relaxants (ex. baclofen) decreased muscle tone, allowing better limb
mobility.
Improved Nutritional Status :
Using modified feeding techniques and nutritional support allowed the child to have fewer feeding
challenges, which increased weight gain and energy.
Reduced Risk of Complications :
Regular repositioning and supervised positioning reduced the risk of pressure sores and contractures.
Improved Family Understanding and Competence :
Education, information sharing, and modelling encouraged the family to feel more confident in delivering
care and using assistive devices, as well as cope better emotionally.
Stable Vital Signs :
Ongoing appropriate monitoring and management during the supportive care helped to stabilize
respiration, temperature and heart rate, especially in cases of feeding or respiratory difficulties.
Long-Term Outcome:
Improved Independence Functionally:
With continuous therapy and use of assistive devices, the child is expected to develop independence with
movement which may include better ability to walk, eat, and communicate independently.
Improved Quality of Life:
Multi-faceted care and emotional support, plus engagement of family, can improve social interaction,
self-esteem and improve function in day-to-day situations.
References

American Academy of Pediatrics. (2006). Clinical report: Identification and evaluation of

children with autism spectrum disorders. Pediatrics, 120(5), 1183–1215.
https://doi.org/10.1542/peds.2007-2361

Centers for Disease Control and Prevention (CDC). (2022). What is cerebral palsy? Retrieved
from https://www.cdc.gov/ncbddd/cp/facts.html

National Institute for Health and Care Excellence (NICE). (2017). Cerebral palsy in under 25s:
Assessment and management (NICE guideline NG62). Retrieved from
https://www.nice.org.uk/guidance/ng62

Rosenbaum, P., Paneth, N., Leviton, A., Goldstein, M., Bax, M., Damiano, D., ... & Jacobsson,
B. (2007). A report: The definition and classification of cerebral palsy April 2006.
Developmental Medicine & Child Neurology, 49(s109), 8–14. https://doi.org/10.1111/j.1469-
8749.2007.tb12610.x

Butler, C., & Darrah, J. (2001). Effects of neurodevelopmental treatment (NDT) for cerebral
palsy: An AACPDM evidence report. Developmental Medicine & Child Neurology, 43(11), 778–
790. https://doi.org/10.1111/j.1469-8749.2001.tb00146.x
Bronchiolitis

Patient's Initials or ID: ER

Age: 11 months old / Born August 2024

Gender: Female

Diagnosis: Bronchiolitis

Date of Admission: July 5, 2025

Presenting Symptoms: Cough, wheezing, nasal congestion, low-grade fever, poor feeding, and mild
respiratory distress

Case Study Details:

History/Background:

Patient's Medical History:

Client had no previous history of any known chronic disease. She was a term baby, born with normal
spontaneous vaginal delivery without complications. All recommended immunizations appropriate for
her age, including influenza vaccine, have been administered to her. This illness began with cough and
nasal discharge three days prior to admission, which progressively worsened into wheezing and poor
feeding.

Family History:

No asthma, allergies, or family history of respiratory disorders. Her parents are healthy, and her older
brother has a history of frequent colds but no hospitalization.

Social History:

The family resides in a Kisumu with adequate sanitation. The mother is at home to take care of the child,
and the father works in a nearby factory. There has been no prior exposure to passive cigarette smoke.
The infant is exclusively breastfed and has only just started complementary feeding.

Clinical Presentation:

Client was brought to the pediatric emergency department by her mother with progressive shortness of
breath, decreased feeding, and chronic cough. Physical examination found her to be irritable but alert,
with nasal flaring, subcostal retraction, and wheezing.

Vital Signs upon Admission:

Temperature: 37.8°C

Respiratory Rate: 58 breaths/min

Heart Rate: 142 bpm

Oxygen Saturation: 91% on room air

Weight: 8.5 kg

Laboratory and Diagnostic Results:

Full Blood Count: Mildly elevated WBC at 14,000/mm³

Nasopharyngeal swab: RSV Positive

Chest X-ray: Hyperinflated lungs with patchy infiltrates, no consolidation

Diagnosis and Clinical Pathway:

Primary Diagnosis: Acute bronchiolitis due to RSV infection

Differential Diagnoses: Pneumonia, Asthma (though rare at this age), Foreign body aspiration

Diagnostic Tests and Rationale:

The RSV test was performed to identify the viral etiology. Chest X-ray was done to rule out pneumonia
and complications. Blood work was performed to screen for possible bacterial co-infection.

Treatment Plan

Given humidified oxygen by nasal cannula.

IV fluids for hydration due to poor oral intake.

Nebulized salbutamol to ease airway irritation.

Antipyretics (paracetamol) for control of fever.

Nasal suctioning to ease congestion.

Close respiratory surveillance.

Nursing Assessment:

Initial Assessment:

Respiratory: Wheezing, nasal flaring, mild retractions, tachypnea, rhonchi.

Cardiovascular: Tachycardia, warm extremities, good capillary refill.

Neurological: Alert, responsive, but at times irritable.

Psychosocial: Mother was anxious and worried; needed reassurance.

Nutritional: Inadequate oral intake over the past 24 hours; decreased breastfeeding.
Ongoing Monitoring:

Client’s respiratory rate and oxygen saturation values were closely monitored during the clinical shift.
Frequent suctioning was done to provide clear airways. Intake and output of fluids were observed. Her
oxygen saturation was improved with humidified oxygen from 91% to 96%. Feeding was resumed
gradually as her respiratory effort improved.

Nursing Interventions:

Medical/Nursing Interventions:

Oxygen therapy: To prevent hypoxia and provide adequate oxygenation.

Nebulized hypertonic saline: Loosened secretions and decreased inflammation within the airway.

Recurrent suctioning: Facilitated airway patency and diminished work of breathing.

Monitoring of vital signs: Enabled the early recognition of clinical deterioration.

Fluid management: Maintained hydration and electrolyte balance with inadequate feeding.

Paracetamol: Managed fever and facilitated comfort.

These interventions were aligned with pediatric standards of care, such as WHO and regional
bronchiolitis treatment guidelines.

Psychosocial and Emotional Support:

Provided reassurance to the mother about the prognosis and nature of viral bronchiolitis.

Allowed mother to stay with the child in the hospital to increase bonding.

Provided emotional reassurance by describing all steps of procedure and care.

Used play therapy during recovery, with toys and music.

Patient Education:

Taught the mother to recognize warning signs such as higher rate of breathing, chest retractions, and
refusal of feeding.

Recommend home care with safety precautions and continued breastfeeding.

Discussed preventive measures like hand washing, avoiding public places, and the necessity of vaccines.
Reflection on Learning:

Pathophysiology of Bronchiolitis

Bronchiolitis is an infant and child viral illness of less than two years of age. The most common etiology
is RSV. The virus causes inflammation, edema, and the generation of mucus within the small airways,
resulting in airway obstruction and impaired gas exchange.

Key Concepts and Skills Learned:

Recognition and immediate management of childhood respiratory distress.

Supportive care role within the viral infections in which there is no indicated antiviral therapy.

Ability to perform safe nasal suctioning and oxygen therapy in infants.

Pediatric-Specific Skills Used:

Adequate assessment of infant respiratory distress symptomatology.

Understanding growth and nutritional needs in infancy.

Family-centered care with parents' involvement and emotional support.

Challenges Encountered:

Difficulty keeping nasal passages patent due to continuous secretions.

Mother was initially insisting on antibiotics, and education had to be done on viral vs. bacterial
infections.

Overcame these through effective suctioning and patient-centered communication.

Evidence-Based Practice:

Management according to WHO and American Academy of Pediatrics recommendations against the use
of unnecessary medication in bronchiolitis. The avoidance of bronchodilators and antibiotics was
evidence-based unless there were complications.

Outcome of the Patient:

Short-Term Outcome:

By day 4 after admission, client greatly improved. Respiratory rate decreased, oxygen saturation
returned to baseline, and feeding was resumed. Oxygen was weaned and she was discharged home in
stable condition.

Long-Term Outcome:

Client will most probably recover. Parents were advised to follow up in two weeks. She is more likely to
have wheezing in the future, so surveillance in seasons with colds was strongly advised.
References:

American Academy of Pediatrics. (2021). Clinical Practice Guideline: The Diagnosis, Management, and
Prevention of Bronchiolitis.

World Health Organization. (2023). Pocket Book of Hospital Care for Children.

Cunningham, M., McMillan, J. A., & DeAngelis, C. (2019). Current Diagnosis and Treatment: Pediatrics.
25th Edition.

Kenya Ministry of Health. (2022). Basic Pediatric Protocols.

Hall, C. B. et al. (2018). "Respiratory Syncytial Virus Infection in Children." New England Journal of
Medicine, 379(8), 763-773.
 PNUEMONIA

History / Background

Biodata:

Name: T.O.O

Age: 3

Gender: female

D.O.A : 10/7/25

Chief complain

3-year-old male admitted with fever, cough, and difficulty in breathing (DIB).Symptoms began 2 days
prior to admission with a progressively worsening cough and fever.

Past medical and surgical history

No previous hospitalizations or known chronic respiratory conditions. No known allergies to food drug
or enviroment.No history of blood transfusion or surgical procedire done.

Family History:

No family history of asthma, tuberculosis, or immunodeficiency disorders. Parents are healthy and non-
smokers.One elder sibling.No history of chronic disease in the family like HTN or Diabetes.

Social History:

Lives in a one bedroom house with 3 family members. Poor ventilation and occasional use of charcoal
for cooking indoors. Attends a crowded daycare center.Middle-low income household.

2. Clinical Presentation

Signs and Symptoms:

 Cough with purulent sputum.
 Fever (38.9°C), nasal flaring, chest indrawing, and grunting.
 Difficulty feeding and lethargy.
 Audible wheeze and crackles on auscultation.

Vital Signs on Admission:

 Temperature: 38.9°C
 Respiratory Rate:58 breaths/min
  Heart Rate: 140 bpm
 SpO₂: 89% on room air

Diagnostic Results:

 CBC: WBC = 15.35 10^9/L Neutrophils16.65 10^9/L

3. Diagnosis and Clinical Pathway

Primary Diagnosis:

Severe Pneumonia

Differential Diagnoses:

Bronchiolitis

Diagnostic Rationale:

History of acute symptoms + physical exam findings (e.g., respiratory distress)

Treatment Plan:

 IV Antibiotics: Ceftriaxone 650mg OD

 Antipyretics:Paracetamol 195mg TDS
 Oxygen Therapy: Via nasal cannula at 2 L/min.
 Hydration:IV fluids with maintenance and correction for mild dehydration.
 NG feeding: Poor oral intake.

4. Nursing Assessment

Initial Physical Examination:

 Respiratory:Nasal flaring, subcostal/intercostal retractions, grunting, decreased breath sounds

with fine crackles.
 Cardiovascular- Tachycardia; Capillary refill< 2 seconds.
 Neurological: Alert but irritable.
 Nutritional: poor oral intake.
 General Appearance:Pale, fatigued, clingy to caregiver.

Psychosocial Assessment:

 Mother anxious; distressed by child’s condition.

 Strong parent-child bond noted.
 Family coping through faith and community support.
Ongoing Monitoring
 4 hourly respiratory and SpO₂ checks.
 Temperature and fluid intake every 4 hours.
 Monitored for respiratory fatigue and signs of deterioration.
 Noted improved activity and oxygen saturation by day 3.

5. Nursing Interventions
 Administered prescribed antibiotics to treat bacterial pneumonia effectively.
 Administered analgesics to manage fever and enhance comfort.
 Administer Oxygen therapy via nasal cannula to correct hypoxemia and support tissue
oxygenation.
 Proper positioning to mobilize secretions and improve lung ventilation.
 NG tube to ensure adequate nutrition and hydration during poor oral intake.
 Monitored vital signs and oxygen saturation closely early detection of clinical deterioration.
 Encouraged fluid intake orally as condition improved to prevent dehydration and support
recovery.

Psychosocial and Emotional Support:

 Provided emotional support and reassurance to mother.

 Engaged child in play (blowing bubbles, toys).
 Explained treatments in simple, child-friendly terms.
 Maintained therapeutic communication with family.

Patient Education:

 Taught mother about pneumonia, antibiotic use, and warning signs (e.g., fast breathing, fever,
poor feeding).
 Demonstrated home care: positioning, hydration, medication administration.
 Discharge education emphasized importance of follow-up and immunization.

6. Reflection on Learning

Pathophysiology:

Pneumonia involves inflammation of alveoli, often caused by bacterial pathogens. In children, it leads to
fluid-filled alveoli, impaired gas exchange, increased work of breathing, and systemic symptoms like
fever and lethargy.

Key Concepts & Skills Learned:

 Recognition of early and severe signs of pneumonia.

  Pediatric oxygen therapy management.
 Role of nutrition and hydration in pediatric illness.
 Age-specific communication with the child and caregivers.

Pediatric-Specific Knowledge Applied:

 Weight-based drug calculations and IV fluid management.

 IMCI pneumonia classification and treatment protocols.
 Child-friendly explanations and play therapy.

Challenges Encountered:

1. Anxiety and panic from caregiver- resolved by frequent updates and empathetic
communication
2. Difficulty maintaining oxygen saturation >90% -Adjusted nasal flow and reassessed lung sounds
3. Child refused oral feeds- NG tube used temporarily until oral intake resumed |

Evidence-Based Guidelines Followed:

 WHO IMCI guidelines for pneumonia classification and treatment.

 Pediatric pharmacology protocols for antibiotic dosing.
 Best practices for infection prevention and family-centered care.

7. Patient Outcomes
1. Short-Term Outcome:

After 72 hours:

 Fever subsided.
 Oxygen saturation stable on room air.
 Feeding improved; child active.
 Parents educated and confident in home care.
2. Long-Term Outcome:
 Complete resolution expected with full antibiotic course.
 Referred for nutritional counseling.
 Follow-up appointment scheduled in 7 days.
 Advised on good ventilation, hygiene, and immunization updates.