Reference no: EM133860555
Client Profile
Kyla is an 8-month-old infant who lives with her mother, grandmother, and great grandmother in Cincinnati, Ohio. Her mother, Sierra, is a 16-year-old who stopped going to school after she became pregnant by her on-again, off-again 18-year-old boyfriend, Kyle, who visits Sierra but shows no interest in Kyla. He frequently becomes annoyed and leaves when Kyla needs to be fed or have her diapers changed. Sierra's father was very abusive to both Sierra and her mother as Sierra was growing up. He died 6 months ago as a result of a knife wound that occurred during a fight at a local tavern. He and Sierra's mother lived together with their five children and when he worked, he worked for a minimum wage that barely fed his family. Kyla's aunts and uncles (Sierra's three sisters and one brother) keep in contact with their mother and sister, but are busy with their own lives and families. Although Sierra participates in Kyla's care, her mother is the stable caregiver when she is not working. The relationship between Sierra and her mother has been strained since Sierra became pregnant and frequently the two engage in heated arguments over the increased financial stress related to Kyla's needs and Sierra's refusal to seek employment. Sierra's grandmother is in poor health and requires frequent visits to the emergency room as a result of unstable angina.
Case Study
At 2135 hours, Kyla is brought wrapped in a bath towel by her grandmother to the emergency department at the local hospital. The admitting nurse observes that Kyla is crying vigorously and is unable to be consoled. She is in no apparent respiratory distress. According to the grandmother, Kyle came over to see Sierra while Kyla's grandmother was out at the grocery store. When she returned, Kyla was screaming. Sierra said that she and Kyle were talking and Kyla "got real fussy, so we decided to give her a bath to get her to quiet down, but she just kept screaming." Kyla's grandmother wrapped Kyla in a bath towel and brought her to the hospital because she thought that she was sick because "she was so red."
On further assessment the nurse notes that Kyla has blisters on her feet, lower legs, and buttocks, and bruises on her upper arms. The health care provider examines Kyla and arranges for her to be transferred by AirFlight to Cincinnati Shriners' Hospital to be admitted with second-degree burns of her buttocks, genitalia, legs, and feet. Health care providers at the burn center estimate Kyla's burns as 34% of her total body surface area (TBSA) using the "Estimation of the Extent of Burns in Children" chart. Although Sierra calls every other day to ask about Kyla's condition, she doesn't visit her daughter. Kyla's grandmother stays at the hospital with Kyla.
Questions:
1. Discuss your impressions about the above situation.
2. Discuss the factors in this situation that would place Kyla at risk for child abuse.
3. Using developmental theory, discuss Sierra's level of growth and development.
4. The health care providers determined that Kyla's development was appropriate for an 8-month-old infant. Discuss what you would expect when assessing Kyla's growth and development.
5. Discuss how the health care providers arrived at 34% of Kyla's TBSA experiencing second-degree burns.
6. Describe the characteristics of second-degree burns.
7. Using the 4:2:1 rule for calculating maintenance rate of intravenous fluids for Kyla, who weighed 3.18 kg (7 lb) at birth and has experienced a weight gain within normal limits for her age, calculate her hourly IV rate.
8. Determine Kyla's priority nursing diagnoses on admission to the burn center, discussing why each is a priority.
9. Discuss your impressions about why Sierra doesn't visit Kyla at the hospital.
10. Discuss what members of the health care team should be involved in Kyla's care and recovery.
11. Discuss your feelings about child abuse and how you would feel if you were a nurse caring for Kyla in this situation.