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Case Study Presentation

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by

Erin Tak

on 28 October 2014

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Transcript of Case Study Presentation

Renal Biopsy
Two types of Renal Biopsy:
Description of the Child & Family
Diagnosis : Chronic Kidney Disease
Treatment
Chest X-Ray
Open/Surgical Biopsy
- laying down

- two seperate views:
front and side

- used to check for pneumonia

PICC Line
- long, slender, flexible tube
- often placed on the upper part of the arm
- continues into a large vein above the heart
- line can be attached to a drip or syringe
- antibiotics, blood testing, fluids and food
Renal Biopsy Continued:
Case Study Presentation
By: Helen Israel, Lindsay Olson, Erin Takagi, Suzanne Oliveira and Rachel Watts
Mandy - 5 1/2 years old

- She has a younger sibling who is 2 years old

- She lives with both parents

- Bright and precocious (gifted/articulate) child

- Has never been admitted to the hospital before

- Mandy’s paternal grandmother and aunt have a history of kidney disease
- admitted with lethargy, fever and cough

- increased creatine and urea levels with vomiting and diarrhea

- left side pneumonia : inflammation of the lungs and air sacs with fluids

- high blood pressure and nephritis (inflammation of the kidney)
- 14 days of antibiotics

- several other medications for nephritis

-renal biopsy (kidney biopsy)

- chest X-ray

- PICC line
1. Percutanious
- most commonly used
- no general anesthesia used
- 30 minutes to 1 hour to complete
- may require an ultrasound or CT
scan
- fine need aspiration
- needle core biopsy
- history of causing bleeding/blood clots

- previous kidney surgery

- 5 inch incision

- often performed laparoscopicaly
Peripherally Inserted Central Catheter
Prognosis:
- depends on cause and severity of chronic illness

- once Chronic Kidney Disease (CKD) is apparent, the progression to end stage renal disease (ESRD) is almost certain

- progression depends on diagnosis, preventative measures, and the individual

- 70% of children with ESRD have a ten year survival rate

- kidney transplant is often needed

- often children with CKD have high blood pressure as well
Important to know about your kidneys:
- each kidney is made up of millions of filtering units called nephrons

- each nephron filters a small amount of blood

- the neprons work in a two-step process

- lets fluid and waste pass through, prevents blood cells and molecules from passing

- the filtered fluids sends minerals back to the blood stream and releases waste through urine

- also controls levels of minerals such as potassium, sodium, and phosphorus
Causes of Kidney Disease

most often caused from...
- birth defects - urine blockage

- hereditary

- infections

- nephrotic syndrome
Key Issues
Sibling Dynamic : mom says she misses her other child when in the hospital
- assume sibling does not visit

Father Involvement: mentioned he lives with them, however involvement in hospital is unknown

Genetics: both grandmother and aunt have history of Kidney Disease

Pill Swallowing: refuses to take pills and has no previous experiences

Diet: refusing to eat her food and meals

Mistrust: Mandy's first PICC broke which led to her being uncooperative
Key Issues Continued
Behavioural: resists assistance and refuses to cooperate
- uses "I don't want to"!

Mother: flat, difficult to engage, and unemotional

Unknown Diagnosis: final diagnosis undetermined
- only symptoms and testing

Under-stimulated: bright and precocious but assumed not being challenged or provided opportunity to execute skills

Low Self-Esteem: lack of empowerment and decision making
Role Play #1
Mandy & Nurse
Main Issue
Family Dynamic
Father:
- not around and has little involvement
- due to lack of involvement the mother may feel she is taking on a lot in comparison
- Mandy may feel unimportant or unsupported by the father

Mother:
- unengaged and difficult to connect with
- stress from feeling alone and overwhelmed
- Mandy may mirror her attitude and disengagement
- without comfort from her mother, she may act out and refuse to cooperate
- misses her other daughter, who is taken care of by her mother
Mandy
- usually refuses and says "No, I don't want to"! and persists in yelling and crying

- could be her way of trying to gain control over situation

- mother may not be meeting her needs

- enjoys playing with dolls and art (no mention if she gets to play)
Sibling
- lack of interaction with her sibling

- sense of unimportance

- immediate family is uninvolved, Mandy could feel undervalued

- unable to form connections with family and siblings to create trusting relationships
Discussion Question:


What do you think the main issue is ?
Role Play #2
Mother, Mandy and Child Life Specialist
Discussion Question

Do you think Mandy's mother plays a role in her behavioral issues?
Health Care Collaboration
Child Life Specialist:

Behavior Management - refusing procedures and uncooperative
Pill Swallowing - no previous experience and cannot swallow her medication
Right to Know - intelligent and should understand why she is undergoing procedures
Occupational Therapist - addressing psychosocial needs and teaching coping strategies
Promotion of well being - medication management, coping skills, education, social involvement with others
Dieting - can assist with dieting if it is a sensory or behavioral issue
Healthcare Collaboration continued...
Nutritionist:
Diet - refusing foods, mcust ensure she is receiving proper nutrition she needs
Strategies - to ensure she is receiving proper nutrients for her diet
* according to research, nutrition is vital when having kidney issues
- can affect how well kidneys functin

Psychologist:
- strategies to deal with emotional stress
- suggest techniques that reinforce adherence with taking medication and following health care professional's instructions

Social Worker:
- provide support to the mother who is stressed and lacking sleep
- provide resources for extra income (may allow father to work less)
- support for whole family involvement in Mandy's hospitalization
- work with Mandy on behavioral or emotional issues
Teacher:
- Mandy is a bright child who may need more stimulation
- assume she is not attending school
- could be restless and need more activities to play
- engage in play with her (pretend play)
Health Care Collaboration continued...
Action Plan

- continue support from child life specialist for dietary, medication swallowing and behaviour guidance.

- implement visits from social worker for family as a whole and specifically mother.

- incorporate younger sibling into daily play or leisure time. Example: having her present during music or clown visits

- trust building exercises and medical play to help Mandy regain comfort and trust with professionals at hospital

Limitations
this may include...
- father being unable to attend social worker visits
- mother unwilling to engage and take part in exercises to help her and the family
- Mandy may continue to show aggression and refusal with child life specialist and other staff


References:
http://kidney.niddk.nih.gov/kudiseases/pubs/polycystic/index.aspx

http://www.kidney.ca/page.aspx?pid=320

Koller, D. (2014, September) Impacts of Illness. Lectured conducted at Ryerson University, Toronto ON.

Stages of social emotional development. (n.d.). Retrieved from http://childdevelopmentinfo.com/child-development/erickson/
The Kidney Foundation of Canada
Connection to Theory

- According to Mandy's chronological age/fact she is a bright and precocious child means she would fit approximately into the stage of Industry v. Inferiority
- Stage described as child's time to "master more formal skills of life"
- Basic strength of this stage = Competency
- If child's initiative's to feel undustrious are punished or unsuccessful, resort to helplessness

Connection to Erikson
- Based on case study description it is assumed Mandy is approximately within the stage of Autonomy v. Shame
- Though she is bright child, being admitted to hospital for first time and for serious condition may have cause negative affect on her psychosocial developental stage
- Mandy displays feeling of wanting to control surroundings, "No I don't want to!" and having outbursts of emotions.
Any questions or comments?
Thanks for listening!
Full transcript