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Case Study Presentation

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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
Chest X-Ray
Open/Surgical Biopsy
- laying down

- two seperate views:
front and side

- used to check for pneumonia

- 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
- 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
- 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
- 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

- 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
- 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)
- 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...
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

- 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
- 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

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



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