A Case Study for Nursing Students! Meet Peter, A Typical Nursing Evolutions Patient

Are you a nursing student or working to become a nursing student? Curious about pediatric critical care? Here is a case study of the type of patient you might serve in the future! What kinds of patients do we help? Here’s an example!

Case Study

Peter is an 11-month-old male patient who came to our services after an 11-month hospitalization. He was born 26 weeks premature and had bronchopulmonary dysplasia, severe gastroesophageal reflux, tracheal malasia, and developmental delay. Peter requires 16 hours of critical field care daily, seven days a week, with his parents providing care for the remaining hours.

He is on a Trilogy ventilator receiving Intermittent Mandatory Ventilation at 25 breaths per minute with a tidal volume of 90ccs. When awake, Peter takes additional breaths with a respiratory rate of 27 to 35 breaths per minute but does not take extra breaths while sleeping. He receives a set supplemental oxygen dose of 2 liters per minute with a SpO2 range of 95-97%.

Airway suctioning is necessary approximately every 10 minutes while awake and every 30 minutes while asleep. There are no plans for weaning from mechanical ventilation or decannulating the tracheostomy. Peter is on a strict NPO status due to his aspiration risk and severe GERD.

We’ve shared this snapshot of the comprehensive care and attention we give to every one of our precious patients.

Exciting news! You have appointments later today with some of the top healthcare specialists in the field, including the Pulmonary, Otolaryngology (ENT), Gastroenterologist (GI), Physical and Occupational Therapists, and Dietitian teams.

The medical team currently has no plans for “taste” trials for the patient. However, we will focus on the patient’s strength, balance, and mobility. The patient is fully innervated but has limited upper extremity movement, with lower extremity movement only occurring with stimulation. While the upper and lower extremities are relatively weak, the patient’s torso muscles are nearly flaccid, and neck musclesare notably weak. At this time, the patient cannot hold up their head or sit up without full support.

Despite this, the patient does follow movements and actions with their eyes. However, they may be unable to move their head to keep up with the effort if it exceeds what they can see with their eyes. The back of the patient’s head is also flat and bald.

We want to make the most of these appointments and gain as much valuable information as possible.Here are some questions to consider:

  • What information are you hoping to obtain from each Specialty Care Provider team?
  • What are your expectations and concerns for each appointment?
  • What is your advocacy plan for the patient with each of these SCP teams?

We also want to coordinate our efforts to address critical issues, such as:

  • Advancing from continuous G-and G-J-tube feedings
  • Progressive mobilization
  • The plan for supplemental oxygen administration
  • Reducing dependence on mechanical ventilation
  • The eventual plan for tracheostomy decannulation.