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Prelicensure (NUR 329-01) Clinical Makeup

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John Marsh
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Illinois State University

Public Health Nursing: Prelicensure (NUR 329.01)

Clinical makeup

Pediatric Case Study: Infant
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.

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Prelicensure (NUR 329-01) Clinical Makeup

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