Case 2: Infection and Liver
Impairment
Joylie Herd
Age 3
Jouylie Herd is a 3-year-old born to
a drug addicted mother. At birth,
she contracted Hepatitis B from her
mother who unknowingly had the
virus. Joylie has lacked
preventative healthcare, including
routine immunizations. She attends
an unlicensed daycare while her
mother, Jill, a single parent works
at the local supermarket as a
cashier. The daycare recently had an outbreak of Hepatitis A and is
under investigation. Jill has been clean and sober for six months. Jill
is proud if her sobriety and the fact that she and Joylie now live in
an apartment rather than the shelter. Joylie is brought into the clinic
by her mother for flu-like symptoms including poor appetitis and a
‘tummy ache.’ She’s been running a low-grade temperature. Jill
says, “she hasn’t been her usual active self and is napping a lot.”
Please answer the following questions- you may highlight or change
the color of the font or bold the answer.
1. The nurse begins the assessment. What subjective
information should the nurse ask Jill about Joylie? Select
all that apply.
Health history Length and severity of current symptoms
Interactions with her father, Interactions with her father
Normal dietary intake Immunization record
2. What priority safety information should the nurse collect?
Blood pressure Focused abdominal assessment Mother-daughter
interactions Cleanliness of the child
, 3. Upon physical assessment, the nurse palpates an enlarged liver.
What hypothesis can the nurse make from this finding?
This is a normal finding in a 3-year-old This is a normal finding in a 3-
year-old Joylie will likely have a clotting disorder The finding is
abnormal and requires additional testing
4. Because of the enlarged liver, the health care provider orders
some additional tests. Which serum labs should the nurse
anticipate? Select all that apply.
AST, ALT, GGT. Complete blood cell counts Metabolic
panel Arterial blood gasses Amylase and lipase
5. After evaluating the lab report, the nurse performs a more
thorough assessment. What additional findings should be
anticipated?
A high temperature Dark pink mucous membranes Jaundice of the
sclera.
A lack of edema
6. NurseThink® Prioritization Power! Reflect on Joylie’s assessment
findings and identify the Top 3 Priority concerns.
a. Infection related to temperature
b. Abdominal discomfort related to liver enlargement
c. Poor health maintenance related to hepatitis B
7. Joylie is admitted to the pediatric unit for additional tests. The
nurse working that day is precepting a newly graduated licensed
practical nurse (LPN) and an experienced unlicensed assistive
personnel (UAP). For each of the admission tasks on the left,
determine the most appropriate delegation for each skill.
RN LPN UAP or None
a. Gather thermometer and blood pressure equipment- UAP
b. Start an IV- RN
c. Request toddler pull-up diapers from central supply- UAP
d. Obtain health history from the parent-RN
e. Perform a head-to-toe assessment- RN
Impairment
Joylie Herd
Age 3
Jouylie Herd is a 3-year-old born to
a drug addicted mother. At birth,
she contracted Hepatitis B from her
mother who unknowingly had the
virus. Joylie has lacked
preventative healthcare, including
routine immunizations. She attends
an unlicensed daycare while her
mother, Jill, a single parent works
at the local supermarket as a
cashier. The daycare recently had an outbreak of Hepatitis A and is
under investigation. Jill has been clean and sober for six months. Jill
is proud if her sobriety and the fact that she and Joylie now live in
an apartment rather than the shelter. Joylie is brought into the clinic
by her mother for flu-like symptoms including poor appetitis and a
‘tummy ache.’ She’s been running a low-grade temperature. Jill
says, “she hasn’t been her usual active self and is napping a lot.”
Please answer the following questions- you may highlight or change
the color of the font or bold the answer.
1. The nurse begins the assessment. What subjective
information should the nurse ask Jill about Joylie? Select
all that apply.
Health history Length and severity of current symptoms
Interactions with her father, Interactions with her father
Normal dietary intake Immunization record
2. What priority safety information should the nurse collect?
Blood pressure Focused abdominal assessment Mother-daughter
interactions Cleanliness of the child
, 3. Upon physical assessment, the nurse palpates an enlarged liver.
What hypothesis can the nurse make from this finding?
This is a normal finding in a 3-year-old This is a normal finding in a 3-
year-old Joylie will likely have a clotting disorder The finding is
abnormal and requires additional testing
4. Because of the enlarged liver, the health care provider orders
some additional tests. Which serum labs should the nurse
anticipate? Select all that apply.
AST, ALT, GGT. Complete blood cell counts Metabolic
panel Arterial blood gasses Amylase and lipase
5. After evaluating the lab report, the nurse performs a more
thorough assessment. What additional findings should be
anticipated?
A high temperature Dark pink mucous membranes Jaundice of the
sclera.
A lack of edema
6. NurseThink® Prioritization Power! Reflect on Joylie’s assessment
findings and identify the Top 3 Priority concerns.
a. Infection related to temperature
b. Abdominal discomfort related to liver enlargement
c. Poor health maintenance related to hepatitis B
7. Joylie is admitted to the pediatric unit for additional tests. The
nurse working that day is precepting a newly graduated licensed
practical nurse (LPN) and an experienced unlicensed assistive
personnel (UAP). For each of the admission tasks on the left,
determine the most appropriate delegation for each skill.
RN LPN UAP or None
a. Gather thermometer and blood pressure equipment- UAP
b. Start an IV- RN
c. Request toddler pull-up diapers from central supply- UAP
d. Obtain health history from the parent-RN
e. Perform a head-to-toe assessment- RN
