CASE 1: Tommy Johnson is an 18-month old boy. His mother brings him to the doctor because he is 'being difficult' and refuses to be toilet trained....
Question

# CASE 1:

Tommy Johnson is an 18-month old boy. His mother brings him to the doctor because he is "being difficult" and refuses to be toilet trained. Mrs. Johnson states, "He is deliberately not going when I put him on the toilet and then soiling his diapers. He is doing it just to be a pest."She tells you that Tommy also refuses to eat and will not drink anything but fruit punch and lemonade from his bottle. While she is explaining this, Tommy just stares at the wall. When asked about their daily activities, she says that he wakes at about 7AM, but usually cries himself back to sleep. When she gets him out of the bed, she gives him a bottle and sets him in front of the TV, while she does other things around the house. She tries to feed him lunch but he usually eats very little. The rest of the afternoon is spent napping or watching TV.

Mrs. Johnson tells you that she did not expect having a child to be this hard. Mr. Johnson no longer lives with his wife and child. He is behind in his chill support payments, and Mrs. Johnson tells you that she is struggling to pay the bill.

You examine Tommy and find that he is frail and thin looking. It is chilly outside and he is wearing only a thin tee shirt and diaper. Tommy's hair is matted and uncombed. He is in the second percentile for both height and weight. He has multiple bruises on his arms, back and legs. The bruises are in various stages of healing. Tommy is not meeting the developmental milestones for his age. He also does not interact with you at all while you are examining him.

• Identify abnormal findings and client strengths (objective and subjective data)
• Identify cue clusters (grouping of patient data or cues that points to the existence of a problem)
•  Draw inferences (What you think, a judgment about the cues. Example your clue clusters are: swollen finger, reddened and painful. Inference would be Broken Finger)
• List possible nursing diagnosis
• Check for defining characteristics related to your nursing diagnoses
• Confirm or rule out your diagnoses
• Document Conclusions

(1) Nursing Diagnosis that are appropriate for this client includes:

(2)Potential Collaborative Problems include the following:

Case study 2: Rhonda Logan is a 51-year-old divorced woman, with no children. She teaches in a parochial elementary school, attends church regularly and is the primary caregiver for an aging father in ill health. Rhonda is seeking health care related to difficulty going to sleep and staying asleep. She also reports frequent headaches, lack of appetite and motivation and difficulty concentrating.

When interviewed,Rhonda relates that she initiated the divorce 6 months ago, ending a 25-year marriage from an alcoholic,verbally abusive husband. She states that she feels guilty over her decision to divorce because of religious beliefs. Rhonda states she cannot understand how a loving God would have placed her in such a loveless relationship. She indicates that that if she had tried harder to involve Mr. Logan in marriage counseling, perhaps things would have turned out differently. She further reflects that if she had been able to have children or devoted less time to her father, her ex-husband would not have drunk so much.

During the interview with the nurse, Rhonda revealed that she fears that she may lose her job because of the Church's view on divorce. She states that her students are the only thing that keeps her "sane." Rhonda perceives less support from her colleagues during and after the divorce. She states that she is disappointed in their lack of Christian support during these "dark times". She states that she believes their behavior is hypocritical because she is hurting and most of the faculty is not acting in a caring way. Though she attends church regularly, she reveals that she is "going through the motions" but is feeling less and less connected to her congregation. The analogy that she shared was an empty eggshell, void on the inside, fragile on the outside, yet looking whole and strong to onlookers. The nurse noted vary changes in her mood, vacillating among anxiety, anger, preoccupation, sadness and crying.

• Identify abnormal findings and client strenghts (objective and subjective data)
• Identify cue clusters (grouping of patient data or cues that points to the existence of a problem)
•  Draw inferences (What you think, a judgment about the cues. Example your clue clusters are: swollen finger, reddened and painful. Inference would be Broken Finger)
• List possible nursing diagnosis
• Check for defining characteristics related to your nursing diagnoses
• Confirm or rule out your diagnoses
• Document Conclusions

(1) Nursing Diagnosis that are appropriate for this client includes:

(2)Potential Collaborative Problems include the following:

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