Integration of theory with practice- Case world Scenario Critical reflection Critical reflection is an extension of “critical thinking” and requires students to think about their practice and examine their thinking by asking probing questions. Critical reflection moves beyond examining past situations and towards applying knowledge. In this assignment you are asked to; Choose one of the patients presented below and develop an academic assignment that demonstrates your capacity to critically assess this patient’s care taking into consideration the information in CaseWorld as well as your simulation scenario activity. Please Note For this assessment please focus only on the following nursing practice elements for the patient you have chosen Jenny = paediatric pneumonia (secondary infection) and adverse drug reaction To assist your thinking, use the headings on the next page to structure your paper and refer to your marking rubric Headings in your Content under these headings essay Introduction  Outline the purpose of this paper.  Introduce the patient, and the scenario. . (100 words approx.) Discussion  Demonstrate how the integration of objective & subjective signs & symptoms and medications impacts on the care (2000 words provided approx.)  Identify the elements of care that are needed because of the events in the simulation scenario, use supporting evidence to explain the required care  Discuss the role of inter professional collaboration in this case  Highlight and discuss the specific psychosocial issues that arise in this case Recommendations Provide a summary of the evidenced based care you & Conclusion recommend for your patient in their simulation scenario and a succinct conclusion of the keys points discussed in the (400 words paper. approx.). References Please include a minimum of eight (12) primary or secondary references Your discussion must be supported by relevant and rigorous sources whenever relevant Remember to use the draft Turnitin to check your work PRIOR to final submission g o Jenny COSTE Introduction: Jenny is a typically active 9 year old girl who lives with her family, parents Sam and Henry and her two older siblings, Josh and Annalise. Jenny has recently complained of pain in her legs and her mother is keen to have this investigated as it appears to be increasing in severity, in conjunction with some other generalised symptoms, such as a marked decrease in her appetite. We follow Jenny through investigation of her pain, subsequent diagnosis with acute lymphoblastic leukaemia (ALL) and management of her cancer through her various stages of treatment. Case writing team: Written by Dr Christine McCloud and Roma Dicker, SoNM, Flinders University and adapted for CaseWorld™ Michelle Abbott, SoNM, Flinders University Peer review: This case was peer reviewed by Julie Duffield, CPC, Women's and Children's Hospital (Palliative care). Case updates: This case contains the following updates. • Meet Jenny Patient information MRN: 1009642 Surname: COSTE Given names: Jenny DOB: 19/12/2003 Gender: Female o Timeframe: July 2013 o Personal details Patient: Jenny COSTE DOB: 19/12/2003 Age: 9 Address: 29 Grant Crescent, Blakeview SA 5114 Weight: 23 kg Height: 135 cm BMI: 13kg/m2 MRN: 1009642 Hobbies Jenny enjoys visits to the local playgrounds and exploring the reserves along Smith creek with her older siblings. She has just begun to play netball at school and she particularly enjoys little athletics. On Sunday mornings they go to nearby suburb Smithfield for the little athletics competition. Background Jenny lives with her parents, brother and sister in a three bedroom home in the relatively new suburb of Blakeview. She shares a bedroom with her sister and attends the local primary school. Josh and Annalise accompany Jenny to school each day, as the high school they attend is next to the primary school. Most days they walk the short distance together, as their mother Sam has a part time job at the local supermarket and father Henry is a self-employed electrician. He usually works on the new housing estates in the area. While Henry often leaves for work early, before the children are awake, but he is usually home in the afternoon when they return from school. Sam works a variety of hours at the supermarket, but tries to be home in the evenings. Past medical history Varicella (chicken pox) aged 3 years Past surgical history Nil Past family history Nil significant Allergies Nil known Medications Nil current o Investigations and diagnosis- Recently Jenny has been complaining of pain in her legs. At first her mother thought it was due to a muscle strain from Jenny’s sports or play activities, but it hasn’t resolved. Now Jenny is also complaining of feeling tired, this week she did not want to go to Little Athletics, and although she accompanied the family she only watched Josh and Annalise compete. Jenny spent the morning sitting on the bench nestling up to her mother. After they returned home Sam and Henry discussed Jenny, they both thought that she looked a little pale and recalled that she hadn’t been showing her usual interest in her food. That evening after the children had gone to their rooms, Sam rang her mother for advice. It was decided to ring the local GP clinic in the morning for an appointment. The first available appointment was on Tuesday at 10.00 am. By the time they arrived at the surgery Sam was becoming quite concerned. Far from recovering, Jenny was becoming more lethargic and irritable. The family GP is Dr Sue Brown, who has a diploma in paediatrics and a keen interest in healthcare for children and adolescents. She has cared for the Coste family since they moved to Blakeview and knows Jenny well. Dr Brown asks Jenny to get up onto the examination table and notes that Sam needs to assist the normally independent and energetic Jenny to do this. On examination Dr Brown notices that Jenny is very pale, mildly febrile, her respiratory rate is elevated and she is quite lethargic. Jenny tells Dr Brown that her legs hurt. There are no other obvious symptoms, but Dr Brown decides to order some further tests as Jenny is clearly unwell, her mother is quite concerned, and a diagnosis is not clear. Dr Brown writes a pathology request for a mid-stream specimen of urine (MSSU), full blood examination (FBE), Haemoglobin (Hb)), white blood cell count (WCC) & differential), urea, electrolytes and C-reactive protein (U & E). She asks Sam to bring Jenny back in two days for the results, or sooner if she is at all concerned. o Investigations and diagnosis- Jenny is not keen on the idea of blood tests but accompanies her mother to the pathology collection centre. There the phlebotomist, Karen, greets them and explains the procedure to Jenny and Sam. After the specimens have been collected both Jenny and Sam are rather tired and anxious but Jenny does not want any ‘rewards’ for having her blood taken. She declines the suggestion of an ice cream or donut (normally her favourites) and asks to go home. Later that afternoon Dr Brown receives a call from the pathologist to discuss abnormalities in Jenny’s white cell count. The receptionist calls Sam and asks her to bring Jenny back to the GP clinic, and asks if Jenny’s father can accompany them. At 1700, the family see Dr Brown. She carefully explains the blood results and tells them that they have a provisional diagnosis of acute lymphoblastic leukaemia (ALL), also known as acute lymphocytic leukaemia, and that she has arranged an urgent appointment at the paediatric oncology unit tomorrow. Dr Brown spends some time with the family answering as many of their questions as she can, explaining what will happen next. After a sleepless night, the family drive to the paediatric hospital where Jenny is to be admitted for further tests and to commence treatment. o Hospitalisation- Jenny and her parents present at the paediatric oncology clinic as organised. Josh and Annalise have been taken to school by Sam’s mother. Neither Sam, nor Henry have slept overnight and Jenny is anxious and teary. Henry has spent a great deal of time on the internet looking at various websites in relation to ALL. Both parents are struggling to come to terms with what they have been told by Dr Brown. Whilst they were aware that Jenny has been ‘off colour’ lately, neither of them believed her to be so seriously ill. Sam has expressed a great deal of guilt over not picking up on the signs. Last evening the whole family helped Jenny pack her bag as she will be spending some time in hospital for diagnostic testing and initial induction of treatment. Jenny is very frightened about going to hospital. Upon presentation to the oncology/haematology clinic Sam and Henry are asked to complete a number of forms and are provided with a set of information booklets. The staff are very warm and welcoming and the family are made to feel comfortable. Jenny has her own room and the nursing staff explain that a number of health professionals will be around to talk to the family throughout the day. Jenny has been placed on the afternoon operating theatre list to have a bone marrow biopsy (BMB) and lumber puncture (LP) performed after a busy morning planned meeting a number of different specialists. Jenny is additionally scheduled to have a port inserted, most likely tomorrow. The family are reeling from the rapid pace of the treatment and the amount of information they are receiving, and Henry in particular is struggling to keep up with all that needs to happen and why. o Home based palliative care- Following Jenny's initial intensive treatment 18 months ago and a brief period of remission, she relapsed and has experienced a rapid decline, despite aggressive treatment. She has become progressively unwell. Sam, her mother, has resigned from her position at the local supermarket as she was unable to balance work with Jenny’s ongoing healthcare. The family have been well supported by their family, friends and wider community during this difficult period and Sam often marvels at the kindness and support they have received. Jenny has been hospitalised for the past ten days with fungal pneumonia and remains very weak. Jenny is being organised to be discharged home with the palliative care team and home care support services. v