Reference no: EM133675001 , Length: word count:1000

Ashley

Ashley is a 13-year-old girl, current weight of 25kg, who presented to the emergency department (ED) earlier this morning when her mother, Robyn, noticed swelling in Ashley's right hand. In the ED, Ashley displayed heightened anxiety and distress when attempts were made by the medical and nursing staff to assess her right hand. As a result, the ED team sedated Ashley with a combination of intranasal fentanyl and nitrous oxide. Under sedation, an X-ray confirmed a fracture of the right ulna and radius. She proceeded to be transferred to the theatre, where an open reduction internal fixation (ORIF) under general anaesthetic (GA), was performed on her right forearm. Additionally, while under GA, the opportunity was taken to remove 2 molars affected by cavities and administer
Gardasil and Boostrix immunisations. Ashley is being admitted to the paediatric ward following surgical ORIF of right ulna and radius and dental extraction.

Past Medical History
- Ashley was diagnosed at 3 years of age with Autism Spectrum Disorder.
- She has a history of constipation and iron deficiency secondary to limited dietary intake, Ashley will only eat cereal, plain toast and drink water.
- Immunisations are up to date.

Social
Ashley lives with her mother, Robyn, who is a single parent. She has no siblings.
Ashley is in grade 6, she attends a primary school that supports children with special care needs. Ashley has been described as having communication and sensory disability.

Current Status
Ashley is transferred to the ward with her right forearm in a plaster cast. She has a peripheral IV in her left cubital fossa with Y-site attached. one arm of the Y-site is running an infusion of 5% Dex and 0.9% Normal Saline at 43m1/hr, the other arm of the Y-site is running a continuous infusion of IV Morphine 12.5mg in 50ml normal saline at 1 ml/hr.

375 mg of IV or oral paracetamol is ordered 6 hourly prn.

Case study questions

Question 1. Discuss the incidence, aetiology and diagnostic criteria for Autism Spectrum Disorder.

Question 2. Discuss the pathophysiology that has led to Ashley's fracture of her ulna and radius.

Question 3. Discuss two actual nursing problems and related priorities of care for Ashley.

Question 4. Discuss the discharge planning and education requirements for Ashley and her mother.