Case Study of Joi Anderson
Joi Anderson, a sixteen-year-old female, arrives at the Emergency Department (ED) with her grandmother Sharyn complaining of bilateral thigh and hip pain. This pain has been present for one day and is steadily increasing in severity. Paracetamol and Ibuprofen have not relieved her symptoms. Sharyn denies Joi has had any recent trauma and states she hasn’t partaken in any excessive exercise.
Joi reports feeling “tired all the time”, breathless and that “it hurts when I go to the toilet to wee”. When asked if she has needed to go to the toilet more often, she replies yes. Sharyn also reports that Joi has had similar pain to this before which required hospitalization when Joi was four and was diagnosed with sickle cell anemia. Joi sees a hematologist once every one to two years for check-ups and has not required further treatment.
No one in Joi’s family has had similar complaints. Sharyn explains that Joi’s father, Ben, is a fly-in-fly-out (FIFO) worker and has just returned to work for the next four weeks. Joi’s mother, Chloe, works long hours, so Sharyn lives with them to help with Joi’s cares.
Medical Past History:
Sickle cell anemia – diagnosed aged 4, controlled since the age of 6.
Medications:
Nil.
Allergies:
Nil.
On examination:
• Temperature 37.5 °C
• Orientated to person time and place (GCS 15)
• Conjunctiva and mucosal membranes slightly pale in colour
• Capillary refill sluggish (5 seconds).
• Nonspecific bilateral anterior thigh pain with no abnormalities detected, pain score 3/10
• All other findings within normal limits
Investigations ordered:
• Blood test – FBE including reticulocyte count, blood group and cross match, U&E’s and LFT’s
• Ward urinalysis
• Urine BHCG test
Significant findings from the above investigations were:
• WBC: 17 X 109/L
• Hb: 71g/L
• Urinalysis – Leukocyte esterase, nitrates, protein and blood present
The Subject Learning Outcomes demonstrated by successful
completion of the task below include:
a) Explore and discuss the impact of chronic health problems on care planning needs of a person, family and community, using an evidence‐based approach.
c) Demonstrate clinical reasoning through nursing assessment, interventions and evaluation, to support the health care of persons with chronic health problems.
d) Discuss legal, professional and ethical considerations in care delivery.
e) Explain and integrate the impact of co‐morbidities, quality use of medicines
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