CASE
ANALYSIS 3
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James Lopez is entering third grade .His teacher comes to you, the
school nurse ,because she is concerned about his poor performance in school .He
frequently comes to school late and often puts his head on his desk and appears
to be falling asleep. You notice that James has gained a significant amount of
weight over the summer. His face is much fuller now than in his second grade
picture.
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ASSESSMENT (INITIAL
VISITS)
You call James’ mother and make appointment for a home visit.
You do a health history ,noting family history of diabetes,
current eating, and activity and sleeping patterns for James and the family,
and determine whether he has a regular physician and insurance or Medicaid.
You assess his vital signs, height and weight, hearing, and
vision.
You talk more with his teacher about his activity on the
playground and any signs of excessive thirst, hunger, or general fatigue.
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NURSING DIAGNOSES
After a home visit, a meeting with James’ teacher, and two
observations with James, you decide on the following nursing diagnoses:
1. Nutrition: more than body requirements related to James’ eating
as a way of coping and his sedentary lifestyle.
2. Altered family process related to mother’s recent change from
being a stay-at-home single mom to attending truck driving school
(necessitating absences of several days at a time, with James cared for by a
married teenage sister and her husband).
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FINDINGS, PLAN AND
IMPLEMENTATION
James has been eating large quantities of snake food and fast food
meals for the last 3 months, since his mother started her training. He has also
quit participating in soccer and baseball, because his mother can no longer
provide transportation. His bicycle was recently stolen, and he spends a lot of
time playing video and computer games. James misses his mother when she is away
and says that he “stays up late watching television” and has “trouble getting
up for school” when he is at his sister’s house.
You plan to work with the family to refer James to his physician
to rule out diabetes. A family meeting is scheduled so that you can provide
some health education on childhood obesity and inactivity. You discuss some
possible interventions that the family can put into place:
1. Decrease reliance on fast food meals.
2. Have a regular evening meal time and encourage less snaking.
3. Decrease sedentary activity (e.g., video and computer games,
television viewing) and increasing physical activity (e.g., team sports,
walking, bicycling, active outdoor games).
4. Establish a reasonable bedtime and consistently enforce it.
5. Offer referral for family counseling so that James can discuss
his feelings in a safe environment.
6. With the family’s input, seek ways for James and his mother to
keep in better contact and for his sister to gain a greater understanding of
good parenting practices.
7. Meeting with the teacher, the family, and James to discuss ways
to help with his school performance.
8. Continue to monitor James’ progress with monthly height and
weight checks, personal interview, home visits, and teacher conference.
EVALUATION
The physician reported that James does not have diabetes; however,
if he continues to gain weight and remains inactive he is at a high risk for
type 2diabetes.Evaluation of nursing diagnoses 1and 2includes the following
goals:
1. The family will report less reliance on fast food and more
meals cooked at home.
2. The family will report more purchases of fresh fruits and
vegetables and fewer purchases of high-calorie, high-fast snakes.
3. James will report more physical exercise and fewer hours spent
in sedentary activity.
4. James will exhibit less tardiness and fewer signs of sleep
deprivation at school, and his school performance will improve.
5. James and his family will complete session with a family
counselor.
6. James’ weight will remain stable or will decrease as his height
increase over time.