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CCA206 Care of Children and Adolescents: Role of Nurse case Study Appraisal Assessment Answer

Subject Code and Title
CCA206 Care of Children and Adolescents
Critical Appraisal of a Case Study
1500 words (+/- 10%)
Learning Outcomes
The Subject Learning Outcomes demonstrated by successful completion of the task below include:
  1. Define and apply the key concepts related to the growth and development of children and adolescents to nursing assessment and care planning.
  2. Explain the theoretical underpinnings of a range of childhood health issues and apply this knowledge when using skills in simulated practice.
  3. Critically evaluate the psychosocial and cultural needs, the ramifications of illness and hospital admission use this knowledge in care-planning and professional practice.
  4. Explore the complexities of medication management with children and adolescents and interpret and apply to care planning.
  5. Recognise child protection responsibilities and collaborative processes with a multidisciplinary team.
Total Marks
100 marks

Task Summary

In this assessment task, you will be required to

  • Select one (1) case study to explore.
  • Critically evaluate the information provided in your case study scenario.
  • Demonstrate an in depth understanding of common adolescent pathologies, and the role of the nurse in the assessment, planning and delivery of care.
  • The word limit for this task is 1500 words (+/- 10%). This is an individual task.
  • Please refer to the Task Instructions for more details.


As adolescents mature and develop their independence, they will at times present on their own to seek health care services. Adolescents will also commonly present with their parents(s), requiring the nurse to practice family centred care.

When planning, delivering, and evaluating nursing care for adolescents who present without a parent in the emergency department setting, the nurse needs to build and sustain a therapeutic relationship with the adolescent, and advocate for their rights and needs.

In clinical scenarios where adolescents present on their own, and do not wish to include their family in their care, the nurse and medical team can be faced with moral and ethical dilemmas as to whether the family should be involved, despite the patient’s refusal. Adolescents should be viewed as individuals, and a determination should be made as to whether they are Gillick competent, whilst ensuring local legislation and policy is upheld. The determination as to whether an adolescent can be deemed Gillick competent, should also be made when an adolescent presents with parent(s) or a guardian, as it is essential to include the adolescent in decision making practices.

The case scenarios provided below, will test your knowledge of different pathologies and your understanding of the role of the Registered Nurse (RN) when caring for adolescents.

Task Instructions

To complete this assessment task, you must:

  1. Visualise yourself in the role of the newly graduated Registered Nurse (RN), working in a busy metropolitan emergency department (ED). Your patient has been seen by a medical officer who has commenced assessment and they have handed the patient over to you for nursing care.
  2. Choose one case study from the four presented.
  3. Write a 1500-word (+/- 10%) essay using the suggested structure below.
  4. Incorporate current evidence-based literature into the critical appraisal.
  5. Respond to each of the points listed below pertaining to the selected case study:
    • Outline and describe the pathophysiology of the clinical diagnosis.
    • Identify and briefly describe the signs and symptoms of the clinical presentation and how they relate to and/or support the clinical diagnosis.
    • Consider the growth and development milestones for the age of the case study character and how this will influence nursing assessment and the planning of care.
    • Discuss whether the adolescent in the scenario can provide informed consent, and make independent medical decisions based on your knowledge of Gillick competence, considering the clinical diagnosis.
    • Identify the child protection responsibilities of the case study character whilst in the hospital setting and collaborative processes with a multidisciplinary team.
    • Outline any psychosocial and/or cultural needs 



The following paper focuses on the role of a nurse while dealing with adolescents and how proper care is ensured. The paper also focuses partly on Gillick competence and what can be done in order to ensure that nothing is done unlawfully. This paper also focuses largely on the role of a registered nurse while dealing with adolescents and what care must be taken in order to provide a sustainable environment for the growth and development of a child in the process of recovery. The paper focuses on one particular case of a 15-year-old boy who playfully fell from a terrace and how, as an efficient nurse can he or she protect and care for the child.


Adam was admitted with deformity being caused at lower leg which was caused by falling off from the terrace. After doing an x- ray a tibial plafond fracture was detected. The blood pressure was detected at a normal range. The pulse was also checked to be at a normal range. Adam was detected to be showing results of stress and distress (Masera & Tavakoli). This can be well understood as Adam had past medical history of autism. He also had undergone a process of getting his tonsils removed. Also, after consulting his mother it was clear that he had difficulties in communicating and expressing his emotions due to his autistic symptoms. 

Diagnosis and Importance

Due to the deformity caused in the leg due to the fall, a proper gauze dressing was suggested in order to keep the leg intact and not cause any further problems. Continuous sp02 monitor of the left leg is important to keep a track of the saturated oxygen level. It is because that leg had been through a trauma and it is important to keep a track on the pressure measurements at intercompartmental levels. The vital signs are asked to be checked at every 30 minutes (Randazzo, Ferretti & Pasero, 2020). It is because patients entering the care system for the trauma must be checked for the vital signs to be intact in order to understand the chances of survival. Fasting for theatre was assigned to him and it abstained him from the intake of any liquid or solid diet. Neurovascular observations were made important to be made every 15 minutes. It is important because any delay or compromise made in observing neurovascular changes can lead to loss of limb or worst even death. 

Development Milestones

Adam is bed ridden due to the deformity caused in his leg and in times of healing, it is the nurse who has to play a major role in understanding the development milestones and set up a routine accordingly. A proper plan of action is very much needed in order to prevent further complications (Malenfant et al. 2020). As the patient shows signs of development it becomes important for the nurse to secure the patient in an orthopaedic bed. Supporting of the fractured sites with pillows and sandbags are essential for the maintaining of a neutral positioning of the leg. Sufficient personnel would be required for turning as trying to turn independently may result in serious deformities. 

Gillick Competence

Adam does not show any readiness in needles being applied on him and according to the Gillick Competence a nurse or a doctor can not apply on a child under the age of 16 with any sort of medical procedures without his or her consent. Though the consent of Adam might not be well informed, but taking any sort of medical step which, he is unwilling would be unlawful and thus the best way out of it would be to find altered measures (Massey et al. 2020). In this case Adam has a fear of needles with his previous encounters in the hospital and that must be kept in mind as applying needle without the consent of Adam could lead to serious troubles for him. No medications would work properly for Adam if it would be applied to him without his consent as it would lead him to a more traumatized state and lead him to depression and the medication would not work as expected. 

Child Protection Responsibilities

In case of Adam, a nurse has to follow the rationale responsibilities in order to protect the child from any harm. These include-

The fractured joints must be provided with ample support especially while turns and movement. 

A board must be secured under the mattress or he must be shifted to an orthopedic bed.

A neutral position must be maintained for Adam with the help of sandbags, footboard and trochanter roll (Lancaster et al. 2020). 

Sufficient personnel must be ensured while the turning process and abduction bars must be avoided for the same. 

Position must be maintained for traction integrity.

The splinted extremity must be carefully observed and evaluated for the edema to resolve.

Restrictions must be imposed on bending and sitting with Buck traction.

Electrical simulation must be initiated and maintained.

Adam must be positioned in such a way that there is a maintained appropriate pull on the bone’s long axis (Davoodvand, Abbaszadeh & Ahmadi, 2016).

The wrap notes must be secured and the pulleys must be lubricated and ropes must be checked for fraying. 

Psychological and Cultural Needs

A nurse must play a holistic role while caring for a patient. Adam is a child of 15 years with a mind of an 8-year-old.  As a nurse, it must be the sole responsibility of a nurse to meet Adam’s psychological as well as cultural needs. It is important to match to the mentality of Adam in order to provide comfort to Adam and make him feel at ease. As from the prior understanding and past medical histories it has been already established that Adam is autistic and is unable to express him emotions and is frightened of hospitals and strangers (Golsäter et al. 2016). As a nurse it is important to establish friend like relations with Adam in order to make him feel comfortable and treat him as a child. It is important for a nurse to calm him and make him feel at home. This will help him be put at ease and he can cope up faster than it can be anticipated. It is very different for patients, be of any age, to feel at ease, it helps in recovering faster, and only a nurse can ensure of this. 


It is essential for a nurse to create a sustainable and emotionally supportive environment for a child to heal. This can be accomplished by the following ways-

Calmness- Anxiety is a big threat to a child especially in a medical setup. A nurse when shows signs of stress and tension, it creates tension and nervousness among patientsIt is important for the nurse to maintain calmness while dealing with a child in order to ensure a child’s level of calmness (Gureje et al. 2020).

Talking- Another way of assuaging the fear among children is by making conversations with them (Ekström, 2020). Though it has been established that Adam is autistic, as a nurse it is important to promote conversations to put Adam at ease.

Music- Music plays an important role in soothing the mind of a child. It provides relaxation and helps in controlling anxiety.

Physical comfort- In case of Adam especially, it is important to ensure physical comfort as his leg is deformed and he must be in pain but due to his problem at communicating, it has to be ensured on the part of a nurse that Adam’s physical comfort level is met. 

Role of a Registered Nurse

As a registered nurse, these are the following roles that must be provided while taking care of an adolescent. 

Normalizing a child’s life during the period of hospitalization.

Minimizing the effect of the unique condition of a child.

Maximum growth and development must be fostered.

Realistic, coordinated and functional plans of home care must be developed (Ekström, 2020).

The role of the family in caring for a child must be respected.

Health of the child must be promoted.


As is evident from the above analysis of a role of a child, it is very must understandable that an adolescent must be treated with utmost care and delicacy. The case study which is chosen for the study was very much relevant in the understanding. In this case Adam is autistic and fears strangers, hospitals and needles. However, it was established by the mother of the child that though he is 15 years old he has the mentality of an 8 year. Under the Gillick law, it is unlawful to apply any sort of medication without the consent of a child and if done otherwise is punishable by the law. Hence altered ways should be found in place of injecting needles. In order to comfort him and make him less frightened of the hospital and strangers, it was essential to calm him using various sustainable measures which ensure an environment which fosters development, causing a happy mind enables faster healing rather than a mind full of anxiety. 

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