Joanna is 16 years old and has cystic fibrosis. Recently she has had an increasing number of hospital admissions for two weeks of intravenous antibiotics and intensive physiotherapy. Over the past 6 months she has been prescribed high calorie supplemental drinks between meals. Prior to this she was rarely in hospital and had managed to keep a stable weight gain appropriate to her height on the 25^th centile. You have built up a good rapport with her and she reveals that this is all a waste of time; she would prefer to die than continue with a lifetime of taking drugs. She craves to be normal like her friends.

• Why is she saying this?
• What can the Children’s nurse do to help her manage her life and treatment schedule?

It is inevitable that Joanna faces a lifetime of administered drugs and chest physiotherapy. The nurse should explore how she is taking her medication and supplemental drinks and when she tends to take them.

• Explore what she perceives as normal behaviour for a 16-year-old
• Help her to problem solve how she could also share in these activities
• Explore the developmental psychology related to a 16-year-old. She would be striving towards independence but with a chronic illness that makes this difficult
• Discuss with her consultant, dietician and physiotherapist how Joanna’s current feelings could be addressed
• Would it be helpful to introduce other professionals such as a psychologist?

For many teenagers, acne is part of their adolescent years, compounding their desire to conform to a body image that has appeal to their peer group. Various medical treatments exist that can reduce the severity of the problem; however they often require medication to be given over a long period and at regular intervals.

• Why is body image of importance to this age group?
• What medication could be given?
• What are the side effects of such medication?
• How could the practice nurse or school nurse or children’s nurse support the young person to be concordant with their medication?
• What other advice could be given?

The following websites may be helpful

• www.bnf
• www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=video&cd=3&cad=rja&uact=8&ved=0ahUKEwiHwYrXwMPOAhWPDRoKHRQNAwQQtwIIMDAC&url=http%3A%2F%2Fwww.channel4embarrassingillnesses.com%2Fvideo%2Fdoctor-response%2Fdoctor-responses-acne%2F&usg=AFQjCNEQ7N5RbOeOsM7XaK4whl9h2gmJhQ&bvm=bv.129422649,d.d2s
• www.nhs.uk/Conditions/Acne/Pages/Causes.aspx
• http://webarchive.nationalarchives.gov.uk/20130512000000/youtube.com/watch?v=EeL7pggDsNw

Regarding adolescence and body image read: Bee, H. and Boyd, D. (2014) The Developing Child, 13^th edn. London: Pearson. Chapter 19.

• Enquire what treatments they have tried already and their cleaning regime
• If they have previously taken medication, discuss how long the course of treatment was for and whether it was effective. If possible ascertain whether the medication was taken regularly
• After obtaining consent check the young person’s body to assess the severity of the acne
• Discuss skin hygiene, choice and use of washing products

You are on placement with a health visitor and have accompanied her on a new birth visit. Mandy gave birth to Joshua 12 days ago and already has a 3½ year old daughter called Phoebe. Phoebe has an ear infection and has been prescribed amoxicillin. Whilst in the house you notice that Mandy has left a packet of paracetamol and a bottle of amoxicillin on the work surface in the kitchen.

• Why might this have happened?
• What should you as a children’s nurse do?
• What advice should be given to Mandy?

Answers

• How is Mandy coping with a new baby and a toddler who is unwell?
• Is she aware of the potential dangers in leaving medication within access of Phoebe?
• Is there anywhere within the kitchen where medication could be safely stored?

Your patient, Emmanuel, has been receiving a continuous infusion of morphine via an infusion pump as Patient Controlled Analgesia. The syringe is nearly empty so you have asked your mentor for a new syringe. Together with another RN your mentor prepares to draw up another syringe. On checking the CD register, there appears to be fewer morphine ampules than on the register.

• What should happen next?
• What may have happened?

Answers

• Where have the empty ampoules gone? Have any entries been made in the register, perhaps on the wrong page? Inform the designated pharmacist, the sister and the senior nurse.
• An investigation will have to be started; who had access to the CD keys since they were previously checked as correct?
• Ultimately this may require a police investigation and criminal prosecution, if a criminal offence has occurred with ensuing dismissal from the Trust plus referral to the NMC and dismissal from the Register.
• In the midst of this it is important not to forget Emmanuel if his PCA syringe is not replaced prior to the current one running out.
• Finally thought should be given to staff training. One possible reason for the discrepancy could be that the missing ampoules were accidentally broken and the nurses involved were unaware of the appropriate procedure required.