Shelly is a 4 year old preschooler who lives with her parents and younger
brother. She and her brother attend a local daycare center during the week
while their parents are at work in a small northern Ontario community. In
the evenings, she and her brother take a bath and then their parents read to
them before bedtime at 20:00. Shelly’s daycare group includes many
children her age and she enjoys playing outside with them. Although snack
times are planned, Shelly would rather play and does not always finish her
beverage. Shelly has not been to daycare the past 2 days due to a fever.
This evening, Shelly’s mother, Louise brings her to the health center since
the local hospital is 1 hour away. She tells the nurse that Shelly has been
“running a fever of 101oF (38.4oC) for the past 2 days” and although her
temperature decreases to 99F (37.2oC) with acetaminophen, it returns to
101oF (38.4oC) within 3 hours of each dose. Louise also states that Shelly
complains that “it hurts to pee-pee” and she has noticed more frequent trips
to the bathroom. Shelly is lying on her mother’s lap and doesn’t want the
nurse to touch her or talk to her. She is irritable and tearful.
How should the nurse approach the interview of Shelly?
What assessment data would be helpful for the nurse? How should she
approach the sequence of assessment?
What is the significance of Shelly’s clinical manifestations?
Would a multi-disciplinary approach be beneficial to this family? Who
should be involved in this team?
List the teaching priorities for this family.
Please read the case study and answer all the questions
How should the nurse approach the interview of Shelly?
The nurse should begin by introducing herself/himself to the parents and
Shelby to develop trust and to establish a rapport with Shelly and the parents
(Perry et al., 2017). Shelly may be uncomfortable given the symptoms she is
experiencing and the new unfamiliar environment. Pre-school children may be
curious and nervous; therefore, the nurse may allow Shelly to explore the
environment by examining equipment to relieve anxiety in children (Perry et
al., 2017). Additionally, the parents and nurse should use simple age
appropriate statements to explain the reason for the visit (Perry et al., 2017).
What assessment data would be helpful for the nurse? How
should she approach the sequence of assessment?
Assessment data would include Shelly’s past health history including
previous similar symptoms and possible prior treatments (Perry et al., 2017). It
is important to gain consent and for the nurse explain each step prior to
proceeding to alleviate anxiety associated with the assessment (Perry et al.,
2017). Non-threatening words that Shelly will understand should be used such
as sample instead of specimen (Perry et al., 2017). Provided the information
that Shelly does not always consume the whole beverage at snack time, Shelly
is experiencing a fever, pain when urinating, and frequent trips to the bathroom,
a urinary tract infection (UTI) may be suspected. Additional assessment data
would be a clean urine specimen by wiping the perineum with an antiseptic pad
and voiding a few millimetres of urine (Perry et al., 2017). Perry et al. (2017)
states that the recommendation for a febrile UTI includes antibiotic treatment
for seven to ten days.
What is the significance of Shelly’s clinical manifestations?
Clinical manifestations associated with urinary tract infections (UTI) for
individuals two to fourteen years old includes poor appetite, frequent urination,
painful urination, fatigue, incontinence in a toilet-trained child, and pallor
(Perry et al., 2017). Young girls have a short urethra measuring at two
centimeters compared to twenty centimeters for males, thus providing a quick
pathway for bacteria to enter (Perry et al., 2017). Morello et al. (2016) states
that Escherichia coli (E. coli) is the most frequent bacteria associated with
UTIs, with a rate of about 80–90 %.
Would a multi-disciplinary approach be beneficial to this
family? Who should be involved in this team?
At this point, it is important for the nurse to provide education regarding
signs and symptoms, factors that may be contributing to the UTI, prevention,
and follow up care with their family physician (Perry et al., 2017). If symptoms
are recurrent and persist, a multi-disciplinary approach may be beneficial if
further tests are required. However, at this time, education and prevention may
be provided by the family physician/pediatrician and nurse.
List the teaching priorities for this family.
Parents should be informed to regularly monitor for clues suggesting a
potential UTI to ensure prompt medical care (Perry et al., 2017). Further
education would include increasing fluid intake because concentrated urine
may allow for bacteria to multiply and poor fluid intake is a factor associated
with a UTI (Morello et al., 2016). Teaching priorities to prevent UTI recurrence
include proper perineal hygiene by wiping front to back, avoiding tight clothing
and diapers, not holding in urine, double voiding by voiding and then waiting a
few minutes before voiding again, and avoid straining (Perry et al., 2017).

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