Essay On Care Of Children And Adolescent


This is the case study analysis of Joanne Wills a 15-year-old girl who was physically assessed by the pediatric emergency department due to some injury caused while playing soccer. After the diagnosis physician stated that the girl had a fracture of the distal Radius and Ulna. While she was attempting to guard the ball she slipped, tripping onto the right forearm and extended hand she got injured. After the fall, she had been in excruciating pain and had a clearly deformed right forearm. The right arm was bandaged and transported by ambulance to PED. On the route to the health center, she was given an inhaler with penthrane to relieve her agony. She also received cuts on her right elbow and knee. The vital signs observed were not disturbed like her respiratory rate was 24 breaths/minute, oxygen saturation was 96%, heart rate was 104 beats per minute, bp was 108/68 mm of Hg and temperature was 37.2°C. This condition is becoming common among adolescents and thus needs to be evaluated and treated properly.

Pathophysiology Of The Diagnosis

The displacement of each bone and joint with in forearm and the hand can be encapsulated as the pathophysiology of the injury.  As a result, the person may experience excruciating pain, disfigurement, and impaired function. Surgery to repair the injury is typically the initial step in the treatment strategy before going into rehabilitation (Richards & Deal, 2014, pp. 385-391). A full fracture of the distal radius and ulna in a 15-year-old girl is certainly the consequence of high-energy trauma, such as a drop from an altitude or an accident with a speeding object. This is the scenario that best explains the condition's aetiology. Any injury to the forearm can cause distal radial fractures. Smith's, Colle's, Torus/Buckle, Greenstick, Die-punch, and isolated radial shaft fractures are examples of solitary DR fractures. Falls on the outstretched hand (FOOSH) injuries are the leading cause of such breaks. As per the case study, Joanne got injured by this kind of fracture due to high energy fall suffered on the playground while playing soccer which is the main reason behind this DR fracture in adolescents (Sieg, Reeves, & Corsino, 2022).

Signs And Symptoms

Signs of a significant injury in this area are frequently visible, similar to most fractures. Even though some wrist fractures in bones are much more acute than others, excruciating pain is frequently a marker of a distal radius break. Another sign of a broken wrist is edoema. Sometimes the edoema can get so severe that moving the damaged hand or wrist gets challenging or practically impossible to tingle at the ends of the fingers or possibly restricted finger movement (Pidgeon, 2021). There could even be a literal depiction of the fracture, based on how severe it is. For example, the wrist may seem malformed if a bone slips out of position. As per the case study, Joanne had shown many signs as after falling she experienced severe pain that doctors had given her pain killer named Penthrane. Moreover, her musculoskeletal examination shows that there had been a deformity of the right arm, tenderness, swelling, and ecchymosis. Additionally, she was unable to turn her arm, thus all these signs described the injury.

Growth And Developmental Milestone

Development and growth milestones for age have an impact on the nurse assessment and procedure for care planning since they offer a methodology for assessing a child's physical, intellectual, social, and emotional growth throughout the period. They can also help identify process bottlenecks or problematic regions (Medline Plus, 2022). It is crucial to regard developmental stages more as a suggestion than a hard set of guidelines to follow because reach adulthood in their own time. In order to completely cure the fracture of the right forearm, it will take 3-6 months. By 6 months Joanne will become comfortable and will be able to do every activity like manual work and playing different sports like motocross in 3-4 months. However, she has to take full precautions in order to prevent re-fracture in case of playing aggressively. However, Joanne was having deficiency of Vitamin D as per her medical history therefore it might take more time for her to get fully cured as vitamin D Calcium and protein are the three major bone healing substances needed in the body (McCallum, 2021). Moreover, Joanne can also undergo Gillick competence as she was under 16 years of age and if the treatment is not in the best interest of the patient then the patient like Joanne can refuse it or can give consent to the treatment. Nevertheless, a teenager's decision may be overturned if they reject a course of action that could kill them or severely injure them permanently (Griffith, 2016, pp. 2-3).

Protection Responsibilities Of Registered Nurse

The nurse plays a crucial role in assessing the needs of the kid, and he or she has many duties related to child security to fulfill (Government of Australia, 2022). An authorized nurse's duties in the area of child protection include surveying and monitoring a child's health and condition, reporting findings to experts and other healthcare practitioners, communicating with parents and caregivers, organizing patients' practices and programs, recording findings, medication management, and injections, assisting with persistent testing, and maintaining strict cleanliness requirements and privacy (El-Radhi, 2015, pp. 769-770). In this case, the nurse is responsible to take care of Joanne in managing the fracture by implying adequate Pediatric Medical Review and consultation with higher authorities and other professionals when required. The nurse must partner with their parents of Joanne as it will enhance trust, and respect, and get satisfactory health outcomes by sharing accurate information. In the first instance, the nurse must relieve the pain which Joanne is suffering from after getting fractured. They must also maintain asepsis, and record the vital signs timely. Moreover, the nurse must also manage the wound and should take adequate steps to minimize oedema. Additionally, she/he must assess Joanne for the infection that might take place and must prevent it (Belleza, 2021).

Role Of Multidisciplinary Team

Multidisciplinary approaches are crucial in this situation to deal with complex safeguarding issues. It may be chosen to chair interdisciplinary safeguarding meetings because the burden of responsibility may be too large for nurses to bear alone (NSW Health, 2020). Meetings to discuss child protection allow for the sharing of this obligation and may even benefit the children under evaluation. Implementing safeguarding surveillance can also aid in the process of safeguarding because it provides a secure, private setting for the supervisor and supervisee to discuss test cases and problems experienced in practice (SCIE, 2018).

Psychosocial, Cultural And Emotional Needs Of Adolescent

As per the case study as Joanne is suffering from fracture in her right arm distal radius and Ulna it has been observed that she might also suffer from some psychosocial, cultural and emotional needs that needs to be addressed and prevented by nursing professionals. During the adolescence children might have various behavioural issues and get irritated easily (Kosuge & Barry, 2015, pp. 442-446). It is the age of freedom when the child needs freedom to do anything, however, in the case of Joanne she was admitted to the hospital and her arm is fractured thus she is restrained to do anything. Moreover, in the hospital, she might get depressed as she got injured and cannot play or go to the resultant where she was employed. She might also get stressed out as she was unable to earn the living for the family thus facing financial issues. As Joanne does not have a financially sound background thus it is the responsibility of the nurse to not discriminate in the treatment procedure based on this factor. The nurse must communicate with the child in the language she understands, must encourage her to take care of her, and motivate her to get healed faster. This approach will develop trust in the child’s mind and she will be encouraged to take medications timely (Kourkouta & Papathanasiou, 2014, pp. 65-67).

Medication Management

Medication complexity is often a concept that encompasses factors that can put kids with complicated medication prophylaxis at risk for medication-related errors. These factors include the amount of medication a person has to take (polypharmacy); problems with compliance; failure to obtain treatment goals due to inadequate or incorrect medication routines; and preventable problems or damage caused by drugs (WHO, 2016, pp. 7-10). The nursing professional should adhere to appropriate caring strategies in this situation to minimize medication management complications. Many patients initially require IV preparations such as morphine or fentanyl, although some can be treated adequately with oral medications. Advanced techniques such as hematoma blocks or ultrasound-guided nerve blocks may be a consideration for DR fractures that will require manipulation and reduction. Sedation must be given to Joanne in such treatment (Abdolrazaghnejad, Banaie, Tavakoli, Safdari, & Rajabpour-Sanati, 2018, p. 2).


In this case study, it has been informed that Joanne has been suffering from severe pain and other complications since her right forearm got fractured. In this condition, the importance of the nursing profession has been observed which helps in evaluating the adolescent psychosocial, cultural, and emotional needs in addition to the significance of the setting of serious illness. moreover, challenges in the medical treatment or management of the medication have also been assessed which might be helpful in the treatment process. Multidisciplinary processing of the team is also observed which might prove to be an essential component in delivering satisfactory care and treatment to Joanne. These teams help in the proper assessment of the risk using tools helpful in pediatric treatment.


Abdolrazaghnejad, A., Banaie, M., Tavakoli, N., Safdari, M., & Rajabpour-Sanati, A. (2018). Pain management in the emergency department: a review article on options and methods. . Advanced journal of emergency medicine, 2(4). doi: 10.22114/AJEM.v0i0.93
Belleza, M. (2021). Fracture. Retrieved from Nurseslabs:
El-Radhi, A. S. (2015). Safeguarding the welfare of children: what is the nurse's role? Br J. Nurs, 24(15), 769-773. DOI: 10.12968/bjon.2015.24.15.769
Government of Australia. (2022). Understand your obligations to protect children. Retrieved from Government of Australia:
Griffith, R. (2016). What is Gillick competence? Human Vaccines & Immunotherapeutics, 12(1), 244-247.
Kosuge, D., & Barry, M. (2015). Changing trends in the management of children’s fractures. . The bone & joint journal, 97(4), 442-448.
Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in Nursing Practice. Mater Sociomedica, 26(1), 65-67. doi: 10.5455/msm.2014.26.65-67
McCallum, K. (2021). How to Heal Bones Faster. Retrieved from Houston Methodist :
Medline Plus. (2022). Adolescent development. Retrieved from Medline Plus:
NSW Health. (2020). Multidisciplinary team. Retrieved from NSW Health:,respect%20and%20trust
Pidgeon, S. T. (2021). Distal Radius Fractures Broken Wrist. Retrieved from OrthoInfo: There could even be a literal depiction of the fracture, based on how severe it is. For example, the wrist may seem malformed if a bone slips out of position.
Richards, T. A., & Deal, D. N. (2014). Distal ulna fractures. The Journal of hand surgery, 39(2), 385-391.
SCIE. (2018). Multidisciplinary teams. Retrieved from SCIE:
Sieg, R. N., Reeves, R. A., & Corsino, C. B. (2022). Distal Radius Fractures. Retrieved from NIH:
WHO. (2016). Medication Errors. Retrieved from WHO: file:///C:/Users/SystemJP/Downloads/9789241511643-eng.pdf
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