complete the care plan

10/3 1135

Nursing Note: Mackenzie visited the office upset and tearful. The orthopedic residents from the local children’s hospital screened students for orthopedic risk factors last week. During physical education, Mackenzie had complained of back pain and was placed on the screening list. Called mother with Mackenzie in the office. Notified her of the screening results (noted a positive finding for scoliosis) and the need for a follow-up visit with a primary care provider for further testing and future options. After a phone call, I had an extensive talk with Mackenzie. Mother stated they use the pediatric clinic at the children’s hospital. She feels the other students are already friends and leave her out. She also feels the teacher doesn’t offer options to help her fit into the class. Mackenzie stated, “Ms. Harper told the whole class about me coming to the nurse and about my crooked back!” Mackenzie denies bullying but misses her other school and friends. I will refer to the school counselor and send a memo to the teacher.

10/17 1300

Clinical Specialist Nursing Note: Met with Mackenzie and her mother for teaching. Discussed the need for the brace, care of the brace, skincare, donning and doffing the brace, and use of the brace. Also provided a preliminary discussion of movement, stairs, sleeping, and eating. Mackenzie was sullen but attentive. She appeared slightly cheered up when she heard she would grow a few inches from the bracing. Provided teaching guide. I walked with Mackenzie to the brace shop for brace mold creation. The fitting will be done later this afternoon. I will provide additional teaching after fitting.

10/3 0930

Scoliosis Screening Note: The nurse's notes record several instances of mild back pain. Noted asymmetry and unilateral rib hump and moderate lateral curvature of thoracic spine noted with Adam’s forward bend. Recommend referral to an orthopedic specialist for x-ray and scoliometer and discuss management strategies.

10/3 1400

School Counselor Note: Moved to our rural community school from a metropolitan city. She is the only new child in the class and is feeling alienated. She stated, “Everybody else has friends, and everyone stares at me. The teacher made me sit way in the back with many boys and put me in a group with people who didn’t like me. If I have to get a brace, I won’t do it!” We discussed ways to make friends, and Mackenzie has a goal to find one friend in the classroom in the next week. I will visit Mackenzie weekly and follow up with her after the appointment with the health care providers about the screening findings.

10/3 1135

Intraoffice Memo:

To: Mrs. Scott, 5th Grade Teacher

From: Shavon Harper, School Nurse

Re: Mackenzie Bramble

CC:  Dr. Otis Hartly, Principal

I met with Mackenzie Bramble today after she was sent to the office. She claimed you announced to the “whole class” that she had a “crooked back” and might need a brace. I would like to reinforce that divulging this information in class is a HIPAA violation. I am aware that the school functions under the FERPA guidelines, but I must reinforce confidentiality related to healthcare and health issues as a nurse. In addition, I ask that you provide opportunities for Mackenzie to adjust to the new class and fellow students. She has expressed feelings of not fitting in and would benefit from experiences that would allow her to work closely with fellow students, make friends, and adjust to this new environment. I would be glad to discuss this at your convenience.