Case Study 1- Medical 3-year-old “Thomas”, has just been transferred to the Paediatric Ward, presenting with a 2-day history of reduced oral intake, reduced wet nappies, tachypnoea, cough and wheeze. He has been diagnosed with acute asthma. Thomas’ older brothers have also been unwell with a cold. His mother, Tanya, has primary care of Thomas and his siblings, with his father caring for the children on weekends. Thomas is up to date with his immunisations. Thomas was born at 32 weeks’ gestation via c- section. He was hospitalised in Special Care Nursery until 34 weeks, for hyperbilirubinaemia and poor feeding. After many hospital and doctors’ visits during his life so far, Thomas has been diagnosed recently with Cerebral Palsy. Thomas currently has moderately increased work of breathing and requires 1 litre of oxygen via nasal prongs for oxygen saturation of 88%. Thomas is irritable and keeps pulling the oxygen tubing off. He has been ordered a once-only medication of Salbutamol via MDI, spacer and mask, every 20 minutes for 1 hour STAT. He cries and pushes the mask off each time the nurse tries to administer it. His mother cries and leaves the room when the nurses administer the salbutamol, saying she is too upset to watch, which makes Thomas more distressed.

Case Study 2- Surgical 16-year-old Alex is an inpatient on the Paediatric Surgical Ward, and presented with signs and symptoms of appendicitis. He is now 1-day post-op open appendectomy. The Paediatric Surgeon discovered that his appendix was perforated intra-operatively. Alex presented with a 3-day history of right sided abdominal pain, nausea, vomiting and fever. Alex is otherwise normally well, and was conceived through IVF. He is in Year 11 at school and is an only child. Currently, both parents and several visitors, including young children, are visiting and eating take-away at Alex’s bedside. Alex is currently nil by mouth, on full IV maintenance fluids, and a morphine PCA. He has an IDC and nasogastric tube (NGT) on free drainage with 4-hourly aspirates. Alex is presenting as quiet and withdrawn, but frequently asks the nurse to remove the NGT. He denies having any pain despite having several bad tries on the PCA, and is refusing to be moved for pressure area care or to be washed by the nurses. He rates his nausea as 10/10 most of the time.