Dominic Antelli
Dominic Antelli, 9-year-old boy who is on the autism spectrum. Dominic attends a school
specifically for children with autism. Dominic is in foster care and this is his fourth placement in
a foster family. During his most recent medical examination it was noted that Dominic is pale
and lethargic. One of the children at Dominic’s previous foster care home was being treated for
lead poisoning by the local health department. The previous foster family shared that Dominic
would often eat non-edible substances and was noted to eat paint chips and other things that he
would find on the floor in their old home. Dominic likes only a few foods and often will not eat
when requested; at other times Dominic eats his favorite foods in large amounts. Although
Dominic was potty-trained by the age of 5, he has recently started to experience periods of
enuresis. Dominic is sometimes self-injurious. He has above grade level intelligence. The new
foster family has lots of questions about autism, enuresis, and available resources for children
with autism. The community health nurse provides teaching to the new foster family.
Your
Category response Explanation
Community Increased The foster parents are interested in community resources related
Assessment acuity to autism.
Culture/Beliefs/ Normal There is no indication that this is a concern in this case.
Spirituality acuity
Disease/Illness Increased The client’s care associated with lead poisoning and autism
Prevention acuity reflect the three levels of prevention.
Education/ Increased The foster parents require education. The client may benefit
Counseling acuity from counseling.
Health Promotion Increased The client has concerns related to enuresis, nutrition, self-injury,
acuity lead poisoning, and health promotion.
Resource Increased The client and foster parents may benefit from additional
Identification acuity resources.
Risk Reduction Increased The client engages in disordered eating and will benefit from
acuity risk reduction.
Self-Management Increased The client and foster parents may benefit from additional
acuity teaching and counseling about self-management.
Social Determinants Increased The client and foster parents are vulnerable to social aspects of
of Health acuity their environment, including safe housing, nutrition, and social
aspect of living
Surveillance Increased
acuity
Scenario 1
The community health nurse refers Dominic to the local public health clinic and a lead level is
drawn after a complete history and physical. The lead level is noted to be 70 mcg/dl. At this
level, chelation treatment was recommended. The current foster parents are eager to comply with
treatment to allow for healing. Dominic’s foster family asks the community health nurse about
the process of treating lead poisoning. Which information should the nurse include in teaching?
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, Statu
s Label Explanation
N Administration of This is not correct. The dorsogluteal site is no
intramuscular BAL longer recommended for intramuscular
(chelating agent) in injections, especially in children. The
Dominic’s buttocks ventrogluteal and vastus lateralis muscles are
(dorsogluteal site). preferable.
Y Assess renal function This is correct. Chelation substances are
prior to chelation excreted by the kidneys and adequate renal
therapy. function is required to ensure the medication
does not accumulate and reach toxic levels.
Y Ensure adequate This is correct. Adequate hydration ensures
hydration during appropriate distribution of the chelating to all
chelation therapy. tissues and to eliminate the lead from the
tissues.
Y Prepare for several This is correct. Repeated chelation treatments
chelation treatments. are needed to lower lead levels to safe
thresholds.
Y Talk with Dominic and This is correct. Usually treatment is done on an
his family about the inpatient basis with intravenous hydration,
need for inpatient intramuscular injections, assessing serum lead
treatment. levels, and other diagnostics. Children with
autism may struggle with the new experiences
associated with hospitalization. Anticipatory
guidance and sensitive teaching are important
for clients on the autism spectrum.
Y Administer BAL This is correct. The anesthetic agent will ease
(chelating agent) with the pain of the injection.
an anesthetic agent.
Scenario 2
Dominic is discharged to home after successful chelation therapy. The foster parent calls the
community health nurse one afternoon expressing frustration with Dominic’s behavior. Dominic
wanted to wear the same shirt he had been wearing for three days and his parent convinced him
that it needed to be washed. Since Dominic took the shirt off, he has been hitting himself,
rocking, and will not make eye contact or respond to his foster parent. The parent asks the
community health nurse for advice. Which of these interventions might be effective in assisting
with Dominic’s behavior?
Statu
s Label Explanation
Y Consider seeking This is correct. Specially trained healthcare
expert counseling to professionals and counselors may be able to
This study source was downloaded by 100000890439723 from CourseHero.com on 02-19-2025 09:26:30 GMT -06:00
https://www.coursehero.com/file/127431819/Dominic-Antelli-Swift-Riverdocx/
Dominic Antelli, 9-year-old boy who is on the autism spectrum. Dominic attends a school
specifically for children with autism. Dominic is in foster care and this is his fourth placement in
a foster family. During his most recent medical examination it was noted that Dominic is pale
and lethargic. One of the children at Dominic’s previous foster care home was being treated for
lead poisoning by the local health department. The previous foster family shared that Dominic
would often eat non-edible substances and was noted to eat paint chips and other things that he
would find on the floor in their old home. Dominic likes only a few foods and often will not eat
when requested; at other times Dominic eats his favorite foods in large amounts. Although
Dominic was potty-trained by the age of 5, he has recently started to experience periods of
enuresis. Dominic is sometimes self-injurious. He has above grade level intelligence. The new
foster family has lots of questions about autism, enuresis, and available resources for children
with autism. The community health nurse provides teaching to the new foster family.
Your
Category response Explanation
Community Increased The foster parents are interested in community resources related
Assessment acuity to autism.
Culture/Beliefs/ Normal There is no indication that this is a concern in this case.
Spirituality acuity
Disease/Illness Increased The client’s care associated with lead poisoning and autism
Prevention acuity reflect the three levels of prevention.
Education/ Increased The foster parents require education. The client may benefit
Counseling acuity from counseling.
Health Promotion Increased The client has concerns related to enuresis, nutrition, self-injury,
acuity lead poisoning, and health promotion.
Resource Increased The client and foster parents may benefit from additional
Identification acuity resources.
Risk Reduction Increased The client engages in disordered eating and will benefit from
acuity risk reduction.
Self-Management Increased The client and foster parents may benefit from additional
acuity teaching and counseling about self-management.
Social Determinants Increased The client and foster parents are vulnerable to social aspects of
of Health acuity their environment, including safe housing, nutrition, and social
aspect of living
Surveillance Increased
acuity
Scenario 1
The community health nurse refers Dominic to the local public health clinic and a lead level is
drawn after a complete history and physical. The lead level is noted to be 70 mcg/dl. At this
level, chelation treatment was recommended. The current foster parents are eager to comply with
treatment to allow for healing. Dominic’s foster family asks the community health nurse about
the process of treating lead poisoning. Which information should the nurse include in teaching?
This study source was downloaded by 100000890439723 from CourseHero.com on 02-19-2025 09:26:30 GMT -06:00
https://www.coursehero.com/file/127431819/Dominic-Antelli-Swift-Riverdocx/
, Statu
s Label Explanation
N Administration of This is not correct. The dorsogluteal site is no
intramuscular BAL longer recommended for intramuscular
(chelating agent) in injections, especially in children. The
Dominic’s buttocks ventrogluteal and vastus lateralis muscles are
(dorsogluteal site). preferable.
Y Assess renal function This is correct. Chelation substances are
prior to chelation excreted by the kidneys and adequate renal
therapy. function is required to ensure the medication
does not accumulate and reach toxic levels.
Y Ensure adequate This is correct. Adequate hydration ensures
hydration during appropriate distribution of the chelating to all
chelation therapy. tissues and to eliminate the lead from the
tissues.
Y Prepare for several This is correct. Repeated chelation treatments
chelation treatments. are needed to lower lead levels to safe
thresholds.
Y Talk with Dominic and This is correct. Usually treatment is done on an
his family about the inpatient basis with intravenous hydration,
need for inpatient intramuscular injections, assessing serum lead
treatment. levels, and other diagnostics. Children with
autism may struggle with the new experiences
associated with hospitalization. Anticipatory
guidance and sensitive teaching are important
for clients on the autism spectrum.
Y Administer BAL This is correct. The anesthetic agent will ease
(chelating agent) with the pain of the injection.
an anesthetic agent.
Scenario 2
Dominic is discharged to home after successful chelation therapy. The foster parent calls the
community health nurse one afternoon expressing frustration with Dominic’s behavior. Dominic
wanted to wear the same shirt he had been wearing for three days and his parent convinced him
that it needed to be washed. Since Dominic took the shirt off, he has been hitting himself,
rocking, and will not make eye contact or respond to his foster parent. The parent asks the
community health nurse for advice. Which of these interventions might be effective in assisting
with Dominic’s behavior?
Statu
s Label Explanation
Y Consider seeking This is correct. Specially trained healthcare
expert counseling to professionals and counselors may be able to
This study source was downloaded by 100000890439723 from CourseHero.com on 02-19-2025 09:26:30 GMT -06:00
https://www.coursehero.com/file/127431819/Dominic-Antelli-Swift-Riverdocx/
