Topic 1: Gastrointestinal Case Study

You will be assigned one of the case studies by your instructor. Once you have completed the assigned case study please respond to 2 of your classmates by the assigned due date.

Timothy is an 11 month old infant who lives with his 16 year old mother and his grandmother in an urban apartment. His mother, Fascia, has stayed at home with Timothy since his birth, but plans to return to school this coming fall. His grandmother works 12 hour shifts to support her daughter and grandson. Because of her mother's work schedule, Fascia has little guidance at home. Fascia and her mother bring Timothy in to the clinic for his first visit because he needs a physical and "shots" so he can be enrolled in daycare when Fascia returns to school in a month.

While taking his history, the nurse finds that Timothy has generalized weakness and is cachexic. He weighs in the 5th percentile for his height and age. The nurse notes that Timothy has not received his 2, 4, or 6 month immunizations. Fascia tells the nurse that she didn't know he needed "shots" until she and her mother tried to enroll him in daycare. She further tells the nurse that when Timothy cries, she feeds him but he usually drinks only "half a bottle (8 oz)" of cow's milk at each feeding. She feeds him table food when he is up at a time she is eating. Fascia tells the nurse that Timothy is a "good baby" who doesn't cry much and sleeps most of the time. He sits up by himself but hasn't started crawling. Fascia keeps him in his play yard when he is awake and he reaches and grasps objects with the palms of his hands. He says "mama" and "bye bye". Fascia says she doesn't hold Timothy "much because I don't want to spoil him".

1. What is a potential diagnosis for Timothy?
2. What other assessment data would be helpful for the nurse practitioner to have?
3. What are Timothy's risk factors for his potential diagnosis?
4. Compare organic, nonorganic and idiopathic FTT.
5. Discuss the usual diagnostic tests used to determine which type of FTT a child has.
6. What are the priorities of care for Timothy?
7. Discuss the impact of the potential diagnosis of nonorganic failure to thrive on Timothy's growth and development.
8. Discuss the potential long term effects of FTT.
9. Would a multidisciplinary team approach be beneficial to Timothy and his family, if so, who should be involved in this team?
10. Discuss the teaching priorities for Fascia prior to taking Timothy home from the clinic (Broyles, 2006) .