Limited mobility in the right arm

Sebastian, a slightly built 12-year-old child, presents to the emergency department of a major Brisbane hospital with his mother, Amy. Sebastian presents with limited mobility in the right arm, swelling, and an exposed, six centimetre long cut on his right forearm that looks to be a number of days old. Amy informs staff that the injury was sustained while Sebastian was playing a few days ago and states she’s been too busy to come in with Sebastian any earlier.

Manuela is the registered nurse assigned to Sebastian, and she recognises Sebastian as a patient whom she had previously cared for on the paediatric oncology ward of the last hospital that she worked at. Manuela greets Sebastian and mentions that she remembers him from his many stays in the cancer ward where she had previously worked.

She asks Sebastian if his cancer is in remission and he shyly tells her ‘Yes, for the last two years’. Manuela notes that Sebastian seems very withdrawn and anxious compared to her previous memory of him. Manuela proceeds to clean and dress Sebastian’s cut and check his general health.

While taking Sebastian’s blood pressure, Manuela observes some faint bruises on his upper arms and shoulders. Manuela also observes that Sebastian’s temperature is raised, and his skin is pale. The treating team recommend an x-ray to check if there are any broken bones in Sebastian’s arm.

Amy agrees to this. While waiting for the results, Manuela overhears Amy speaking to Sebastian in a stern voice saying, ‘Don’t you dare tell your father or anyone else what happened to you, or you will be very sorry, do you understand?’

The x-ray shows no fractured bones. However, the treating team determine that the cut on Sebastian’s arm is severely infected and advise Amy that Sebastian should begin a course of antibiotics immediately to ensure the infection is controlled.

It is unclear whether his infected cut is the single cause of Sebastian’s raised temperature or whether there is another underlying condition, so the treating team recommend that Sebastian be admitted to the short stay section of the hospital so that further tests can be carried out to determine the reason for his high temperature and the swelling and limited mobility in his right arm.

Amy refuses to consent to the admission for further tests saying that her son is just being a ‘big cry baby’ and that he will be fine in the morning.

Amy also refuses to consent to Sebastian receiving antibiotics for his infected cut stating, “You doctors are always trying to shove drugs down my son’s throat.” Sebastian remains silent throughout the consultation with treating team members, but Manuela notes that his expression changes to a slight smile when the option of hospital admission is raised. Manuela is worried that Sebastian’s health will suffer significantly if Amy does not consent to one or both, of the antibiotics and hospital admission.

1. Ethical principles

[discuss what each ethical principle is AND your application of them to the facts]

1. Code of Ethics 

[insert elements from the ICN Code of Ethics AND your application of them to the facts]

1. Law

[set out the law AND apply it to your facts here]

1. Action
   1. Code of Conduct

[insert principles from the Code of Conduct AND your application of them to the facts]

1. Options for Action 

• [insert dot points OR a paragraph here]

1. Implementation

• [insert dot points OR a paragraph here]

1. Assess Outcomes 

• [insert dot points OR a sentence here]