ACE.P triptych


Damon McAdam


The case begins when Damon McAdam is brought to the emergency room of the community hospital with vomiting and diarrhea that has persisted over several days. The nurse notices some unusual bruising and his mother says that he exhibits some strange behaviors. He is admitted to the pediatrics unit for treatment of his gastroenteritis and dehydration, and a referral is made to social services to investigate potential child abuse.  A few weeks later there is a home visit to further assess his developmental delays. A potential diagnosis of autism is pending.

Amber McAdam’s Introductory Monologue

Damon’s mother Amber talks about the symptoms that caused her to bring him to the ER. She also describes some of his unusual behaviors. She talks about her husband and two other children and describes their life at home.

Scenario 1 Scenario 2 Scenario 3

The case begins when Damon is brought to the emergency room of the community hospital with “stomach flu.” Learners are expected to complete a head-to-toe assessment, notice some hand-shaped bruises under each arm, and report findings.

Simulation Scenario 2 occurs the next day. Damon was admitted to the hospital and has been receiving IV fluids. He had 3 episodes of diarrhea, but no further vomiting. Social Services was notified about the bruising, and the social worker talked to his mother, who stated she does not know how he got the bruises.

Simulation Scenario 3 occurs during a home visit two months after Damon’s discharge from the hospital. A tentative diagnosis of autism has been made, and further evaluation by a developmental specialist is scheduled. Child protective services followed up and Damon’s father has been attending parenting classes..


Finish the Story Assignment

Learners have now seen the McAdam family at three snapshots in time. What do they think his life will be like three months from now?

Author Information

Mary Cato, EdD, RN
Oregon Health & Science University School of Nursing (recently retired)
Portland, OR