Care Given to a Baby with Breathing Difficulties - Essay Example

?Running Head: Nursing Care Nursing Care [Institute’s Nursing Care Introduction In particular, this paper will include efforts to scrutinize video footage of the care given to a 17-day old baby and her family. During this report, the researcher will use a pseudonym for the baby to protect her identity in accordance with the Nursing and Midwifery Council (2008) Code of Professional Conduct. In this regard, the patient will come under reference as Flora, a newly born baby admitted to a paediatric accident and emergency department via ambulance, as she indicated struggles to breathe; she was 17 days old at the time. In addition, this report will try to identify different factors that were under consideration by Professor Carley and his team that were concerned about Flora’s high pulse and respiratory difficulty. Moreover, the paper will include efforts to understand the foetal circulation in relation to a neonate circulation along with an explanation of provision of the most appropriate treatment and care to Flora, as well as to her family members. Lastly, the researcher will endeavor to provide a clarification of ways that a children’s nurse can take to make a respiratory assessment of a child of Flora’s age, as well as assessments of older children. Discussion On arrival at The Royal Manchester Children’s Hospital, the team took Flora to the resuscitation room where they noticed her having breathing difficulties and a high pulse rate. Results of the initial assessment indicated her to be at a high risk; however, it was usual as infants often confront respiratory distress and similar signs and symptoms due to undiagnosed cardiac problems (Fergusson, 2008, 23-39). Subsequently, Professor Carley evaluated Flora’s physical condition and her behaviour using observational assessment of her airway, breathing, and circulation (Resuscitation Council UK, 2006, 1-10). It was noticeable that Flora was able to move all of her limbs with vigour, and there was no evidence of pallor that could indicate hypoxia (Fergusson, 2008, 35-40). In addition, the team noticed signs of efforts for breathing and visual signs of recession while observing Flora’s chest (Nursing and Midwifery Council, 2010, 29). The team also listened to the sound of Flora’s breathing, and luckily, both nasal flaring and chest recession were evident. Vital signs such as, temperature, blood pressure, pulse rate, respiration rate, and oxygen saturation were intact and functioning (Federspiel, 2010, 135). Furthermore, the team took blood samples for testing, which revealed that her kidneys were working in satisfactory condition and she was not anaemic, and additionally, Flora’s iron levels in her blood were normal as well. The hemoglobin levels in her blood were good, oxygenated cells were in high enough numbers within the blood to deliver oxygen to all tissues around the body that was another good sign. In addition, the team carried out blood tests to check PH imbalance and white cell count, as when in high numbers, they could indicate infection (Harrison, 2008, 56-67). After evaluating all these tests, Professor Carley reassured Flora’s parents by using the word ‘safe’ while explaining her immediate condition. In particular, Flora was at an age when cardiac abnormalities are often usual. One of the reasons is that in utero, the foetus obtains oxygenated blood, and nutrients from the placenta via the umbilical vein as defined by Chamley et al (2005, 11-26), and the lungs are not functional at this stage. At birth, important changes occurred to turn the foetal circulation into that of a neonatal circulation and before a baby can take in oxygen; her heart had to connect with the lungs (Holmes, 2010, 12), and this transition enabled Flora’s body to take over and begin to work independently (Glasper et al., 2007, 30-55). In particular, with every baby’s first breathe, the airways open and the drop-in pressure causes blood to rush to the lungs to receive oxygen, this oxygen reaches blood, and subsequently, flows to the heart. The forman ovale is one of the two foetal cardiac shunts that close when the pressure in the left atrium reaches higher than in the right atrium (Chamley et al., 2005, 11-26). On the other hand, the Ductus arteriosus is the other shunt, a large artery that joins the aorta and pulmonary artery within the foetal heart (Fox et al., 2010, 1-11). This artery closes functionally by fifteen hours after birth and even up to three weeks in some cases (Lomax, 2011, 61-68). If the Ductus arteriosus remains open, it results in symptoms, such as respiratory tract infections, sleep apnoea’s that may lead to congestive cardiac failure (Brough & Nataraja, 2010, 29-37). Due to these reasons, Professor Carley scanned Flora’s heart to check for any cardiac defects (Gardner & Merenstein, 2006, 20-29). During the arrival, Flora had shown a high pulse rate indicating that her heart was pumping faster than the normal rate. A normal heart rate for a child of Flora’s age should be 110-160 beats per minute (Green, 2011, 9-30). Experts have suggested, “A heart that beats over 200bpm is unacceptably high and constitutes an arrhythmia. The rise in rate is a result of hypoxia (low oxygen level in the extracellular spaces of the tissues) as the heart attempts to circulate the available oxygen to tissues” (Lumsden & Holmes, 2010, 123). In particular, Hypoxia is a shortage of oxygen within the tissues (Dougherty and Lister 2008). It is an observation that usually early intervention help in minimisation of damage to the brain and Flora’s level of consciousness (Fox et al, 2010, 15-26). This was the reason that the team worked fast to prevent further deterioration (European Resuscitation Council, 2005). In particular, the medical team appeared to initiate oxygen therapy and placed a mask near to her face to give wafting oxygen; done to help vital organs receive enough oxygen to reduce the risk of any tissue damage (Fox et al, 2010, 16-22). Flora’s respiratory difficulties put her at a high risk as her fast pulse rate was pumping oxygenated blood to the lungs. Still these efforts could have proven unproductive if there were any underlying problems with her lungs, such as infection, fluid, or disease (Pediatric Nursing, 2008, 29). For this reason, the team carried out a chest x-ray that revealed that part of Flora’s lung had collapsed; the team explained this to Flora’s parents who showed signs of extreme anxiety. However, Professor Carley minimised such anxiety by explaining that this was common and that it could have been something as simple as a small drop of milk that could have got into her lungs and caused the collapse. He assured them by explaining that the treatment will include antibiotics and Flora will be fine, as milk aspiration causes severe respiratory distress, such as chemical pneumonitis; inflammation of the lung by inhalation (Round et al., 2008, 45-58). In this situation, it is an understanding that a children’s nurse must be able to work efficiently as part of the medical team (Aitken et al, 2010). Observing and assessment of a child is one of the most important roles of a children’s nurse (Nursing and Midwifery Council, 2009). Aylott (2006, 38-44) indicates that using paediatric assessment triangle and observing breathing, circulation, and appearance is vital in such situations. Recording signs such as, temperature, blood pressure, pulse rate, respiratory rate, and oxygen saturations are significant as well, as they alert the nurse on time to ensure wellbeing of the child (WHO, 2003). Measurement of such data can come under comparison with normal ranges of similar age range to identify any deterioration (European Resuscitation Council, 2005). Particularly, the normal respiratory rate for a child of Flora’s age should be 30-40 breaths per minute, and heart rate should be 110-160 beats per minute (Dougherty & Lister, 2011, 20-41). In addition, if the temperature goes above 38 C/100 F, this could indicate an infection within the body and if remains high in a child of Flora’s age, this could put her at risk of dehydration (Cleaver, 2007, 10-29). During such situation, nurses should visually observe the child’s chest to monitor functioning and efforts of breathing, as well as to check the use of intercostal muscles and movement (Davies, 2010, 6-23). In addition, the nurse should listen to the sound of breathing, as well as head bobbing, whilst watching for nasal flaring and recession of the chest (Rosdahl & Kowalski, 28-34). The nurse should observe the chest for rise and fall of breaths for over a full minute along with the utilization of a stethoscope placed over the heart to listen all breath sounds, as without use of the stethoscope, one can miss the smaller breaths and only the deeper breaths would come under observation (Aylott, 2006, 38-44). In this regard, heartbeat count for a full minute may give an accurate reading. Besides heartbeat, nurse should check blood pressure as well, and a reading between 60-90 systolic and 20-60 diastolic is normal for an infant of Flora’s age (Huber, 2006, 12-37). Major changes in a child’s blood-pressure reading or scores well outside of this range could indicate conditions, such as cardiac failure and hypoxia (Nettina, 2006, 15-31). Findings from these observations will give the practitioner a guide to the infant’s wellbeing (Timby, 2008, 26-33). In this regard, a children’s nurse should be very well aware with comprehensive knowledge of child anatomy and physiology. With such knowledge, the children’s nurse will then be able to assess any changes in the child’s condition and alert other medical staff quickly. In addition, the nurse will be able to recognise the effects of medication and keep the family informed regarding health of the child, as well as supporting the team and the family. However, one should put efforts to ensure clear recording of all the above-mentioned assessments, as lack of recording may result in ineffective outcomes (Aparna et al., 2008, 624). On the other hand, an older child may have difficulty talking or walking while confronting respiratory distress. In particular, older children usually demonstrate signs of Hypoxia with shortness of breath, and results of different assessments have indicated appearance of chest recession suggesting severe respiratory problems as well (Fergusson, 2008, 10-17). Similar to infant child, nurses should check the child’s vital signs along with comparison with normal ranges (Aparna et al., 2008, 624). An older child’s ability to understand what is going on depends on his/her cognitive stage of development; the nurse needs to assess this and develop an understanding of the child’s perspective (Arnold & Underman, 2007, 78-89). The Platt report in 1970 (Davies, 2010, 6-23) recommended that sick children should be allowed to stay with parents in the hospital (Davies, 2010, 6-23). From this perspective, the nursing staff gave Flora to her mother; this calmed the baby down and enabled the mother to feel less anxious as well. The outcome of a study by few experts (Davies, 2010, 6-23) highlighted the need for the child to remain with his/her secure attachment figure whilst in hospital, and it was recognised that levels of stress and anxiety were reduced in all cases (Shields & Priddis, 2011, 16-20). In addition, family centered care should provide information and detailed explanation to families as well (Galvin et al., 2000, 624). For instance, in the case study, the nurse with the team supported Flora’s family by reassuring them and keeping them aware about happenings in accordance to the pediatrics nursing guidelines (Shields & Priddis, 2011, 16-20). In particular, the language they used was clear and open, no jargon and at a level and pace, which was appropriate (Arnold & Underman, 2007, 78-89). This resulted in involvement of family members, and they did not feel isolated; utilization of the word ‘safe’ throughout the conversation resulted in genuine compassion, especially when they looked at the heart scan (Dougherty & Lister, 2011, 20-41). The data collected from Flora’s mother informed the team that Flora was not born prematurely. At this point, communication with the family was vital, providing the team with information surrounding Flora’s birth, as well as her health. The medical history and information about the child’s birth and mother’s pregnancy, along with family history could suggest problems surrounding the child’s developmental status and congenital heart disease (Federspiel, 2010, 135). Conclusion Conclusively, the medical team was successful in delivering the care that the child needed through a series of different tests that facilitated the professor and his team in treating the child efficiently and effectively. The comprehensive assessment provided valuable information as to the health of the patient and in monitoring the effects of the treatment. In addition, it is an observation from this case study, as well as from analysis of different studies that children’s nurses play a very important role in the prevention and early detection of illness. Specific understanding of childhood development and the communication used to reassure the family helped in managing and controlling anxiety and stress levels as well. Finally, the report included discussion and analysis of different aspects of neonatal care by healthcare and nursing professionals. The paper has identified and analyzed different studies related to the topic while focusing on the case study of 17-day old Flora; however, it is anticipation that future researches in this regard will allow a more comprehensive and updated understanding of the impact of nursing on newborn patients. It is an expectation that the report will be beneficial for students and professionals in better understanding of the topic. References Aparna, K., Gerrad, A., Irfan, A., and Muhammad, W. 2008. “An infant with respiratory distress.” Paediatric Emergency Care. Volume 24, Issue 9, pp. 624. Arnold, E. C. and Underman, K. 2007. Interpersonal Relationships. Missouri: Elsevier. Aylott, M. 2006. “Observing the Sick Child: Part 2a Respiratory Assessment.” Pediatric Nursing. Volume 18, Issue 9, pp. 38-44. Brough, H. A. and Nataraja, R. 2010. Rapid Paediatrics and Child Health. West Sussex: Wiley-Blackwell. Chamley, C. A., Carson, A., Randall, P. and Sandwell, M. 2005. Developmental Anatomy and Physiology of Children. London: Elsevier. Cleaver, K. W. J. 2007. Emergency Care of Children and Young People. Oxford: Blackwell. Crisp, J., Potter, P. A., Taylor, C., & Perry, A. G. 2005. Potter & Perry's fundamentals of nursing. Elsevier Australia. Davies, R. 2010. “Marking the 50th anniversary of the Platt Report.” Journal of Child Health. Volume 14, Issue 1, pp. 6-23. Dougherty, L.; Lister, S. 2011. The Royal Marsden Manual of Clinical Nursing Procedures. Sussex: Willey-Blackwell. European Resuscitation Council. 2005. Provider Manual for use in the UK. London: Springer. Federspiel, M. C. 2010. “Cardiac Assessment in the Neonatal Population.” Neonatal Network. Volume 29, Issue 6, pp. 135. Fergusson, D. 2008. Clinical Assessment and Monitoring in Children. Oxford: Blackwell Publishing. Fox, G., Hoque, N. and Watts, T. 2010. Oxford Handbook of Neonatology. Oxford: Oxford Press. Galvin, E. 2000. “Family Centered Care Philosophy.” Paediatric Emergency Care. Volume 24, Issue 9, pp. 624. Gardner, S. L., Merenstein, G, B. 2006. Handbook of Neonatal Intensive Care. Missouri: Elsevier Inc. Glasper, E. A., McEwing, G., and Richardson, J. 2007. Handbook of Children's and Young People's Nursing. Oxford: University Press. Green, Carol J. 2011. Maternal Newborn Nursing Care Plans. London: Jones & Bartlett Publishers. Harrison, Vincent. 2008. The Newborn Baby. Cape Town: Juta & Company Limited. Holmes, D. 2010. Care of the Newborn, by Ten Teachers. London: Springer, pp.12. Huber, D. 2006. Leadership and nursing care management. Elsevier Health Sciences. Lomax, Anne. 2011. Examination of the Newborn. London: John Wiley & Sons. Lumsden, H. and Holmes, D. 2010. Care of the Newborn. London: Hodder and Arnold. Nettina, S. M. 2006. The Lippincott Manual of Nursing Practice. Lippincott Williams & Wilkins. Nursing and Midwifery Council. 2008. “Code of Professional Conduct.” Performance and Ethics. London: NMC. . Nursing and Midwifery Council. 2009. Recordkeeping. London: NMC Press. Nursing and Midwifery Council. 2010. Student Guidance. London: NMC Press. Pediatric Nursing. 2008. RCN Vital signs. Volume 20, Issue 1, pp. 29. Resuscitation Council UK. 2006. Paediatric Basic Life Support. RC-UK Press. Rosdahl, Caroline B., Kowalski, Mary T. 2008. Textbook of Basic Nursing. London: Lippincott Williams & Wilkins. Round, J., Stradling, L. and Meyers, A. 2008. Paediatrics, Clinical Cases Uncovered. West Sussex: Wiley-Blackwell. Shields, l. and Priddis, S. 2011. “Interactions between Parents and Staff of Hospitalised Children.” Paediatric Nursing. Volume 23, Issue 2, pp. 16-17-20. Timby, B. K. 2008. Fundamental Nursing Skills & Concepts. Lippincott Williams & Wilkins. WHO. 2003. Managing Newborn Problems. World Health Organisation Press. Read More