Health of Infants, Children and Young People - Assignment Example

Health of Infants, Children and Young People Assignment 1: Child Health Assessment Report Insert scanned image of the signed consent form on this page or upload file to Gradebook (It is a legal/ethical requirement to have a consent form for this activity; assignments will NOT be marked without accompanying consent forms) Health of Infants, Children and Young People Assignment 1: Child Health Assessment Report SECTION 1: Child Health Assessment Pro Forma (500 words) Conducted by Date Child’s first name Jenny Age 1year 6 months Parent Consent Gained Yes Gender Female PHYSICAL ASSESSMENT Height 92cm Weight 16.8Kg H/C 46.1cm Temperature 38.6°C Pulse 153beats/min Respirations 25/min Physiological Findings Was previously healthy, developed fever (high grade, intermittent, not associated with chills or sweating), runny nose, and dry cough and convulsions. Prior treatment for ear congestion with Amoxicillin, ear drops and Paracetamol for 3 days. Fever persisted, convulsions developed on day 4(on admission): generalized tonic-clonic for 5 minutes, no associated cyanosis and neurological complaints. No history of head trauma, metabolic disease or drug ingestion. No known food and drug allergies. No family history of epilepsy. Uneventful delivery at term and normal perinatal period. Immunisations are upto date. Has normal growth curve. Psychosocial/ Emotional Development Normal developmental milestones achieved; Walked at 13 months, can speak but a lot of jargon, plays interactively except the last 3 days. Is the youngest her 3 siblings Lives with parents, employed and in a good relationship. Other family members healthy and no history of chronic disease. General Assessment Skin Inspection: Light skin, no erythema, vitiligo or abnormal pigmentation. No rashes Palpation: febrille, soft to touch. Normal skin turgor Hair and nails Thick red, normal hair uniformly distributed on the scalp. Nails well developed, well trimmed, no splinter haemorrhages or nails separation. Normal capillary refill. Head No head deformities, symmetrical face. Both fontanels fused. Eyes Brown eyes, normal eyelashes, pupils equal and reactive to light, Normal eye movements (no squint and diplopia). Normal visual acuity. Ears Pinnae normal, left ear has scanty purulent discharge. No hearing difficulties. Nose No nasal deformities, clear mucus discharge from both noses. Mouth and throat Normal dentition for age, mucous membranes pink in colour, no blisters, oral thrush or ulcers, well formed gums with no bleeding. Tongue and lips normal. Cardiac Inspection: No neck veins engorgement. Palpation: Peripheral pulses are regular, rate 120/min and of normal volume. Palpable apex beat at 5th intercostal space midclavicular line. Auscultation: S1 & S2 heard. No murmurs. Chest and Respiratory Inspection: No respiratory distress e.g. nasal flaring, Respiratory rate 25/min, Normal bilateral chest movement. No chest deformities Palpation: Trachea is in midline, Chest expansion is normal. Auscultation: Normal bilateral air entry, Vesicular breathing. No added sounds. Gastrointestinal Normal bowel habits, no abdominal pain and no pain defecation. Inspection: No abdominal distention Palpation: Non tender, No organomegally Auscultation: normal bowel sounds Urinary No dysuria and no change in urinary patterns, straw colored urine. Musculo-skeletal Normal posture and smooth spine alignment No tenderness and step offs. Neurologic Alert child with good communication. Neck soft with negative kerning’s sign. Language development is as expected for age. Normal motor and sensory function. Record any other comments made by the child about their general health status ie Allergies SOCIAL HISTORY Age appropriate sleep Sleeps once during the day (in the afternoon) and at night as expected. No sleep disturbances. Age appropriate Nutrition Still breast feeding, takes three main in a day and 2 snacks between main meals. No feeding problems have been experienced except in the last 24 hours where there was reduced appetite. Age appropriate physical activity Able to stand and walk without support, creeps upstairs. No motor Problems reported. SECTION 2: Discuss how you would communicate and build rapport with a child of your chosen age group. (500 words) Include in your discussion the use of body language, eye contact, appropriate touch between nurse and child, cultural considerations you have made, listening techniques and legal and ethical issues associated with a child health assessment. This part of the assignment should not be in the first person When a child is sick parents experience a stressful situation with a range of emotional changes (e.g. anxiety, anger, fear, sadness etc) which can hinder effective communication and assessment by nurses. Equally, a sick child may present a challenge coupled to their age associated differences requiring a good way of effective communication and rapport building. Greetings to the parent or caregiver in a friendly manner and seeking consent them from sets a conducive environment for assessment. Children in this age group may manifest a wide range of behaviour from active and curious, to shy and cautious and slow to warm up type (Inston, 2002). For a 1yr old 6 months child, assessment is better done when the child is seated on parent or caregiver’s lap and this avoids distress from developing because of stranger anxiety. Starting by observation of the child before engaging in conversation is important and gives a glimpse of the general health status. A good rapport forms the foundation for the collaborative relationship between the nurse and parent that will provide the best nursing care for the child (Ball, Bindler & Cowen, 2010). After consent a self introduction including the name, title and role in caring for the child helps in easing any tension and also knowing other family member accompanying the details. Talking to the parent or any accompanying caregiver gives the child confidence before talking to the child. Explain the purpose of the assessment and this entire assessment is best done in a private environment where no interruptions occur (DeLaune & Ladner, 2002). Then the child can been engaged in the conversation once the environment and mood is set to allow other steps to continue. The child is approached in a gentle and calm way. Rapport establishment can be easily achieved by offering the child something to play with such as a toy or even a stethoscope or examining their toy first. These are a source of amusement to a child and establish relationship between a nurse and child. Smiling to the child and maintaining eye contact enables monitoring of the child’s activity and early detection of discomfort resulting from examination or pathology. This may seem awkward but they help in making the child assessment easier. Communication gives children a means to learn, interact and express themselves and for emotional satisfaction from parents and other social contacts. This is done both verbally and nonverbally. Children’s cognitive and language functions are immature hence communication is also achieved through art, music, and play. Therefore using toys, storytelling and other non verbal strategies help in getting insight to the child’s experience especially when they are unwell. Nursing care also require encouraging them express their feelings. Use of language and words understandable to the child and parents and seek clarification for any ambiguous areas help in communication. Understanding the family background and parenting skills, culture, ethnicity and beliefs helps in nursing care (Ball, Bindler & Cowen, 2010). Maintaining eye contact during this process helps to note any changes in child’s and/or parent’s facial expressions due to emotional reactions, physical discomfort or other forms of dissatisfaction. It also helps the client feel understood and cared for as it communicates openness and a willingness to care by the nurse (Ball, Bindler & Cowen, 2010). It also aids to maintain other aspects of non verbal communication and attracts the attention of the child. Listening during this process is important to both the child and the parent as it boosts the confidence they have on the nurse during assessment. This makes them feel cared for and allows them express themselves even better. Empathy has to be displayed during the entire process and listening aid. Careful Listening is also necessary to understand the child and parents when obtaining history and examination. Responding appropriately to the child’s reaction requires listening attentively. Physical appearance is very important in child assessment and conveys important non verbal information. Uniforms and artefacts may hinder interpersonal interactions during assessment and may even scare the child by instilling fear and make assessment futile. How one is dressed therefore determines child’s perception and the effectiveness of interaction. Moreover, facial expressions add up to this hence initial approach above has to be tailored to this age group. Touch is a powerful communication tool that can be used for soothing, comforting, and to establish and maintain rapport and bond between nurse and a child (Ball, Bindler& Cowen, 2010). It shows care and can calm a crying child. Sometimes a child may not respond well to touch and may get more irritable especially if they are in pain. Use of touch has to be applied considering that both responses can be the case taking into account cultural perceptions. Use of gestures during communication like waving the hands, tapping the feet, and shaking the head all add to verbal communication help in adding amusement and creates a non threatening environment enabling rapport maintenance. However, intimidating gestures and other aspects such of non verbal communication such as intrusiveness and glaring eye contact should be avoided (Ball, Bindler & Cowen, 2010). Cultural considerations have to be considered given the different multicultural set up in our country because it determines social interaction and hence communication (Giger & Davidhizar, 1999). This ranges from differences in language and other aspects of non verbal communication, like touch and eye contact (Various beliefs and values affect parents’ health perspectives that affect assessment such as exposure and also explaining the conditions of the child to the parent. Apart from consent, other ethical issues to consider are parents’ autonomy with regards to their children and also confidentiality during their assessment. Other ethical principles also apply. Any sign of child abuse would be noted and notification of relevant authorities would be done after assessment as per regulations (Savage, 2011). SECTION 2: Analysis and Interpretation of the Assessment Data (1000 words) - within your referenced discussion identify expected parameters and normal and abnormal findings of the child’s data from section one. Discuss future health implications for the child in relation to health assessment data. Jenny who is from aboriginal descent and of 1year 6months with 92cm (> 97th percentile), 16.8kg (> 97th percentile) and head circumference of 46.1cm which is normal for her age and sex. She was managed for febrille convulsion and Otitis media. The vital parameters; temperature was 38.6°c showing fever given the normal temperature ranges from 36.5 to 37.5°c, this was attributable to the middle ear infection and upper respiratory tract infection. The pulse rate was 153/min showing a tachycardia which could be attributed to the underlying response to infection and respiratory rate was 25/minute within normal range of less than 40/min for this age group. Absence of dehydration was evidence by normal skin turgor, moist mucous membranes and absence of sunken eyes and normal capillary refill. With a history of one episode of generalised seizure history and neurological examination is crucial to rule out important differentials such as bacterial meningitis, encephalitis, metabolic, other infections and electrolyte derangements. The level of consciousness is depressed in severe diseases that affect the brain, giving states such as drowsiness, stupor and coma as depending on severity. Given her alertness suggests against primary brain pathology. No signs of meningism such as neck stiffness and kernig sign were present, this occurs in conditions like meningitis and encephalitis (Burg, Pollin, Gershon & Ingelfinger, 2006). There was normal cranial nerve examination including normal vision, hearing, eye movements and facial sensation. Motor function, sensation and reflexes were normal. In infections and other insults of the nervous system, cranial nerve palsies may occur and in complicated cases, further motor, sensory and cognitive deficits occur. Absence of headache, vomiting and irritability makes meningitis unlikely however a lumbar puncture for analysis of cerebrospinal fluid is mandatory to rule out this (Shaked, Peña, Linares and Baker, 2009). Head and ear, nose and throat assessment revealed nasal discharge and a history of constant nasal blockage. This had been managed previously as flu without improvement. The pinnae were normal however; the left ear had purulent discharge which pointed towards Otitis media as normal ears don’t discharge pus. The external auditory meatus was not narrowed; this usually occurs in Otitis media especially chronic form and is associated with hearing problems (Verhoeff et al, 2006). Untreated acute Otitis media can progress to chronic Otitis media and may sometimes cause cholesteatoma (especially in adults). In acute cases sepsis, meningitis and spread to other sites can occur hence the need for microbial therapy and aural hygiene to prevent this and also to allow penetration of the ear drops and enhance recovery (Acuin, 2007). Failure to respond to first line antibiotics needs review of therapy and change after 48-72hours since no improvement had occurred (Nader et al, 2012). Long term risk of hearing loss is minimal with adequate treatment but follow up is necessary. Hearing loss varies with the severity of the infection and sometimes may remain undiagnosed for long especially in indigenous communities with limited healthcare access (Harvey, 2009). This was the probable reason for her fever and convulsion. The oral cavity, mouth, skin and hair were normal. The tongue had no areas of injuries as this mostly occurs in a convulsion. Changes can occur in presence of infections involving the parts or conditions that affect these parts such as HIV infection and malnutrition among others (Joseph, 2011)). Apart from reduced appetite, no gastrointestinal anomaly was reported or found out. Appetite reduction was attributed to the Otitis media. Continued intake of feeds despite this ensured no dehydration. Respiratory and urinary systems were normal on examination and symptomatically. This was evidenced by absence of respiratory distress such as nasal flaring, intercostal recession, normal respiratory rate, and vesicular breath sounds and normal urinary pattern, output and urine colour. This was important to ascertain since febrille convulsion is a diagnosis of exclusion and requires all other possible causes be ruled out (Marla and Ghazala, 2006) such as pneumonia and Urinary tract infections in this case. She falls within the age group febrille convulsions occur commonly; between 6months and 6 years and a seizure is triggered by fever in a neurologically unstable brain of the young (Hodgson et al, 2008). Repeated convulsions are associated with risk of brain damage and risk of cerebral palsy in this young age and mental retardation hence showing clear importance of adequate evaluation. Febrile convulsions occur in 2 to 5% of healthy with minimal risk of future epilepsy except in case of positive family history of epilepsy and neurodevelopmental problem (Marla and Ghazala, 2006). Both of which were absent in Jenny. She therefore has negligible risk of hearing loss due to acute course of ear infection which attention was sought for and also slim chances of any neurological sequelae. Detailed history and physical examination is important to find the source of fever and manage this and also rule out differentials that cause seizures in children. REFERENCE Acuin J, 2007 Chronic Suppurative Otitis Media: Burden of Illness and Management Options. World Health Organization, Geneva. Ball, J W., Bindler, R C. & Cowen, K J. 2010. Child Health Nursing:  Partnering with Children & Families. Pearson: New York Burg, F. D., Pollin R A., Gershon, A. A. & Ingelfinger, J. 2006.Burg: Current Pediatric Therapy. Elsevier: Saunders Byrnes, K. 1996. Conducting the pediatric health history: A guide. Pediatric Nursing, 22, 135–137. DeLaune, S., & Ladner, P. 2002. Fundamentals of Nursing. Clifton Park, NY: Delmar Learning. Giger, J. N., & Davidhizar, R. E. 1999. Transcultural nursing: Assessment and intervention (3rd ed., pp. 43–60).St. Louis: Mosby. Harvey, L C, 2009. Current management of otitis media in Australia. Med J Aust; 191 (9): 37 Hodgson E. et al. 2008. Febrille seizures: Clinical practice Guideline for Long-term Management of the Child with Simple Febrile. American Academy of Pediatrics. 121; 1281. DOI: 10.1542/peds.2008-0939 DOI: 10.1542/peds.2008-0939 retrieved on 25th September 2013 from http://pediatrics.aappublications.org/content/121/6/1281.full.html Instone, S. L. 2002. Developmental strategies for interviewing children. Journal of Pediatric Health Care, 16(6), 304–305. Joseph, E. K. 2011. Nelson Textbook of Pediatrics. Elsevier: Saunders. Marla, J. F and Ghazala, Q. S. 2006. Seizures in Children. Pediatr Clin N Am 53; 257–277 Nader, S., Alejandro, H., Howard, E. R and Marcia, K. 2012. Development of an Algorithm for the Diagnosis of Otitis Media. Academic Pediatrics, 12:3, 214-218 Savage, P. 2011. Legal issues for nursing students. 2ndEd. Pearson: Frenchs Forrest. Shaked, O., Peña, B. M., Linares, M. Y. and Baker, R.L. 2009. Simple febrile seizures: are the AAP guidelines regarding lumbar puncture being followed? Pediatr Emerg Care.; 25(1):8–11 Verhoeff, M., et al. 2006.Chronic suppurative otitis media: a review. Int J Pediatr Otorhinolaryngol; 70:1–12. World Health Organisation (WHO) retrieved on 25th September 2013 at http://www.who.int/child-adolescenthealth/publications/ . Assessment criteria Distinction / HD (75-84 5)(85-100%) Higher level/exemplary Competence in most areas. HD: Exemplary competence Credit (65-74%) Competency in all parameters. PLUS: demonstrates higher level competence on some parameters. Pass 1 (55-64%) Basic competence in all criteria. Pass 2 (50-54%) Basic competence on most parameters. Most requirements for pass are reached. Fail 1 (40-49%) Insufficient competence on some parameters. Deficiencies in meeting Pass requirements. Fail 2 (0-39%) Competence not demonstrated on most parameters. Requirements for Pass clearly not met. Collects and uses recent, relevant literature in the discussion sections of the proforma Higher/Exemplary level of knowledge and application is indicated by: As for Credit with extensive use of different peer reviewed journal articles, particularly research. A good level of knowledge and application is indicated by: As for Pass1 but more than three recent peer reviewed journal articles used. Satisfactory level of knowledge and application is indicated by: Consistent use of textbook and and at least three recent peer reviewed journal articles. Used References 2006 or later Basic knowledge and understanding is indicated by: Adequate use of course textbook and at least three recent peer reviewed journal articles. Used References 2006 or later Limited knowledge and understanding is indicated by: Little use of textbook. Non-reputable sources used. One or two recent peer reviewed journal articles used. References older than 2006 Minimal knowledge and understanding is indicated by: Course textbook and e-readings not used. Non-reputable sources used. No recent peer reviewed journal articles used. References older than 2006 Presents assignment in accordance with criteria in Course Information Booklet, demonstrating an understanding of the health assessment process All components exemplary. All components addressed at a good level, demonstrating a sound understanding of the health assessment process. Presented as per Course Information booklet. A satisfactory level of understanding of the health assessment process is demonstrated throughout the assignment. All sections of assignment are adequately presented; or the inadequacy of one section is made up for by better answers in other sections. Limited attention to assignment criteria. More than one section does not demonstrate an understanding of the health assessment process. Little or no attempt to follow assignment criteria. A poor understanding of the health assessment process is demonstrated throughout the assignment. The written work demonstrates written literacy as appropriate to the discipline and professional area of nursing As per Credit and: Demonstration of an excellent ability to critically analyse information using language appropriate to the nursing profession. As per Pass 1 and: Demonstration of an above average ability to critically analyse information using language appropriate to the nursing profession. Sentences/paragraphs that are constructed so that they relate to each other. Sentences/paragraphs that consistently progress the ideas related to the topic. Consistent and correct use of spelling, grammar &/or punctuation. Sentences/paragraphs that occasionally do not relate to each other. Sentences/paragraphs that inconsistently progress the ideas related to the topic. Occasional poor use of spelling, grammar &/or punctuation. Sentences/paragraphs that occasionally relate to each other. Sentences/paragraphs that occasionally progress the ideas related to the topic. Limited and inaccurate spelling, grammar &/or punctuation. Sentences/paragraphs that rarely relate to each other. Sentences/paragraphs that rarely progress the ideas related to the topic. Numerous spelling, grammar &/or punctuation mistakes Accurate documentation of health assessment data Excellent, detailed assessment data – nothing missing in any sections. Mostly a thorough health assessment - some minor details missing. Adequate assessment data; more details required in several aspects of pro forma. Most of the health assessment details are recorded but some major gaps identified. Some assessment data is unclear and/or very little detail is documented. Most of the assessment data is unclear and/or missing. Accurate discussion of the establishment of communication and a therapeutic relationship with the chosen age group As per Credit and: Refers to the differences between cultures and communication techniques allowed for these. As per Pass 1 and: Refers to developmental theories to support age appropriate communication techniques Appropriate understanding of how to create a therapeutic relationship with a child. Appropriate link made between age appropriate communication and the age of the chosen child The use of 5 communication areas provided in the template Basic understanding oh how to create a therapeutic relationship with a child Appropriate link made between age appropriate communication and the age of the chosen child The use of 3 communication areas provided in the template Limited understanding of how to create a therapeutic relationship with a child Minimal links provided between age appropriate communication and the age of the chosen child Use of less than 3 communication areas provided in the template No clear understanding of how to create a therapeutic relationship with a child. No link provided between age appropriate communication techniques and the age of the chosen child. No use of the key communication areas provided in the template No discussion of key communication areas. Analysis of health assessment data demonstrates a holistic concern for the child As per Credit plus: Answers demonstrate a broader analysis of the literature. Links between different ideas and opinions are made. As per Pass 1 plus: Evidence of an accurate understanding of the possible implications of the strengths/health problem for the child and their family. Accurate identification of most of the important health parameters of topics in the pro forma. States the future health implications for the child. Satisfactory rationales for health analysis Some accurate identification of important health parameters of topics in the pro forma. Some identification of future health implications for the child. Limited rationales provided for health analysis Limited identification of important health parameters of topics in the pro forma. Limited identification of future health implications for the child. Inadequate rationales provided for health analysis. Minimal &/or inaccurate Identification of important health parameters of topics in the pro forma No clear identification of future health implications for the child. No analysis or rationales provided. Correctly uses Harvard referencing technique. Correct use of Unisa Harvard referencing technique throughout. Correct use of Unisa Harvard referencing technique although occasional errors evident. Limited or inaccurate use of Unisa Harvard referencing technique: refer to AIO? Significantly limited/inaccurate use of Unisa Harvard referencing technique Answers not referenced: refer to AIO Lecturer Comments Read More