Analysis for a Child with Viral Croup - Term Paper Example

Name: Tutor: Title: Case study analysis for a child with viral croup Course: Date: Case study analysis for a child with viral croup Introduction Croup is a very common, mainly viral illness of the respiratory tract in children. Croup basically affects the trachea and larynx, although the infection may also affect the bronchi (NSW Health, 2010). The most frequent etiology for croup includes cough, hoarseness, and commencement of severe stridor basically in febrile children. Infection of croup leads to inflammation, and profuse production of mucous. The superior airways also swell. Croup is known to affect children within the age of 6months to three years. Although croup can decline on its own, some children require hospital admission. With regards to the case study, this paper will therefore discuss nursing care of sick children with viral croup and their families. It will also outline clinical practice guidelines aimed at achieving the optimal care in nursing management. Clinical practice guidelines with regards to management of children with viral croup The clinical practice guidelines in Australia are chiefly aimed at attaining the excellent pediatric care in the entire State. Every patient needs to be individually assessed and evaluated and the best decision determined as to appropriate care and management so as to obtain the best clinical result. The clinical practice guidelines in NSW about sick child recognition concerns assessment. This means that it is not just intended to establish intervention or differential diagnoses. The moment a sick child or baby is identified, the objective is timely and suitable treatment and supportive care (NSW Health, 2011). As a principle rule, a child presented to the Emergency Department needs to be regarded as sick, until otherwise proved. One similar clinical practice guideline from another country is Canadian clinical practice guidelines for management of asthma. The goal of this guideline is to provide practice that is evidence based in the management of asthma in children (Lougheed MD et al, 2012). Clinical judgment With regards to the case study, two spontaneous and important priorities for nursing care of Serena need to be identified. The first priority for care of Serena is to maintain a patent airway. The second priority is to promote effective patterns of breathing. In accordance with the clinical practice guideline in Australia on assessment and physical examination, the framework of ABCDE will be used whereby the child will be assessed in terms of airway, breathing, circulation, disability and exposure. It is important to assess the child’s airway. Children’s airway always have a higher chance of having obstruction compared to the adult’s airway because of the significantly small measures and differences in anatomy with respect to shape and size of the children’s soft tissues. The nurse in the emergency room is able to identify the child’s level of consciousness through airway assessment (Glasper et al, 2011). In accordance with Serena’s assessment, she had a marked inspiratory stridor, infrequent barking cough, increased nasal secretions, mild intercostals recession and use of abdominal muscles. Stridor is brought about by partial obstruction of the trachea or the larynx thus confirming obstructed airway. In breathing assessment, both the effort and the efficacy working and gas exchange of the child need to be assessed. Oxygen saturation needs to be measured in order to assess the breathing efficacy (Johnson & Keogh, 2010). Serena’s SaO2 is 93% in room air. The normal range in children is 97 to 100%. With this in mind, Serena’s percentage is considered abnormal because it is below 97%. The normal respiratory rate in children is 20 to 40. On examination, Serena is found to have a respiratory rate of 32 breathes per minute which is within the normal limit. In terms of assessing circulation, it is important to assess heart rate and blood pressure so as establish circulation adequacy (Johnson & Keogh, 2010). The normal heart rate in a child ranges from 80 to 100 beats per minute. According to the case study, the child is said to have tachycardia since her heart rate is 162pbm which is above the normal range. This could be an indication of high blood pressure. The child is also assessed for disability whereby the level of consciousness is evaluated. Although the child was pale, she was not unconscious; however she was assessed in terms of alertness, voice responsiveness, pain and unresponsiveness. Her scores were generally reasonable. Lastly, the child is assessed for exposure. Upon a physical examination, Serena’s body temperature read 38.9 degrees Celsius. This is slightly above the normal value which is 37 to 37.5 degrees Celsius. This means the child has slight fever. The child is also irritable, pale, and peripherally warm. Nursing interventions Nursing interventions, evaluations and goals for the sick child are determined by the nursing diagnoses (Wong et al, 2011). With regards to the case study, the nursing diagnoses are similar to the important priorities which are; to maintain a patent airway and to promote effective patterns of breathing. The first nursing diagnosis is ineffective clearance of airway due to inflammation, mechanical obstruction, profuse secretions, or pain as proved by the presence of infrequent barking cough, secretions, and inspiratory stridor. The nurse will also consider an outcome identification and evaluation for the Serena. For instance, the child’s airway will be maintained in a patent way, free from obstruction or secretions, breathing work that is easy, respiratory rate and heart rates that are within the normal parameters for the child’s age (Wong et al, 2011). In order to achieve the nursing outcome which is to maintain a patent airway, the nurse will have to carry out a number of interventions. For instance, the nurse will have to position the child with airway open. The rationale behind this positioning whereby the airway is open facilitates adequate ventilation. Room air or oxygen needs to be humidified; the nurse should also make sure that there are enough intakes of fluids either oral or intravenous so as help liquefying of secretions to increase in clearance (NSW Health, 2010). The nurse should carry out chest physiotherapy in case it is ordered so as to enhance mobilization of secretions. All in all, the equipment of emergency should be readily available so as to delay in case airway turns out to be not maintainable. The second nursing diagnosis with regards to the priorities of nursing care is ineffective pattern of breathing as relates to inflammatory process proved by increased breathing work and inspiratory stridor. The relevant outcome identified and evaluated by the nurse is that the child will demonstrate adequate ventilation evidenced by respiratory rate in the age ranges for age, breathing work that is easy (with retractions absence, grunting and use of accessory muscle), breath sounds that are clear with sufficient aeration, saturation of oxygen above 95% or in the prescribed ranges. Since the nursing intervention is to promote breathing patterns that is effective, the nurse will frequently assess breath sounds, respiratory rate, and breathing work to make sure that detection of deterioration can be noted. Pulse oximetry is used to monitor saturation of oxygen. The rationale is to observe oxygen adequacy and make sure that hypoxemia can be detected (NSW Health, 2010). Positioning the child for comfort keeping in mind open airway and enough room for expansion of lungs as well as using pillows or padding where needed is important so as maintain appropriate position (NSW Health, 2010). The rationale is to enhance optimal ventilation through maximum expansion of lungs. Administration of supplemental humidity and/or oxygen as ordered is also an effective nursing intervention. This will enhance oxygenation. The nurse should also observe the child for input and output of fluids. The outcome is that the child’s fluid volume will be maintained. This will be evidenced by elastic skin turgor, oral mucosa that is moist and pink the output of urine should be within the range of 1 to 2 ml/kg/hr. to obtain this outcome, the nurse will have to administer fluids particularly intravenously so as to maintain sufficient hydration. Upon discharge, the nurse should provide sufficient information to the family of the child about home management and care of the child based on the condition. Pharmacological intervention The treatment of choice for management of croup is corticosteroids like is seen in the case study where the child was planned for oral corticosteroids. Research shows that corticosteroids are effective in viral croup within the initial 6 hours following treatment (NSW Health, 2010). These drugs are known to reduce edema of the mucosa of the larynx through their action of anti-inflammation. They also prevent reoccurrence of stridor. The recommended dose for Serena is oral dexamethasone 0.6 mg/kg. The potential side effects associated with corticosteroids include vomiting, headache and restlessness. Comparison and contrast of clinical practice guidelines With regards to both clinical practice guidelines that is; Australians and Canadian, they both consider the need for assessment as a priority so as to establish the extent of illness in order to plan for an effective management and treatment. The Australian guidelines are purposed to achieve the excellent pediatric care in the entire State. The Canadian guidelines offer recommendations that are based on evidence to help providers of health and their patients in choosing the best choices in the process of decision making for the care and management of asthma (Lougheed MD et al, 2012). Communication Apparently, when children are sick, they tend to be less loud, and cracker. Most of the time, they remain calm. Communication, particularly effective communication is the most significant concept in clinical practice particularly pediatric nursing (Wong et al, 2011). This involves communication between health care providers, the patient and family. Communication among healthcare givers is also important. Communicating with kids can be a challenging experience although the mastery of this skill can be very beneficial. A number of strategies have been identified to boost communication between sick kids, parents and health professionals. For instance, it has been established that a picture dictionary that consists of medical terms including simple definitions of instruments, diseases and medicines can be very helpful for children. Video images can also boost communication in children’s hospitals. Bedside messages are also helpful in promoting effective communication in children hospitals. Another strategy of enhancing communication between health professionals, parents and children is by taking various photo albums. Research suggests that use of common vocabulary that involves groups of basic needs and want can promote effective communication. Picture walls enable children to quickly respond to various questions concerning the pictures on the wall. With regards to the case study whereby the child was admitted to the children’s ward from emergency department, it is crucial that the concerned nurse provide care that is co-ordinate and integrated around the particular needs, and the family’s needs. This would involve provision of information and support to enable them to comprehend and deal with their child’s illness. This is basically boosted by effective communication between nurses, the child and the family. Staff working within the children unit should have sufficient training so as to facilitate necessary skills of communication thus enable them to effectively work with children, their parents and among staff themselves (Wong et al, 2011). This is important because it will facilitate a decisive process of decision making. Conclusion As discussed above, croup is a viral illness that basically affects children. With effective nursing care and management, the illness can be minimized promptly. It is noted that children who are presented to the emergency department should be considered unwell until proven otherwise. The main goal of clinical practice guidelines in Australia is to attain the excellent pediatric care in the entire State. This guideline is similar to the Canadian’s clinical practice guideline on management of asthma. The nursing interventions are also provided for management of viral croup based on the case study. The pharmacological intervention for viral croup is oral dexamethasone. This is a corticosteroid that is known to be effective in alleviating breathing problems caused by croup. Communicating with children especially when they are sick can be very challenging but the paper has illustrated how various strategies like the use of videos and bedside messages can enhance effective communication. Bibliography Glasper, E. A., Mcewing, G., & Richardson, J. 2011, Emergencies in Children's and Young People's Nursing, Oxford, OUP Oxford. Johnson, J. Y., & Keogh, J. E. 2010, Pediatric nursing demystified, New York, McGraw Hill Medical. Lougheed MD, et al, 2012, Canadian Thoracic Society 2012 guideline update: diagnosis and management of asthma in preschoolers, children and adults, Canadian Respiratory Journal: Journal of the Canadian Thoracic Society. 19. NSW Health, 2010, Infants and children: acute management of croup, North Sydney, NSW, NSW Dept. of Health. NSW Health 2011, Recognition of a sick baby or child in the emergency department, NSW Health, Sydney. Wong, D. L., Hockenberry, M. J., & Wilson, D. 2011, Wong's nursing care of infants and children, St. Louis, Mo, Mosby/Elsevier. Read More