The Use of Clinical Practice Guidelines - Case Study Example

CASE STUDY: SPRING 2012. LUCAS A SEVEN MONTH OLD INFANT Case study: Spring 2012. Lucas a Seven Month Old Infant Customer Inserts His/her Name Customer Inserts Grade Course Customer Inserts Tutor’s Name 31, 03, 2013 Background and Purpose Clinicians in pediatric departments are expected to provide best cares. To achieve this goal, they are directed by certain clinical practice guidelines, which can be based nationally. Clinical Practice Guidelines (CPGs) refers to statements that are systematically developed to help practitioners and patients in making decisions regarding certain health circumstances. Countries have their own CPGs for clinicians in pediatrics departments. Prepared by a group of clinical experts, CPGs main aim is to ensure that clinicians provide best cares. CPGs are based on an organized review of clinical evidence. Evidence-based healthcare is a feature characterizing the growth of CPGs. The increasing developments in CPGs gain its ground from clinicians, management, and politicians interested in consistency of costs and quality in healthcares. There importance is increasing, though they have not brought major impacts in healthcares. When implemented, CPGs justify variations in referral, continuing education, acts as a source of quality control and identifies shortcomings in current literatures. This helps make suggestions for future researches (Wollersheim, Burgers & Grol 2005). CPGs can be viewed as a current trend in healthcares, aiming at improvement of care services as a result of its evidence-based nature. Understanding the applications of CPGs is essential for clinical students to make them fit in the healthcare environments. The purpose of this paper is to plan and organize a nursing care for Lucas, a seven month old infant diagnosed with AOM, upper respiratory tract infection and moderate dehydration, and his family using CPGs from Australia and United States of America, US. The CPGs’ from Australia were provided by the teaching staff. The second CPGs from the US were found by searching the internet. Medical search engines were used to find the CPGs for the US in management of AOM, published journals on AOM, and other medical definitions. The literatures obtained were not to be older than 5-10 years. Literatures published before 2003 were rejected in this case study analysis. Using PubMed and organizational websites, as the key search engines the CPGs from the US were found. During the search process, the key words used for the search were “Clinical practice guidelines for Acute Otitis media.” The search utilized the materials published in English. Specifically, the search method for the CPGs from another country (US) was by the use of the medical search engine, PubMed. Priorities for Nursing care of Lucas Basing on the CPGs from the selected two countries (Australia and US), this section covers two immediate and essential priorities for nursing care for Lucas. From the Lucas case, he has been diagnosed with AOM, upper respiratory infection and moderate dehydration. In this case, the AOM in the patient is severe because the patient’s temperature is above 39°, specifically, 39.7°. The condition being acute, two priorities for nursing care of Lucas are systematic antibiotic therapy and treatment using an appropriate analgesic. The former (systematic antibiotic therapy) is an essential priority because the AOM in this case is severe. As explained earlier, severe AOM in infants who are six months and more old is treated by use of antimicrobial therapy (Thornton, Parrish, & Swords 2011). The later (appropriate analgesic) is vital when a child diagnosed with AOM has showed a positive assessment of pain (Thorton et al. 2011). For instance, in Lucas case, he shows signs of pain, characterized by irritability and crying. Plan Nursing care for Lucas With the use of the identified priorities, this section is a discussion of a nursing care plan for Lucas. The plan is designed on the basis of the CPGs from the US and Australia. Use of CPGs is crucial to help develop a plan that is founded on strong evidence. According to Thorton et al. (2011), current studies provide evidences that suggest importance of using CPGs in management of AOM. Lucas is also diagnosed with moderate dehydration, which is characterized by the dry mucous membrane, and abnormal respiratory pattern (infection of the upper respiratory tract). A nursing care plan Basically, a nursing care plan is founded on signs, symptoms or a patient’s responses. This refers to what is happening to a patient. A plan has to begin with assessment to have an understanding of what is happening to a patient. This care plan discussed under this section is designed for Lucas case. The case has an already prepared assessment. Therefore, the plan is build on the symptoms and signs presented in the case study. In addition, the care plan puts into consideration the interventions identified earlier to discuss a care plan for the development of the infant, Lucas. Considering the suggested priorities of nursing care for Lucas, the suitable nursing interventions are control of pain, preventing complications, treatment of AOM using antibiotics, and relieving the patient from the infections. In addition, there should be washing of hands after contact with the patients, encouragement of fluid intake to improve the patient hydration, monitoring of white blood cells counts, monitoring signs of infections, asses the presence of risk factors, and checking nutritional status. When these interventions are applied, it would be easier for the nurse to conduct a systematic antibiotic therapy and use of an appropriate analgesic. Control of pain is vital in a patient diagnosed with AOM. Different literatures have characterized ear pain as the major symptom of a person with AOM. A study by Bolt, Barnett, Babl and Sharwood (2008) affirms that ear pain is present in patients suffering from AOM. The CPGs from US for the treatment of AOM suggests that pain control in the management of AOM is essential even when antibiotics are not prescribed (Lieberthal et al. 2013). Antibiotics therapy does not have the ability to stop pain within 24 hours. In Lucas case, pain originates from the swollen tympanic membrane and increased temperatures. Using an analgesic reduces pain associated with AOM within 24 hours (Rovers et al. 2006). The parent or caregiver has to be involved in the preference of the analgesic used because there is no specific method prescribed for pain management. After assessing the pain, there is need to monitor signs related to pain. Some of these signs include temperatures, and restlessness. Pain is completely eliminated when the infant can have good sleeping patterns and frequent crying is stopped. Antibiotic therapy intervention is vital for Lucas. Studies indicate that this therapy must be prescribed to patients who ranges between six to 23 months and have severe AOM, which is indicated by high temperatures. This is a strong recommendation, which requires a parent or caregiver involvement for easier follow up (Tahtinen et al. 2011). According to Gulanick and Myers (2007), use of antibiotics is essential in controlling and full recovery of the patients. There is a need to emphasize the importance of proper drug administration to the parents or caregivers. Improper antibiotics administration enhances drug resistance, which may complicate the management of the condition. Proper use of antibiotics can be indicated by lose of pain, complete sleep at night, and no discharges from the ear (Doenges, Moorhouse & Murr 2008). Relieving the patient from the infection, and prevention of infection interventions are necessary to prevent future reoccurrence of the patient’s condition. In this case, Lucas has been diagnosed with upper respiratory tract infection and moderate dehydration. Studies indicate that AOM is known to follow upper respiratory infections. To reduce the chances of the patient contracting AOM in future, there is need to give the patient an influenza vaccine to prevent future upper respiratory infections. For instance, in the United States, influenza vaccine is recommended for children aged six months and above, to reduce the burden of AOM (Centers for Disease Control and Prevention (CDC) 2011). In addition, there is need for Luca’s parent to increase breastfeeding to reduce the chances of AOM reoccurring. The assessment results indicate a need to increase breast feeding. Increased breastfeeding for at least one through six months to one year is necessary as long as the mother and the child mutually desire (Section on Breastfeeding 2012). This recommendation aims to reduce chances of AOM occurring or reoccurring. Breastfeeding is also a way to increase fluid intake. Increasing fluids intake is essential to hydrate the patient (NSW Health 2011). Taking extra fluids is necessary for an AOM patient to replace the fluids lost through discharges resulting from the infections. Proper fluids intake should be reflected in a patient when the mucous membranes become moist. History assessment is essential in nursing Lucas. Assessment of the patient historic factors helps determine risk factors that a patient may have. Recurrent otitis, poor feeding habits, and improper use of antibiotics to cure AOM are some of the possible risk factors associated with AOM. In this case, a nursing diagnosis can indicate that failure of primary defense systems led to reoccurrence of the disease. In addition, due to mal-nutrition, the patient’s secondary defense system is rendered weak. According to Gulanick and Myers (2007) mal-nutrition causes a weakness in the normal body defense. Encouraging intake of suitable diet will help in overcoming the illness. In evaluating the intervention of assessing historic factors, a patient should have his temperatures regulated, proper intake of drugs, proper meal intake, which depends on what the parent can afford. Encouraging washing of hands by the significant people related to Lucas after handling him. Hand washing is an important activity for people coming in contact with an AOM patient. In the assessment report, Lucas is reported to produce nasal secretions. Such secretions are known to contain pathogens, which are transferable from one person to another (Grijalva, Nuorti, & Griffin 2009). Encouraging hand washing will reduce chances of re-infection in the patient. In addition, proper cleaning of the patient’s ear is critical. In evaluating the success of this intervention, a parent and the clinician should demonstrate confidence in washing the ear and the practice of washing hands most of the times using alcohol or any other disinfectant. It is also important to monitor the white blood cells count in the nasal discharges. This is important in determining the ability of the body to protect itself from microbial attacks. Reviewing the plan discussed above, there is need to implement interventions which are evidence-based. This means that a clinician has to identify possible intervention that he or she can justify. This is possible by adhering to selected CPGs. In this case, CPGs used were from Australia and US. The guidelines from the US addressed the management of AOM. Conversely, Australia guidelines addressed the identification of a sick infant with different conditions. In both guidelines, moderate dehydration in infants was managed by increasing fluids input coupled with continuous monitoring. The guidelines identified pain as a major symptom in recognizing a sick infant. In addition, the guidelines acknowledge the parent or caregiver roles in recognizing and treatment of a sick infant. Developing good communication strategies is critical in the development of the infant, Lucas. The strategies have to ensure good flow of information among the families, children, and healthcare professionals. In this case, a communication strategy of enhancing behavior meaning is necessary. Lucas is an infant making it hard to interact with him through verbal communication. Understanding certain behaviors will help interpret the condition of this infant. This will help healthcare professional and family members to take appropriate steps. Some of the behaviors that can be examined include pain, which reflects physical challenges, and fever, which indicates high temperatures. Last, communications with the family members should be made formal to help in keeping records for future references. For example, the parents should be informed on the kind of drugs used on the patients and the recommended foods. Conclusion This study concludes that use of CPGs is instrumental in promoting evidence-based healthcare services in pediatrics. Use of evidence to implement clinical interventions promotes patients involvement and justification of the selected method. Specifically, in Lucas case management of AOM in an infant requires evidence-based interventions because not all interventions are relevant in different situations involving AOM. Therefore, use of CPGs in administering healthcare helps meet certain health standards put in place by a particular country or health bodies. Reference List Bolt P, Barnett P, Babl FE, & Sharwood, LN 2008, “Topical lignocaine for pain relief in acute otitis media: results of a double-blind placebo-controlled randomised trial”, Arch Dis Child, vol. 93, no. 1, pp. 40–44. Centers for Disease Control and Prevention (CDC) 2011, “Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)”, MMWR Morb Mortal Wkly Rep. Vol. 60, no. 33, pp.1128–1132. Doenges, ME, Moorhouse, MF & Murr, AC 2008, Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales, 11th edn., Davis Company, Philadelphia . Grijalva, CG, Nuorti, PJ & Griffin, MR 2009, “Antibiotic Prescription Rates for Acute Respiratory Tract Infections in US Ambulatory Settings”, JAMA, vol. 302, no. 7, pp. 758-766. Gulanick, M & Myers, JL 2007, Nursing Care Plans: Nursing Diagnosis and Intervention, 6th edn, Mosby Elsevier, St. Louis. Lieberthal, AS, Caroll, AE, Chonmaitree, T, Ganiats, TG, Hoberman, A, Jackson, MA, Joffe, MD, Miller, DT, Rosenfield, RM, Sevilla, XD, Schwartz, RH, Thomas, PA & Tunkel, DE 2013, “Clinical Practice Guidiline: The Diagnosis and Management of Acute Otitis Media”, Pediatrics, vol. 131, no. 3, pp. 964-999. NSW Health 2011, Recognition of a sick baby or child in the emergency department. NSW Health, Sydney. Rovers MM, Glasziou P, Appelman CL, Burke, P, McCormick, DP, Damoiseaux, RA, Gaboury, I, Little, P, & Hosea, AW 2006, “Antibiotics for acute otitis media: an individual patient data meta-analysis”, Lancet, vol. 368, no. 9545, pp. 1429–1435 Section on Breastfeeding 2012, Breastfeeding and the use of human milk, available from: . 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