Paediatric Care of the Child with Hypovolemia - Essay Example

Basing on the history and examination of the child its most likely that she was undernourished, was infested with mites, hypovolemia. Significant problems of a predominantly social nature that is associated with sara condition include: Pre-existing (pre-emergency) social problems (e.g. extreme poverty; belonging to a group that is discriminated against and also Emergency-induced social problems (e.g. family separation; disruption of social networks; destruction of community structures, resources and trust; increased gender-based violence) hypovolemia which Sara was sufferering from is a state in which the blood volume is lower than the normal specifically plasma volume. It is thus it results from loss of blood volume due to things such as hemorrhaging or dehydration, It differs from dehydration, which is defined as excessive loss of body water. Furthermore, hypovolemia defines water deficiency only in volume rather than specifically water. If it was recognized that Sara had internal bleeding the life-saving measure which was to be taken was to immediately call for emergency assistance. Another immediate action to be taken on Sara was: Emergency oxygen was to be involved to increase the efficiency of Sara remaining blood supply .This intervention is critical because is life-saving. intravenous fluids was to be used for lost fluid volume compensation, but IV fluids cannot carry oxygen in the way that blood can, however blood substitutes are being developed which can. If Sara hypovolemia was caused by medication, the antidotes administration of may be appropriate and careful monitoring is appropriate to avoid shock or the emergence of other pre-existing conditions For Sara condition who was having hypovolemic shock the following investigations would be carried out to save her condition: Blood tests: U+Es/Chem7, FBC, Glucose, Cross-match Central Venous Line/Blood Pressure Arterial Line/Arterial Blood Gases Urine output measurements (via urinary catheter) Blood pressure SpO2 Oxygen saturations The following interventions would be carried out: IV access Oxygen as required Surgical repair at sites of hemorrhage Inotrope therapy (Dopamine, Noradrenaline) Fresh frozen plasma/whole blood It was also seen that Sara was having Myalgia literary means muscle pain and is associated to many diseases and disorders. The most common causes are the overuse or over-stretching of a muscle or group of muscles. Myalgia without a traumatic history is often due to viral infections. Longer-term myalgias may be indicative of a metabolic myopathy, For Sara condition It may be probably due to some nutritional deficiencies or syndrome,tensionor stress, diseases, disorders and medicationsas well as Infections, including: Influenza (the flu) ,Lyme disease, Malaria, Dengue Fever, Muscle abscess, Polio,Rocky Mountain spotted fever,Trichinosis (roundworm),Lupus,Polymyalgia rheumatic,Polymyositis,Rhabdomyolysis Acrylamide, colesevelam, darbepoetin, darunavir, ezetimibe, ibandronate sodium, imiquimod, interferons, isotretinoin, procainamide, quinupristin/dalfopristin, could be the possible medication to be given. Pallor is another type of condition Sara was in and is a reduced amount of oxyhemoglobin in skin or mucous membrane, a pale color which can be caused by illness, emotional shock or stress, , lack of exposure to sunlight, anemia or genetics. It is more evident on the face and palms. It can develop suddenly or gradually, depending on the cause. Pallor is not usually clinically significant unless it is accompanied by a general pallor (pale lips, tongue, palms, mouth and other regions with mucous membranes). It is distinguished from similar symptoms such as hypopigmentation (loss of skin pigment). The Possible causes could have been emotional response, due to fear, embarrassment, grief anemia, due to blood loss, poor nutrition, or underlying disease such as sickle cell anemia shock, a medical emergency caused by illness or injury panic attack heart disease hypothyroidism hypopituitarism scurvy shock (medical) tuberculosis sleep deprivation depression Sara appropriate treatments needed doctors advice. Sara had Scabies sometime back and actually it was supposed to be treated, itching, a generalized rash and secondary infection, superficial burrows, blisters and pustules on the palms and soles of the feet, are some of the commonly characteristic symptoms of scabies in infants Generally diagnosis was made by finding burrows.It may be hard because of scarcity and being obscured by scratch marks, the entire skin surface of the body was to be examined If burrows are absent in the primary areas suspected to be affected. ink from a fountain pen or a topical tetracycline solution is rubbed on the suspected area ,it glows under a special light. Alcohol pad is used to wipe off the surface; if Sara was infected with scabies, the characteristic zigzag or "S" pattern of the burrow across the skin will appear. When a suspected burrow is found, diagnosis may be confirmed by microscopy of surface scrapings taken with a scalpel or curette. These are then placed on a slide in glycerol or mineral oil and contained with a cover slip. Avoiding potassium hydroxide is necessary because it may dissolve fecal pellets. Positive diagnosis is made when the mite, ova or fecal pellets are found. scabies sites detection is cumbersome . It involves scraping of suspicious lesions down to the superficial dermis, hence resulting to minor bleeding. In most cases the most appropriate diagnosis is by the history, physical findings and response to effective topical treatment. The diagnosis of Crusted Scabies is not as elusive and a scraping under the fingernail is often diagnostic. Sulphur could have been prescribed to Sara in the treatment of scabies; this drug has been used since around 25 AD. The clothings and beddings were to be washed in hot water, later treated with Permethrin for effective elimination. Permethrin 5% is topical medication of choice according to Scheinfeld NS (2004). Toxicity may resemble allergic reactions. Application was to be done before bedtime and left on for about 8 to 14 hours, then in the morning to be showered off. One application is usually sufficient to cure an infection and should go hand in hand with doctor's instructions. Malnutrition condition develops due to body lack of right amount of the vitamins, minerals, and other nutrients that is required to maintain function of healthy tissues and organ. This kid seems to have been consuming too few essential nutrients. Additional nutrients are needed for Infants as well as pregnant women or breastfeeding women. Diarrhea, excessive sweating, heavy bleeding, or kidney failure can contribute to nutrient loss. Protein-energy malnutrition result from inadequate calories intake from proteins, vitamins, and minerals .According to the condition of Sara that has been described, most likely she was having kwashiorkor and marasmus. The complications of sight, taste, and smell as well as anxiety, changes in mood, and other psychiatric symptoms all is due to Nutritional disorders. Sara who was underweight of 10.4 BMI was evident that she was undernourished. Malnourished victims may be skinny or bloated. Pale skin, thick, dry, and bruises easily may also be seen. Commonly Rashes and changes in pigmentation is experienced. Sara overall appearance, behavior, body-fat distribution, and organ function can alert a family physician, internist, or nutrition specialist to the presence of malnutrition. Sara guardian was supposed to be asked what Sara eats during a specific period. Nutritional status can also be determined by: Comparing a patient's weight to standardized charts Calculating body mass index (BMI) according to a formula that divides height into weight The circumference of the upper arm measurement. After Sara coming to conscious, normalizing nutritional status was needed by first starting with a nutritional assessment If it was found out that she had higher-than-average risk for malnutrition then, close assessment and reevaluate should have been done during nursing care. Sara condition may have been attended to as below: interventions from a range of health professionals were necessary and it depends on the specific nature of the individual's malnutrition, may include: Dieticians engages in screening and assessment nutritional status, determining daily energy requirements as well as provision of nutritional supplements accordingly; Pharmacists works on prescription of food supplements; Laboratory specialists Is engaged in monitoring the progress, such as checking for side effects to feeding supplements or monitoring an individual's response to micronutrient therapy; Discussion between Health professionals and parents/guardians on child's condition and habits is essential. It will involve the child's eating habits and any potential barriers to nutritious food intake (e.g. financial circumstances, cultural beliefs which prevent the consumption of certain foods) which may affect the parent's ability to adequately nourish their child. Acounseling regarding appropriate infant, preparation of infant foods, meal sizes for children. They are also likely the importance of micronutrients and appropriate to advise that malnourished children benefit from physical contact, and child feeding patterns, breastfeeding structured playtime, physical activity and maternal involvement throughout their treatment. In the first week it was necessary to stabilize the child through the provision of intravenous feeding and treating any coexisting complications. Prescribed wide spectrum antibiotics to prevent infection, is commonly given to prevent hypoglyaecemia electrolytes and micronutrients given to balance Rehabilitating the child and feeding reintroduced in the form of specially prepared, protein-energy and nutrient rich formulas, Feeding was to be done regularly (i.e. every four hours) until the child’s weight was sufficient enough to be discharged. Before Sara discharge, advice was to be given to guardian on the appropriate feeding and preventative intervention, such as high energy foods and supplements, immunization and six monthly vitamins-A supplements. Daily structured play was to be emphasized and regular visits to a clinic for weight and development check previous studies have argue malnourished babies that the degradation in relations between mothers poor relationship between mother and child (or more broadly is a side effect of the stresses unsatisfactory interactions with the infant feeding and later infantile anorexia as a entourage maternant) itself contributes to the onset of malnutrition. “Defensive strategy” on the part of the child Bouville (2004), 29 of the condition, Bouville argues that .He refers explicitly to poor Correlations thought provoking and should probably not be children in his sample are quite. Dismissed lightly between mothering practices and the found in the psychoanalytic literature condition In the psychoanalytic literature one finds an apparent resonance with this sense of the child as having an active role in choosing whether to eat or not to eat. Contributing to the highly developed literature on the role of attachment in childhood malnutrition, Jean-François Bouville argues in a study of infant feeding practices in Abidjan that when a child fails to thrive because of anorexia, his lack of appetite is in effect a defensive strategy in the face of a distant and unresponsive mothering environment, what he refers to as the “environnement relationnel”. Strong sense of self through a healthy attachment to the mother becomes fearful of exploration and refusal to eat a diverse diet. Economic analysis of childhood malnutrition and cultural explanations for the problem, Bouville insists that global and by cultural group don’t explain the variations among individuals explanations by class: Sociocultural factors are sometimes put forward to explain attitudes that are at base individual.1(Jean-François Bouvilleet al) Regardless of the type, malnutrition may be a consequence of primary or secondary malnutrition, or both.  In children and adolescents factors which predispose malnutrition include In conclusion Sara at her tender age needed immediate attention. Mild or moderate signs of malnutrition observed may be addressed by parents/guardians, but health facility for future weight checks is necessary later. In cases where malnutrition is severe, as it was most likely for Sara admission to hospital for treatment was essential. Deep diagnosis and examination was needed for exact identification of the condition that Sara had in order to get proper medication. She also needed close guardian attention. References Jean-François Bouville, La malnutrition infantile en milieu urbain africain: Etude des étiologies relationnelles (Paris : L’Harmattan, 2004), 33. Bouville (2004), 29. National N.ltritiol1 Strategies. 1978 Scabies" DermNet NZ, New Zealand Dermatological Society Incorporated. http://www.dermnetnz.org/arthropods/pdf/scabies dermnetnz.pdf Scheinfeld NS (2004). "Controlling scabies in institutional settings: a review of medications, treatment models, and implementation" Amer J Clin Dermatol 5 (1): 31–7. doi:10.2165/00128071-200405010-00005. PMID 14979741 Resources Books Flancbaum, Louis, MD, with Erica Manfred and Deborah Biskin. The Doctor's Guide to Weight Loss Surgery, West Hurley, NY: Fredonia Communications, 2001. Periodicals Alvarez-Leite, J. I. "Nutrient Deficiencies Secondary to Bariatric Surgery." Current Opinion in Clinical Nutrition and Metabolic Care 7 (September 2004): 569-575. Amella, E. J. "Feeding and Hydration Issues for Older Adults with Dementia." Nursing Clinics of North America 39 (September 2004): 607-623. Bryan, J., S. Osendorp, D. Hughes, et al. "Nutrients for Cognitive Development in School-Aged Children." Nutrition Reviews 62 (August 2004): 295-306. Malnutrition References 1. National Collaborating Centre for Acute Care. Nutrition Support for Adults, Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. National Collaborating Centre for Acute Care. 2006, London. [cited 2009, January 15] Available from http://www.rcseng.ac.uk/ 2. Golden, B.E. Primary Protein Energy Malnutrition. In: Garrow, G.S. James, W.P.T., editors. Human Nutrition and Dietetics. 9th ed. Churchill Livingstone Press. 1993.pp 440-55. 3. Commonwealth Scientific and Industrial Research Organisation. 2007 Australian National Children's Nutrition and Physical Activity Survey: Main Findings. Commonwealth of Australia. 2008. [cited 2008 December 15] Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/66596E8FC68FD1A3CA2574D50027DB86/$File/childrens-nut-phys-survey.pdf 4. BAPEN, The MUST explanatory booklet: a guide to the Malnutrition Universal Screening Tool (MUST) for adults. Malnutrition Advisory Group for BAPEN. 2003. [cited 2009, January 15] Available from: http://www.bapen.org.uk/ 5. Middleton, M.H. Nazarenko, G. Nivison-Smith, I. Smerdely, P. Prevalence of malnutrition and 12-month incidence of mortality in two Sydney teaching hospitals. Internal Med J. 2001; 31(8):A11-31. 6. National Public Health Partnership. National Aboriginal and Torres Straight Islander Nutrition Strategy and Action Plan 2000-2010. Strategic Intergovernmental Nutrition Alliance. 2001. [cited 2009, January 15] Available from: http://www.nphp.gov.au/signal 7. Black R.E. Morris S.S. Bryce J. Where and why are 10 million children dying every year? Lancet. 2003; 361: 2226-34. Read More