Dynamics of Paediatric Nursing Care - Essay Example

Paediatric Care Introduction This brief essay, seeks to explore the dynamics of paediatric nursing care using a case study approach. Important to the discussion is how a nurse should include the child’s comprehensive care from the point of view of the child and that of the child’s parents, how the nurse can recruit other parties to complement in the nursing care, how a child’s immediate, short-term and long-term care needs can be adequately met and how the paediatric patient can be effectively treated beginning from admission through discharge and unto post-admission period. These issues are discussed from the perspective of scholarly theoretical tenets and contemporary literature in paediatric care. Towards this end, the essay begins by considering the immediate and short-term nursing care of Sara, the case study paediatric patient, before exploring the ways that a nurse can engage and win her cooperation in the nursing care. The essay then proceeds to consider ways in which the nurse can engage the patient’s family in the care process as well as how the nurse can recruit other parties in the hospital and society to complement in the nursing care. The essay also considers possible limitations and complications that may accrue during the paediatric nursing care process and how such limitations can be overcome. To terminate the discussion, the essay also considers the proper discharge process for the paediatric patient as well as the patient’s future care needs, all as part of the nursing care process. This leads to a viable conclusion of the issues discussed throughout the essay. Sara’s Immediate Nursing Care Needs To begin with, this section will analyse the immediate nursing care needs of Sara. At four years of age, Sara has been admitted after fainting while at an Early Childhood Centre. The first nursing procedure should be to provide emergency care for Sara such as loosening her clothes, providing adequate oxygen, hydrating her body and reviving her from the faint (Jaimovich 2004, pp. 1430-1433). The initial treatment should also help subside the symptoms such as myalgia, low-grade fever, headache etc, before proper treatment ensues (Duncan 1998, pp. 46-73). Painkillers would sufficiently cater for these symptoms temporarily (Jaimovich 2004, pp. 1430-1433). This done, the nurse should then proceed to diagnosis. Every indication is that Sara is sick, and that the fainting is an indication of another condition. Indicatively, Sara is suffering from an iron-deficiency anaemia condition. Iron-deficiency anaemia in children has some very distinct symptoms, including a pale skin, poor muscle tone, reduced activity, a dysfunctional circulation and an abnormal milk intake (Chen, 2010). Anaemia is a medical condition where the body lacks adequate healthy dose of red blood cells (Glader 2007, pp. 441 – 457). The red blood cells are responsible of transporting oxygen to the body tissues (Glader 2007, pp. 441 – 457). Anaemic conditions are of various types, one of them being iron deficiency anaemia, which is consequent to a decreased volume of healthy red blood cells circulating in the blood consequent to a deficiency of iron in the body (Glader 2007, pp. 441 – 457). One symptom noted among young children with this type of anaemia is that they have a very poor appetite (Chen, 2010). Sara’s teacher has said that she had eaten much, something that confirms the probability of her condition. The teacher also said that she was not interacting well with the other children. This can be explained by the fact that iron-deficiency anaemia in children is almost always indicated by reduced child activity, general body weakness and unexplainable fatigue (Pearson 2001, pp. 117-189). Further, her skin is poor in texture and very pale to look at during examination, coupled by a distinct paleness around the fingernails and the mouth. The paleness is most attributable to hypovolaemia (a condition of having low level of circulating blood in the body), a common symptom of iron-deficiency anaemia in children (Glader 2007, pp. 441 – 457). Another notable symptom is the fact that Sarah’s pulse is abnormally weak and difficult to accurately palpate (Duncan 1998, pp. 46-73). This can be explained by the fact that, with reduced blood volume, the little blood being pumped through the arteries has a rapid speed, doesn’t feel full and has a rate that is difficult to count (Glader 2007, pp. 441 – 457). Having noted these symptoms, the ideal course of action should be to conduct some tests immediately to confirm the condition. Iron-deficiency anaemia can be tested using a physical exam, where a blood sample from the patient is examined in a laboratory (Heird 2007, pp. 406 - 421). If Sara has iron-deficient anaemia, her red blood cells will appear very small and pale under a microscope (Chen, 2010). Other tests that should be performed to confirm Sara’s condition include a Serum ferritin test which reveals amount of iron in the body, serum iron test which shows amount of iron in the blood or the total iron binding capacity test (TIBC) which measures ability of transferring (a blood protein) to transport iron around the blood (Glader 2007, pp. 441 – 457; Chen, 2010). Any of these tests should be immediately ordered for (Chen, 2010). If iron-deficient anaemia is diagnosed, which is the most probable outcome, immediate treatment should be initiated. First, Sara should be given iron supplement (like ferrous sulphate) tablets to swallow (Chen, 2010). The iron supplements can also be given via an injection or IV-line into the muscles or vein respectfully (Chen, 2010). Simultaneously, glucose and other simple energy giving foods should be provided to revitalize Sara’s muscles so that she can replenish her body energy (Pearson 2001, pp. 117-189). It would be best to avoid solid foods at first since iron is absorbed best on an empty stomach (Chen, 2010). Again, the nurse should avoid giving Sara milk and other antacids alongside the iron supplements since they have been known to interfere with proper iron absorption (Chen, 2010). Once the treatment has begun, the nurse in charge of Sara should then proceed to test Sara for other medical conditions and infections. It would be advisable to ask the parents, teachers and Sara herself whether she had had a severe haemorrahage in the recent past (the loss of large volumes of blood internally or externally). There might be internal breeding, although it is highly unlikely in Sara since her anaemia is not due to blood shortage but due to low red blood cells count in the blood due to iron deficiency. If there has not been a severe haemorrahage, blood transfusion would then be unnecessary (Glader 2007, pp. 441 – 457). It is important that the nurse also addresses the untreated scabies attack on Sara. Sara had a scabies attack six weeks prior to her fainting, and was never treated for it. Although the intense itching may have subsided, the contagious Sarcoptes scabiei (human itch mite) causative organisms are still in her skin (Pearson 2001, pp. 117-189). The mite’s females will definitely have laid thousands of eggs in burrows on her outer skin layers. If the infection is not treated immediately, Sara will experience a far worse attack than the first one. In a week’s time, up to a period of 16 weeks after the scabies attack, Sara will experience a painful pruritic rash all over her skin following a sensitisation to the eggs and adult mites (Pearson 2001, pp. 117-189). The most affected areas are likely to be the webs of her fingers as well as the flexor surfaces of her thighs and writs. This may end up attracting secondary bacterial infections (Pearson 2001, pp. 117-189). To diagnose Sara of an underlying scabies infection, the nurse should immediately scrape the burrows of her skin for microscopic identification of any existing larvae, adult mites and eggs (Pearson 2001, pp. 117-189). If detected, Sara should immediately undergo simultaneous treatment such as with a topical application of scabicides such as permethrin or crotamiton. If she is still experiencing itching at the time, the nurse should provide oral antihistamines and a salicylate to reduce the itching (Pearson 2001, pp. 117-189). Taking care of this two primary disease and infection respectfully, that is anaemia and scabies, will help eliminate Myalgia (diffuse pain in the muscle tissues) and the accompanying symptoms of general body weakness, discomfort, distress, unease, skin paleness etc (Pearson 2001, pp. 117-189), all of which have been identified in Sara. Sara’s Short-Term Nursing Care Needs Having undergone the immediate nursing care procedures, Sara will be ready to proceed with short-term care. This should ideally be the course of action for the nurse in charge and the complimenting personnel or parents for three to four days after her admission (Duncan 1998, pp. 46-73). To begin with, Sara should be put under a special diet of high vitamins and proteins to aide in her recovery, as well as complex and simple carbohydrates to supply her body with energy (Pearson 2001, pp. 117-189). But the most important part of her diet should be iron-rich foods such as raisins, egg yolks, fish, meats (more importantly, liver), poultry, whole-grain meals like bread and also protein-rich legumes like beans and peas (Chen, 2010). The iron will facilitate the replenishment needed in the body for the manufacture of red blood cells, itself a treatment of iron-deficiency anaemia alongside the iron supplements (Chen, 2010). Secondly, Sara needs physical nursing care. She needs regular full-body washing to help reduce the activity of the Sarcoptes scabiei on her skin and control itching. While bathing her, the care giver should not only ensure that her skin is clean, but also that she does not feel unnecessary pain and discomfort in the process. The bed sheets she is using should be changed severally in a day since their contact may limit the effectiveness of the treatment since they will carry the mites and their eggs. Again, the bed sheets will most probably be easily soiled due to the application of jelly-like scabies’ treatments. It is evident that Sara is not receiving adequate parental care as is due to her in her age. As noted during examination, she is dirty and her hair is dull, dry and unkempt. Her aunt, the guardian is evidently not keen on keeping her either smart of hygienic. This projects two care needs for Sara. For one, she needs physical care that can help her clean up and look smart. Secondly, it presents the nurse with an opportunity to provide psychological and emotional care to Sara. Sara is evidently used to lack of attention and motherly love that four-year olds are very dependent on (Duncan 1998, pp. 46-73). Her family is unable to provide for her emotional needs, and she might have tried to attract or demand for attentions in other ways while at home such that her aunt believes that her fainting is just another feat to attract attention. It is important that the nurse in charge and her support team fill in this void by focusing attention on her, cuddling her, making her feel important and raising her positive emotions. By cleaning and making her hair, giving her a mirror to see the outcome and spending quality time with her while helping her care for the hair is going to be a milestone achievement towards her recovery. It is important that the nursing care provided also stimulates her participation by talking to her, explaining things (such as treatments) to her in a simple language or even soliciting for comments and approval. Even for a four year old, being involved and allowed to participate in a treatment process is vital in attaining positive patient outcomes. By asking her a simple question as, ’Sara, would like me to wash your hair so that you can look smart?’, is adequate to solicit for her cooperation by seeming to make her views important and giving her a existent choice, even though having the decisions made for her indirectly by default (Duncan 1998, pp. 46-73). During the course of her treatment, the nursing care providers should also spend time to diagnose any other nutrients deficiencies in Sara, even the ones that have not become pronounced as yet, and according requisite treatment. Other infections should also be scouted for and if diagnosed, treated. Sara should also begin the immunisation program for all the diseases that she has not been immunised against, as deemed fit by the experts under whose care she is entrusted. Some immunisation should commence during her admission and scheduled for continuation even after discharge, if necessary. Engaging Sara in the Nursing care Sara will, like many children her age do, be baffled, perplexed and even apparelled by the new hospital environment she has been thrown in without preparation. This can work against the nursing care since, in ignorant rebellion, tension, apprehension and fear, Sara might become impossible to maintain in the hospital. She might refuse to be touched or talked to by any hospital personnel and cry incessantly to be taken home or other environments she is used to. To prevent this from happening, the nurse in charge should insist on the presence of the people that Sara already knows and trusts (such as her family, teachers, friends, siblings etc) during the preliminary encounters. This will render some form of familiarity to the scene for Sara and will contextualize the medical team as part of the people she can trust. It will reduce some of her apprehension and tension as well as give her a level of confidence. The nurse and the nursing team should also seek to earn Sara’s trust from the word go and seek acceptance as friends out to help her and not to torture her. It will also help if the nurse can take Sara around to see other children in the hospital under the care of nurses. She is used to having children around her at the care centre and the sight of other comfortable children at the hospital can reassure her that she is in a safe environ. The best thing to do is to have the family or teacher explain to Sara exactly what is happening in a way that she can understand, let her know the importance of being in the hospital and what is going to happen to her while there. It is sometimes surprising to see how much little children can understand if one seeks to make them understand and how much they can accept if they understand why they need to accept it. If the nursing team wins her trust and her confidence, Sara will not only comply with the process but also recover faster and more effectively. As noted earlier in the foregoing sections of the discussion, her unkempt hair presents an opportunity to provide for the psychological care Sara needs. Helping clean and make her hair will provide the attention and motherly love that Sara needs and arouse not only her attention but also her trust. The nurse can simply promise to help her hair become as beautiful as that of a girl she has seen in school or one in the magazine. Not only will this fill a void of attention in her, but cuddling her and making her feel important will be part of the treatment process as well as a demonstration to the family of what they ought to be doing. By cleaning and making her hair, giving her a mirror to see the outcome and spending quality time with her while helping her care for the hair is going to be a milestone achievement towards her recovery. Every little girl loves looking cute and making her achieve that goal, helps win the trust, love and confidence of any girl towards the provider. It is important that she not be left to play with toys for an extended time, since it is most probable that that is exactly what her family does as well as what she and other children do at the care centre. Sara needs human attention and care, one that extends beyond the toys to a physical, human touch. Engaging Sara’s family in the Nursing care The family should also be considered for orientation to the fact that their child is in hospital. It will not be easy for the family to bear the pressure and strain of having their daughter hospitalized or even to participate in the nursing care provision process. Ideally, the nurse and the nursing care team should spend time with the family to help them understand Sara’s condition, her care needs, her treatment course and her prognosis. This will help them to know what to expect, what to do and what to help with. The family also needs to be educated about the dietary needs of Sara in her condition and after discharge. It is evident that Sara’s dietary needs have not been met for a while and the family might not be aware of it. After being educated about balanced diets and proper diet preparation for the four-year old, they should also be involved in preparation of the food Sara eats while at the hospital. This will give them adequate practice before Sara is discharged and an opportunity to be advised by the nursing team on the appropriate diet. The nursing team, inclusive of the dietary therapist, should help the family identify the specific foods they should include in their diet, and especially that of Sara, as well as how they should prepare it. Besides dietary needs, the family needs to be involved in caring for Sara both physically and emotionally, so as to fill the existing void in Sara. They might have abdicated that duty out of ignorance. Many parents and guardians when educated on the psychological, physical and emotional needs are always welcoming and ready to reform according to paediatric research. The fact that Sara is already toilet-trained and dressed appropriately for the weather means that they are willing and ready to provide for her needs, at least those needs they are aware of. Involving them in the nursing care and educating them on the various facets of child care may be the key that unlocks a healthy upbringing for Sara after discharge. Collaboration Strategies for Sara’s Care Provision The nurse in charge of Sara cannot provide for all her care needs alone. She or he needs to recruit other specialists and care givers who can comprehensively provide the care that the little girl needs (Vandenberg, Hutchison and Parshuram 2007, pp. 940 – 946). A child psychologist for instance, would come in handy in helping draw Sara out of her restraint, depression and withdrawal. Sara also needs a dietary therapist to help in building up her immunity, iron other nutrition needs. The nurse in charge should use the services of the psychologist and therapist to complement her efforts in helping Sara attain full recovery (Vandenberg, Hutchison and Parshuram 2007, pp. 940 – 946). The paediatric hospital set up of modern times, a nurse has many children under her care and may not affords the time to give extensive personal attention to a single patient (Vandenberg, Hutchison and Parshuram 2007, pp. 940 – 946). Sara for instance needs a lot of devotion, time and personalized care as already noted. The nurse might not be available to provide all that care alone. As such, he or she should recruit the services of allied health workers or unregistered health workers in the paediatric ward to devote their efforts in complement to the nursing team while helping Sara (Vandenberg, Hutchison and Parshuram 2007, pp. 940 – 946). Ideally, the nurse should seek for a team approach to care provision where an assortment of professionals ranging from physicians, therapists, psychologists, care givers etc all contribute towards providing a comprehensive, all-round care for Sara. This will help take care of her medical, emotional, psychological and physical needs during her stay at the hospital and to hasten her full recovery (Vandenberg, Hutchison and Parshuram 2007, pp. 940 – 946). Possible Nursing Care Limitations and Complications While most nurses hope for having a straightforward care process with most of their patients, there are incidences where there arise complications and limitations. For instance, Sara and her parents might not share a common language with the nurse. This will mean that the nurse can communicate with Sara or her parents. From the foregoing sections, the need for communication has taken a centre stage in the care process. Without patient-care giver communication, nursing acre becomes impossible, ineffective and inadequate. Not only will sa4ra and her family not contribute and comply with the requirements of the nurse, but out of their misunderstanding, Sara may end up receiving ineffective care (Stack and Dobbs 2004, pp. 146 -149). In this regard, the nurse would have to result to seeking for a qualified, competent interpreter who will help Sara and her parents communicate with the nurse and vice versa (Stack and Dobbs 2004, pp. 146 -149). The interpreter may be a care giver in the hospital who share a common language with the patient and her family, and who has the competency to build patient understanding (Stack and Dobbs 2004, pp. 146 -149). Not everyone who knows a language can function as a good interpreter and the nurse should ensure that the interpreter chosen is qualified to work in health care setups involving children patients (Stack and Dobbs 2004, pp. 146 -149). Other possible complications and limitations that may arise and which the nurse must address amicably if Sara is to helped include difficult parents, Sara’s lack of compliance, secondary conditions developing, family’s economic and social marginalisation to the extent that they can provide for Sara’s needs etc (Stack and Dobbs 2004, pp. 146 -149). The nurse should at all times seek relevant help from the nursing care team, hospital or society to eliminate such complications and optimize care delivery (Stack and Dobbs 2004, pp. 146 -149). Sara’s Discharge With good fortune, the meticulous, careful, dedicated and informed care provided Sara during her hospitalization may ultimately bring good results. Once recovery has been attained or confidently approximated, the nurse in charge should begin planning for Sara’s discharge (Fraser et al 2010, pp. 47-62). The planning process should begin by testing the progress of treatment and the health status of the girl. This will help illustrate any further care and treatment needs that she still requires met (O'Connor 2009, pp. 565-570). Secondly, the care givers at home should be educated and made aware of the continued needs of the patient after discharge so that they know what is expected of them immediately the patient is put under their care (Fraser et al 2010, pp. 47-62). Thirdly, the nurse should ensure that Sara’s family are able to provide the care that Sara needs after discharge and help them seek for such help from the society if they are unable to meet them (Fraser et al 2010, pp. 47-62). Having ensured that the family is aware of the needs and are able to meet them, the nurse should then proceed to then determine the needs for follow up and consultation after the discharge (O'Connor 2009, pp. 565-570). In this accord, the treatment that Sara is already under, such as that of scabies and of iron-deficiency anaemia, will need to be continued after the discharge. The family should also know how to and when to wash the girl and apply treatments as well as provide other medications. Sara will need to proceed with the immunisation until all have been done after the discharge. The nurse therefore needs to set up appointments with Sara during which he or she can gauge the progress of treatment, the adequacy of the care given to Sara, her progressive health status, her psychological, emotional and physical condition etc, after being with the family for a duration after the discharge. This will give the nurse an opportunity to correct errors, advise on what is omitted, commend what is done right and ensure that the best care for Sara is being accorded continuously (O'Connor 2009, pp. 565-570). It is also important that the nurse set up appointments to gauge Sara’s nutritional health in respect to iron and other vital nutrients and to provide appropriate advice to her family (O'Connor 2009, pp. 565-570). Sara’s Future Care Needs The family of Sara might however be willing but unable to meet all her care needs after discharge. This is especially so when it comes to the dietary needs of Sara (a balanced diet rich in iron, minerals and proteins). Even after being educated on appropriate diet, nutrient sources and food preparation, the family may forget and begin ignoring some important facets (Heird 2007, pp. 406 - 421). The family might also not follow the treatment requirements to help Sara recover fully from scabies and anaemia. They might, again, forget about the immunisation needs of the little girl. In this regard, the nurse should use some charts and diagrams to illustrate the important information about Sara’s dietary needs and how they should be met. Most paediatric units today have booklets, brochures and wall charts to give their patient’s care givers to assist their memory in providing requisite care after the patient is discharged (Duncan 1998, pp. 46-73). The medication should also be packed with clear directions and instructions of use, preferably win the language that the family speaks, to ensure that the family can refer back in case they forget (Jackson 2001, pp. 161-175). The immunisation chart should be provided to help the family remember the dates that each immunisation is due (Stack and Dobbs 2004, pp. 146 -149). Finally, regular and consistent follow ups and consultations should help the nurse keep abreast with the patient and her care progress (Jackson 2001, pp. 161-175; Duncan 1998, pp. 46-73). When her anaemic condition is resolved, her scabies healed and her immunisation complete, the nurse might change the advice given to the family and help them maintain the health of the little girl (Stack and Dobbs 2004, pp. 146 -149). Then consultation and follow up might reduce and even be terminated, as long as all the interests of Sara are catered for in such decisions (Jackson 2001, pp. 161-175). It would be better however for the nurse to maintain an occasional eye on her to ensure that her condition and predicament does not relapse (Duncan 1998, pp. 46-73). Conclusion This brief essay sought to explore the dynamics of paediatric nursing care using Sara’s case study. It used scholarly theories in contemporary literature on paediatric care to focus and inform the discussion. To begin with, the discussion considered the immediate and short-term nursing care of Sara. Sara was determined as having emergency care needs to revive her from the faint and to eliminate her headache and other symptoms, immediate care needs to treat iron-deficiency anaemia and scabies, as well as the short-term needs of physical, emotional and psychological care ranging from orientation in the hospital to earning compliance, form washing to cuddling and from immunisation to medical checkups. Thirdly, the discussion explored the ways in which the nurse could engage and win Sara’s cooperation in the nursing care such as communicating to her, showing care and love, serving her needs and requirements as well as involving the people she trusts. The essay then proceeded to consider ways in which the nurse can engage the patient’s family in the care process in such activities as preparing Sara’s food, washing her and spending time with her. The discussion also highlighted how the nurse could recruit other parties in the hospital and society to complement in the nursing care, including psychologists, diet therapists and unregistered/allied health care workers. The essay also considered possible limitations and complications that may accrue during the paediatric nursing care process and how such limitations can be overcome. Such limitations discussed included language problems between the patient and care givers, which could be solved by a competent interpreter. To terminate the discussion, the essay also considered the proper discharge process for the paediatric patient. The discharge planning should begin by testing the progress of treatment and the health status of the girl, according to the discussion, followed by educating the care givers at home of the continued needs of the patient after discharge so that they know what is expected of them immediately the patient is put under their car, as well as ensuring that Sara’s family are able to provide the care that Sara needs after discharge and help them seek for such help from the society if they are unable to meet them. The essay concluded that the nurse should set up appointments with Sara during which he or she can gauge the progress of treatment, the adequacy of the care given to Sara, her progressive health status, her psychological, emotional and physical condition etc, after being with the family for a duration after the discharge. Finally, the discussion also explored the patient’s future care needs, all as part of the nursing care process. This includes use of charts and diagrams to illustrate the important information about Sara’s dietary needs and how they should be met, as printed in booklets, brochures and wall charts. The medication should also be packed with clear directions and instructions of use, preferably win the language that the family speaks, to ensure that the family can refer back in case they forget. Again, the essay concluded that the immunisation chart should be provided to help the family remember the dates that each immunisation is due, and that there should be regular and consistent follow ups and consultations to help the nurse keep abreast with the patient and her care progress. References Chen, Y 2010, ‘Iron deficiency anaemia – children’, MedLinePlus, Accessed 11 September 2010, from Duncan, A 1998, Paediatric Intensive Care, London, MBJ Books, pp. 46-73. Fraser, L, Fleming, T, Miller, M, Draper, E, McKinney, P and Parslow, R 2010, Palliative care discharge from paediatric intensive care units in Great Britain, Palliative Medicine, Vol. 24 (2), pp. 47-62. Glader, B 2007, Iron-deficiency anaemia, in Kliegman, R, Behrman, R, Jenson, H and Stanton B, eds, Nelson Textbook of Paediatrics, Eighteenth Edition, Philadelphia, Pa, Saunders Elsevier, pp. 441 - 457. Heird, W 2007, Iron-deficiency anaemia, in Kliegman, R, Behrman, R, Jenson, H and Stanton B, eds, Nelson Textbook of Paediatrics, Eighteenth Edition, Philadelphia, Pa, Saunders Elsevier, pp. 406 - 421. Jackson, A, Johnson, B, O'Toole, M and Auslander, G 2001, Discharge planning for complex paediatric cases, Social Work in Health Care, Vol. 34 (1,2), pp. 161-175 Jaimovich, D 2004, Admission and Discharge Guidelines for the Paediatric Patient Requiring Intermediate Care, Paediatrics, Vol. 113 (5), pp. 1430-1433 O'Connor, N 2009, Infant formula, American Family Physician, Vol. 79 (1), pp. 565-570. Pearson, G 2001, Handbook of Paediatric Intensive Care, London, WB Saunders, pp. 117-189. Stack, C and Dobbs, P 2004, Essentials of Paediatric Intensive Care, Cambridge, Cambridge University Press, pp. 146 -149. Vandenberg, S, Hutchison, J and Parshuram, C 2007, A Cross-sectional Survey of Levels of Care and Response Mechanisms for Evolving Critical Illness in Hospitalized Children, Paediatrics, Vol. 119 (4), pp. 940 - 946. Read More