Individualized Care Recovery Of Patients: Nursing Assessment, Treatment And Care Plan

Discussion of activities of daily living related to the case study (breathing and controlling body temperature)

Discuss About The Individualized Care Recovery Of Patients?

Nurses play a critical role in individualized care and recovery of patients. Systematically prepared care plan is the right means of guidance for them to meet specific health care needs of patient and manage their critical conditions. Assessment of activities of daily living is also an important action before preparing care plan. It helps to determine the level of support and assistance needed by patients while under care (Howatson-Jones et al.  2015). This meticulous process of assessment of patient condition and planning care is described in this report through the case of Kyle. Kyle is a 2 year old male admitted to the paediatric ward with whopping cough. The main symptoms observed in patient includes rhinorrhea, red blood shot eyes and repetitive forceful coughs. In relation to the patients conditions, the report specifically provides an overview about changes in  the activity of living of breathing and controlling body temperature due to whooping cough and how the assessment related to the changes can be done. Furthermore, the assessment process guides in determining the type of treatment needed for each symptom. Secondly, the report identifies one clinical issue related to breathing and the nursing strategies and evaluative measures needed to address the issue. On the whole, the report develops understanding regarding the critical elements of care and nursing process followed for implementation of care.

Kyle has been admitted in hospital due to whooping cough. It is a condition in which a person experiences long burst of cough due to infection in the nose, throats and lungs. The infection is mainly caused by the bacterium, Bordetella pertusis (Giayetto et al. 2017). Small children like Kyle face difficulty due to several coughing spells and breathing difficulty. This causes great distress to children and affects their activities of living particularly breathing and controlling body temperature (Shields and Thavagnanam 2013).

Breathing difficult in children with whooping cough is seen as a result of the action of the bacteria Bordetella pertusis. It leads to the production of toxin after the bacteria attaches to the cilia of the respiratory epithelial cells. This results in inflammation of the respiratory tract and disrupts clearing of the pulmonary secretion (Kilgore et al. 2016). This  ultimately has an impact on the activities of living of breathing and children like Kyle experience breathing problem and regular spells of cough. During bout of cooking, the face turns red and attempts to breath lead to production of whooping sound. In some children, the breathing also stops at the end of a coughing bout and they go pale for sometime. It resumes again making child go pale for some time.

Affect on activities of living(AoL) due to whooping cough

In relation to of the AoL of controlling body temperature, this is altered significantly due to whooping cough. The infecting bacteria affect the lining of the airways and in the first stage, mild cough and slightly high temperature is seen. Secondly, in the paroxysmal stage (main coughing stage) too, fever is seen with bouts of intense coughing (Kline et al. 2013). Fever is an adaptive response to inflammation in the respiratory tract. Schell-Chaple et al. (2015) also points to the body temperature abnormalities in patients with respiratory distress

The first step for assessment of AoL of breathing difficulty in Kyle is observation of breathing pattern. The signs of increased work of breathing and wheezing sound indicates ineffective breathing pattern in patients. Children like Kyle may engage in frantic exhaling and inhaling activities. To detect alterations in breathing patterns, the nurse can do the following assessment:

• Assessment of respiratory rate, rate and depth of breathing
• Assessment of ABG levels and oxygen saturation level
• Assessment of breathing pattern and rate and depths of respiration
• Regularly checking the children for shortness of breath is important
• Nurse can also look for level of accessory muscle use and skin color to determine the level of difficulty in breathing
• Listening to breathing sounds such as whooping or wheezing sound is also an important assessment as it gives an idea about the cause of breathing problem (Sousa et al., 2015).

• To regularly obtain baseline temperature of patients and compare them with further recordings
• To closely observe the child for symptoms of hypothermia or hyperthermia
• In case of initiation of antimicrobial therapy, nurse should regular observe for adverse signs and symptoms

To manage breathing difficulty faced by Kyle, the nurse can provide the following treatment and intervention:

• The first step is to reduce respiratory distress in patient by providing antibiotics and respiratory medications as per physician’s order. Generally, erythromycin family of antibiotics is given for 2 weeks.
• Secondly, regular observation of vital signs, respiratory status and pulse oximetry is needed to manage adverse issues instantly.
• Supportive care is also needed to remove thick secretions from the throat and nasal passage of Kyle
• Rapid active bronchodilator should be given for wheezing sounds and the child should be observed after every three hours for signs of improvements or complications (World Health Organization 2013).

• If Kyle had fever then paracetamol and antipyretic medications should be provided
• Environmental factors of Kyle like room temperature and body temperature should be adjusted.
• In case of fever, nurse should maintain adequate food intake in patient (Wang et al. 2014)

Considering the current symptoms of Kyle, the major clinical issue in the child is his paroxysmal cough. This is making him lethargic and apathetic. The repetitive bout of cough is seen in the paroxysmal stage where series of cough is followed by sudden inspiration and whooping sound (Hartzell and Blaylock 2014). Children like Kyle stop breathing temporarily and sign of cyanosis is seen during coughing bout. Hence, paroxysmal cough  is a factor that affects the AoL of breathing pattern and developing care plan to address this issue is important. The main goal of the care plan will be to reduce bouts of cough in Kyle, observe the severity of cough and breathing difficult, provide a calm environment, adequate rest and maximize nutrition and recovery of the child (Bocka 2017). To prevent the child from additional difficulty, a comprehensive care plan is needed that can address the following:

• Firstly, during the catarrhal stage of infection, Kyle should be isolated to prevent transmission of infection
• There is a need to provide restful environment to patient free from dust and smoking so that any incidence of paroxysm is prevented. Proper body alignment of the child should also be maintained to maximize breathing pattern. Humidifying the room promotes clearance of secretion (McNamara et al. 2014).
• Preventing the child from infection at this stage is important. So, it will be necessary to start antibiotic therapy and regularly observe for signs of airway obstruction by checking vital signs, respiratory rate and pulse oximetry. To reduce breathing problem, the plan is to carefully observe for apnea and cyanosis and provide mechanical ventilation and breathing treatments at the right time (Scanlon et al. 2015).
• The most important plan for recovery of Kyle would be to provide supportive therapy effectively. This includes all activities to prevent risk and complication in patients. This is dependent on regular observation of patients and monitoring of heart rate, breathing rate and oxygen rate.
• Adequate sleep periods and rest should be provided to relieve Kyle for distress.
• Although there is no specific consideration, considering the age of Kyle, he should be given oral feedings or intravenous fluids if oral feeding is not appropriate due to breathing problem. Regular fluid intake and small and frequent feeding is important (Heininger 2010).

Improvement in the work of breathing, respiratory rate and breathing sounds can give an indication if the above mentioned care plan was successful for the recovery of Kyle or not.

Conclusion:

The case analysis of Kyle, a 2 year old child with summarized gave insight into the series of clinical issues faced by children with whooping cough. As the bacteria Bordetella pertusis causes inflammation in the respiratory tract, it disrupts clearance of pulmonary secretions. Due to the pathogenesis of the disease, two AoL was identified to be affected and altered in patient- breathing patterns and control of body temperature. The report discussed how both these AoLs are affected in Kyle. The report provided the idea for nursing assessment needed to identify these alterations. Secondly, in relation to the issue of breathing problem and changes in body temperature, the report gave appropriate treatment options to provide relief to patient. It also reflected on one issue arising due to breathing problem and gave a comprehensive care plan to promote recovery of patient. The key learning from this research is that to prevent complications in patients, it is necessary to start supportive care for patients early to promote recovery and well-being.

Reference

Bocka, J. 2017. Pertussis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Immunization. Emedicine.medscape.com. Retrieved 10 August 2017, from https://emedicine.medscape.com/article/967268-treatment

Giayetto, V.O., Blanco, S., Mangeaud, A., Barbas, M.G., Cudola, A. and Gallego, S.V., 2017. Features of Bordetella pertussis, Bordetella spp. infection and whopping cough in Córdoba province, Argentina. Revista chilena de infectologia: organo oficial de la Sociedad Chilena de Infectologia, 34(2), p.108.

Hartzell, J.D. and Blaylock, J.M., 2014. Whooping cough in 2014 and beyond: an update and review. Chest, 146(1), pp.205-214.

Heininger, U., 2010. Update on pertussis in children. Expert review of anti-infective therapy, 8(2), pp.163-173.

Howatson-Jones, L., Standing, M. and Roberts, S., 2015. Patient assessment and care planning in nursing. Learning Matters.

Kilgore, P.E., Salim, A.M., Zervos, M.J. and Schmitt, H.J., 2016. Pertussis: microbiology, disease, treatment, and prevention. Clinical microbiology reviews, 29(3), pp.449-486.

Kline, J.M., Lewis, W.D., Smith, E.A., Tracy, L.R. and Moerschel, S.K., 2013. Pertussis: a reemerging infection. American family physician, 88(8)

McNamara, D.G., Asher, M.I., Rubin, B.K., Stewart, A. and Byrnes, C.A., 2014. Heated humidification improves clinical outcomes, compared to a heat and moisture exchanger in children with tracheostomies. Respiratory care, 59(1), pp.46-53.

Scanlon, K.M., Skerry, C. and Carbonetti, N., 2015. Novel therapies for the treatment of pertussis disease. Pathogens and disease, 73(8).

Schell-Chaple, H.M., Puntillo, K.A., Matthay, M.A., Liu, K.D. and National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network, 2015. Body temperature and mortality in patients with acute respiratory distress syndrome. American Journal of Critical Care, 24(1), pp.15-23.

Shields, M.D. and Thavagnanam, S., 2013. The difficult coughing child: prolonged acute cough in children. Cough, 9(1), p.11.

Sousa, V.E.C., Lopes, M.V.D.O., Silva, V.M. and Keenan, G.M., 2015. Defining the key clinical indicators for ineffective breathing pattern in paediatric patients: a meta?analysis of accuracy studies. Journal of clinical nursing, 24(13-14), pp.1773-1783.

Wang, K., Bettiol, S., Thompson, M.J., Roberts, N.W., Perera, R., Heneghan, C.J. and Harnden, A., 2014. Symptomatic treatment of the cough in whooping cough. The Cochrane Library.

World Health Organization, 2013. Pocket book of hospital care for children: guidelines for the management of common childhood illnesses. World Health Organization.