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Case study You are the nurse looking after Bree, an 18 month old female admitted to the Paediatric ward with bronchiolitis. She currently has symptoms of shortness of breath, cough. expiratory wheeze, a temperature of 38.2 degrees Celsius and runr nose oozing clear mucous. Instructions: Structure your assignment so that it meets the following requirements: You may use headings. 1. Introduction. (approx 250 words). Serves as a 'map" of The essay, outlining to the reader the key points contained in the body of the work. 2. Discussion of Activities of Living (AoL's) related to the Case Study —Breathing and Controlling Body Temperature (approx. 600 words) Discuss how the AoL's of breathing and controlling body temperature have been altered for Bree. Your answer must include the following: 

• An overview of how the two AoL's may be affected

• How you would assess Bree in relation to the two identified AoL's

• How you would you treat Bree's symptoms for each AoL 3. Nursing Care Plan.

Using the Nursing Care Plan provided identify one issue related to either breathing or controlling body temperature that has arisen from the case study. From this issue formulate a plan/goal for improving this issue, identify strategies for meeting the planigoal and then discuss what evaluative measures will be taken to determine if the plan/ goal was met. 

Activities of Living: Breathing and Controlling Body Temperature

The impact of a health adversity or a disorder on the patient generally depends on the severity of the disease and the present condition of the patient as well. However, the impact of a health disorder is extreme on the activities of living or AOL for the individual. Activities of living can be defined as the care activities that a particular individual requires to complete with respect to continuing normal functions of living (Mansbach et al., 2012). A disease or a health disorder is often seen as affecting most of the activities of living which in turn affects the health and wellbeing of the patient. In case of infants and toddlers as well, a particular health disorder impacts their activities of living which can have a significant detrimental effect on the child.

In this essay, the case study selected represents the case of Bree, an 18 month old girl who had been submitted to the Paediatric ward of the facility with Bronchiolitis with symptoms including shortness of breath, expiratory wheezing, and runny nose that is oozing clear mucous, cough, and temperature at 38.2 degree Celsius. It has to be mentioned that the activities of living for a toddler like Bree includes breathing, feeding, controlling body temperature and excretion; and the impact of all the symptoms that she had been suffering from due to her bronchiolitis will alter some of the activities of living. In this case, two most important activities of living that are being affected includes breathing and controlling body temperature which can have an evident impact on the safety and recovery of the patient (Meissner, 2016). This essay will attempt to discuss how the symptoms of bronchiolitis that Bree had been exhibiting are altering the AOL of breathing and controlling body temperature. Followed by that, this essay will also discuss adequate assessment for each of the affected AOL for Bree and subsequent treatment with a detailed care plan.

Alteration of AOLs: 

Bronchiolitis can be defined acute inflammatory injury present in the bronchioles facilitated usually by a viral infection or can also be exacerbated due to allergens or bacteria as well (Farley et al., 2014). Regardless of the etiologic course of the disease, an infection leading to bronchiolitis produces inflammation in the bronchioles, increased mucus secretion, bronchial obstruction and constriction, and alveolar cell death leading to viral invasion. The excessive mucous production due to the infection further narrows down the already inflamed airways leading to impaired gaseous exchange in the patient. Hence, the patient experiences shortness of breath due to the restricted airflow and leads to affecting the AOL of breathing (World Health Organization, 2013).

Considering the second AOL which is controlling the body temperature, it has to be mentioned that mild fever is a common immune reaction to the disturbance of homeostasis in the body. According to Schnabel, Brand et al. (2012), fever is an integral part of the defence mechanism of the body against any infection, and in children especially any mild or severe viral infection causes a rise in the body temperature leading to fever. In case of Bree as well the infection leading to bronchiolitis caused a significant alterations in the homeostasis in her body and led to uncontrolled body temperature causing fever.

Assessment for the Affected Activities of Living

Assessment: 

Assessment of bronchiolitis symptoms is a very important aspect of the treatment and care planning and implementation procedure. As mentioned by Mansbach et al. (2012), it is very important for the assessment to be efficient and quick addressing each and every need of the patient so that each of the activities of living can be addressed immediately. For the AOL of breathing, the nursing professional will have to assess the respiratory rate and gaseous exchange for Bree. Along with that, the nurse will require to carry out pulse oximetry and arterial blood gases assessment as well to understand the level of airway obstruction and oxygen deficiency. As Bree had been suffering from wheezing as well, the nurse will also require to assess her breathing sounds by ausculating (Florin, Plint & Zorc, 2017). Lastly, the nurse will have to assess the quantity and consistency of the cough along with the colour of the exudates. For controlling the body temperature the nurse will have to assess her body temperature periodically and frequently both orally and under the arm.

Treatment measures: 

It has to be mentioned that Bree is exhibiting symptoms for each of the affected activities of living or AOL. The shortness of breath and wheezing can be considered as a key symptomatic manifestation of her altered activity of living of breathing. In order to treat the symptoms of altered AOL of breathing, the nurse will have to provide external oxygen therapy to help enhance the airflow immediately and reduce the level of oxygen deficiency. Along with that, Bree will also require the aid of bronchodilators such as salbutamol or albuterol as well to reduce the inflammation of the bronchial tubes. Lastly, airway clearance carried out periodically will also help treat the breathing troubles that Bree had been facing (Vinci & Bauchner, 2014).

In case of the altered AOL of controlling body temperature, the symptomatic manifestation is mild hyperthermia or elevated body temperature at 38.2 degree Celsius. In this case, to treat the symptom, Bree will require Antipyretic and mild analgesics to help with her the fever and discomfort. Along with that, a warm and comfortable atmosphere will also help the patient recover faster (Tapiainen et al., 2016).

Nursing care plan: 

Although there are a number of different symptoms manifested by the patient regarding the affected activities of living, the most impactful symptom that has the potential to affect her health and safety profoundly is the shortness of breath. Hence, the chosen symptom for a curated care plan in Bree’s case is shortness of breath.

Assess

Plan

Implement

Evaluate

First and foremost, the nursing professional will require to assess the respiratory status of the patient periodically every 2 to 4 hours to assess the changes in the breathing pattern for the child due to depleting energy (Hockenberry & Wilson, 2014). In the next step, the nurse will require to assess the level of consciousness and configuration of chest by palpation followed by checking the adventitious breathing sounds by auscultating.   

The primary goal of the nursing care is to enhance the level of airflow and increase the percentage of oxygen saturation in turn enhancing the gaseous exchange for Bree. In order to achieve that airway clearance and external oxygen assistance will need to be implemented along with necessary medication to perform bronchodilation (Tapiainen et al., 2016). This will widen the narrowed bronchial tubes restricting airflow for Bree and will help her breathe more comfortably allowing the oxygen depletion in her body to be overcome gradually

First and foremost, the nurse will have to administer humidified oxygen externally via mask to Bree. It will help in providing her immediate relief of breathing and will avoid the risk of any severe consequences (Brand et al., 2012 ).

The next intervention that needs to be implemented to the patient includes airway clearance through suction which will reduce the airway obstruction drastically. However, the nursing professional needs to be very careful regarding the suction to not cause any damage to the delicate respiratory system (Tapiainen et al., 2016).

Along with that, the nurse will have to administer bronchodilators such as salbutamol or albuterol. These medications will have an instant bronchodilation effect on the patient widening the bronchial tubes and improving the airflow through the lungs and will help in improving the condition of the patient (Farley et al., 2014 ).

The nurse will also have to keep changing the posture of the patient in an attempt to enhance comfort and help the patient feel better (Stotts et al., 2013).

The nurse will need to encourage better fluid intake to help enhance the energy level and comfort as well.

It is critical for the intervention implementation to be evaluated so that the progress of the patient can be tracked and the efficiency of the medicines can be tracked. A few indicators can be evaluated to assess the progress of the recovery of the patient (Tapiainen et al., 2016).

The nurse will have to assess the respiratory rate and oxygen saturation periodically to track improvement in air exchange ( Joshi, Kasi & Lew, 2015).

The nurse will have to auscultate breathing sounds as well to check for reduction in the wheezing (Hockenberry & Wilson, 2014).

Lastly, the nurse will have to monitor the child for any signs of discomfort or irritability as well along with level of consciousness and activity.

Conclusion:

On a concluding note, a severe disease such as bronchiolitis can have a significant impact on the wellbeing of an individual and for the children the impact is even more accelerated for the children. It has to be mentioned that activities of living are affected with even the slightest change in the homeostasis in the body. In case of Bree, the patient in the case study as well, Bronchiolitis and the symptomatic manifestations of the disease had a significant impact on the activities of living as well, especially breathing and controlling the body temperature. This paper successfully discussed the process of alterations in the mentioned AOL, assessment for the anomalies observed, and a set or possible treatment interventions to treat the symptoms associated with the mentioned AOLs. Along with that, the essay also discussed a curated care plan for one critical symptom associated with one of the two mentioned AOLs. As shortness of breath had been the most impactful symptom that the patent had been suffering with, the care plan has focused on shortness of breath. Hence, with the implementation of the recommended interventions, symptom management for Bree can be easily achieved and she can attain a speedy recovery.  

References: 

Brand, H. K., de Groot, R., Galama, J. M., Brouwer, M. L., Teuwen, K., Hermans, P. W., ... & Warris, A. (2012). Infection with multiple viruses is not associated with increased disease severity in children with bronchiolitis. Pediatric pulmonology, 47(4), 393-400.

Farley, R., Spurling, G. K., Eriksson, L., & Del Mar, C. B. (2014). Antibiotics for bronchiolitis in children under two years of age. The Cochrane database of systematic reviews, 2014(10), CD005189.

Florin, T. A., Plint, A. C., & Zorc, J. J. (2017). Viral bronchiolitis. The Lancet, 389(10065), 211-224.

Hockenberry, M. J., & Wilson, D. (2014). Wong's nursing care of infants and children-E-book. Elsevier Health Sciences.

Mansbach, J. M., Piedra, P. A., Stevenson, M. D., Sullivan, A. F., Forgey, T. F., Clark, S., ... & Camargo, C. A. (2012). Prospective multicenter study of children with bronchiolitis requiring mechanical ventilation. Pediatrics, peds-2012.

Mansbach, J. M., Piedra, P. A., Teach, S. J., Sullivan, A. F., Forgey, T., Clark, S., ... & MARC-30 Investigators. (2012). Prospective multicenter study of viral etiology and hospital length of stay in children with severe bronchiolitis. Archives of pediatrics & adolescent medicine, 166(8), 700-706.

Meissner, H. C. (2016). Viral bronchiolitis in children. New England Journal of Medicine, 374(1), 62-72.

Stotts, A. L., Northrup, T. F., Schmitz, J. M., Green, C., Tyson, J., Velasquez, M. M., ... & Hovell, M. F. (2013). Baby's Breath II protocol development and design: a secondhand smoke exposure prevention program targeting infants discharged from a neonatal intensive care unit. Contemporary clinical trials, 35(1), 97-105.

Tapiainen, T., Aittoniemi, J., Immonen, J., Jylkkä, H., Meinander, T., Nuolivirta, K., ... & Korppi, M. (2016). Finnish guidelines for the treatment of laryngitis, wheezing bronchitis and bronchiolitis in children. Acta Paediatrica, 105(1), 44-49.

Tapiainen, T., Aittoniemi, J., Immonen, J., Jylkkä, H., Meinander, T., Nuolivirta, K., ... & Korppi, M. (2016). Finnish guidelines for the treatment of laryngitis, wheezing bronchitis and bronchiolitis in children. Acta Paediatrica, 105(1), 44-49.

Vinci, R., & Bauchner, H. (2014). Bronchiolitis, deception in research, and clinical decision making. JAMA, 312(7), 699-700.

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

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