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1. Describe the pathophysiology of the presenting complaint in the case study.  
2. Evaluation of the nurse’s role to deliver developmentally appropriate nursing care in relation to your chosen case study. Address:
• growth and developmental theories,
• family centred care and,
• the effects of hospitalisation of the child, on the child and family. 

Case Study on Intussusception

The essay brings about the discussion on the child adolescence and family nursing and the related aspects. For the purpose of the description and analysis of the nursing in the healthcare, a case study has been chosen. It also describes the role of nurse in delivery effective nursing care to the children. The later part of this essay leads to the demonstration of the family centred care approach, effects of the hospitalisation of the child on the child and the family. Therefore, these concepts in relation to the case study have been clearly stated well which further derives remedies to the issues represented through the case (Sista et al, 2015).

The case study taken for the describing and analysing the issues or problems from the disease represents a 4-month old boy, Jay who is admitted to the paediatric unit in a hospital via emergency. The boy was identified with a number if symptoms such as intense abdominal bleeding, vomiting, reduction or low-level feeding, and the changes in the bowel actions. Patients with these symptoms feel high and intense pain and cry out loud in some cases. With reference to the case, Jay also drew his legs up and felt intense pain.  After the diagnosis and the ultrasound, it was stated that these symptoms are the cause of intussusception.

The term intussusception refers to the severe state or condition of the human body in which a part of the intestine slides into the adjacent intestine. Intussusception is found to be a common illness or health issue to the children or infants who are less than 2 years of age. This situation often blocks the flow of the foods and fluids in the body. In every 1000 infants who take birth, every 1 to 4 children face the same problem. Primarily the issue has been observed mostly between the infants who are 5 to 9 months old. It results in symptoms such as intermittent spasmodic abdominal pain, vomiting, and makes the children cry out in pain  (Applegate & Sadigh, 2018).

Pathophysiology has been undertaken for the assessment of the Jay’s case. It can be defined as the disturbance in the normal mechanical, biological and the physical functions of the human body, which is often the result of any disease or illness. In a simpler sense, it refers to the altered or disordered functions in the living organism. The state of the individual’s homeostasis is affected by the same.

Pathophysiology of Intussusception

Intussusception explains about the telescoping of the one portion of the bowel into the next, therefore the pathophysiology includes certain terms such as ileum, i.e. the last part of the small intestine, cecum, and the jejunum. The problem states that the ileum enters the cecum, however the prolapsing of the ileum or jejunum into itself is rarely found situation. Almost, in every case it has been found that the occurrence of intussusception takes place when the intussusceptum is closely located to the intussuscipiens. Intussusceptum refers to the part which is invaginated with another part during intussusception (Yen et al, 2016).

The term intussuscipiens is the part of the bowel which receives the invaginated part during intussuception. The situation occurs due to the peralistic action of the proximal segment into distal segment. This invagination of one part often blocks the blood supply which leads to ischemia.  The mucosa here is sensitive to the ischemia and creates a red-currant jelly stool, which is often observed in less number of cases.  Therefore, the presence of the red-currant jelly stool must be treated differently depending on the case. Hence, the above discussion defines about the pathophysiology of the intussusception in the children (Smolowitz  et al, 2015).

The problem described through the pathophysiology of the case often caused blood supply to stop and the lack of blood supply may cause the intestinal walls to die. This can further cause infection in the lining of abdominal cavity. Thus the intussusception leads to the major illness, which can be rectified by effective health care services or effective role of the nurse. The role of nurse is crucial in taking care of the child or adolescent intussusception. From the beginning till the final diagnosis or the treatment of the problem nurses play an important role. They must deliver their services by maintaining a NPO status, which will contribute in examining the patient timely and assessing the condition of the child. It is considered essential step because the pain may lead to the situation of proferation (Chauhan et al, 2017). 

The effective delivery of the services is often the result of an appropriate leadership style in the healthcare. This further explains the nurse’s role in monitoring the change, explaining the situation of the patient to their parents, about severe pain and the causes, also how to deal with the child effectively. The nurse is also responsible to give assurance to the parents regarding the diagnosis and the results for the condition of the child (Ruvalcaba-Romero et al, 2017).

The Role of the Nurse in Child and Adolescent Nursing

The essay focused on the illness in the infants or the children in their younger years therefore it requires certain theories of the child growth and development. As the case study focused on the development of the child in nursing and healthcare, therefore certain concepts are essentially important to be considered. With context to the case, as Jay, babies of his age that generally includes 4-7 months aged babies, learns to understand things slowly and gradually. They learn to coordinate their new perceptive abilities, which include vision, touch, and hearing. In addition, it also states about the motor skills such as grasping, rolling-over, and crawling are some of the expected development milestones. Thus, it describes about the motor skills, language skills, and the other social and emotional skills which he might have acquired till that age (Holloway & Galvin, 2016). 

Discussing the development of the children in their younger age, it must be understood; that the children must be involved in the medical related. The child growth and development theories in respect to the case study of Jay include the cognitive, psychosocial, behaviourist and the ecological theories with respect to the illness. The theories and concepts ensure the wellbeing of the child and adolescents (Crain, 2015).  

The concept of delivery the effective services to the children with such disease or illness, is often supported with the use of the family centred care approach. The approach includes the involvement of the family members or parents in the treatment of the illness. The nurses in the healthcare settings provide a family-centred approach which may be neonatal, paediatric and the adolescent nurse. Paediatric care has now adopted the family-centred approach, in order to enhance the well-being of paediatric patients. Therefore, the nurses have identified their responsibilities towards both the family as well as the child in such cases. This will ensure the wellbeing and wellness of the child effectively in consideration to the family (Coyne, Hallström & Söderbäck, 2016).

The concept also accepts the racial, socio-economic background and differences of the family, and the cultural diversity of the families in context to the healthcare practices. The approach encourages the family support and responds to both the child and family developmental needs. There is a greater role of the family in the nursing of the child and adolescents in their younger age. Nine elements of this approach which includes recognising the family and the family members as the constant in the child’s life, facilitating parent-professional collaboration at all different levels of healthcare  (Betancourt et al, 2016).

Child Growth and Development Theories

It is effectively applicable with the case of Jay, in which the nurses and the healthcare can effectively improve the state of wellbeing of the child. The inclusion of the family with the Jay’s treatment will help in easy and fast recovery from the illness, as the family members understands him well. It can be stated that the social, emotional, and developmental support is integral to the healthcare which can be easily facilitated by the family members of the Jay. As it will lead to the better and positive outcomes, and will enhance the level of satisfaction to both the patient and the family. The symptoms diagnosed as in the Jay’s case includes the policies such as keeping the open visiting hours, for the family members and the extended family. It also includes their participation in effective decision making for their child. Thus, the approach is considered to be effective (Lawrence et al, 2016).

With the context to the given case study, it has been mentioned that due to the application of the rotavirus vaccines, the situation became worse with him and the other infants. As Jay, was diagnosed with the intussusception, it was natural that there is an essential role of the hospitalisation and medication. Applying medical procedures affect the child and the family both significantly. Hospitalisation and the treatment of the illness are the stressful experiences for the child and his family. As the child lives in an environment which is often surrounded by a number of other patients, and other professional and non-professional staff affects the child negatively is one of the issue of the hospitalisation. These all situations exert an influence over child. This in turn makes the family nervous or conscious regarding the treatment of their child, and the outcomes in the longer term  (Schoeps et al, 2018).

To conclude the above discussion, it has been analysed that the effective child and adolescent nursing is a major concern in today’s scenario. The purpose of gaining a better understanding of the factors and diseases affecting wellness is demonstrated by the case study of Jay. Moreover, the role of the nurse and the medical procedures are crucial to the children or infants. The essay described about the intussusception and the effective treatments for the illness, which will improve the wellbeing of the children. The treatment is considered with respect to the effects of hospitalisation on the child and family. Hence, the healthcare institutions must incorporate the effective way of treating the patients and consider their physical, social, and emotional aspects of health. 

References

Applegate, K. E. & Sadigh, G. (2018). Intussusception in Infants and Children: Diagnostic Evidence-Based Emergency Imaging and Treatment. In Evidence-Based Emergency Imaging (pp. 567-582). United Kingdom: Springer.

Betancourt, J. R., Green, A. R., Carrillo, J. E., & Owusu Ananeh-Firempong, I. I. (2016). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public health reports.

Chauhan, A., Chauhan, D., Kotecha, R., & Chouhan, S. P. (2017). Chronic intussusception due to lipomatous polyp in adult presenting as intestinal perforation: A case report. Indian J. Sci. Res, 15(1), 80-83.

Coyne, I., Hallström, I. & Söderbäck, M. (2016). Reframing the focus from a family-centred to a child-centred care approach for children’s healthcare. Journal of Child Health Care, 20(4), 494-502.

Crain, W. (2015). Theories of Development: Concepts and Applications: Concepts and Applications. United States: Psychology Press.

Holloway, I. & Galvin, K. (2016). Qualitative research in nursing and healthcare. United States: John Wiley & Sons.

Lawrence, D., Hafekost, J., Johnson, S. E., Saw, S., Buckingham, W. J., Sawyer, M. G. & Zubrick, S. R. (2016). Key findings from the second Australian child and Adolescent Survey of Mental Health and Wellbeing. Australian & New Zealand Journal of Psychiatry, 50(9), 876-886.

Ruvalcaba-Romero, N. A., Fernández-Berrocal, P., Salazar-Estrada, J. G. & Gallegos-Guajardo, J. (2017). Positive emotions, self-esteem, interpersonal relationships and social support as mediators between emotional intelligence and life satisfaction. Journal of Behavior, Health & Social Issues, 9(1), 1-6.

Schoeps, A., Nebié, E., Fisker, A. B., Sié, A., Zakane, A., Müller, O. & Becher, H. (2018). No effect of an additional early dose of measles vaccine on hospitalization or mortality in children: A randomized controlled trial. Vaccine, 36(15), 1965-1971.

Sista, F., Penna, A. D., Abruzzese, V., Leardi, S. & Amicucci, G. (2015). Intestinal Intussusception by Monophasic Synovial Sarcoma: Case Report and Literature Review. Chirurgia, 110, 391-395.

Smolowitz, J., Speakman, E., Wojnar, D., Whelan, E. M., Ulrich, S., Hayes, C. & Wood, L. (2015). Role of the registered nurse in primary health care: meeting health care needs in the 21st century. Nursing Outlook, 63(2), 130-136.

Yen, C., Healy, K., Tate, J. E., Parashar, U. D., Bines, J., Neuzil, K. & Steele, A. D. (2016). Rotavirus vaccination and intussusception–Science, surveillance, and safety: A review of evidence and recommendations for future research priorities in low and middle income countries. Human vaccines & immunotherapeutics,  12(10), 2580-2589.

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