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Nursing: Family And Children Nursing Add in library

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Questions:

Using the case study assessment template:

• Identify two immediate and important nursing priorities for every child and infant
• Provide a rationale for the two nursing priorities for every child and infant
• Explain the planned nursing interventions for these priorities for every child and infant o Explain planned approaches to nursing care that consider the development of the infants and children .

1)

patient name ;- Antonio Valencia

age ;- 4 month old boy
diagnosis ;- viral pneumonia
history ;- increasing difficulties of feeding i last 2 days .

current observation ;-Heart rate ;- 168 /min , respiration ;- 35/m  AND USE OF  abdominal muscle T ,;- 38;C , o2 ;- required by hudson mask

breast feeding on demand
his mother staying in hospital with him
Plan ;- continues O2 therapy and observe .

2)

patient name ;- Simon Green

Age ;- 15 month  boy

brought from emergency after several seizures

vomiting periodically

not pass urine several hours

awake and lethargic

PLAN;- observation fluid and review tomorrow .

3)

patient name ;-  Alla jones

age ;- 5years old girl

diagnosis ;- exacerbations  asthma

heart rate ;- 148/min

Respiration ;- 40/m
spo2 ;- 95% with 6l of 02 by hudson mask

moderate respiratory distress and audible wheeze .

she is receiving salbutamol in every 20 min

medical review in 1 hours

she has got history of head injury .

4)

patient name ;-   Alex Baka

age ;-12 yers girl

diagnosis ;- suspected appendix earlier today

Mild and moderate abdominal pain  and low grade fever

observation ; heart rate ;- 120/min

temperature ;- 37.9;c  BP ;- 96/58 mmhg  

seen by surgical team

PLan ;- continue observation

currently she is in NPO
 
 

Answer:

Nursing priorities

Nursing priorities for Antonio Valencia, a 4month old boy includes: deficit in fluid volume and ineffective clearance of airway.

Nursing priorities for Simon Green, a 15th month old boy: prevent seizure activity and maintain respiratory function.

Nursing priorities for Alla Jones, a 5years old girl: ineffective pattern of breathing and ineffective airway clearance. 

Nursing priorities for Alex Baka, a 12years old girl: acute pain and possibility of poor fluid volume.

1st Case

Rationales

Deficit in fluid volume

Associated risk factors: immense loss of fluid (mouth breathing, fever, profuse diaphoresis, vomiting) and reduced oral intake

Expected outcome: demonstration of fluid balance supported by clammy mucous membrane, improved skin turgor, steady vital signs and rapid refill of the capillaries

  • Increased temperature and extended fever raises fluid loss and metabolic rate through evaporation. Heart rate increases and elevating tachycardia may specify systematic deficit of fluid (Judd, 2008).

  • Indirect signs of fluid volume adequacy, though mucous membranes of oral region may get dry due to supplemental oxygen and mouth breathing.
  • Presence of the symptoms reduce oral intake

  • Gives instruction regarding fluid volume adequacy and replacement requirements

Ineffective clearance of airway

Associated risk factors: fatigue, decreased energy, edema formation, raised production of sputum and bronchial inflammation.

Evidence by: rate alterations, respirations depth, abnormal sound of breathing, accessory muscle ulitization, cyanosis, dyspnea, ineffective or effective cough along with or without production of sputum.

Expected outcome: show behaviors to accomplish clearance of airway and display clear breathing sounds and absence of cyanosis and dyspnea.

  • Shallow respirations, tachypnea and uneven movement of chest are present due to uneasiness of movement of chest wall and fluid inside lungs (da Silva et al., 2008).
  • Reduced flow of air takes place in the areas with accumulated fluid. Breathing sounds can generate in these areas. Crackles and wheezes can be heard during breathing because of fluid accumulation, airway spasms, obstruction and thick secretions.

Nursing interventions for fluid volume deficit 

  • Evaluation of the alteration of vital indications, for example: prolonged fever, elevated heart rate, increasing temperature, trachycardia, prolonged fever.

  • Assessment of the wetness of mucous membrane and skin turgor.

  • Investigation reports of vomiting and nausea.

  • Monitor output and intake, urine character and color. Calculation of fluid balance. Focus on insensible loss and weigh as recommended.

Nursing interventions for inefficient airway clearance

  • Evaluation of respiration depth and rare and movement of chest.

  • Auscultation of lungs, making a note of absent airflow or reduced airflow and wheezes.

Developmental nursing care includes weight gain and easing the feeding difficulties. This child should receive adequate hydration and nutrition to support positive weight gain. 

 

2nd Case

Rationales

Prevent seizure activity

  • Minimize chances of injury during seizures, when patient is placed in bed.

  • Patient can feel restless and should be ambulated, thus unintentionally moving patient from secure set up and trouble-free observation (Ashley, 2011).

Maintain respiratory function

  • Reduced the possibility of aspiration or lodging of foreign bodies inside pharynx.
  • Helps draining secretions and prevents the tongue from hampering airway (Schmölzer, 2012).

Nursing interventions for prevention of seizure activity

  • Use side rails with bed in low position, keep bed up next to wall and if rails are not available floor need to be cushioned.
  • Maintain strict bed rest if aura experienced and illustrate the significance for the actions.

Nursing interventions for maintaining respiratory function

  • Make sure patient to clear mouth if aura takes place and avoid sucking lozenges in case of seizures.
  • Maintain straight lying position of the patient, flat surface and side turn of head during seizure.

Developmental nursing care includes understanding the psychosocial needs of this child. Hospitalization may restrict the child’s independence and regular routine. A developmental nursing care, for example: loss of control could be a nursing strategy that allows Simon Green to choose when to play and what foods to have.

3rd Case

Rationales

Ineffective breathing pattern

  • Rise in the rate of respiration can worsen patient’s condition
  • To minimize breathing difficulty
  • To increase expectoration effort

Ineffective airway clearance 

  • Systemic hydration maintains moist secretion and easy expectoration

  • Techniques improve ventilation, secretion mobilization with no fatigue and breathlessness (Urso, 2014).

  • Bronchial irritants give rise to bronchoconstriction and raised production of mucus that interferes with the clearance of airway.

Nursing interventions for ineffective breathing pattern

  • Record and monitor vital signs.
  • Elevated bed head and alter the patient position in every 2hours (Busse, 2004).
  • Encourage coughing exercise and deep breathing.

Nursing interventions for ineffective airway clearance 

  • Keep patient properly hydrated
  • Encourage and teach application of couching exercise ad diaphragmatic breathing
  • Instruct patient to become cautious from bronchial irritants like: fumes, extreme temperatures.

It is said to be the middle stage for preschoolers and school age. This is the case of a 5years old girl, who is suffering from Asthma.  So, nursing plan should include training of proper inhaler management, along with toilet training that supports their self-esteem.  

4th Case

Rationales

Acute pain

  • Helpful in evaluating medication effectiveness and healing progression; alteration in characteristic features associated with pain indicates abscess development or peritonitis, which require rapid medical intervention and evaluation.

Poor fluid volume

  • Differences help pointing out varying intravascular volumes.
  • Indicators of cellular hydration and peripheral circulation adequacy.

Nursing interventions for acute pain

  • Evaluate pain, recording characteristic features, location and severity by using pain rating scale. Examine and report alterations in pain.

Nursing interventions for poor fluid volume

  • Monitor pulse and blood pulse (Wasnik et al., 2015).
  • Examine mucous membranes, assess capillary refill and skin turgor.

Developmental nursing care should include knowledge enhancement. This means a 12 years child will be much interested to understand his/her condition. So, in this case, nurse might inform her about her health condition as a visual presentation and definitely inform her that she will become physically fit soon and can play like children if she follows prescribed medications and rules properly.   

 

References

Ashley, M. (2011). Seizures. Leicester: Matador.

Busse, W. (2004). Management of asthma exacerbations. Thorax, 59(7), pp.545-546.

da Silva, V., de Oliveira Lopes, M., de Araujo, T., Ciol, M. and de Carvalho, E. (2008). Clinical indicators of ineffective airway clearance in children with congenital heart disease. Journal of Clinical Nursing.

Judd, S. (2008). Respiratory disorders sourcebook. Detroit, MI: Omnigraphics.

Schmölzer, G. (2012). Respiratory function monitor guidance during respiratory support in the delivery room. Resuscitation, 83, p.e82.

Urso, D. (2014). Acute asthma exacerbations: an overview. RHC, 5(3).

Wasnik, N., Agrawal, V., Yede, J., Gupta, A. and Soitkar, S. (2015). Role of supplemental oxygen in reducing surgical site infection in acute appendicities: Our experience of sixty four cases.International Journal of Biomedical and Advance Research, 6(2), p.124.

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