Pediatrics a Case Study
The therapeutic relationship is a significant foundation of nursing. Competency standards state that nurses should be responsible for creating, maintaining, and concluding relationships with clients. To make Yasmin and her aunt feel well received, I would go through these three steps. Firstly I would Give recognition: I would acknowledge and indicate that I do understand the signs and symptoms Yasmin’s aunt is describing. I will also seek clarification of the facts she has stated about the Yasmin. Secondly, I would Offer myself: I would go ahead and tell her that I am here to help her with what I can but avoid giving her false promises. Finally, I would Make observations: I would study the child’s mannerisms to understand the child’s situation better while also reassuring Yasmin’s aunt that I have observed the child, and I am in a better position to serve Yasmin.
Since time immemorial, there have always been development milestones that children are surpassed to achieve by the time they reach a certain age. However, poor nutrition and sicknesses may cause the child to stunt in development or even loose some of the behaviors or manners he or she may have already learned. In our case scenario, Yasmin’s growth may slow since, as the aunt describes her as not her usual self may mean the child may be losing some of the skills she had already acquired, such as showing gestures. Moreover, the child’s parents are not present at the time when Yasmin is brought to the hospital and lastly. It is also quite evident that the child seems withdrawn; this may profoundly affect the child’s social and emotional development.
It is essential that before a patient is admitted into the hospitals, the signs, vitals, and symptoms should be well assessed by a certified nurse as it not only helps in patient diagnosis but also in determining the urgency of the situation. To begin with, the child’s body temperature is slightly above average by just a few degrees, however. Secondly, the child’s oxygen saturation is too low, considering the age. Moreover, the child seemingly suffers from constipation due to decreased bowel sounds. Finally, due to the vomiting, it may be possible that the child may be suffering from peritonitis (Chisholm 2017). It is also evident that the child is dehydrated since she is lethargic and has no tears.
Dehydration is an experience everyone has gone through. We, as adults, however, are less vulnerable as we have bigger bodies with a smaller cross-area to volume ratio (Akech,. et al. 2017). This makes it necessary for us to identify these signs early. The Early signs of dehydration include dark-colored urine and a feeling of thirst; on the other hand, new signs of dehydration include skin that does not bounce back when pinched and rapid heartbeat and breathing (Akech,. et al. 2017).
Dehydration also has a scale whereby we can learn its intensity. We are able to determine this according to the signs and symptoms observed in the individual. Unfortunately, in Yasmin’s dehydration signs range from severe to moderate. His sunken eyes indicate mild dehydration, and his deep and rapid breathing is a sure indicator of his respirations show a critical dehydration sign. The child may also be suffering from severe dehydration and is too lethargic to suggest so, but on the other hand, dry lips indicate moderate dehydration. The low urine output shows extreme dehydration, but the Yasmin looking like a child of her age indicates mild dehydration as severe dehydration is characterized in some cases by the child looking older due to the dehydrated skin.
According to research, priority nursing actions are quite essential for a qualified nurse. Just like Maslow’s hierarchy needs (Dubois, et al,. 2018), priority nursing actions help the nurse decide what to do first according to the varied different situations. I would administer intravenous fluids to Yasmin and monitor his vitals every two to four hours to assess hydration and the effectiveness of fluid replacement. I would raise side rails to prevent the child from falling. Moreover, I would monitor serum sodium concentration, and finally, I would plan activities for the child in order to distract and promote her recovery.
Diarrhea is an experience most of us have experienced at least once. Scientifically it is defined as the passing of more than two watery stools in a 24hour range (Santillanes & Rose 2018). However, in infants’ case, it is an increase in the frequency of stool or liquidity that the mother will consider abnormal (Santillanes & Rose 2018). Diarrhea may be secretory or osmotic. Secretory diarrhea brought about abnormal secretion of water and salt into small intestines. Osmotic diarrhea, on the other hand, occurs when an ingested substance is thought to be isotonic; thus, water passes through the gastrointestinal system unabsorbed, causing diarrhea (Diallo,. et al. 2017). This diarrhea may cause hypertonic dehydration where there is more water loss to sodium or hypotonic dehydration where sodium loss is in excess of water, causing electrolyte imbalance (Akech,. et al. 2017). Moreover, since diarrhea does not allow enough intake of water, the body is left deficient of water, thus dehydrated.
Diarrhea is the second most significant reason for infectious children’s death in children less than five years globally (Santillanes & Rose 2018). There are many ways of treating diarrhea, including traditional and conventional means; however, the common ones include; PATHOPHYSIOLOGY, ORAL REHYDRATION THERAPY, and MEDICATION.
PATHOPHYSIOLOGY, which restores blood volume, then goes on to restore interstitial fluid volume and finally hydrate and replace continuous losses.
ORAL REHYDRATION THERAPY; this is the most common as it can be administered at the comfort of one’s home; moreover, it is faster than intravenous fluid therapy.
MEDICATION; pharmacology agents such as Zofran may be implemented but aren’t recommended mainly due to toxicity.
Unlike adults, children do not understand why you are giving them better- tasting medicine regardless of their health. We may try to persuade them, but it is not a sure method that works each time, and sometimes we don’t have the time assuming it’s a hospital emergency.We could use techniques such as disguising the taste, but in our setting, it would not be viable. In Yasmin’s case, I would use a calibrated syringe and insert it between Yasmin’s gum and cheek. Therefore, Yasmin won’t be able to spit out.
If we suspect that a child is suffering from dehydration, we will surely go through the necessary steps in curing the baby. We must, however, have a method of determining whether the child is indeed improving or worsening in order to know what steps to take next. In Yasmin’s case, these are the signs I would look out for. Yasmin’s eyes will look healthy and moister; the child will also have tears. Moreover, her lips will be wetter and lose their dryness; she will also increase her urine output, and her breathing will finally return to normal.
References
Akech, S., Ayieko, P.Irimu, G., Stepniewska, K., English, M., & Clinical Information Network authors. (2019). Magnitude and pattern of improvement in processes of care for hospitalized children with diarrhea and dehydration in Kenyan hospitals participating in a clinical network. Tropical Medicine & International Health, 24(1), 73-80.
Chisholm, J. S. (2017). Navajo infancy: An ethological study of child development. Routledge.
Diallo, A. F., Cong, X., Henderson, W. A., & McGrath, J. (2017). Management of childhood diarrhea by healthcare professionals in low-income countries: an integrative review. International journal of nursing studies, 66, 82-92.
Dubois, C. A., D’amour, D., Brault, I., Dallaire, C., Dery, J., Duhoux, A., … & Zufferey, A. (2017). Which priority indicators to use to evaluate nursing care performance? A discussion paper. Journal of advanced nursing, 73(12), 3154-3167.
Qureshi, F. (2018). A pre-experimental study to assess the effectiveness of planned teaching programmed on the knowledge regarding prevention and management of diarrhea among mothers of under five-year children in the selected community. International Journal of Advanced Scientific Research.
Santillanes, G., & Rose, E. (2018). Evaluation and management of dehydration in children. Emergency Medicine Clinics, 36(2), 259-273.