NRSG257: Nursing - Pathophysiology - Growth And Developmental - Essay Writing Assessment Answer

Nursing Essay Assignment

Case Scenario: 1

Mark is an 8-year-old boy who has presented to the emergency department in the local hospital with right iliac fossa pain. On further assessment by the emergency registrar, appendicitis is suspected. He is made nil by mouth, commenced on IV therapy and admitted to the paediatric unit for a surgical review for possible theatre that evening.

The surgical team agree that the signs and symptoms are associated with a possible appendicitis and take Mark to theatre for an appendectomy.

The handover on return to ward is that the surgical team found a gangrenous perforated appendix with peritonitis. Mark has returned to the ward with a nasogastric tube insitu on free drainage, morphine PCA, IV therapy and triple IV antibiotics.

Due to the severity of the infection and the potential complications, Mark will need to remain in hospital for 10 days of IV antibiotics and pain management.

Mark is the oldest of five children and his parents own and run an Indian restaurant in the city.

Case Scenario: 2

Jayda is a four-month old girl admitted to the paediatric unit via emergency with vomiting, decreased feeds no bowel actions and intermittent spasmodic abdominal pains. During the spasmodic pain episodes, Jayda would draw her legs up and have a high pitched cry.

After a diagnostic ultrasound, intussusception was the cause of the presenting symptoms and Jayda was admitted to the ward. Her treatment plan included observation, electrolyte monitoring and IV therapy and antibiotics until a contrast enema could be implemented to correct the intussusception.

The approximate length of stay for Jayda will be 2 days, during which time, Jayda’s mother is informed that the rotavirus vaccine that Jayda had at 4 months has increased the incidence of this condition amongst infants. Jayda’s mother is now having serious doubts regarding future vaccines for Jayda.

Case Scenario: 3

Steven is a 15-year-old indigenous boy who lives in a remote town in rural Australia. Steven was diagnosed with asthma at the age of two. His asthma has been well managed over the years predominantly with relievers and preventers with the occasional need for steroidal anti- inflammatory medication.

Steven has presented to the local hospital complaining of shortness of breath and relays to the triage nurse that he has a past history of asthma.

A health history taken by the triage nurse on arrival reveals that Steven has had a two-year history of smoking cigarettes and is not always compliant with his asthma medication or management plan.

Steven lives with his mother and his 6 brothers and sisters.

Assignment Task

Choose one (1) of the case studies below and address the two (2) associated questions. Your Assessment will be written in academic essay format with an introduction, body and conclusion. Using evidence specific to your chosen case study, address the following two (2) questions:

1. Describe the pathophysiology of the presenting complaint in the scenarioand link this to question
2. Evaluation of the nurse’s role to deliver developmentally appropriate nursing care in relationto care of the child and family in the chosen case study including:

• growth and developmental theories,
• family centred care and,
• the effects of hospitalisation of the child and family.

Introduction

This essay depicts about the nursing care given to a client for Asthma who is from indigenous cultural background in remote setting. Asthma is a major issue in the rural and indigenous population of Australia (Rosenbaum, 2008, p. 147). In the essay various strategies have been described thoroughly and evaluation of nurse’s role in regards to family centred care, growth and development of adolescents and finally when impacts of hospitalisation seen on client and family.

Pathophysiology of Asthma

Asthma is a long-lasting inflammatory issue of the airway that outcomes in the discontinuous of airway blockage due to bronchial hyper responsiveness, aggravation, broncho constriction and overabundance mucous creation (Braun & Anderson, 2011). Basically the complete pathogenesis of Asthma is still unknown although distinctive etiological classifications or patterns of asthma have been recognized which are intrinsic asthma, Extrinsic asthma, exercise triggered asthma, drug prompted asthma, cardiac and triad asthma and in these etiological classes immune and inflammatory response is frequently stimulated through introduction to an allergen and it varies person to person, which is called "trigger"(Braun & Anderson, 2011) (Copstead & Banasik, 2005).

Usually triggers can be dust, smoke, creature hair, exercise, temperature, extreme illness, and anxiety (Braun & Anderson, 2011). What's more, at whatever point an individual is presented to the trigger, an immunoglobulin (IgE)- negotiated hypersensitivity response is quick(Braun & Anderson, 2011)(Copstead & Banasik, 2005). IgE mast cells are animated to discharge chemical mediators and these chemical mediators advance increased edema and ensuing bronchoconstriction in the airway (Braun & Anderson, 2011). Further results of aggravation

move into the region and mast cells call forward extra chemical mediators between, for example, histamine and prostaglandins and thus leukotrienes are discharged which cause significantly more bronchospasm, swelling and unreasonable mucus generation in the airways (Braun & Anderson, 2011). Gradually development of mucus plugs from exudate and cell debris happens in the route which can take weeks to resolve and over the time the cells of long-term inflammation alongside eosinophils, invade the airways and causes eradication of the respiratory epithelium, smooth muscle hyperplasia, and constricting of the airways (Braun & Anderson, 2011). In the event that airway rebuilding structure is unequivocally influenced, then the condition can be irreversible (Braun & Anderson, 2011).

It has documented that bronchial hyperresponsiveness is caused due to the decreased airflow (Towns & Van Asperen, 2009). Thus, the main physiological occurrence, which could be linked with the asthma, is narrowing of the airways. Thus, the functional and structural changes in the airway occur “in the form of bronchospasm, mucosal edema, epithelial cell sloughing, mucus gland hypersecretion and cilia cell disruption” (Towns & Van Asperen, 2009

Essential Role of Nurse in Providing Care

Growth and Developmental Stages

Asthma is a pulmonary chronic disease that results in respiratory difficulties, and mainly affects the children from minority groups of Australia. Chronic illness leads to many co-morbidities and occurrence of depression and stress in adolescents (Sadof & Kaslovsky, 2011, p. 374). The role of nurse is very important in this regard. According to the case study of Steven, he is a 25 years old indigenous boy, who comes from a rural and remote part of

Australia. Historically it has been identified that indigenous population have many difficulties in living a healthy and efficient life. Due to various factors, this population suffer from more severe health problems. Steven is also suffering from Asthma since the age of 2 years.

The role of nurse is very important in the case of Steven. According to the growth and developmental theories, adolescence is the age of rapid growth and significant transition to adulthood (Sadof & Kaslovsky, 2011, p. 376). This age is also characterized by the cognitive changes, change in relationship with family and peers. Managing asthma in Adolescence could be a difficult task, because children at this age are more influenced by their peers and detach from their parents. Children at this age wants to be more independent, and from parent care teen shift to self management of the disease. Due to early abstract thinking, they start using the formal logic behind things, such as deductive and scientific reasoning (Rhee et al, 2009, p. 184). They further develop the moral concepts of thinking, justice, equality, rights and welfare. The moral reasoning of the teens is associated with equal rights and dignity. The nurse may have to deal with an adolescent by considering all these aspects of developmental stages (Sadof & Kaslovsky, 2011, p. 374).

Nurses would also have to expect the self management techniques of asthma according to developmental issues of adolescents. Peers are more important for teens, they might ignore medication and self-management of asthma in front of their peers to avoid unnecessary questioning by peers, and often they don’t want their friends to know about their disease. These situations could be a major barrier for the self-management of asthma (Mammen & Rhee, 2012, p. 181). Parental recommendation of taking medication is also challenged by teens, because the influence of the peers is the highest. Steven is also not regular about his medication, as he might not want his peers to know about his problem (Rhee et al, 2009, p. 185).

Nurse can help Steven in self-management of asthma, by setting goals in accordance to development and growth issues and requirements of the patient. Nurse should try to encourage positive self-image and confidence in the patient, and make him aware about his personal responsibilities (Mammen & Rhee, 2012, p. 183). Acceptance of peers is very important for teens, thus trustful peer can be involved in the treatment and by developing stronger therapeutic relationships with patient. Cognitive justification of asthma management should be necessarily explained to Steven, so that he could understand the importance of self-management of asthma regardless of non supportive peers. Evidence based studies like asthma education and educating peers about the disease could be a helpful intervention.

Family Centred Care

Family centred care (FCC) is an important and most recent aspect of quality nursing practice. This approach is designed by keeping in mind the young patients and their families. Family is the most important and closest part of an individual’s life. It is also the primary support for an individual. For treating the young adolescents, family can play a very significant role. Family and social environments are the first influence for the life of children (Kuo et al, 2012, p.297). For offering high quality care and for obtaining positive outcomes, it is important that family should be involved in decision making and disease management. The main focus of the family centred care is to offer quality care to the patient with the involvement of family members. For paediatric nurses, family centred care is a very essential element towards duty of care. Such approach is also important in order to offer physical and psychological well-being of the patient by providing continuous emotional support of family (Kuo et al, 2012, p.299).

Nurse must understand that motive of family centred care is to provide emotional and mental support to the patient, and increase patient’s trust in healthcare services. The management of

asthma in adolescents is a very challenging task for nurses and other healthcare professionals. The minority group, like indigenous population have very low asthma control. Due to low education level, these people often think that regular medication decreases the efficiency of the medication and also families face difficulty in making the teens understand about taking the responsibility of self-management. Involving parents in asthma management plan can be very beneficial of teens (Rhee, Belyea & Brasch, 2010, p. 478). Involving parent of Steven in his care plan can be very important for him. With family support, the barriers in medication and understanding the importance of self management can be removed. Thus, working in collaboration with families is highly essential and core of family centred care.

Effect of Hospitalization on Patient and Family

The effect of hospitalization could be very challenging for the patient and his family. Adolescents have different thinking pattern and understanding towards things. Adolescents are often emotionally reactive, and due to the rapid hormonal growth their views are often psychologically based. The chronic disease like asthma could be a difficult situation for a teen and identifying own identity outside the disease could be difficult. Adolescents also have a more independent nature, and hospitalization could be a barrier among their independent nature (Impact of hospitalisation on children and adolescents, 2016). They would not be able to plan their immediate future, and this may develop feeling of frustration. Due to puberty, young children often have rapid cognitive and physical development, and may require formal reasoning behind everything. They also have the developed sense of moral conducts, and understand the importance of dignity, respect and rights.

Thus, nurses must treat such patient with dignity and should also respect their autonomy. The demands of treatment may hamper their normal activities, which can further interfere with their social activities. Unable to conduct all the social and normal activities may result in development of hopelessness and depression (Impact of hospitalisation on children and adolescents, 2016). Nurses should respect the feeling of the adolescents and should also respect their privacy. Adolescents may also display rebellion nature due to identity development, so adolescents must be communicated about treatment plans and cognitive justification of all the plans. Family members may often suffer due to rebellion nature of their child, but by providing emotional support they can make the process of hospitalization easy.

Conclusion

Asthma is chronic pulmonary disease, which is caused by airway obstruction and reducing exchange of gases. The problem of Asthma is mainly seen in the young indigenous children and may occur at the very young age. The paper provides the Pathophysiology of the disease, with the role of nurse in disease management. Paper is based on the case study of 15 years old indigenous boy, Steven. He is suffering from asthma since a very young age and have the history of smoking, which have worsened his condition. Paper also identified the importance of growth and developmental theories and family centred care; and, also identified the effects of hospitalization on adolescents and their families.