NURS13128: Nursing Care For Children And their Families -Bronchiolitis Case - Assessment Answer

Nursing Care For Children And their Families Assignment

Assignment Task

For this assignment you are to consider that you are a new graduate registered nurse and your responses should be reflective of this. The assignment task is as follows:

The purpose of this assessment is to encourage critical analysis and reflection on nursing practice that would be applied in a paediatric setting. It is expected that you will demonstrate how planned nursing care aligns with the registered nurse standards for practice. When nursing children and their families in hospital there are some crucial points to consider and the nurse needs to specifically address these factors for the child and her family in this case study. The plan should be in essay format, with responses informed by evidence based literature. It is not necessary to include a tabled plan of care and will be an outline of care over three days. However, if you wish, you can include a tabled plan of care in the appendix in addition to discussing the plan of care in essay format in the body of your assignment.

Develop a three-day plan of care, demonstrating that you are prioritising, planning and implementing care in order to manage and promote Mary’s wellbeing whilst she is a patient in the Paediatric Ward. This includes:

1 . Pathophysiology of bronchiolitis and respiratory syncytial virus, and national and international incidence statistics of bronchiolitis.

2. The immediate and ongoing care needs of Mary upon admission to the ward. Discuss how identified care needs are the same or differ from other developed and/or developing countries.

3. Developmental stages and needs of Mary whilst she is in hospital to ensure safe, therapeutic nursing care.

4. Person and family centred care

5. Legal and ethical issues related to caring for Mary

6. Cultural aspects of paediatric nursing in relation to Mary and her family

7. Infection control

8. Falls risks

9. Pressure area assessment and prevention

Consider and discuss appropriate health promotion and management strategies that require a collaborative approach to nursing care whilst in hospital and when planning and preparing for Mary’s discharge from hospital.

Introduction

Respiratory syncytial virus is considered as the most common cause of bronchiolitis. Every year many infants are hospitalized due to this disease in developed countries (Centers for Disease Control and Prevention, 2012). The children who are at higher risk of this disease are those who are less than 6 weeks old, who are born premature, or those who have immunodeficiency and cardiopulmonary disorder. It has also been noticed that in 80% cases this problem occurs with age of 1 year (Leung, Kellner, & Davies, 2005). The assignment is based on the case study of 6 months old infant, Mary. She has been brought to hospital with complain of cough, runny nose and decreased feeding. She is diagnosed with bronchiolitis. This essay aims towards providing a three-day care plan for Mary, by discussing Pathophysiology of the disease, immediate care plan and ethical and cultural aspects of pediatric nursing.

Pathophysiology of bronchiolitis and Respiratory syncytial virus

Bronchiolitis is a disorder, which generally occurs in infants due to the viral lower respiratory tract infection. This is a very common disorder found in young infants. The Pathophysiology of Bronchiolitis is characterized by edema, acute inflammation, and increase in mucus production, bronchospasm and necrosis of epithelial cells lining small airways. Respiratory syncytial virus is the common pathogen that leads to Bronchiolitis. This virus causes infection in the respiratory tract and results in inflammation of small airways. The process of spread of RSV occurs through direct contact with respiratory secretion. The spread of the virus in the respiratory tract is unknown, but it is believed to spread cell to cell (Bracht et al, 2011).

The clinical infection is noted to spread from the period of 4 to 6 days. This virus is responsible for damaging the immune cells in the lungs and structural airway. Infants are significantly affected by this virus due to their underdeveloped immune system. The diameter of the airway is very small in infants, and due to this infection and inflammation the diameter becomes smaller. The laminar airflow is impaired that results in respiratory distress in affected infants. The inflammatory response of the host contributes to Pathophysiology of Bronchiolitis. Host recognize the RSV virus and secrete cytokines (IFN-?, IL-1?, IL-4, IL-8) that cause inflammation (Leung, Kellner, & Davies, 2005). The local tissues are also influenced, which increases the inflammation. Many cytokines are also responsible for supporting the infection of RSV bronchiolitis. The cytokine IL-17 increases the RSV infection and leads to mucus production. It slows down the cell activation of CD8T and hampers viral clearance (Leung, Kellner, & Davies, 2005).

Family members of Mary are smokers, which mean that smoking in the home environment increases the risk of the disease. When Respiratory syncytial virus comes in contact with smoking environment it increases the risk of bronchiolitis in infants. The infection in the epithelial cells due to RVS leads to copious rhinorrhea in the upper respiratory tract. Immature immune system in infants fails to fight this virus in the upper tract, and thus virus replicates and reaches to lower respiratory tract. Virus further infects the epithelial cells of the lower respiratory tract and results in cough, poor feeding and dehydration (Leung, Kellner, & Davies, 2005).

Immediate and Ongoing Care Needs For Mary

Most of the children, who have good health and are infected with RSV bronchiolitis, do not require detailed treatment and with the help of medication, it can be treated at home. Hospitalization is very important for those infants, who have poor feeding and reduced fluid intake and respiratory distress. The immediate and ongoing care requires supportive nursing care. The first intervention is the respiratory monitoring (Eiland, 2009). Collection and analysis of the respiratory data is important to ensure child’s airway patency and proper exchange of gas. Frequent monitoring provides the basis for the change in respiratory rate. It can be done by using pulse oximetry (Baraldi et al, 2014).

Child’s response towards medication should be noted. Child should be placed in the head-up position or in parent’s lap, as this position helps in improved aeration. Humidified oxygen can be administered through mask or hood as it helps to loosen the secretion and also decreases inflammation (Zamora-Flores et al, 2015). Fluid management is another immediate and ongoing strategy, which is used to maintain the fluid balance. Loss of fluid from the body requires immediate replacement. Parents should be included in the care plan for infants (Baraldi et al, 2014).

The identified care needs are all most same in the developed countries. In United States, the circulation of RSV is mainly in the months of November and March (Nair et al, 2013). This is a very common disease in US and thus it is managed with supportive and individual care strategies. Bronchiolitis is also considered as the most common cause of hospitalization of young infants in developed countries (Nichols, Campbell, & Boeckh, 2008). Most of the developed countries use supportive therapy. However, in developing countries the management of RSV is not very specific. According to a Brazilian Journal no prevalence studies have been undertaken for the infants suffering from RSV infection (Pitrez et al, 2005).

Developmental stages and needs of Mary

Therapeutic nursing care is very important for Mary; developmental stages may require improved breathing. Her respiratory baseline will return to normal and she may not experience respiratory failure. Frequent monitoring of the respiratory rate will help in improving the quality of the respiratory effort. Medication given to the child will also improve oxygenation (Nichols, Campbell, & Boeckh, 2008). At this stage child requires comfort and ease. Personal and individual care will provide ease and comfort to the child with the help of parents. Next stage would be the correction of the fluid deficit. With fluid therapy, the hydration status of the child would improve and child would be able to take fluids orally. The nurse requires monitoring the fluid intake and fluid loss to evaluate the stability of the child’s condition (Nichols, Campbell, & Boeckh, 2008). Hospital may ensure the safety of the child by monitoring the child’s weight. Child must be able to intake beverage of choice by parents or by the help of nurse. Parents must be informed about the treatment, procedures and condition of the child. They must be encouraged to remain close to child and incorporate care plan in the home routine as well.

Person and Family-centered care

The main focus of the person and family centered care is to consider every patient as an individual. This approach is used to develop a therapeutic relationship for the delivery of quality care. The therapeutic relationships are made through verbal and non-verbal communication. This approach is based on building trust, respect among the care receivers and care providers (Harrison, 2010). The meaningful engagement and proactive relations are also vital. The main aim of understanding person and family centered care in pediatrics is very important. For a child, family is the main source of support and strength. For making the high quality clinical decision, perspectives and information provided by the family and parents is very essential. This develops an integral partnership among health care team and family. For improving the patient outcomes patient- and family-centered pediatric practice seems to be very valuable (Ralston et al, 2014).

The healthcare professional who work in the pediatric units, must understand the importance of person and family-centered care. This is a very innovative approach that helps in planning, evaluation and delivery of the quality care, which is rooted in the beneficial partnership among families and healthcare providers (Kelsall-Knight, 2012). Mary is a six months old infant. She is completely dependent on her grandmother, who is an immediate family member for Mary. For achieving the developmental and emotional support for Mary, nurses and healthcare practitioners must respect child’s family members (Kamban & Svavarsdottir, 2013). The strength and cultural values of family are very important for child; these must be acknowledged and respected in order to improve healthcare outcomes. Family’s perspective about the clinical decision making must be valued and respected, as it enhances parent’s confidence and trust in the healthcare facility. Person and family centered care also aims towards honoring cultural, ethnic, racial and socio-economic background of patient and family (Institute, F. P., & Family-Centered Care, 2012). It further helps to planning and delivery of healthcare according to their preferences and perspectives.

Legal and ethical issues

The chronic respiratory infections are major health issue among the indigenous infants. These children often face repeated respiratory infection. This is mainly due to the unhealthy and crowded environment they live in. The best decisions made for the infants can only be done by joint decision of family and healthcare providers (Bainbridge et al, 2015). Legally, every child or infant, regardless of their mental or physical underdevelopment have dignity and also claim to have protection and respect. The legal issues may arise, when information about the child is not truthfully and clearly communicated to the parents or guardians. Every decision should be made with the concern of guardian and parents (Hendrick, 2011).

The ethical issue may arise when parent or guardian do not want to provide consent regarding particular medication or treatment. Such medication may be important for infant. However, in case of Mary no ethical or legal dilemmas have been observed. However, if the parents or the guardians are incompetent to provide consent, then court may appoint a legal guardian for the infant to make medical decisions about the child (Guedert, & Grosseman, 2012).

Cultural aspects of pediatric nursing

Cultural competence is very significant for the nurses and healthcare providers, as it enables them to work in cross-culture environment. There is a great requirement of integrated spirituality and cultural approach in pediatric care. Understanding the cultural aspects of different cultures, helps nurses to develop effective and sensitive communication with child’s family (McEvoy, 2003). Pediatric nurses must understand that there are many other intersecting factors, which may create issue while providing nursing care to infants, thus culturally sensitive communication must always be avoided. The focus of Pediatric nurses must be on the child and family’s personal values, beliefs and traditions. Nurses should understand that how these dimensions would influence the child’s health (Assem, 2015). The framework for the Pediatric nurses that can be used to avoid issues in nursing practice encompasses respect towards family’s values and beliefs, understand daily practice of family and encouraging community involvement (McEvoy, 2003). In case of Mary nurses must understand the values and beliefs of her family. The daily routine and practices of Mary’s family must be examined, in order to prepare quality nursing plan for her. Family must also be encouraged to develop healthy living conditions in their home environment.

Infection Control

According to the family history of Mary, her parents and grandmother all are smokers. They also have a 3 more children in their family. The socio-economic status of the family is very low, due to which children do not get enough food and healthy living environment. In such conditions, the risk of the infection is high. RSV Bronchiolitis is a viral infection (Ralston et al, 2014). Thus, the chances of disease transmission should be diminished.

• Smoking should be avoided inside the home, as it can increase infection and respiratory illness.
• Before touching the child, hands should be properly washed.
• Parent must try to limit the contact of infected child with other children in home.
• In order to control the infection, vaccinations should be given timely.

Falls risk

The risk of falls is influenced by the child’s development, environment and illness. For a 3 day nursing care plan for Mary, it should be noted that child may never be left unattended. Child should not be kept on unstable surface (Cooper & Nolt, 2007). In absence of nurse, parents or care givers must provide safe environment to child, in order to prevent falls.

Conclusion

The best healthcare strategies which can be used for the child is supportive care. This paper presented the case study of 6 months old infant. She is suffering from Respiratory syncytial virus Bronchiolitis. The paper presented the nursing care plan for the child, while considering the ethical and legal dilemmas in providing care to infants.