Child Case Study Assignment

ASSIGNMENT COVER SHEET Electronic or manual submission Form: SSC-115-07-06 UNIT NAME OF STUDENT (PRINT CLEARLY) CODE:NNT2204 TITLE:INTRODUCTION TO PAEDIATRICS STUDENT ID. NO. SHELDRAKE CHRISTINE FAMILY NAME FIRST NAME NAME OF TUTOR (PRINT CLEARLY) 10248343 DUE DATE DOREEN COLLYER 13/09/13 Topic of assignment CASE STUDY 1 Course Group or tutorial (if applicable) Campus K45 BACHELOR OF SCIENCE (NURSING) WEDNESDAY @ 11AM I certify that the attached assignment is my own work and that any material drawn from other sources has been acknowledged. JOONDALUP OFFICE USE ONLY Copyright in assignments remains my property. I grant permission to the University to make copies of assignments for assessment, review and/or record keeping purposes. I note that the University reserves the right to check my assignment for plagiarism. Should the reproduction of all or part of an assignment be required by the University for any purpose other than those mentioned above, appropriate authorisation will be sought from me on the relevant form. If handing in an assignment in a paper or other physical form, sign here to indicate that you have read this form, filled it in completely and that you certify as above. Signature Date 13/09/13 OR, if submitting this paper electronically as per instructions for the unit, place an ‘X’ in the box below to indicate that you have read this form and filled it in completely and that you certify as above. Please include this page in/with your submission. Any electronic responses to this submission will be sent to your ECU email address. Agreement X Date 13/09/13 PROCEDURES AND PENALTIES ON LATE ASSIGNMENTS    Admission, Enrolment and Academic Progress Rule 24(6) and Assessment Policy A student who wishes to defer the submission of an assignment must apply to the lecturer in charge of the relevant unit or course for an extension of the time within which to submit the assignment. Where an extension is sought for the submission of an assignment the application must :  be in writing - preferably before the due date; and  set out the grounds on which deferral is sought. Assignments submitted after the normal or extended date without approval shall incur a penalty of loss of marks. Academic Misconduct Rules (Students) All forms of cheating, plagiarism or collusion are regarded seriously and could result in penalties including loss of marks, exclusion from the unit or cancellation of enrolment. ---------------------------------------------------------------------------------------------------------------------- ASSIGNMENT RECEIPT To be completed by the student if a receipt is required (not normally given) UNIT NAME OF STUDENT NAME OF LECTURER STUDENT ID. NO. RECEIVED BY       Topic of assignment DATE RECEIVED Assignment Title: CASE STUDY 1 Unit Code: NNT2204 Lecturer/Tutor: DOREEN COLLYER Student Name: CHRISTINE SHELDRAKE Student Number: 10248343 Date of Submission: 13/09/13 Table of Contents ASSIGNMENT COVER SHEET.......................................................................................1 PROCEDURES AND PENALTIES ON LATE ASSIGNMENTS.....................................................1 Admission, Enrolment and Academic Progress Rule 24(6) and Assessment Policy............1 ASSIGNMENT RECEIPT To be completed by the student if a receipt is required (not normally given)...............................................................................................................1 Introduction.......................................................................................................................1 Discussion of Chief Complaints and Health Issues..............................................................1 Assessment and Diagnoses of Child's Needs......................................................................2 Nursing Management and Interventions............................................................................3 Evaluation of Care and Key Points......................................................................................6 Conclusion..........................................................................................................................7 References..........................................................................................................................9 Introduction.......................................................................................................................1 Discussion of Chief Complaints and Health Issues.............................................................1 Assessment and Diagnoses of Child's Needs......................................................................2 Nursing Management and Interventions...........................................................................3 Evaluation of Care and Key Points......................................................................................6 Conclusion..........................................................................................................................7 References.........................................................................................................................9 1 Introduction Respiratory Syncytial Virus (RSV) affects approximately 90% of children before their second year of life (Verger & Verger, 2012). It is estimated, 80% of cases of RSV will escalate to bronchiolitis, making it the most causative pathogen of bronchiolitis (Verger & Verger, 2012). Liam, a three-month old boy is presented following a diagnosis of bronchiolitis confirmed by a nasopharyngeal swab testing positive for Respiratory Syncytial Virus (RSV). He is showing signs of respiratory distress and dehydration. From the case study presented, the chief complaint(s), interpretation and diagnoses from assessments, nursing management and interventions, family centered care considerations and the evaluation of care will be discussed. Bronchiolitis is a leading cause of acute illness and hospitalization in young children, making it extremely prevalent within society (Zorc & Hall, 2010). Discussion of Chief Complaints and Health Issues Bronchiolitis is a seasonal, more prominent in winter, viral lower respiratory tract infection common in infants and toddlers of less than 12 months in age with symptoms generally lasting 3-7 days (Seiden & Scarfone, 2009). Bronchiolitis commonly refers to the inflammation of the bronchioles, however as this is rarely observed it is inferred in a young child presenting with respiratory distress and signs of a viral infection (Zorc & Hall, 2010). As previously stated, bronchiolitis is most commonly caused by the RSV virus and is most predominant during the winter months (Verger & Verger, 2012). Usually, bronchiolitis is quite a mild disease; however some cases can become quite severe and require hospitalisation (Zorc & Hall, 2010). Bronchiolitis is characterised by an onset of cold-like symptoms such as: rhinorrhea, cough, sneezing, fever and lethargy (Da Dalt, Bressan, Martinolli, Perilongo & Baraldi, 2013). With the progression of the 2 disease, children can experience reduced feeding and respiratory distress (Da Dalt et al., 2013). Assessment and Diagnoses of Child's Needs From the assessments conducted the conclusion can be drawn that Liam is experiencing marked respiratory distress and dehydration. Liam's respiratory distress is indicated by the marked work of breathing, subcostal and intercostal retractions, wheezing, nasal flaring, low SpO2 saturation and tachypnea that he is experiencing (Verger & Verger, 2012). According to the Princess Margaret Hospital (PMH) Guidelines, the normal range for respiratory rate for an infant under the age of 12 months is 20-45 breaths per minute whereas Liam is experiencing 54 breaths per minute (2013). His respiratory distress is further evidenced by Liam's low oxygen saturation (Princess Margaret Hospital [PMH], 2013). According to Glasper & Richardson a low saturation is characterised by a saturation of less than 92%, where as Liam has an oxygen saturation of 91% (2010). This combined with a high respiratory rate is an indicator of hypoxia (Porth & Matfin, 2008). Hypoxia is further evidenced by his mother reporting "he turned bluish during a feed". Cyanosis around the lips and fingernails is an indication of late-stage hypoxia (Porth & Matfin, 2008). From the information provided, it can be concluded that Liam is also suffering from dehydration. This is evidenced by his anterior fontanelle appearing slightly sunken, which is a good indication that an infant is experiencing dehydration (Glasper & Richardson, 2010). Tenting skin turgor is also present which is another sign of dehydration in a person of any age (Porth & Matfin, 2008). Liam's mother reports that he is not finishing any of his feeds, which 3 indicates he is not receiving the required hydrational intake to keep him well hydrated. This is further evidenced by a diminished urine output, and the mother reporting that his nappies feel "drier than normal" (Verger & Verger, 2012). Liam's pulse is at 152bpm, according to the PMH Guidelines the normal range for a child's heart rate of Liam's age is 100-160 bpm (2013). Therefore Liam's heart rate is at the maximum end of the normal range and should be further monitored. This high-end heart rate combined with a low systolic blood pressure of 74 mmHg, normal range for Liam's age (less than one year) is 75-120 mmHg, indicates a low blood volume due to dehydration (Porth & Matfin, 2008). A high percentage of children with bronchiolitis are cared for at home by family members (Selby, 2008). However, due to Liam's respiratory distress and associated difficulty feeding, and therefore dehydration, it is indicated that Liam should be considered for admission to hospital for further monitoring and care (Selby, 2008). Nursing Management and Interventions Evidence has shown that medications are generally not effective for the treatment of bronchiolitis (Zorc & Hall, 2010). As bronchiolitis is a viral condition, antibiotics are not indicated for treatment, unless a secondary bacterial infection is present (Zorc & Hall, 2010; Fitzgerald & Kilham, 2004). According to Zorc & Hall, research suggests that corticosteroids and bronchodilators have also been found to show little efficacy in the treatment of bronchiolitis (2010). Supportive nursing care formulates the basis of treatment and management (Selby, 2008). Management for bronchiolitis includes hydration, nutrition and oxygenation, inclusive of airway clearance (Da Dalt et al., 2013). From the assessment(s) 4 conducted and Liam's vital signs, it is clear that his oxygenation and hydration should be considered top priority in his care. To reduce trauma experienced by Liam and his family the least invasive intervention should be considered and implemented first (Kelsall-Knight, 2012). If ineffective interventions should be escalated to more invasive procedures, with the most invasive being used as a last resort (Kelsall-Knight, 2012). As previously stated, Liam's oxygenation is one of the top priorities in his care. His oxygen saturation is at 91%; therefore supplemental oxygen should be supplied to maintain a saturation greater than 92-95% (PMH, 2013). First and foremost it is imperative to clear Liam's airway so that he may return to normal breathing. Liam is an obligatory nasal breather, defined as a physiological preference to breathe through the nose, rather than the mouth (Selby, 2008); therefore nasal suctioning is indicated to clear nostrils of nasal secretions and to improve airway patency (Da Dalt et al., 2013). As part of family centered care (FCC), Liam's family should be educated on how he breathes and furthermore instructed and involved in conducting nasal suctioning as required (KelsallKnight, 2012). If required, supplemental oxygen can be used to raise Liam's oxygenation saturation (Selby, 2008) According to the PMH Guidelines, as Liam is less than one year old a headbox is the best practice for supplying oxygen (2011). Headboxes are used to deliver moderate-high doses of oxygen to infants who are less than one year old and spontaneously breathing (PMH, 2011). A small headbox should be selected to administer a minimum of 12L/min of oxygen with up to 95% saturation (PMH, 2011). As Liam's mobility will be restricted from wrapping, special consideration needs to be taken to assure that he is repositioned at regular intervals to ensure no skin irritation or pressure areas 5 occur (PMH, 2011). As part of family centered care (FCC), Liam's family may be employed to assist with his repositioning (Kelsall-Knight, 2012). Another top concern is Liam's hydration. As seen from the conducted assessments, Liam is dehydrated and interventions are required. If his hydration levels are not improved he will not receive the nutritional intake he requires and is at risk of deteriorating (Subcommittee on Diagnosis and Management of Bronchiolitis, 2006). Before escalating to invasive therapies, the less traumatic intervention should always be considered, and if appropriate, implemented first (Kelsall-Knight, 2012). PMH Guidelines state that if a child is tolerating at least 50% of feeds, then oral intake should be continued (2013). As it is unclear how much Liam is tolerating his oral feeds should continue with his level of intake monitored to establish how much hydrational and nutritional intake he is receiving (R). Involvement of the family in this is key to future education, reducing stress and maintaining a family bond (Kelsall-Knight, 2012). His mother should be instructed to perform shorter, more frequent feeds and to monitor, and report his intake (Kelsall-Knight, 2012). As an obligatory nasal breather, Liam will become tired when feeding, if shorter, more frequent feeds are conducted then he won't become as exhausted when feeding (Kelsall-Knight, 2012). If it is found that Liam is not tolerating at least 50% of his oral intake then the use of a nasogastric tube (NGT) to deliver hydration and nutrition should be implemented (Verger & Verger, 2012). This will also have a secondary benefit of helping to clear any nasal secretions that Liam has (Nagakumar & Doull, 2012). As a last resort only, should intravenous therapy be implemented to provide fluids to Liam (Kelsall-Knight, 2012; Nagakumar & Doull, 2012). This is due to the invasive, traumatising nature of the procedure not only for Liam, but for his family (Kelsall-Knight, 2012). 6 Evaluation of Care and Key Points RSV is the one of the leading causative pathogens for bronchiolitis, a seasonal 'flu-like' virus affecting infants and toddlers less than two years of age (Seiden & Scarfone, 2009). Medications are not indicated for treatment of bronchiolitis and minimalistic supportive care should be provided (Nagakumar & Doull, 2012). Unless the child is experiencing respiratory distress, or there is an underlying issue, care is usually provided by the family at home and hospital admission is not required (Selby, 2008). Common interventions provided are aimed at oxygenation and hydration, inclusive of nasal suctioning, supplemental oxygen, NGT feeding and IVT hydration (Da Dalt et al., 2013). With consideration to Liam and his parents, who may be particularly anxious in regards to their sick child, the less invasive measure should always be taken and only escalated if it is considered not effective (Kelsall-Knight, 2012). An integral part of supportive care for bronchiolitis is education for Liam's parents so that they may understand his condition and ways to provide supportive care at home (Kelsall-Knight, 2012). Promotion of shorter, more frequent feeds when sick are an example of this . With implementation of nursing interventions, it is expected that Liam shall make a clinical improvement. With supplemental oxygen and nasal suctioning, Liam's oxygen saturation will rise to a more acceptable level (Kelsall-Knight, 2012). This can be evaluated through monitoring his vital signs and conducting a respiratory assessment to determine whether he is still in respiratory distress (Kelsall-Knight, 2012). Through feeding interventions, such as shorter feeds, NGT or IVT if necessary; improvement in Liam's hydrational status should also be seen. Signs of dehydration such as: sunken anterior fontanelles, tenting of the skin and diminished urine output should be lessened (Da Dalt et al., 2013). These 7 changes can be evaluated by monitoring Liam's fluid intake and output, using a fluid balance chart, as well as conducting a nutrition and hydration assessment to further determine his level of hydration (Subcommittee on Diagnosis and Management of Bronchiolitis, 2006). Once Liam's condition has improved and his oxygen saturation is at least 92-94% in room air he can be considered for discharge into family care at home (Da Dalt et al., 2013). Conclusion Viral bronchiolitis is one of the most common causes of hospital admission for young infants and in most cases, is it caused by RSV. Rather than pharmacological treatment, supportive nursing care is indicated and in most cases, bronchiolitis is mild and can be managed at home through simple interventions. Liam, a three month old boy is presented showing signs of respiratory distress as evidenced by: and dehydration, as evidenced by: . Through nasopharyngeal aspirate sampling, he has tested positive for RSV which has confirmed a diagnosis of bronchiolitis. Minimalistic interventions improving his oxygenation and hydrational status are required, only escalating to more invasive interventions if necessary. Hydrational interventions include educating his parents on his condition, and promoting shorter more frequent feeds as required, escalating to NGT feeding if necessary and IVT fluids as a last resort. Oxygenation interventions include providing supplemental oxygenation via headbox or nasal prongs and nasal suctioning as required, which can be performed by the parents. Bronchiolitis is hugely present during the winter months and usually is quite mild. In most cases education and reassurance to parents is all that is needed to provide care, however infants presenting with more severe symptoms will require nursing interventions and generally hospital admission. 8 9 References Da Dalt, L., Bressan, S., Martinolli, F., Perilongo, G., & Baraldi, E. (2013). Treatment of bronchiolitis: State of the art. Early Human Development, 89(1), 31-36. Fitzgerald, D. A., & Kilham, H. A. (2004). Bronchiolitis: Assessment and Evidence-Based Management. The Medical Journal of Australia, 180(8), 399-404. Glasper, A., & Richardson, J. (2010). A textbook of children's and young people's nursing. (2nd ed.). London: Churchill Livingstone. Kelsall-Knight, L. (2012). Clinical assessment and management of a child with bronchiolitis. Nursing Children and Young People, 24(8), 29-36. Nagakumar, P., & Doull, I. (2012). Current Therapy for Broncholitis. Archives of Disease in Childhood,97(1), 827-830. doi: 10.1136/archdischild-2011301579. Porth, C. M., & Matfin, G. (2008). Pathophysiology: Concepts of altered health states. (8th ed.). Philadelphia: Lippincott Williams and Wilkins. Princess Margaret Hospital for Children (PMH). (2013). Bronchiolitis Management Guidelines. Retrieved from www.blackboard.ecu.edu.au. Princess Margaret Hospital for Children (PMH). (2013). General Observations, Including Respiratory Assessment Monitoring Vital Signs. Retrieved from www.blackboard.ecu.edu.au. Princess Margaret Hospital for Children (PMH). (2011). Oxygen Delivery Devices. Retrieved from www.blackboard.ecu.edu.au. Selby, M. (2008). Bronchiolitis. Practice Nurse, 35(4), 19-21. Seiden, J. A., & Scarfone, R. J. (2009). Bronchiolitis: An evidence-based approach to management. Clinical Pediatric Emergency Medicine, 10(1), 75-81. doi: 10.1016/j.cpem.2009.03.006 Subcommittee on Diagnosis and Management of Bronchiolitis. (2006). Diagnosis and management of bronchiolitis. Pediatrics, 118(1), 1774-1793. doi: 10.1542/peds.2006-2223 Verger, J. T., & Verger, E. E. (2012). Respiratory syncytial virus bronchiolitis in children. Critical Care Nursing, 24(1), 555-572. doi: 10.1016/j.ccell.07.008 Zorc, J. J., & Hall, C. B. (2010). Bronchiolitis: Recent evidence on diagnosis and management. Pediatrics,125(1), 342-349. doi: 10.1542/peds.2009-2092

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A Child Observation Case Study

A child description

A child observed in the study is a 5 year-old boy. His name is Ansar. His family is immigrants from United Arab Emirates. Ansar’s mother’s native language is Arabic. She speaks English a little. There are 5 children in the family: Ansar, his two brothers, and two sisters. Ansar loves his baby sister very much and tries to patronize her but he often fights with his older brothers. Ansar has close relationship with his mother and adores her. Ansar goes to kindergarten 2. He has to learn English for communication with other children and adults. He is very smart boy but he is rather naughty and independent. He likes active games. Ansar is a kinesthetic learner who remembering the information better by moving, carrying subjects in the hands, or playing. The child does not like learning but his success increases in the learning process if he is motivated. For example, after hearing from the mother that he will be allowed playing computer games if he learns well, Ansar worked at the lesson thoroughly. Ansar likes competing with other peers and it stimulates him to take part in games and activities by learning.In our study we conducted the child’s observation in two settings: his involvement in a child initiated play experiences and in teacher initiated learning experiences. It gives us an opportunity to examine child’s behavior in each of three domains, determine the strengths and weaknesses of a child in all domains, and work out a plan of development on the bases of the theories of development.

2. Examples of the child’s learning in the three domains By playing in blocks center with the group, Ansar cooperates with other children and helps them build castles if they have difficulties to place a necessary block at the appropriate place. He discusses with his peers which color they want and what shape the blocks have. He shares toys with other children eagerly. The observation of Ansar’s playing in blocks center gives us an opportunity to judge about the development of the child across three domains. First of all, we can come to conclusion that Ansar’s gross motor skills are well-developed, since his moves are coherent and exact. Then, the child’s communication and interaction with other children and his intentions to help and organize peers in the work characterize Ansar as an open, friendly, kind, and helpful person who likes to be a leader in the group. It allows us to make an assumption that his social domain is well-developed for his age. In addition, Ansar’s interaction with other children shows that he has a high self-esteem, as most of his peers. Then, the observation of the child in his playing in blocks center with other children shows that Ansar’s cognitive domain development corresponds to his age. Thus, he can find an appropriate place for a certain block and build castle in such way that blocks will not fall down. Therefore, he has good logical …

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