Challenges and Compassionate Care

MODULE 1: - Paediatric Assessment:

Paediatric nurses face severe challenges in terms of providing compassionate and person-centred care to paediatric patients as patients suffer from anxiety and lack of emotional as well as psychological maturity. Different behaviour and expression are shown by children that makes it difficult for paediatric nurses to evaluate their proper health needs. in this context, nurses need to understand the emotional, behaviour and psychological situation of children while providing them with proper care and support which is important to assist the children to adapt themselves to the healthcare environment. in our ward, there was an admission of a 3-year-old child, Beth who suffered from asthma. Primary nursing care of asthma includes immediate hospitalisation, effective as well as immediate medical support or the use of oral corticosteroid course (Carroll WD et.al 2012). There are life-threatening aspects that are associated with the severer exacerbation of asthma. Vulnerability in children to the risk of severe exacerbation asthma occurs due to many important factors such as lack proper asthma control, poor maintaining therapy, poor medicine management and increased exhalation of nitric oxide (Fuhrman C, et.al 2011).

After the admission of Beth into the ward, her physical health assessment has been conducted in terms of understanding her current health condition as well as her health needs. health assessment is the process which allows the paediatric nurses to set the effective care plan for paediatric patients in terms of improving their health condition. The Nursing and Midwifery Board of Australia (NMBA) has set the standard and Codes of Conduct for the paediatric nurses in which there needs to be done a systematic and comprehensive health assessment of the patient that allows nurses to develop an effective high relevant care plan through consultation with the other nurses and health professionals. Under the care standard set by NMBA, paediatric nurses need to work effectively in interdisciplinary health team and take an active part in handling the rapidly unexpected changes in the health condition of patients.

During the initial stage of her treatment, Beth does not with nurses which pose big challenges on the nurse to understand her health needs and determine her pain. in this context, it is important to show polite and friendly approaches to Beth which will assist nurses to gain her trust. The evidence-based report has suggested that children suffering from a severe exacerbation of asthma have a risk of poor lung function that impact on their pulmonary function (O'Byrne PM et.al 2009). Children with asthma are more vulnerable to poor lung capacity as compared to adolescent and adults. While treating asthma patients, it is important to determine the level of airflow obstruction in the patients. another important technique on determining the health condition of asthma patients is analysing the level of airway hyper-responsiveness. Diagnosis, as well as medicine, are prescribed for asthma treatment is not similar for children of all age group rather nurses and health professionals need to evaluate the premedical history, current physical health of patients and their ability to respond to the treatment before starting specific treatment recess. For example, impulse oscillometer and spirometry cannot be done in case of all children. the overall health assessment of Beth is as follows:

General inspection:

Alertness/activity:

The paediatric nurse needs to check whether the child is engaged, alert or restless and quiet

Cyanosis:

Nurses need to check whether there is any bluish or discolouration of the skin of the child. The bluish and discoloration of the skin is due to the poor circulation throughout the body.

Breath shortness:

this condition of child shows that children can have the risk of respiratory illness (pulmonary illness) and cardio vascular disease.

Pallor:

Pale skin colour of child leads to the risk of anaemia (chronic disease and blood dyscrasia) and lack of proper perfusion (cardiac failure).

Weight:

nurses need to check that whether the weight of child is relevant to her height and age.

health assessment of patients suffering from asthma is as follows:

• check respiratory status of patients
• check breathing status
• check breath sounds
• check peak flow of patients
• check oxygen saturation level by using pulse oximeter
• observe vital symptoms and signs in patients

After admission of Beth, her baseline observation has been done to make her overall health assessments. By checking physical status of Beth, the report is well-documented in observation flowsheet. Paediatric nurses check the temperature, heart rate, oxygen saturation level, blood pressure and breathing status of Beth. as Beth is only 3-year-old, spirometry cannot be done in her case. Peak flow meter is not reliable in determining the peak flow of oxygen in patients of less than 10 years. therefore, in the case of Beth Peak flow meter cannot be used. After performing initial assessment of current health condition of Beth, health professionals make a care plan and start the main treatment.

MODULE 2: Respiratory & Cardiac Conditions

Cardiorespiratory monitoring is most effective technological measurement tool that allows health professionals and nurses to measure to heart rhythm and rate, SpO2 and respiratory rate. In paediatric nursing, children suffer from abnormal heath rhythm and respiratory rate are eligible for undertaking cardio vascular monitoring. In paediatric ward, nurses need to provide proper cardiovascular support to patient admitted into paediatric cardiac intensive care unit (CICU). There are wide ranges of patients in cardiac intensive care unit (CICU) such as children with congestive cardiac failure, patients with cardiac surgery, children with arrhythmias and post-operative patients who undertake the circulation surgery to recover from congenital heart disease.

Prevalence of CHD or congenital heart diseases in Australian children become a matter of great concern. Development of CHD in children less than 5 years poses adverse impact on their mental, physical and emotional wellbeing. moreover, the disease also poses significant challenges on the children who suffer from CVD, their parents and carers. Evidence-based report mentioned that children suffer from CHD are more prevalent to the risk of hospitalisation and premature deaths. (Davies, S et.al 2014). In many children CND developed as te chronic health condition that persists throughout their entre lifespan.

Patient education:

Health literacy or health education is important in terms of not only educating patients but also improve their behaviour, decisions and approaches towards the management of their health. in paediatric nursing, nurses play crucial roles in educating parents about the reason, health outcomes and treatment of congenital heart disease and cardiovascular disease (CVD). On the other hand, through providing proper health education, paediatric nurses can improve parent’s’ knowledge and understanding on how to manage the health and wellbeing of their children. health literacy will allow parents to gather knowledge in managing cardiac issues, respiratory illness and poor physical health in their children by developing healthy habits, good behaviour and systematic lifestyle.

Pathophysiology:

Congenital heart disease or CHD is referred to as the physiological and anatomical defects of the heart that is generally present in the child since his or her birth. this health condition is called cyanotic or acyanotic defects. The health condition of a child is referred as acyanotic while there is a left to right shunt in the heart which leads to mixture of deoxygenated and oxygenated blood. On the other hand, in case of cyanotic condition, there is less amount of oxygen is present in the blood. This cardiac health condition interferes with the normal hemodynamic circulation and cardiovascular physiology of patients.

Symptoms signs and nursing agreement of CHD or congenital heart disease:

Congenital heart disease can differ in the level of complications, severity and symptoms in different children. These different symptoms and signs of congenital heart disease are based on the varying age group and intensity of the defect. The treatment of this health condition includes angioplasty, resect and repair, proper medication, temporary recovery of the health condition until the child gets matured and older. Paediatric nurses generally perform two types of clinical interventions while treating heart disease. there two interventions are objectives intervention and subjective intervention. Objective intervention includes checking the skin colour of child, hypotension, swelling of feet and hands and the signs of heart failure. On the other hand, subjective intervention is checking whether the child has any difficulties in eating, respiratory issues or becoming restless.

Subjective intervention assists paediatric nurses to check the abnormal sound of heart, assess the cyanosis and check the pallor. On the other hand, in case of conducting the objective intervention, nurses need to make catheterisation of patients suffering from CHD and then prepare them for surgery. in paediatric nursing, nurses need to have proper knowledge of performing primary care treatment and post-operative function in terms of assuring patient’s safety and promote patient’s positive health. in primary function, nurses need to provide proper nutrition, mental and physical support to patient, prevent any types of infection, improve their respiration, reduce the level of anxiety in patients and manage their health and safety. In postoperative condition, nurses need to assure that patients with congenital heart disease receive sufficient oxygen that maintain the proper balance of saturated oxygen in their body. in this context, paediatric nurses need to assure that, after the surgery patients will not face any respiratory difficulties. proper assessment of the circulation in patients with CHD in post-operative condition is highly dependent on pulse, blood pressure, urine output and capillary refill of patients. Here the nurses need to check the mixed venous saturation (SvO2) in determining the level; of cardiac output (CO2) and oxygen inside the body.

MODULE3: Pain Management and Musculoskeletal Trauma:

Children suffering from the acute musculoskeletal injuries in the emergency ward experience the maximum pain during the time when the ger hurt and the fracture occurs. A child admitted in the emergency ward of paediatric clinic will also experience severe pain during the immobilisation of limb in the cast. In this period child is undergone to the process of manipulation of injured limbs by physicians, nurse, X ray technician and medical trainee (J. Kircher et.al 2014). During this process there is confusion regarding usefulness of analgesia is minimising child’s pain. while working with primary care horse in the emergency department (ED), we receive the calls regarding a child who gets major trauma injuries. In case of children, they have less fat and tightly packed thoracic and abdominal structure that can lead to multisystem injuries in their bodies that cause severe trauma in them (Stafford PW et.al 2002). Evidence based report has suggested that there are more than 50% children with multiple injuries who experience serious mental trauma. While treating these children with Musculoskeletal injuries, nurses need to check their blood pressure, pulse and body temperature to have their proper physical assessment. In many cases of musculoskeletal injuries, chid face cardiorespiratory failure ad excessive blood loss. Therefore, nurse needs to make proper health assessment of child who experiences injuries and provide proper medical support on the patients.

The child admitted in the ED is provided with the following primary nursing care:

Bleeding:

By performing a sterile dressing at the wound site bleeding is controlled.

Deformity:

Immobilisation of the wound site is done by skilled nurse thereby fixing the wound limb at a comfortable possible so that it can reduce the pain

Swelling:

Icepacks are applied on the swollen areas supporting the injures site throughout 48 hours

Pain or anxiety:

Intravenous or oral analgesia is applied into the child to reduce the pain.

The assessment of child that is done by my team is as follows:

After the assessment is completed the doctor has been called for starting the main treatment through analysing the report of primary nursing care.

References

1. 1. Alexander J, Manno M (2003) Underuse of analgesia in very young paediatric patients with isolated painful injuries. Ann Emerg Med May; 41(5):617-22
2. 2. Cantor RM. (2007) Paediatric major trauma: an approach to evaluation and management. Avarello JT, Emerg Med Clin North Am. Aug; 25(3):803-36
3. 3. Carroll WD, Wildhaber J, Brand PL (2012). Parent misperception of control in childhood/adolescent asthma: The Room to Breathe survey. Eur Respir J 39: 90–96
4. 4. Celermajer.D, Strange.G, Cordina, R., Selbie, ., Sholler.G, Winlaw.D., Alphonso.N, Justo R,Nicholae,M., Kasparian.N, Weintraub .G, Cheung.M., Grigg, I., Brizard, C.P., Wheaton.G.Disney.P., Stewart.S., Bullock.A, Ramsay.J., Gentles.T & D’udekem.Y. (2016). "Congenital Heart Disease Requires a Lifetime Continuum of Care: A call for a Regional Registry." Heart, Lung and Circulation 25(8): 750-754
5. 5. Davies.S., Hofer. A. & Reeve.C. (2014). "Mortality attributable to rheumatic heart disease in the Kimberley: a data linkage approach." Internal Medicine Journal 44: 1074-1080
6. 6. Fuhrman C, Dubus JC, Marguet C, et al. (2011) Hospitalizations for asthma in children are linked to undertreatment and insufficient asthma education. J Asthma. 48: 565–57
7. 7. Kircher, A. L. Drendel, A. S. Newton, S. Dulai, B. Vandermeer, and S. Ali, (2014) “Paediatric musculoskeletal pain in the emergency department: a medical record review of practice variation,” Canadian Journal of Emergency Medicine vol. 16, no. 6, pp. 449–457,
8. 8. Lang A, Konradsen J, Carlsen KH, et al. (2010). Identifying severe problematic asthma in the individual child: does lung function matter? Acta Paediatr Scand 99: 404–410
9. 9. O'Byrne PM, Pedersen S, Lamm CJ, et al (2009). Severe exacerbations and decline in lung function in asthma. Am J Respir Crit Care Med .179: 19–24
10. 10. Sala KA, Carroll CL, Tang YS, et al (2011.). Factors associated with the development of severe asthma exacerbations in children. J Asthma; 48: 558–564
11. 11. Stafford PW, Blinman TA, Nance MLS (2002) Practical points in evaluation and resuscitation of the injured child. urg Clin North Am Apr; 82(2):273-301.
12. 12. Schäfer I, Barkmann C, Riedesser P, Schulte-Markwort M (2006) Posttraumatic syndromes in children and adolescents after road traffic accidents--a prospective cohort study. Psychopathology. 39(4):159-64
13. 13. Todd KH, Ducharme J, Choiniere M, Crandall CS, Fosnocht DE, Homel P, Tanabe P (2007) Pain in the emergency department: results of the pain and emergency medicine initiative (PEMI) multicenter study., PEMI Study Group Jun; 8(6):460-6).

Dig deeper into Care of Patients With Complex Condition with our selection of articles.