NCS3101 Child And Adolescent Health


Case Study Based On Evidence

Jane, Sophia’s nine-year old mother brought Sophia to the local emergency room.

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Jane reports that Sophia has been feeling lethargic over the past three hours. Sophia has not wanted to eat or drink for the last few hours and is complaining about a headache. Jane says that Sophia was given oral paracetamol, ibuprofen and an antacid at home.

Sophia has a visible rash of purpuric on her trunk. She appears pale and distantly cool.

The assessment records the following information:.temperature (axillary), 39.7 degrees C, heart rate 70 beats per minute (apical)

.respiratory speed, 11 breaths each minute, no marked breathing, blood pressure 120/60, left upper arm

.SpO2, 97% Room Air

Unimmunised, vegan diet purpuric skin rash above trunk

Dry lips pink.tacky mucous membranes.gastrointestinal/genitourinary: abdomen soft, no tenderness or distension; normal bowel sounds, no scars.musculoskeletal/skin: cool, pale; range of motion reduced; tenting skin turgor; no deformities, central capillary refill < 2 Neurological: Reacts to voice, is irritable and PERL; has a tendency to move the neck or extremities. .nutrition = 1 day less eating and drinking .elimination - The bowels normally open once a daily, normal appearance Jane reports that urine output has dropped and "Sophia is not passing urine all day". Height and weight are in the 70th percentile. Social history: Sophia resides with her family, which includes her mother and father as well as her two brothers. Sophia is given a provisional diagnosis for Meningitis. She is Haemophilus influenzae b (Hib). What do the details of the physical assessment reveal and why? (Holistic assessment, overview and assessment of the child’s immediate physical, emotional and psychological needs. Discuss two major problems. Give reasons for prioritizing them. Finally, discuss the planning, execution, and evaluation. (Identification of two key problems and justification for your choice. They are important. Why did you prioritize them? What is the associated altered anatomy? You can choose shock to explain the underlying pathophysiology. What are the best practices suggested by literature? What are the family, child and community-centered care considerations. This includes the need of treating close relatives or family members. What is the importance of this?

Answer to Question: NCS3101 Child And Adolescent Health

The case of Sophia is the subject of this essay.

Sophia, a nine year-old girl, was admitted at the emergency department complaining about lethargy.

Haemophilus Influenza type b meningitis was confirmed in her.

Sophia was able to perform a physical examination.

Sophia identified potential problems after the physical exam.

These problems are discussed and how to manage them.

This article discusses a step-wise approach to managing Haemophilus fluentii type b meningitis.

We also discuss aspects to consider when providing family-centered health care.

Physical Assessment

An individual’s complete health status can be gathered through a physical assessment.

The nurse may use different methods for physical assessment such as inspection, palpation or percussion.

Sophia had a physical exam by the nurse.

Her heart beat rate was 70 beats a minute.

These heart beats were lower for Sophia’s ages.

For her age, the heart beat should be within the 70-110 range.

Her blood pressure measured 120/60 mmHg.

While her diastolic and systolic blood pressures were normal, they were slightly higher.

Normal is her respiratory rate of 11 breaths a minute.

She was able to breathe normally and had no breathing difficulties.

Her oxygen saturation level also appears normal.

Sophia might have sepsis if she is infected. This cardiopulmonary assessment should be done.

Sepsis is a systemic immune response syndrome (Ahmedet al. 2013).

Sepsis can cause reduced blood pressure and abnormal temperatures.

Patients with meningitis are also at risk for developing pulmonary complications due to blood clotting.

Hypoxia can result from blood clotting and insufficient blood flow to organs.

This hypoxia can increase the demand for oxygen and cause lung to breathe at a faster rate.

Sophia noticed a purpuric skin rash around the trunk.

Purpulish discoloration or small bleeding vessels could cause this rash.

This is caused by infection.

Sophia reported pink lips and dryness of the mouth.

Sophia might have pink lips because of anemia.

Anemia in H influenzae meningitis, according to literature, is generally more severe than other types.

Sophia shows a tough mucous membrane.

This is usually due to anemia.

Sophia’s gastrointestinal examinations were normal.

Her abdomen was firm without tenderness or ditension.

Her bowel sounds were normal.

Her abdomen showed no scarring.

An important part of the physical exam is skin evaluation for color and turgor as well as lesions, bruising, and other wounds (Ronit et. al., 2013).

Sophia was able to observe tenting skin-turgor.

Skin turgor can be used to evaluate the patient’s dehydration.

If the skin turgor does not disappear for more than a few seconds, it can be considered tenting skin.

Her skin was pale.

The result of inflammation of the brain, blood vessels and clot formation within the veins leads to weakness, loss of sensation and inability to move in the extremities.

Sophia also reduced movement in the extremities.

Acquired brain injuries can result from meningitis.

Sophia developed behavioural changes.

These behavioural changes include irritability. Having trouble concentrating. Sleep disorders.

Menigitis patients generally react aggressively and are intolerant to voices.

Sophia was also responding.

Patients with meningitis can experience sluggishness due to muscle weakness or aches.

Sophia was also suffering from sluggishness.

It was painful and stiffening the neck.

It is therefore difficult to move.

Sophia’s meningitis resulted in a decline in her eating and drinking habits.

Sophia’s bowel opening was normal. However, her urine output was drastically reduced.

Sophia had multiple behavioral, physical and social problems, according to a physical assessment.

By assisting her in daily tasks, physical support can be offered to her.

She will be unable move or function in her daily life due to fatigue and motion problems.

Sophia was displaying irritable behavior.

You can help Sophia with this behavior by consulting a social worker or psychiatric.

Sophia and her families should receive emotional support.

Sophia and her family members could also benefit from this emotional support.

Sophia may feel fear about social isolation from her disease.

This should give her confidence that society will support her in her recovery (Ball, et al. (2014)Problems:

In Sophia, chronic fatigue and kidney problems were identified.

These two problems were evident during physical assessment.

Sophia’s kidney problem has reduced urine output.

Prioritization of Sophia’s kidney problem is crucial because urinary retention, although rare, is a very common manifestation of meningitis.

It is essential to use an intermittent clean catheter and a urethral cath on an immediate basis. Urinary retention has a good prognosis.

It is not easy to detect typical signs and symptoms of meningitis during the initial phase.

Meningitis can be diagnosed by urinary obstruction in such cases.

Patients with meningitis are more likely to experience urinary retention due to impaired detrusor muscular contractibility and bladder obstruction.

Urinary retention is not considered a symptom of meningitis.

Meningitis-retention syndrome refers to the combination of urinary retention and meningitis.

This type of urinary retention usually occurs in young people after 8-9 days with meningitis.

Urethral catheterization should be the first treatment for urinary retention.

Atonic or hypotonic neurogenic bladders can cause urinary retention. The bladder filling phase is characterized by intact bladder sensation.

This results in impaired bladder contractibility.

The result is a reduced ability to void and urine retention (Roberton; South, 2007).

Neurogenic bladder is a cause of urinary obstruction.

A neurogenic bladder is a result of infection or inflammation in the peripheral or central nervous systems.

These patients are often associated with severe suprapubic symptoms.

While lower abdominal distention is common in these patients it was not seen in Sophia.

For Sophia, the nurse should order tests to find out why there is urinary retention.

Nurse should order tests to determine the cause of urinary retention in Sophia. These tests include blood cell count as well as erythrocyte and sedimentation rates.

Nurse should order urine and blood culture examinations.

Nurse should assess Sophia’s medical history regarding urine retention, structure and function of the urethra, diabetes, hematuria, and history for urethral surgical procedures.

The nurse should conduct a digital rectal examination.

This digital rectal examination can give you an idea about the prostate size and shape.

By using palpitation, nurses should assess for hardening and tenderness.

Fluid management should be the main intervention for the Sophia.

Oliguria is caused mainly by intravascular hypovolemia.

These patients require prompt and adequate resuscitation.

It includes isotonic-ringer solution for 30 minutes.

After the administration of the isotonic-ringer solution, your urine output should rise in about 5-6 hours.

Oliguria that persists beyond 6 hours should be monitored by a nurse for further evaluation.

After 6 hours, oliguria can be monitored by a catheter.

A nurse should keep daily notes of input and outflow, daily weight, and sodium levels.

Hyperkalemia can often be managed by reducing potassium intake, and increasing potassium use by cells.

You can increase the utilization of potassium in cells by giving sodium bicarbonate.

This sodium bicarbonate can also be used to treat mild acidosis.

Patients suffering from hypertension with urinary retention can be treated using intravenous and sublingual calcium channel blockers.

In extreme cases, dialysis should always be performed.

This dialysis can be used to remove toxins and maintain optimum acid/base balance.

A slight insertion should be made to clear the obstruction of the urinary catheter neck.

Endoscopic ablation (Menkes, et al. (2006) can be used for obstruction of the urinary tract.

Most cases of fatigue in patients with meningitis are benign.

A patient may feel fatigued after meningitis recovery.

Previous studies showed that fatigue and headaches can start after three months of meningitis relief and can last for up to one year.

Meningitis fatigue can become a serious problem over time.

This problem can be very severe in the initial stages. However, it will have more serious consequences in the long-term.

It is imperative to manage fatigue during the initial phase.

It is vital to manage fatigue as it can negatively impact Sophia’s quality-of-life.

Sophia’s daily activities could be affected by fatigue.

Sophia should be assessed for fatigue by a nurse.

This quantitative score of fatigue will help Sophia determine the best type of intervention or management.

Sophia’s cause of fatigue should be identified by the nurse.

Sophia’s fatigue could be caused by anemia or less food intake.

Sophia’s infection would cause a decrease in red blood cell production and the destruction existing RBCs.

Red blood cells have hemoglobin that contains iron.

Hemoglobin aids red blood cells in carrying oxygen from blood to lung and carbon dioxide between blood and lungs.

ATP production drops when there is less oxygen available for muscles (McGregor

The oxygen supply to brains, hearts, muscles and other organs also decreases.

This results in less energy being available to these organs.

This causes fatigue.

Sophia may also experience fatigue due to central mechanisms.

Sophia is prone to cytokines overgrowth due to inflammation, infection, and inflammation.

These cytokines could cause alteration in the neuroimmune interplay, which can lead to neural plasticity and altered circuity.

Cachexia is another reason for fatigue in Sophia.

Cachexia (Wang, 2008) is a condition that causes malnutrition and body weight loss.

The nurse should ask the patient to eat more.

Nurse should administer her medication for anemia.

Sophia should be given the medication. Nurse should also develop a plan together to manage fatigue.

Nurse should evaluate the nurse’s daily activities and then assist with them.

The nurse should examine blood glucose, hemoglobin (BUN), blood urea Nitrogen (BUN), oxygen saturation.

These parameters should be evaluated by nurses who will take corrective actions if there are any anomalies.

Sophia should be evaluated for her sleeping habits and removed any external stimuli.

Sophia should determine her fatigue level before she begins any activities.

Sophia should make sure she has a rest break during her activities.

Sophia should establish her priorities for completing activities.

Sophia should receive balanced nutrition. This includes fats carbohydrate protein and vitamins as well as minerals.

Sophia should be provided with cool showers as well as massages by her nurse.

Sophia’s family members and nurse should be trained on fatigue signs and symptoms.

Research shows that polyunsaturated oil and adenosine thophopspahte (ATP) are effective in improving fatigue (Scheld 2014; Manno 2012.

Best Practice

Primary care and emergency medicine should be used to manage meningitis.

In order to manage meningitis, doctors should have experts from multiple fields, including neurologist, infectious disease specialist, and neurosurgeons.

A physician who is trained in neurosurgeons and infectious disease specialist can manage meningitis.

Early diagnosis and prompt treatment of meningitis is key.

Blood culture should be performed to establish the initial diagnosis.

For confirmation of infection in the cerebrospinal Fluid (CSF), lumbar puncture should also taken.

Due to difficulties in obtaining CSF for some patients, a CT scan is recommended before analysis of CSF.

This CT scan will help detect nerve system lesions.

If the CSF analysis is delayed or CT scan is not available, the doctor should administer antimicrobial therapy.

This would help to prevent the spread and spread of infection.

It is important to initiate adjuvant treatment in conjunction with antimicrobial therapies.

If severe infection is suspected, delayed treatment could result in morbidity and death.

Antimicrobial therapy must be planned according to patient age.

It is possible that undetectable microorganisms may be present in the CSF if treatment is initiated before CSF analysis.

CSF samples should be sent for diagnostic testing.

Following the identification of microorganisms in the CSF, treatment should be adjusted according to the need (Tunkel, et al. 2004).

Family-centered Care

As children lack knowledge about diseases and health, it is crucial that children receive family-centered nursing care.

Sophia’s relatives should inform nurse about Sophia’s mental health, diet habits, and other issues.

On the basis of this information, the nurse should plan her nursing intervention for Sophia.

Sophia will benefit from holistic care provided by the nurse.

Sophia should be supported emotionally and morally by her loved ones.

Sophia could be supported by her family to avoid social consequences.

Sophia’s family should feel secure that Sophia will be able to get the best possible care with proper medication (Chalmers, 2017).

Sophia’s nurse should involve her family in the planning of nursing care.

Nurses should inform family members about how to improve urine output and manage anaemia.

Family members should also be trained by nurse on how to manage fatigue.

Sophia’s activity and sleeping patterns should be prepared by the nurse with the assistance of her family.

Nursing should tell her family members to maintain good hygiene because infection could exacerbate Sophia’s disease.

Sophia’s family members should be advised that she receive fluids regularly.

It would improve Sophia’s urine output.

This knowledge would be beneficial in relieving stress from family members (Barnsteiner und al., 2014).

Sophia’s strengths, as well as her family members’ weaknesses, should be known by nurse.

Sophia’s family should have accurate information about her health.

While providing nursing assistance to Sophia, the nurse must consider socioeconomic and cultural factors.

Sophia should be encouraged to receive hospitalization by her nurse with the support of her parents, as children do not like being in a hospital.

Sophia shouldn’t be exposed to her hospitalization and diseased status, as this could lead to social consequences (Shaul; Watson and Rodwell (2014)).Conclusion:

Sophia is suffering from Haemophilus influenzae type B meningitis.

Sophia does not have any physical symptoms that would support Haemophilus type b Meningitis.

These symptoms include irritability. Inability to move. Pink lips. Dry mouth. Taky mucous membranes. Pale skin. Reduced eating and drinking. Sluggishness.

Sophia has identified two issues as a result: kidney dysfunction, and fatigue.

Sophia can be managed with best practices by using a stepwise approach to assessment.

Sophia and her family need to be centered on their care.

The patient suffering from Haemophilus influenzae type B meningitis would benefit greatly from the implementation of evidence-based treatment and follow up.References:Ahmed, A.S., Khan, N.Z., Hussain, M., Amin, M.R., et al., (2013).

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