Answer:
Introduction:

Optimal maintenance and regulation of child and adolescent health is one of the fundamental bases of effective nursing and midwifery practices. This case study determines the different aspects of remedial treatment required for optimal treatment by nurses especially under emergency conditions. These skills are required to provide immediate treatment to physical, social, cultural, emotional and psychological needs of Sophia. The prevailing condition in Sophia occurs due to alteration in the active and passive immunity responses towards the degrading condition in her (McCance & Huether, 2015). Active immunity is the one which is innate and is naturally acquired by the immune system of a person in response to an unfavourable condition. While, passive immunity is also self generated but requires addition of antibodies from outside targeted to the disease. This analysis has been conducted on the guidelines provided by consulting management custom framework (F&CCC) and National Institute for health and care Excellence (NICE) guidelines (Mantje, Smit, Sterk, & Mens, 2016).

The report determines detailed analysis on alteration in active and passive immunity by undertaking the case study of nine years old girl named as Sophia whose provisional diagnosis is Meningitis.

This report outlines the different aspects of remedial treatment such as physical assessment, alternate possible condition, alteration to active and passive immunity responses, two possible concerns, effective treatment, patient and family oriented care and expected outcomes.

Physical Assessment:

The primary role of nursing and midwifery practitioners is to provide effective patient-oriented services by providing the primary and secondary remedial solutions to the patient. The primary treatment undertakes the immediate treatment of the needs and requirements of the patient targeting the physical, social, cultural, emotional and psychological needs. According to the case study, Sophia is a little girl who is only nine years old and has been suffering from certain symptoms such as lethargy, altered diet, headache, high temperature, lower rate of respiration, low blood pressure, dry mouth, low oxygen saturation, unimmunised diet, decrement in nutrients, tacky mucous, purpuric rash, soft abdomen with no distension, pale skin, sluggishness and reluctance towards movement, bowel movement once a day, no urine excretion (Charnock, Lee, & Miller, 2014).

These signs and symptoms have made the child patient cranky, unresponsive, stressed, scared and shocked. Such signs and symptoms are prevalent in Sophia due to disease, new environment of the hospital and unresponsiveness towards the interventions. The main role of the nurses is to provide immediate effective remedial care to the child. The physical needs require optimal implementation of pharmacological and non-pharmacological interventions as prescribed by other healthcare professionals. Furthermore, Sophia needs manual handling for her care in terms of movement, imparting of interventions and other procedures. The emotional needs of Sophia that needs to be tackled are stress, shock, uncomfortable due to new environment of the hospital. These factors can be effectively treated with the help of efficacious patient-oriented palliative care. Social needs of Sophia comprise of friendly environment for treatment, love from other healthcare professionals and family members, acceptance for prevailing condition and safe treatment undertakings (Golightley, 2014). Psychological needs of Sophia are decrement in confidence, lack of senses in terms of analysing and decision-making, effect on mental health and others. These factors can be effectively treated with the help of social, spiritual and culturally sensitive palliative care to Sophia. This can be undertaken with the help of analysing the case history and studying the family background of Sophia and her family. Cultural needs of Sophia can be respecting the cultural needs and identity of the family of child patient and provisioning effective paediatric palliative care. The cultural needs can be life experiences, values, language communication, predetermined beliefs and notions on remedial treatment, religious practices and others. A nurse must target and impart treatment as per the cultural needs to maintain the ethical and moral beliefs of the patient and her family (Kirmayer, Bennegadi, & Kastrup, 2016).

Alternate Provisional Condition:

The provisional analysis has determined the presence of Haemophilus Influenzae that is responsible for respiratory conditions. These respiratory conditions are of two types restrictive and obstructive. Such respiratory disease coincides with various circulatory diseases. According to the case study the provisional analysis, the symptoms shown by Sophia are of meningitis that occurs due to haemophilus influenzae type b (Hib). Furthermore, according to my analysis on the prevailing symptoms, Sophia may be suffering from paediatric percarditis circulatory disease. The pericarditis is a medical condition that occurs due to inflammation of pericardium which is two thin sac-like membranes present around the heart. Paediatric Percarditis is one of the prevailing conditions that arises in children with much similar signs and symptoms as of meningitis as the primary virus is same for both. This condition also arises from haemophilus influenzae and has most of the symptoms such as low blood pressure, high fever, purpuric rash, lethargy, lower rate of respiration and others as shown by Sophia (Cuccio, et al., 2014).

Alteration To Active And Passive Immunity Responses:

The haemophilus influenza attacks the active immunity by damaging the neutrophils which are also called as white blood cells. Phagocytises occurs in neutrophils that activates the respiratory oxidation. This activation leads to death of the white blood cells and collection of the haemophilus influenza cells. This process lowers the immunity finally altering the active immunity of the body. Furthermore, the passive immunity such as polysaccharide vaccines and conjugate vaccines get altered by limited and rapid degradation in the effects after the administration. Alteration occurs by reduction in effects of administered Polyribosyl Ribitol Phosphate (PRP) that is a common antibody by limiting the interaction and association with b lymphocytes only (Treanor, 2014).

Two Prevailing Concerns, Pathophysiology And Remedial Treatment:

The prevailing two main concerns for Sophia are shock and unresponsiveness towards exerted communication and treatment. These two are critical signs to be serious of because these both symptoms are making Sophia passive towards the implemented remedial treatment.

Pathophysiology Of Shock:

Shock leads to inhibition in the mental activities that occurs by diminished perfusion of tissues. This ineffective and reduction in the perfusion of tissue leads to misbalanced anaerobic metabolism, metabolic imbalance, irreversible damage to organs, organs and cells dysfunction, supply and demand of the oxygen and other important regulatory functions related with the respiration system of the body. The shock responses are severe as they led to alteration in hemodynamic process and configuration of fluid and compartments and others (De Backer, Orbegozo Cortes, Donadello, & Vincent, 2014). Diagnosis can be undertaken by determining the alterations in myocardial function, blood flow, intravascular volume and the vascular resistance.

Pathophysiology Of Unresponsiveness:

Unresponsiveness is another prevalent concern that may or may not arise from shock syndrome. Alteration in mental conditions leads to the prevalence of unresponsiveness. Sudden changes from the existing conditions leads to ineffective working of the central nervous system by breaching the information signalling pathway of the body that is nervous system. Primary level example of this is lethargy which is a symptom shown by Sophia. Furthermore, unresponsiveness occurs due to change in mental condition that occurs due to alteration or degradation of cerebral cortex and haphazard system of reticular activating. These alterations are toxic to normal brain functioning causing dysfunction and impairment of cognitive skills, alertness and effective decision making ability (Dlouhy, et al., 2017).

In addition to this, it is essential to bring Sophia in her comfort for better responding to the treatment provided by healthcare professionals. Furthermore, for the tackling of both conditions, condition-oriented and patient-oriented pharmacological and non-pharmacological interventions must be undertaken precariously. This can be done by making Sophia friendly to the environment of the hospital and allowing her to stay with her family members. Goal-directed therapy must be implemented that targets the optimal regulation of different process of respiration such as ventilation, free airway passage, circulation and oxygenation (Wilber & Ondrejka, 2016). This therapy must target the normal levels of respiration rate, blood pressure, urine output, minerals and vitamins levels, mucous condition, mental condition, saturated oxygen concentration and others. Hypnosis, blood therapies, pain management therapies and other relief providing initiatives must be undertaken by healthcare professionals and family members to provide relief to Sophia. Besides this, pharmacological intervention can also be provided to instil relief to distressed condition of Sophia. Different medication such as vasopressors and intropes can be used as per the prescription by healthcare professionals. Vasopressors such as Norepinephrine, Dopamine, phenylephrine or Vasopressin can be used for the regulation of the effective treatment. Besides this, different intropes that can be used as remedial medication are Milrinone or Dobutamine (Puri, 2013).

Effective Treatment:

Being a nurse, my responsibility is to provide these safeguard interventions along with effective palliative care in accordance with remedial approach for both the patient and her family. The guidelines for effective remedial procedures are provided by the legislation of the country and the management of the hospitals. Furthermore, the procedure for effective advancement is further provided by senior professionals. Optimal formulation, implementation and regulation of remedial practices formation of a multidisciplinary or multiagency team are required (Stuart, 2014). As nurses are pivot to all other healthcare professionals, my work will be assisting these professionals and Sophia along with her family for the regulation of effective treatment. For Sophia, healthcare professionals can be general physicians, psychologists, nurses, carers, family members, pulmonologists, cardiologists and others. These healthcare professionals work altogether for the effective implementation of pharmacological and non-pharmacological interventions emphasising mostly on effective palliative care. Furthermore, effective evaluation will be undertaken by efficacious reporting and change of shift report (cosr) as per the guidelines formulated by the management of the hospital and the legislation of the country (Arnold & Boggs, 2015).

Expected Outcomes:

The expected outcomes are reduction in the shock and unresponsive state of Sophia and further reduction in the prevailing symptoms such as lethargy by maintaining the healthy diet through the treatment. Furthermore, improvement in the respiration rate, low oxygen saturation, low blood pressure, purpuric rash, and balanced urine excretion is expected to be analysed. Besides this, with the equilibrium in these symptoms, other signs such as headache, high temperature, dry mouth, tacky mucous, soft abdomen, sluggishness and others are expected to be withdrawn. This maintenance is expected due to regulation of patient-oriented safeguard interventions (Pitschel-Walz, Leucht, Bäuml, Kissling, & Engel, 2015).

Patient And Family Oriented Care:

Palliative care is an essential instrument for the regulation of effective treatment. Such care must be provided to both patient and family targeting their specific needs and desires. In order to achieve effective results of the imparted remedial treatment, the thinking, wishes, requirement and demands of the patient and her family in terms of physical, social, cultural, economic, psychosocial beliefs must be entertained (Svavarsdottir, Sigurdardottir, & Tryggvadottir, 2014). This can be undertaken by maintaining safety leading to zero harm, maintaining the dignity, optimal and effective information sharing and transparency, involvement of patient and her family and protection of fundamental rights. Furthermore, only then effective treatment will be achieved by preserving and protecting the ethical and moral beliefs of the patient and her family. This step makes the whole process of treatment patient oriented leading to target oriented care (Ignatavicius & Workman, 2015).

Conclusion:

The analysis of this report has been undertaken with the help of evidence-based guidelines provided by consulting management custom framework (F&CCC) and National Institute for health and care Excellence (NICE). This report has undertaken overall case study on the existing condition of a small child named as Sophia. Different signs and symptoms such as lethargy, headache, lower respiration rate, dry mouth, unhealthy and altered diet, tacky mucous, soft abdomen, sluggishness, no urine, limited bowel movement, high fever, lower blood pressure, lower oxygen saturation, lack in nutrient quality and others has led to her hospitalization. Provisional diagnosis determines meningitis but pediatric percarditis can be another condition as per the signs and symptoms. Besides this, any disease occurs due to alteration in the active and passive immunity making them insufficient and ineffective in providing target-oriented immunity. Other two maintain concerns for Sophia are shock management and unresponsive behaviour towards treatment. These concerns are prevailing due to change in the regular environment and severe degrading health condition of Sophia. Effective treatment undertakes optimal regulation of pharmacological and non-pharmacological interventions along with effective patient and family oriented palliative care to achieve enhanced resultants of the imparted treatment. Palliative care approach is necessary for effective pain management as it undertakes interventions keeping the needs and demands of the patients based on social and cultural beliefs and experiences. The expected outcomes can be effective sooner discharge of the patient with balanced signs and symptoms.

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