Nrsg370 | Reviews For The Assessment Answer

The case study was about a 6 months old baby by the name Ava. Ava was brought to the emergency department b her parents who reported that she was having difficulties with breathing besides the cold like symptoms during the past two days .The child health nurse on the other hand says that Ava was just healthy and that she was meeting her developmental milestones. On assessment ,the results included HR of 176 bpm, RR of 62 bpm and the temperature was 38⁰C.The pulse oximetry was at 92% on the room air and her weight was 6.8 kg. Ava was also fussy or crying and she had nasal flaring. She also had the tracheal tug, grunting and abdominal breathing.

Ava’s parents reported a reduced oral intake and wet nappies the previous day. Her admission diagnosis is bronchiolitis and the sputum specimen tested positive for Respiratory syncytial virus. Her initial medication included nasal prong oxygen that was supplied at 1L/minute accompanied by instructions to titrate oxygen so as to maintain the level of oxygen at 95% and above. The medical staff advised that they will start high flow oxygen. Intravenous therapy also started at a bolus of 140 mls N/Saline over 2 hours which was followed by 0.9% saline and 10% dextrose through the scalp vein at 28 mls/hour. Other notable results include EUC blood results with a PH of 7.39, CO₂ 30 and HCO₃ 18 highlighted or the compensated metabolic acidosis. The chest x-ray indicated hyperinflation accompanied by small patchy areas of atelectasis. Her current medications include trial of Ventolin prescribed at 2.5 mg through nebulizer.100 mg paracetamol at every 6 hours through the oral route and finally 100mg of ibuprofen TDS through the oral route as well.

Collection And Presentation Of Health Related Information

Information was collected through interviewing of the parents as well as assessment of the child. The important information collected included difficulties in breathing. This is the reference point for bronchiolitis infection. Another important method that was used to collect information was through diagnosis. Diagnosis provided crucial links between the symptoms and the disease. The child tested positive for the Respiratory syncytial virus which is the causative agent of bronchiolitis.

Nursing Problems Based On The Health Assessment Data

Based on the above case study, there are different health issues .One of the key health issue is ineffective breathing pattern that is related to increased work of breathing and the decreased energy or fatigue. Another important nursing problem is the risk for the fluid volume deficit that is related to the inability to suit the body’s requirement and the increased metabolic demand. The other nursing problem identified in the case study is anxiety both to the child and the parents that is as a result of acute illness, hospitalization, uncertain course of illness and the treatment and finally the home care needs. All this leads to stress and anxiety among the ailing child and her parents. These goals can be achieved through the right nursing care or intervention.

Goals For Priority Of Nursing Care

Based on the above identified health issues, there are different goals for priority of the nursing care. The first goal under bronchiolitis is ineffective breathing pattern that is related to the increased work of breathing and the decrease in energy. The aim is therefore to ensure that Ava returns to the normal respiratory baseline and that she does not experience any respiratory failure. Another goal for priority is to return the child’s oxygenation status back to the baseline.

There are goals for priority due to anxiety of the parents and the ailing child. The goal or rather the objective in this nursing health problem is to ensure that both the parents and the child demonstrate behaviors which indicate a significant drop in anxiety. Another goal for this nursing problem is to ensure that parents verbalize the necessary knowledge of the symptoms associated with bronchiolitis as well as the use of home care strategies before the child is discharged from the hospital.

The risk for fluid volume deficit which is due to the disability of the body to meet the body requirements and increased metabolic demand as a nursing problem also has goals. The goals in this case is to ensure that the child’s loss of fluids is well corrected. Another goal for this nursing problem is to ensure that the child is well hydrated so that she can be able to tolerate the different oral fluids so that she can eventually proceed to normal diets.

Nursing Care For The Patient

To correct ineffective breathing pattern which is related to increase breathing rate and fatigue. The nursing care includes an assessment of the respiratory status of the child which is recommended to be a mi0078nimum of between every 2 and 4 hours (Farley, Spurling, Eriksson, & Del Mar, 2014, p. xx). It can however be more than this time frame which is indicated for a reduced respiratory rate as well as the episodes of apnea. The nurse has to ensure that he regularly monitors the cardiorespiratory and the pulse oximeter that are attached to the child and also record and report any changes to the relevant physician (Gil-Prieto, Gonzalez-Escalada, Marín-García, Gallardo-Pino, & Gil-de-Miguel, 2015).The nurse should also administer the humidified oxygen through the mask, hood or the tent. The nurse also has the role to monitor how the child responds to the nebulizer medications prescribed .The child should be placed comfortably by raising the bed up at the head or on the patients lap whenever she is crying.

The rationale for these nursing care is that the assessment as well as monitoring offer important evidence of the necessary changes as concerns the quality of the respiratory efforts. This would in return provide good intervention (Jat & Mathew, 2013). The use of humidified oxygen on the other hand will loosen secretions which assists to maintain the oxygenation status as reduce the respiratory distress. The nebulizer medications on the other hand improve on the oxygenation while reducing inflammation (Tapiainen et al., 2015). A good position is to ensure that aeration improves and reduce anxiety as well as the amount of energy used.

The priority intervention of the nurses under the risk of fluid volume deficit is to effectively manage fluids. This includes promoting fluid balance so as to prevent complications that arise due to abnormal levels of the fluids (McCallum, Plumb, Morris, & Chang, 2017). The role of the nurse in this case therefore involves evaluation of the need for intravenous fluids and maintaining the IV if at all it is prescribed. The aim of this intervention is replace previously lost fluids. The nurse should also maintain a strict intake as well as the output monitoring and evaluating the specific gravity for each and every 8 hours (Maedel, Kainz, Zacharasiewicz, & Frischer, 2017). Monitoring in this case provides evidence of loss of fluids as well as the ongoing hydration status.

Weight measurement of the patient on a daily basis using the same scale and evaluation of skin turgor and the assessment of the mucous membranes for the presence of tears and reporting the changes to the physicians is another nursing intervention (Manzoni, 2018). The aim of this is to provide evidence of any improvement in the status of hydration.

Anxiety was another nursing problem mentioned. The nursing intervention in this case is reduction of the anxiety and this can be achieved through minimizing of apprehension, dread, forebodes or uneasiness which is related to unidentified sources for the anticipated problem (Chang, Oppenheimer, Weinberger, Rubin, & Irwin, 2016). The nurses can achieve this through encouraging the parents to express any form of fears as well as asking questions and discussing the necessary care, the procedure and the condition changes that arise on course of the treatment (Castro-Rodriguez, Rodriguez-Martinez, & Sossa-Briceño, 2015). The objective is to offer a chance to vent out the feelings and assist reduce the anxiety in the parents.

Evaluation And Reflection Of The Nursing Strategies

On Assessment of the respiratory status, it is expected that within 48-72 hours, the child should be able to return to the normal respiratory baseline. On the use of humidified oxygen, it is expected that the respiratory efforts of the child reduce. The pulse oximeter should readings should also remain at above 94% oxygen saturation during the treatment procedure. It is also expected that the child should tolerate the nebulizer treatment and finally the child should be able to rest quietly in a comfortable position. Since the goals of the nursing problem were achieved, I feel that the intervention was a success and should be utilized at any given time.

There should be improved hydration under fluid management as the health problem. The child should also be able to take oral fluids effectively after 24-48 hours so as to maintain hydration .The weight of the child should also stabilize after each 24-48 hours and the skin turgor should be supple. The child should generally show signs of hydration. All these objectives were achieved and I therefore feel the nursing interventions are up to the standard. Generally, the nursing interventions by the nurses worked perfectly since after the expected time frame. The condition of the child improved drastically.

Conclusion

Bronchiolitis is a condition caused by the respiratory syncytial virus especially in children. This form of infection is characterized by difficulties in breathing. Several nursing issues arise from bronchiolitis and they include anxiety among both the parents and the children who are suffering due to uncertainty during treatment. Another nursing problem include the risk for fluid volume deficit and this arise due to the inability of the body to meet the body’s requirement and increased metabolic rates in the body. Finally, ineffective breathing pattern which is related to elevated work of breathing and fatigue. The nursing intervention include administering humidified oxygen and providing a comfortable resting position for the baby. The general expectation is that the breathing patterns of the child improves.

References

Castro-Rodriguez, J. A., Rodriguez-Martinez, C. E., & Sossa-Briceño, M. P. (2015). Principal findings of systematic reviews for the management of acute bronchiolitis in children. Paediatric Respiratory Reviews, 16(4), 267-275. doi:10.1016/j.prrv.2014.11.004

Chang, A. B., Oppenheimer, J. J., Weinberger, M., Rubin, B. K., & Irwin, R. S. (2016). Children With Chronic Wet or Productive Cough—Treatment and Investigations. Chest, 149(1), 120-142. doi:10.1378/chest.15-2065

Farley, R., Spurling, G. K., Eriksson, L., & Del Mar, C. B. (2014). Antibiotics for bronchiolitis in children under two years of age. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd005189.pub4

Gil-Prieto, R., Gonzalez-Escalada, A., Marín-García, P., Gallardo-Pino, C., & Gil-de-Miguel, A. (2015). Respiratory Syncytial Virus Bronchiolitis in Children up to 5 Years of Age in Spain. Medicine, 94(21), e831. doi:10.1097/md.0000000000000831

Jat, K. R., & Mathew, J. L. (2013). Continuous positive airway pressure (CPAP) for acute bronchiolitis in children. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd010473

Maedel, C., Kainz, K., Zacharasiewicz, A., & Frischer, T. (2017). Severity of respiratory syncytial virus bronchiolitis is increased in children with passive smoking exposure. Paediatric Respiratory Infection and Immunology. doi:10.1183/1393003.congress-2017.pa540

Manzoni, P. (2018). Bronchiolitis in children: The Saudi initiative of bronchiolitis diagnosis, management, and prevention (SIBRO). Annals of Thoracic Medicine, 13(3), 125. doi:10.4103/atm.atm_137_18

McCallum, G. B., Plumb, E. J., Morris, P. S., & Chang, A. B. (2017). Antibiotics for persistent cough or wheeze following acute bronchiolitis in children. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd009834.pub3

Meissner, H. C. (2016). Viral Bronchiolitis in Children. New England Journal of Medicine, 374(1), 62-72. doi:10.1056/nejmra1413456

Ricci, V., Delgado Nunes, V., Murphy, M. S., & Cunningham, S. (2015). Bronchiolitis in children: summary of NICE guidance. BMJ, 350(jun02 14), h2305-h2305. doi:10.1136/bmj.h2305

Tapiainen, T., Aittoniemi, J., Immonen, J., Jylkkä, H., Meinander, T., Nuolivirta, K., … Korppi, M. (2015). Finnish guidelines for the treatment of laryngitis, wheezing bronchitis and bronchiolitis in children. Acta Paediatrica, 105(1), 44-49. doi:10.1111/apa.13162