≫ Caring for the Pediatric Patient Free Essay Sample on Samploon.com

Table of Contents

Overview
Objective
Psychosocial
Medications
Pathophysiology
Treatments
Nursing Care of Plan
- References

It is a general understanding that there are quite a few significant differences in caring for a pediatric patient than for an adult patient. Children have substantial cognitive, physical, and physiological differences than of adults. Therefore, possessing proficient understanding of these differences in children will promote patient-centered care and quality of life in individuals with chronic diseases such as bronchopulmonary dysplasia.

Overview

A three-year-old male patient was admitted with exacerbations of hypoxia, bronchospasm, and airway aspiration with a diagnosis of bronchopulmonary dysplasia at birth. The patient is staying in the unit for respiratory distress management from potential bronchiolitis and/or asthma exacerbation caused by rhinovirus or enterovirus. Patient is currently wearing a nasal cannula and on one liter per minute of oxygen with continuous weaning as tolerated. The patient has a history of prematurity of 24 weeks gestation, chronic lung disease/bronchopulmonary dysplasia (BPD), asthma, and dysphagia.

Objective

Patient is alert and awake with no apparent distress and appears to be stated age and well-nourished. PERRLA. Ears, mouth, neck, and throat do not present with any tenderness, masses, scars, lesions or abnormalities. No difficulty of swallowing noted. No coughing present. No work of breathing and retractions present. Bilateral and symmetrical respiratory expansion noted. No cyanosis or any other abnormal color change in anterior and posterior chest region noted. No masses, lesions, scar or any abnormalities present on anterior and posterior chest region noted. Lung sounds clear to auscultation bilaterally. No rales, rhonchi or wheezing present. No clubbing present. PMI palpable at 5th ICS.

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No heaves, thrills, or tenderness noted. RRR, S1S2 noted. NO MRG. No S3 or S4. Abdomen is flat, soft, and nontender with no masses or abnormalities present. No visible pulsations or hernias noted. Bowel sounds present in all 4 quadrants with no bruits on abdominal aorta. Skin color is appropriate for ethnicity. Skin is warm, dry, and intact with smooth texture and no lesions, rashes, or abrasions. No tenderness and tenting present. No pallor and dressings present. No masses, infections, scars, rashes, ecchymoses, petechiae, lesions or abnormalities noted on all 4 extremities. 0+ edema. Capillary refill is less than 2 seconds. Active ROM for all joints with 4+ muscle strength bilaterally in all 4 extremities.

Psychosocial

Both mother and father frequently visit the patient and state they are all tolerating hospitalization well. Mother states patient appears to be tolerating the nasal cannula and one liter of oxygen well and breathing comfortably. Developmental milestones that the patient met include: “taking turns, understanding the idea of “mine” and “his/hers,” displaying a wide spectrum of emotions, following instructions with two or three steps, stating first name, age, and sex, saying words like “I,” “me,” “we,” and “you,” , separating easily from mom and dad, playing make-believe with dolls, animals, and people, and turning book pages one at a time” (Centers for Disease Control and Prevention, 2018).

The following developmental milestones could not be assessed because of insufficient time with the patient and include: “showing concern for a crying friend, displaying affection for friends without prompting, naming most familiar things, understanding words like “in,” “on,” and “under,” carrying on a conversation using two or three sentences, forming puzzles with three or four pieces, understanding the meaning of “two,” building towers of more than six blocks, climbing well, running easily, pedaling a tricycle, and walking up and down stairs, one foot on each step” (Centers for Disease Control and Prevention, 2018).

Medications

The patient was prescribed several medications throughout the course of stay consisting of: albuterol, fluticasone, ibuprofen, phenylephrine, and prednisolone. Albuterol is a selective beta 2-adrenergic receptor agonist used primarily for bronchodilation to treat the patient’s exacerbating asthma and bronchospasms (Vianna & Martin, 1998). Some common side effects include tachycardia, hypertension, palpitations, and dry mouth and throat (Vianna & Martin, 1998). Ibuprofen is a nonsteroidal anti-inflammatory drug inhibiting “…cyclo-oxygenase-1 and cyclo-oxygenase-2” used to treat the patient’s fever and pain as needed (Bushra & Aslam, 2010).

This medication commonly causes gastrointestinal side effects of diarrhea, constipation, bloating, and flatulence (Bushra & Aslam, 2010). Fluticasone is a corticosteroid used to suppress the patient’s pulmonary inflammation after albuterol use (Mygind et al, 2001). Some common side effects are hoarseness, coughing, and a bad aftertaste after oral aerosol inhaler administration (Mygind et al, 2001). Prednisolone is another corticosteroid that was dispensed to the patient because of the same anti-inflammatory purpose mentioned as fluticasone. As an oral solution, facial and general edema, hyperglycemia, immunosuppression, and protein catabolism are some common effects seen with long-term use (Mygind et al, 2001).

Pathophysiology

Bronchopulmonary dysplasia (BPD) is a common chronic lung disease seen in premature newborns caused by immature lung development and requires oxygenation for increased survival. Immature lung development occurs from “…disruption of alveolar growth” and surfactant formation (Davidson & Berkelhamer, 2017). Alveolar cells are found specifically in the lung and exchange oxygen and carbon dioxide molecules between the lungs and the bloodstream. Surfactant is a lipoprotein secreted by type II alveolar cells that promote lung compliance: the lungs’ ability to stretch and expand for oxygen intake.

Since BPD newborns do not have enough alveolar cells in the lungs, they cannot produce enough surfactant as a result. Hence, “surfactant deficiency further contributes to non-uniform expansion of the lung with areas of focal over-distension and atelectasis” (Davidson & Berkelhamer, 2017). This results in decreased oxygenation leading to increased “alveolar macrophages…contribut[ing] to…inflammation” and causes bronchospasms, coughing, and airway aspiration (Shahzad, Radajewski, Chao, Bellusci, & Ehrhardt, 2016). Continued deoxygenation will affect all organs and tissues within the body causing hypoxia, hypoxemia, and eventual death respectively.

Treatments

There are a handful of treatment options for patients with Bronchopulmonary dysplasia (BPD). One treatment option would be utilizing respiratory care services such as chest physiotherapy and nebulizers because the rationale is to provide airway patency maintenance and improve oxygen exchange for better lung function while decreasing the length of hospital stay (Hough, Flenady, Johnston, & Woodgate, 2008). Another treatment option is a swallow study because the patient has a history of dysphagia and therefore is at risk of aspiration from insufficient air flow into the lungs when consuming meals.

The rationale is to determine any aspiration occurrences and prevent airway occlusion (Hanin, Nuthakki, Malkar, & Jadcherla, 2014). The third treatment option is to continue prescribing bronchodilator and corticosteroid medications to the patient because the rationale is to decrease airway resistance by enlarging the bronchioles and reducing inflammation (Clouse, Jadcherla, & Slaughter, 2016).

Nursing Care of Plan

Three priority nursing diagnoses for the patient with BPD are: impaired gas exchange related to bronchospasms as evidenced by hypoxia, imbalanced nutrition related to increased energy for work of breathing as evidenced by inadequate food intake, and risk for infection as evidenced by bronchopulmonary dysplasia. The first nursing diagnosis is impaired gas exchange related to bronchospasm as evidenced by hypoxia. One intervention is to “assess [the] respiratory rate, depth, and effort” because the patient can “…display signs and symptoms of respiratory distress syndrome such as tachypnea, labored breathing, nasal flaring, grunting sounds, and chest retractions” (Martin, 2018).

Another intervention is to administer diuretics such as furosemide to “decrease the development of alveolar and pulmonary interstitial edema” (Martin, 2018). The third intervention is to educate the parents in using supplemental oxygen inhalation devices such as a nasal cannula for the patient because it further “maintains adequate ventilation and ensures the delivery of concentrated amount of oxygen” to prevent hypoxic episodes (Martin, 2018).

The second diagnosis for the BPD patient is imbalanced nutrition related to increased energy for work of breathing as evidenced by inadequate food intake. One intervention is to “provide small, frequent” meals as the rationale is to “reduce fatigue and enhance intake” (Martin, 2018). Another intervention is to “obtain and record the child’s weight each morning before the first feeding” to “accurately monitor the response or progress to nutritional therapy” (Martin, 2018). The third intervention is to educate the parent(s) about the caloric intake amount necessary for “…normal nutritional body requirements” to maintain “…good nutritional status” and adequate physical and cognitive growth for the patient (Martin, 2018).

The third diagnosis for the BPD patient is the risk for infection as evidenced by bronchopulmonary dysplasia. One intervention is to “assess for change in breathing pattern, color of mucus, rise in temperature, diminished breath sounds, [and] presence of respiratory infection of family members” (Martin, 2018). The rationale is because assessments can “reveal presence or potential for infection, which may be life-threatening” (Martin, 2018). Another intervention is to “assist with the removal of secretions through chest physiotherapy” because the “stasis of secretions provides a medium for infection” (Martin, 2018). The third intervention is to “educate parents about [the] vulnerability to infection and to avoid contact with people with existing respiratory infection” because “any illness, even a minor one will compromise the…respiratory status” (Martin, 2018).

Three interventions were evaluated during the care of the patient with BPD. Evaluating frequent assessments of the respiratory rate and lung sounds resulted in a patent airway with no signs or symptoms of respiratory distress observed for the first nursing diagnosis. The intervention of providing small, frequent meals was unable to be evaluated, however, an expected outcome would be weight gain or maintenance of the patient. Lastly, an evaluation of assisting with secretion removal by chest physiotherapy successfully yielded more coughing and outward phlegm observed from the patient for the third nursing diagnosis.

Lastly, a few short and long-term goals were identified for this patient. For the first nursing diagnosis, one short-term goal will be to demonstrate maintenance of clear lung sounds with nasal cannula use by the end of the shift. One long-term goal will be to tolerate weaning to 0.5 liters per minute of oxygen using a nasal cannula by time of discharge.

As for the second nursing diagnosis, one short-term goal will be to demonstrate 50% of a meal eaten with nasal cannula use by the end of the shift. One long-term goal will be to demonstrate maintenance of weight by the time of discharge. Lastly, one short-term goal for the third nursing diagnosis will be to demonstrate the ability of oral care with nasal cannula use by the end of the shift. One long-term goal will be to maintain absent signs and symptoms of infection until the time of discharge.

In conclusion, it is through understanding the disease that a plan of care can be established to best provide patient-centered care and improve the quality of life of the patient(s).

Caring for the Pediatric Patient