Care Delivery and Management: Nursing the Child and Young Person - Term Paper Example

Care Planning “Care planning is an essential part of healthcare, but is often misunderstood or regarded as a waste of time. Without a specific document delineating the plan of care, important issues are likely to be neglected. Care planning provides a "road map" of sorts, to guide all who are involved with a patient/residents care.” said Dr. Holly F. Sox, Clinical Editor for Careplan.com (online Careplan.com 2006). Sox (2006) explains that accurate and complete evaluation on the patient’s problems and needs is the first step in developing a care plan. In some cases involving acute conditions of patients, a regular reassessment of the patient’s conditions should follow after a thorough nurse’s evaluation. In other cases such as in long-term care settings, a nurse would be required to create the Minimum Data Set (MDS) as a jump off point for progress of the health of patient (online Careplan.com 2006). A method of evaluating a patient’s unique needs and administering the appropriate patient care is common to all nursing models. A measurable objective to assess the process and to provide better care for the patients is an important part of each nursing model. A care plan is used to determine a patient’s treatment by health care professionals such as nurses, doctors and other health care providers. Almost all nursing models use a care plan in assessing a patient’s needs. While the patient is still considered under the care of the nurse or doctor, these documents are regularly evaluated and changes are made on the basis of the patient’s overall progress and well being. Therefore, these documents are generally considered to be living documents (Wikipedia 2006). The nursing models used vary greatly between institutions and countries. However, different branches of nursing have different "preferred" nursing models. These are categorized as: 1) Psychiatric nursing, which includes Roy’s model and Tidal’s model of nursing, 2) Children nursing, which includes Casey’s nursing model, 3) Adult nursing, which includes Nightingale, Roger-Logan-Tierney, and Orem’s nursing model, and 4) Community and rehabilitation nursing, which includes Orem’s nursing model (Wikipedia 2006). In this Care Delivery and Management Plan, we have adopted Roger-Logan-Tierney model in delivering care management to the patient. We followed a holistic care plan giving special attention to the patient’s nursing needs. Roper-Logan-Tierney Nursing Model Roper-Logan-Tierney nursing model (2002) for adult nursing care was built upon the earlier works of Nancy Roper in 1976. The model was a widely practiced in the United Kingdom and many nurses have adapted to the use of this model in medical and surgical settings. Activities of Daily Living (ADL), Lifespan, Dependence/Independence Continuum, Factor affecting ADLs, Individuality of Living are the five major components of this model (Roger-Logan-Tierney 2002). The model focuses on the ADL of the patients in offering nursing care. ADL is an approach to assess and explain the functional condition of the patient. It is a means for evaluating the mind-body connection of the patient. That is, nurses look at the biological symptoms, the patient’s psychological state – i.e. their feelings and beliefs about the illness, and social factors such as family and community relationship that affects health. In providing nursing care, Roper et al. (2002) based their model on 12 ADLs. These ADLs are as follows: 1) Maintaining a Safe Environment, 2) Communicating, 3) Breathing, 4) Eating and Breathing, 5) Eliminating, 6) Personal Cleaning and Dressing, 7) Controlling Body Temperature, 8) Mobilizing, 9) Working and Playing, 10) Expressing Sexuality, 11) Sleeping, and 12) Dying. These 12 ADLs summarize and comprise a patient’s day-to-day life, no matter what is the age, sex, and health condition. More importantly, the information from patients in these 12 ADLs are used as part of the care planning for the patients. Lifespan refers to the time spent between the birth and death of a person. A person’s lifespan can be classified into the following stages: infancy (from birth to one year old); childhood (1 to 10/11 years old); adolescence (teenage years); adulthood; and old age. Roper et al. (2002) notes that analysis of each ADL depends on two factors, the current stage in the patient’s lifespan and loss of previous independence. Roper et al. (2002) emphasizes that nurses should care for and be concerned for patients of all ages. Roper et al. (2002) further underscore that a patient may require a nurse’s care at any stage of his lifespan. On this note, it is a nurse’s duty to care for any person at different stages of a person’s life. In relation to the continuum of a person’s lifespan, a person would move from total dependence to total independence and back again. Roper et al. (2002) suggests that in developing a long-term care plan, it is important to note the level of dependence a patient will undergo even after discharge from the health care institution. For example, not all new born child is automatically guaranteed with total independence. There can be exemptions such as being born with handicapped or learning disabilities. Further to the analysis of ADLs of patients, Roper et al. (2002) also takes into account various factors that influence ADLs. Such factors would include the following biological, psychological, sociocultural, environmental, and politcoeconomic. Nurses need to consider that these factors affect the overall patient’s well-being. By using the process of nursing and its four stages, the aim of model is to provide an individualized care plan to patients. Problem/Need Assessment A patient named Bailey, a two year old boy, was admitted for care. Initial diagnosis reveal pyrexia, but with an unknown origin. Our first step was to diagnose the symptoms attributed to pyrexia as well as to check the patient’s vital signs. One condition would be to determine the criticality of the pyrexia symptom of Bailey. That is, pyrexia is measured to determine the level or grade (i.e. low grade or Hyperpyrexia). If the temperature reaches the range hyperpyrexia, then the fever as a symptom poses a very critical indicator needing immediate attention. In addition, symptoms such as shivering or vasoconscontriction are also considered. Pyrexia is a common sign of many medical diseases (online Biology-Online.org). Our body will react to different diseases such as infectious disease, immunological disease, drug fever, and metabolic disorder. As our body reacts, our body would orchestrate a heat effector mechanism to signal that something is wrong (Soszynski, 2003). While fever should not necessarily be treated, it is important to note that it may a good indicator a follow-up if the illness persists (Fischler and Reinhart, 1997). Using a Roper-Logan-Tierney’s model, we have noted the following ADLs as problems in performing the assessment on the patient. One major concern would be the patient’s age. In the early years of Bailey, it is apparent that Bailey’s ability to communicate is limited. Nevertheless, it is clear that Bailey expresses himself through other forms such as crying. He has total dependence on his parents particularly his mother in trying to convey his needs In addition, it is also important to gather information on other important factors such as the following: 1. Maintaining Safe Environment: Has there been any accidents or incidents that Bailey has encountered life threatening (example, choking or falls)? 2. Breathing: Has there been any irregularities on the breathing patterns of Bailey? Does the parents smoke at home? 3. Eating and Drinking habits: What types of foods or drink did the Bailey last took? Does Bailey have allergies of Bailey on certain food types? 4. Eliminating: Does Bailey have any problems in bowel movement or urinating? 5. Controlling Body Temperature: When did the fever started? How long has it been? It the fever a chronic symptom? 6. Mobilizing: Observations on the bodily movements of Bailey. Does Bailey exhibit abnormal body movements? 7. Sleeping: Does Bailey have difficulty sleeping? Gathering these basic historical information from the parents will help us better assess the problem or need of Bailey. Furthermore, a learning session is conducted to learn more on the background of the parents such as working hours, home location, beliefs, as well as present physical condition and historical diseases and illness will also help in providing an overall picture of Bailey’s condition. While Bailey is unable to provide us with needed information, we believe the parents having the closest contact and understanding of Bailey and they may assist us in formulating our action plan. Nursing Actions In formulating the nursing action plan, we initially gathered all the information obtained from our initial diagnosis of the patient’s vital signs. Bailey’s body temperature was 38.5°C. Pulse rate is at 60 beats per minute. Respiration rate seems is 14 breaths per minute. Deep coughs and sneezing is exhibited by the patient. Blood pressure is 80/120. Nurse’s patient observations include the following: Bailey continues to cry is a good sign of consciousness for the child. We believe crying indicates consciousness on the part of child; moreover, crying is a child’s means to communicate the pain felt. Bailey does not shiver extensively, but exhibits chills and feeling of coldness. Skin rashes appear in the face and body. Bailey exhibits coughing, sore throat, and nasal congestion Nurses had one-on-one interviews with the parents of Bailey to get to know more about him. The family lives in a nearby apartment and has been renting for more than a year now. Bailey’s father is an architect, while his mother currently stays at home to take care of the child. Both parents do not smoke. The father had been sneezing and coughing last week. Nonetheless, the father has avoided contact with his son during this time. The parents believe that Bailey had inadvertently caught cold with his father’s condition. Bailey is the family’s first born son and the parents had been very worried with his symptoms and condition since yesterday. According to the parents, Bailey did not have any accidents or incidents that would endanger him such as choking or hard falls. He had difficulty breathing and seems to have a nasal congestion since yesterday. In addition, he had been continuously coughing and had difficulty breathing due to nasal congestion. He had been continuously crying and body temperature of Bailey had significantly risen in last 24 hours. Bailey is being continually breastfed according to his mother. In addition, his mother has started feeding him with solid foods as well. However, the parents are very cautious and are currently not aware of any food in which Bailey is allergic to. The parents observe Bailey has no problems with bowel movement and urinating. Bailey had been able to stand up, but he still cannot walk. Bailey had difficulty sleeping since last night and had been continuously crying. The parents mentioned that this is the first time their son has exhibit this symptom and expressed their concern and worry on their son’s current condition. The parents believe that coughing and sneezing and coughing since Tuesday. The parents observed Bailey condition and decided to consult immediately after learning Bailey has a fever. After analyzing the inputs provided by the parents and the toddler’s vital signs, we had identified that the disease known as acute nasopharyngitis. We would recommend to the parents the intake of ibuprofen to lower the current body temperature of Bailey. We would not recommend for the baby to in-take medicine for the toddler (Diehl, 1933). We would suggest though a non-medicinal treatment such as intake of lots of fruit juices such as orange juice and water. We would suggest for the parents to regularly provide their son with Vitamin C to both prevent and reduce the effects of common cold (Gwaltney, 2000; Chalmers 1975). Furthermore, we would assure the parents that the symptoms Bailey is only a common cold, which typically affects toddlers who have not developed a strong immune system. We would encourage the parents not to worry, but rather advise them to supplement the toddler’s diet with a balanced diet and lots of fruit juices, particularly those which areVitamin C-rich. We would suggest to give Bailey rest and if the fever escalates or persists for another 2-3 weeks, they may immediately contact us for help. Discussion Common cold is scientifically termed as Acute Nasopharyngitis. It is a mild viral infectious disease in the upper respiratory system, which commonly affects our nose and throat. Sneezing, sniffling, nasal congestion, sore throat, coughing, headache accompanied by fever are symptoms of acute nasopharyngitis. The conidition will generally last for three to five days. Coughing may persist up to three weeks. Acute nasopharyngitis is the most common of all human diseases. The rate of infection would be at an average of slightly one infection per year per person. Children particularly toddlers as well as their caretakers are particularly prone to this disease. This phenomenon is probably due to the high population density of schools and the fact that transmission to family members is highly efficient (Gwaltney, J.M., Jr. 1996; Dingle, Badger, & Jordan, 1964). Numerous viruses cause common cold. Rhinoviruses, coronaviruses, echoviruses, paramyxoviruses and coxsackieviruses are the most common viruses infecting the upper respiratory system. There are several hundred cold-causing viruses that have identified and described. A virus can further mutate to stay alive; thus, making the cure for common cold a long way to go. The nasopharynx is the most common affected area for viruses to attack rather than the throat because of low temperature and high concentration of cells with receptors that is needed by viruses to survive (Harris and Gwaltney, 1996). Viruses are more commonly transmitted from contact with another person with the disease. The virus is transmitted by droplets from coughing or sneezing, which are either inhaled directly or transmitted from hand to hand via handshakes and then introduced to the nasal passages when the hand touches the nose or eyes (Hendley, and Gwaltney, 1988; Harris & Gwaltney, 1996). Ninety-five percent of people exposed to a cold virus become infected, although only 75% show symptoms. One to two days after infection the symptoms such as sore throat will start to show. Later the symptoms such sneezing, running nose, and coughing would emerge as effects of the body’s defense mechanism to expel the invader and inflammation to attract and activate the white blood cells (Harris & Gwaltney, 1996). After recovering from a common cold, the patient develops immunity to the particular virus encountered. However, because of there are several hundred cold-causing viruses, this immunity offers very limited protection. Therefore, a patient can be infected by another cold virus and start the process all over again (Harris and Gwaltney, 1996). There are no medically-proven treatments that directly fight a virus. Because viruses cannot be cured by medication, only our body’s immune system can protect itself and therefore effectively eliminate the invader. Millions of viral particles may typically infect cells in the body. To counter this invasion, our body mass produces antibodies that can prevent the virus from further infecting the cells, as well as white blood cells which kill the virus through phagocytosis and destroy the infected cells to contain the spreading of the virus. The best way to reduce the chances of catching a cold is to avoid close contact with a person suffering from colds. Always wash hands thoroughly and regularly. Anti-bacterial soaps have no effect on cold virus rather the mechanical effect of hand washing removes the virus particles. The Center for Disease Control and Prevent (2002) recommended alcohol based hand gels as an effective method for reducing infectious viruses on the hand. However, similar to standard handwashing, alcohol do not provide residual protection from re-infection. In the case of Bailey, it is important to inform and to help the parents understand the specific nature of the infectious disease. Moreover, it should be emphasized to the parents why toddlers and young children are more prone to such diseases and how the body reacts to these diseases to strengthen the immune system. While care plan does not suggest for Bailey for intake of medicine, we understand that as caretakers the parents play a very vital role in ensuring the continued well-being of the child. It is therefore more important to communicate the nature of the child’s illness, the preventive measures the parents can take, and the current suggested care plan for Bailey to recover faster from the disease. In addition, an assurance that their child would be fine would be more comforting and provide a more conducive environment for Bailey’s healing process. References Chalmers, T.C. (1975). Effects of ascorbic acid on the common cold: An evaluation of the evidence. Amer. J. Med. 53:532-536. Diehl, H.S. (1933). Medicinal treatment of the common cold. JAMA. 101:2042-2049. Dingle, J.H., G.F. Badger, and W.S.J. Jordan. (1964). Illness in the Home. A Study of 25,000 Illnesses in a Group of Cleveland Families. The Press of Western Reserve University, Cleveland. 347 pp. Febricula, definition from Biology-Online.org, consulted August 21, 2006 http://www.biology-online.org/dictionary/Febricula Fischler MP, and Reinhart WH (1997). Fever: friend or enemy? Schweiz Med Wochenschr 127: 864-70. Graham, N.M., C.J. Burrell, R.M. Douglas, P. Debelle, and L. Davies. (1990). Adverse effects of aspirin, acetaminophen, and ibuprofen on immune function, viral shedding, and clinical status in rhinovirus-infected volunteers. Journal of Infectious Diseases. 162:1277-1282. Gwaltney, J.M., Jr. (1996). Acute community-acquired sinusitis. Clinical Infectious Diseases. 23:1209-1223. Gwaltney, J.M.Jr. (2000). The Common Cold. In Principles and Practices of Infectious Diseases, 5th ed. G.L. Mandell, J.E. Bennett, and R. Dolin, editors. Churchill Livingstone, New York. 651-656. Harris, J.M., 2nd, and J.M. Gwaltney, Jr. (1996). Incubation periods of experimental rhinovirus infection and illness. Clinical Infectious Diseases. 23:1287-1290. Hendley, J.O., and J.M. Gwaltney, Jr. (1988). Mechanisms of transmission of rhinovirus infections. Epidemiologic Reviews. 10:243-258. Roper, N, Logan, W, and Tierney, A (2002). The Elements of Nursing 4th edition. Churchill Livingstone, Edinburgh Soszynski D (2003). The pathogenesis and the adaptive value of fever. Postepy Hig Med Dosw 57: 531-54. Sox, H. (2006). What is a Care Plan? Care Plans.com [Online] Available at: http://www.careplans.com/default.asp Read More