Developmental And Psychological Factors In Care Planning For Pediatric Patients – Case Study

Introduction to Nursing Care

Discuss about the Nursing Case Study for Implementation and Evaluation.

Nursing care represents the most impactful and poignant part of the health is experience that the patients receive while they are in the health care facility. The patients spend the most of their tome in the health care facility with the nurses and they are the most dependent on the health care professionals as well. It has to be mentioned that the care planning, implementation and evaluation, the entire step is associated with the nursing care., hence the patient also feel most comfortable around the nurses and can freely share their grievances and preferences with the nursing professionals as well (Davidson et al., 2017). Hence, needless to say, the nurses are required to take the entire responsibility of the care, ensuring that the patient gets the optima benefits of the care. Especially for the pediatric patients, there are various developmental and psychological factors that are needed to be considered while planning the care for them. This assignment will focus on developmental and psychological factors that play a profound role in care planning for pediatric patients taking the assistance of a case study.

This case study represents a four month old boy named Jay who had presented to the pediatric emergency unit with decreased feeds, no bowel actions and intermittent spasmodic abdominal pains. The patient had been going through a spasmodic pain while drew up his legs and crying with a high pitched noise. The preliminary diagnosis of the condition of the patient indicated the chances of the patient having intussusceptions. Now, intussusceptions can be defined as the medical condition where an intestinal segment invigilates into the adjoining intestinal lumen. This phenomenon results into bowel obstruction in the patients by partially or completely blocking food or fluids to pass through the intestine. On a more elaborative note, in severe cases intussusceptions can also cut off the blood supply to the affected part of the intestine. This can lead to bowel perforation, followed by infection and necrosis of the bowel tissue (Walter & Staat, 2016).

Exploring the underlying pathophysiology of the condition it can be mentioned that in the most common cases the intussusceptions generally affects the terminal ileum; as a result the terminal ileum has been found to enter the cecum. Exploring more, according to the Tate et al., (2016), due to the invagination of the intestinal loop, there is a distinct peristaltic action that pulls the proximal part of the intestine inwards, towards the distal part creating the obstructive loop. The manifestation of this condition is facilitated mainly by the obstruction of blood supply. In severe cases it can lead to a life threatening condition called ischemia in the bowel tissues deprived of oxygen and leads to tissue necrosis. The mucosal cells that generally line the intestinal tissues are very sensitive to the oxygen deprivation in this condition and they react by casting off towards the gut region causing further blockages. This phenomenon leads to the most indicative symptom of the intussusceptions which is the red jelly like stool due to the entry of blood and mucosal secretion into the urine facilitated by the obstruction (Chien et al., 2013).

Case Study: Jay’s Diagnosis of Intussusceptions

Intussusceptions can be considered as a rather common occurrence among the infants and children by the age of 1 to 2, however, this health adversity requires a targeted patient centered care plan. The first and foremost role of the nursing professional will be to perform an ultrasound or any other related abdominal imaging to reveal the severity or extent of the intestinal obstruction and whether it will require surgical intervention or not. After the ultrasound that was carried out in the facility, the most preferable intervention was contrast enema to correct the intussusceptions (Riera et al., 2012). However, until then the patient will remain under nursing care. The responsibility of the nurse would be to observe the patent for any signs of deterioration, electrolyte balance monitoring and intravenous therapy administration and monitoring. 

Nursing care is multidimensional, there are various different factors that is needed to be considered when planning and implementing care for different patient populations belonging to different age groups. Especially for the paediatric patients, it is crucial for the nurse to understand the developmental context of the child that is in the care scenario to ensure optimal health and welfare outcome for patient. According to the Yih et al. (2014), chronic illness or hospitalization can have a great impact on the growth and development of the child. Hence the care plan must address the developmental needs of the child to ensure minimal impact. There are various growth and developmental theories that can be taken into account. According to the developmental theory by Piaget, there are different stages of development; the age group of 1 to 24 months is the sensorimotor stage, is the time where the child learns to have some perception regarding their body and the state it is in (Beilin & Pufall, 2013). As the patient under consideration Jay is in the sensorimotor stage, he will also be able to have perception regarding the state of pain that he is in. Along with that, in this stage the children are also able to gain a clear idea of the external environment that the child is in, and they attempt to initiate actions that will attempt to change the movement. Hence, Jay will also be able to understand and feel the foreign environment that he is in and he might react with agitation and irritation. And hence, the nursing professional will need to handle the child with utmost compassion and care with the child so that he is comfortable and least anxious.

Exploring the Pathophysiology of Intussusceptions

Family centered care can be defined as one if the most vital concepts of patient centered care concepts which allow the family to be involved into the care planning and implementation. This is an extremely beneficial framework that facilitates effective and efficient information sharing among the patient family members and the nursing professionals that are providing the care. According to the Weintraub et al. (2014), for a care program to be holistic and patient centered the health care professionals will have to take into consideration the preferences and opinions of the family members of the patients. It has to be mentioned the optima benefit of the construct of family centered care is extracted in the pediatric care scenario. The impact f family is optimal in the life of the child; hence it is also crucial for the health and wellbeing of the child that the family members, especially the parents be involved in each and every step of the care plan and the decision making process (Enane et al., 2016).

The most important aspect of a family centered acre is involving the family of the patient, their values, principles and culture, with the care plan that the nurse is going to prepare for the child. It has to be mentioned that while adapting to the family centered care approach for Jay, the patient under case study, the nurse will have to listen and understand the family’s concerns and preferences regarding the health and welfare of the child (Davidson et al., 2017). The nurse will have to educate and inform the parents regarding each and every step of the care process and how it will benefit their child so that they are least anxious and are most informed. The nurse will also have to consider all the different aspects of their familial culture and values and with utmost cultural safety attempt to include them with the care program.

It has to be mentioned that hospitalization has a significant psychological impact on the patient and the family members of the child as well. Most importantly in case of the pediatric patients, the impact of hospitalization is mostly negative on the behavior and emotional state of not only the child but also the family of the child. It has to be understood that most impact is imposed by the loneliness and separation which effects both the child and the mother, and this negative psychological impact can lead to irritability, agitation, anxiety and depression. In this case the patient in case study, Jay had been suffering from intussusceptions due to rotavirus vaccination that was given to the child, and he had been in extreme pain (Davidson, 2017). The loneliness, foreign environment and separation from his mother at this tender age can agitate him, the nurse will have to ensure compassionate care and motherly affection for the child to calm him. His mother had been very anxious as well, questioning the benefits of vaccination in future. The nurse will have to engage in a therapeutic relationship with his mother and educate her regarding the necessity of vaccination for her child. Along with that the nurse will also have to inform her about the prevalence of intussusceptions and of the progress in her son’s health to reassure her of the benefits of health care interventions (Paul, 2016).

Conclusion:

On a concluding note, it has to be mentioned that pediatric care is complex and there are different factors that needs to be considered while planning and implementing pediatric care. In this case Jay had been an infant diagnosed with intussusceptions, which is a common yet severe health condition required specialized care. However the nurse’s responsibility is extended towards providing family centered holistic that facilitates normal development of the child. Hence extra attention and care is mandatory for pediatric care. 

References:

Beilin, H., & Pufall, P. B. (Eds.). (2013). Piaget’s theory: Prospects and possibilities. Psychology Press, 107-140.

Chien, M., Willyerd, F. A., Mandeville, K., Hostetler, M. A., & Bulloch, B. (2013). Management of the child after enema-reduced intussusception: hospital or home?. Journal of Emergency Medicine, 44(1), 53-57.

Committee on Infectious Diseases. (2014). Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics, 134(2), e620-e638.

Davidson, J. E. (2017). Family-Centered Care. AACN advanced critical care, 28(2), 136.             

Davidson, J. E., Aslakson, R. A., Long, A. C., Puntillo, K. A., Kross, E. K., Hart, J., … & Netzer, G. (2017). Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Critical care medicine, 45(1), 103-128.

Enane, L. A., Gastañaduy, P. A., Goldfarb, D. M., Pernica, J. M., Mokomane, M., Moorad, B., … & Steenhoff, A. P. (2016). Impact of rotavirus vaccination on hospitalizations and deaths from childhood gastroenteritis in Botswana. Clinical Infectious Diseases, 62(suppl_2), S168-S174..

Paul, T. (2016). “Nothing About Us Without Us”: Toward Patient-and Family-Centered Care. AMA journal of ethics, 18(1), 3-5.

Riera, A., Hsiao, A. L., Langhan, M. L., Goodman, T. R., & Chen, L. (2012). Diagnosis of intussusception by physician novice sonographers in the emergency department. Annals of emergency medicine, 60(3), 264-268

Tate, J. E., Yen, C., Steiner, C. A., Cortese, M. M., & Parashar, U. D. (2016). Intussusception rates before and after the introduction of rotavirus vaccine. Pediatrics, 138(3), e20161082.

Walter, E. B., & Staat, M. A. (2016). Rotavirus Vaccine and Intussusception Hospitalizations. Pediatrics, e20161952.

Weintraub, E. S., Baggs, J., Duffy, J., Vellozzi, C., Belongia, E. A., Irving, S., … & Jackson, L. A. (2014). Risk of intussusception after monovalent rotavirus vaccination. New England Journal of Medicine, 370(6), 513-519.

Yih, W. K., Lieu, T. A., Kulldorff, M., Martin, D., McMahill-Walraven, C. N., Platt, R., … & Nguyen, M. (2014). Intussusception risk after rotavirus vaccination in US infants. New England Journal of Medicine, 370(6), 503-512.