Pediatric nursing is developed to provide nursing assistance to pediatric clients and their families with the best use of nursing meta-paradigm. The NFDN-2005 nursing foundations provide care assistance to the process of growth and development of the nursing care for the paediatrics. This study will describe the effectiveness of pediatric nursing care to nullify the traumatic problems of nursing. The study will be developed into two parts. The first part will initiate a case study that will be developed chronologically based on the traumatic problems of the pediatric patients. The second part analyzes the reasons and solution of the problems through pediatric nursing, therapeutic communication and teaching and learning process. The legal and ethical issues will also be described based on the nursing process and meta-paradigm. The concluding part will summarize the whole discussion and will focus on the effectiveness of pediatric nursing for pediatric trauma care.
The case scenario of the pediatric care is capable to unfold the detail of the injury that has led the patient to the traumatic situation. An emergency care treatment is always required for the trauma injury patient to mitigate the initial risk factors associated with traumatic nursing (Plog et al., 2015). The case is as follows:
Jerome is a 2 years old boy who was sitting on the lap of his mother at the backseat of the car. While sitting at a stoplight, the car was suddenly hit by another car which was chased by the city police. With the sudden shock of the accident the mother needed to put her hands out of fear to save herself and the baby boy was thrown down on the floor under the passenger side dashboard. The car was damaged badly and the parents went unconscious stuck by the windscreen. The baby boy was found crying at the scene and was unable to move his lower extremities.
The baby boy was sent to the local pediatric hospital where he had undergone some initial treatment. It was found after a chain treatment process that his right ankle was totally dislocated. The caregivers quickly sent him for the CT scan and were found an intraventricular hemorrhage in his skull fracture. However, the chest position was normal. The intraventricular hemorrhage signifies a little paralysed mental order and a little malfunction in the narcotic elements (Bolisetty et al., 2014).
The emergent laparotomy report suggests that the emergency blood report of the patient. The report has shown that the patient had
Moreover, the report also stated that the baby boy was having additional fluid resuscitation and he needs a place of his left chest tube. A longitudinal aortotomy and a circumferential of intima were noticed in his body that has led the level of his mental disorder to traumatic transection of terminal ileum due to the de-vascularized bowel.
The patient was then sent to the pediatric intensive care unit. He was almost in the comatose situation. He has genuinely required an immediate increase in the oxygen level to improved his brain function. Moreover, an adequate development of circulatory volume was required to optimize the cognitive development (Cook et al., 2017). A great increase in the ICP level was required for adequate development of his paralysed situation. Mannitol, dexamethasone and narcotic treatment went failure for the development of the cognitive health of Jerome. No further improvement of his brain health was noticed. The traumatic situation of Jerome was continuously deteriorating so as a constant decline in his brain function. The platelet level was deteriorated to the level of 109 from 208 and the level of INR was declined to 1.17 from 1.58. A profound respiratory failure was found in Jerome which results in hypoxemia and again moved to Frequency Oscillatory Ventilation (HFOV). Moreover, the respiratory bias gas flow was declined to 20ml/minute where the normal level is 30 to 60ml/minute. Hence, the medical reports of Jerome have shown that there are 58% of the aneurisms, 10% of the aortic rupture 15% of the intimal tear with occlusion and 17% of the intimal acute injury.
The respiratory frequency was lowering even in the ventilation and the pressure of amplitude was declining due to buck flow. The symptoms of barotrauma were further developed in Jerome which was found in the observation after 21 days. After 30 days of the observation, the barotrauma was developed to volutrauma. The symptoms found in the volutrauma are alveolar over-distension that is distributed to the compliant lung. The volutaruma resulted in atlectruama due to the parenchymal injuries. The parenchymal injuries resulted in the constant collapse of the distal airways. Thus, the change in the traumatic situation signifies the deterioration of the traumatic process of Jerome.
The trap under the dashboard promoted the severity of the traumatic injury. Jerome was found crying in that situation that had also affected his mental health. The little delay in the rescue operation promoted his traumatic situation which was ascending its stage as per the severity standard. Jerome presently requires not only medication and chain of medical tests. Instead, he also requires effective nursing care and self-motivated approach from the caregivers to promote his betterment.
Problem description
Accidents generally carry the largest responsibilities to the pediatric trauma. Around 25000 pediatric traumatic cases are the resultant of the car accident in Canada (“Home – Trauma Association of Canada”, 2018). As mentioned in the case study the patient is under severe trauma due to the road accident while travelling with his parents. He had knee fracture and intraventricular hemorrhage that led him to the narcotic malfunction. The narcotic malfunction results in a constant decline in his brain health (Benedict et al., 2013). The initial test reports signified that his platelet, Ptt, pt and INR level was normal. However, the situation declined after 10days of the observation. He was suffering from several acute levels of trauma (Lynch, DeHart, Belknap & Green, 2013). The change in traumatic level signifies the constant deterioration of the mental and physical health. Moreover, it results in a comatose situation that may signify the early brain death.
The intervention process for the pediatric trauma is a time-consuming process. The intervention process must be aligned with the current situation, the severity of the situation and required time for a definite care (Gaudine & Beaton, 2016). The nursing care staffs must communicate the patients and their family properly to record the pediatric trauma score end injury severity scores. The comatose situation can be developed by the physiotherapy and mental assistance (Wesson et al., 2013). As mentioned in the case study, the patient, the patient genuinely requires integral care and physiotherapy in order to mitigate the risks of brain death.
The role of the nurses for the situational development of the pediatric trauma care is to set the tone for ethical care (Anbanad, Singh & Kapoor, 2013). The patients must be soft-spoken to the pediatric patients. The caregivers of the pediatric hospital must communicate Jerome in a soft and quiet manner. He requires a constant mental support and satisfaction for the development of the care process. The attitudes must be composed that can nullify the level of anxiety to the pediatric patients (Anbanad, Singh & Kapoor, 2013). This could be helpful for Jerome develop the cognitive function by reducing the level of anxiety (Schauer & Elbert, 2015). Pediatric surgeries must be conducted after evaluating the EM evaluation. The report of the EM evaluation must be communicated according to the ATLS protocol (Gaudine & Beaton, 2016). The nursing caregivers should be aware of the trauma alert notification of Jerome. This would enable them to convey a rapid mobilization of pediatric trauma care (Anand et al., 2013). Furthermore, the nursing personnel must communicate with the parents of the patients’ family. However, Jerome’s father must be informed all the care process and required elements of effective care (Gaudine & Beaton, 2016). Thus, a comfort and formidable communication with the patients and his family can provide an effective outcome. Apart from that, in case of any comatose situation, a gentle application of physiotherapy could be beneficial to increase the blood circulation in the nerve cells (McDonald, Code & Togher, 2016). Hence, proper dietary advice should be advised to increase the platelet level. Papaya, apple and guava must be provided in the diet chart of the traumatic patient (McDonald, Code & Togher, 2016). Low-fat foods and fruits are capable to increase the level of the platelet. Apart from the diet and medicine, communication and physiotherapy, gentle behaviour and parental assistance are also required for Jerome.
The parents of the child must be informed about the detail care process. They must be assured with quality care for their child (Gaudine & Beaton, 2016). Thus, a communication with Jerome’s parents must be developed for the effective outcome of the process. The information towards the parents can also be beneficial to make them stress-free (Ball, Murrells, Rafferty, Morrow & Griffiths, 2014). Jerome’s father must be assured that of the proper treatment process of Jerome that is helping him to get rid of from his traumatic and comatose situation. The ethical perspective of informing the child’s parents considers the ethical process o the nursing care (Gaudine & Beaton, 2016). The constant flow of information is effective for the quality care improvement of the pediatric trauma.
The traumatic situation of the child affects strongly the mental health of the child’s family. This may result in severe cognitive impairment or permanent mental illusion (Freud, 2013). The as mentioned in the case study, Jerome;’s mother was shot dead after the accident with immediate reaction. However, Jerome’s father went into a traumatic situation on hearing the deteriorating condition of her son. Thus, the immediate effect of the pediatric trauma can lead the parents of the child to severe cognitive decline (Villemagne, 2013) . However, it is the ethical duty of the nursing staffs to take initiative to mitigate the sudden mental tremor of the parents of the patients. Proper communication must be kept in order to heal the aftershock of the patient’s family.
The legal and ethical perspective of the pediatric trauma care defines an autonomous care to the patients. The caregivers must be efficient enough to provide care through an autonomous will. An every time observation is essentially required for trauma care (Villemagne, 2013). Thus, the nursing caregivers of the pediatric hospital must provide non-maleficence and beneficence care to the Jerome for his quick recovery (Villemagne, 2013). The autonomy enables the patients individual freedom, non-maleficence and beneficence uphold the obligation of not to harm and protecting the right of the patients. Moreover, justice must be practised as per the Canada Health Act (1984) in the ethical care Jerome. Thus, the effective maintenance of the nursing care principles can promote the trauma recovery process of the trauma patients (Varcarolis, 2016).
The discussion of nursing meta-paradigm defines the articulation of relationship among four care principles; person, environment, health and nursing. The nursing meta-paradigm can be conceptualised through Virginia Henderson’s theory.
Conclusion
The study has emphasised on the pediatric trauma and traumatic care. A case study has been developed that has defined a car accident faced by 2 years old boy Jerome and his parents. Jerome was admitted to pediatric hospital and his mother was sport dead. Jerome had severe ankle fracture and intraventricular hemorrhage that leads him to severe stages of trauma. Effective care treatment and various nursing care perspectives have been discussed for his betterment care. The proper maintenance of all the care process can provide an effective outcome.
Reference List
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