Essay On Care Plan

In this study, a thorough pediatric nursing care plan would be discussed based on a patient case study. With an emphasis on pediatrics and the clinical treatment of children from infancy to adolescence, pediatric nursing is a subspecialty of the nursing profession. As a result of the growth as well as development that take place during childhood, children's health differs from that of adults, making this a crucial field. While caring for the pediatric patients, nurses must follow the approach of family centered care as the family members of the pediatric patient as the patient is not able to take the decisions.  In this case, a detailed discussion of nursing assessment, planning, implementation, and evaluation would be done based on a pediatric patient case study, named as Easton who is 6 months old. The problem that can be seen in this context is child fever or sepsis pathway.

 

Family-focused care is one of four strategies that offers a broad perspective on working with families and children. Assistance for children with specific needs as well as their families are comprised of a combination of principles, attitudes, and practices known as family-centered service (Berger & Font, 2015). Since, Easton is only 6 months old and still breastfeeding as he is not eating solid foods, hence her mother must be included into the treatment plan. Moreover, as a part of the family centered care the mother of the patient must be informed about the condition and must be educated to improve the overall patient condition.

From the case details it can be seen that Easton is suffering from fever and the body temperature is quite high which is 39.8 C. His heart rate is rapid and excessively fast, rate of capillary refill is 3 sec. In addition, it can also be known that his hands were cool along with his feet and the appearance of him was a mottled one. From the symptoms it can be stated that he has acquired a condition of sepsis. From the pathophysiological perspective of the disease in the children it can be stated that, when an infectious stimulus or vaccine causes a localized inflammatory response that spreads to generate systemic symptoms like fever or hypothermia, it is called sepsis. The systemic inflammatory reaction disorder is the name given to these clinical signs. The generation of cytokines from macrophages and neutrophils such as tumour necrosis factor-alpha, inflammatory cytokines, as well as prostaglandins, mediates the inflammatory response (Jarczak, Kluge & Nierhaus, 2021). The cytokines suppress fibrinolysis while triggering the extrinsic coagulation cascade. Additionally, both inflammatory and anti-inflammatory mediators play a part in sepsis, and an imbalance of either can have a negative impact on patient outcomes.

 

 

The primary educators of hyperthermia nursing knowledge are nursing staff since they are the healthcare workers that engage most frequently with patients' parents and children while they are in the hospital (Toney-Butler & Thayer, 2022). By interacting the parents of the children, the family centered care approach is actually implemented and that would be applicable while caring process for Easton.

 

 

1. The first assessment that could be done by the nurse in this case is to assess the signs of the fever. They should assess the signs and symptoms of sepsis, incorporating weakness, flushed face, rash, tachycardia, respiratory distress, malaise. Since Easton is an infant, hence the nurse must monitor for the sweating report, if the skin is hot and dry, or warm (Schneiderbanger et al., 2014).

 

 

2. The following assessment could be checking the dehydration condition of the patient. It has been seen that dehydration is very common in hyperthermia. Nurses must assess the indications of dehydration, furrowed tongue, dry oral membranes, dry lips, urine output, poor skin turgor, decreased increased urine concentration and, fast pulse.

 

 

3. Frequently assessing the heart rate and respiratory rate is mandatory in this pediatric care. The rationale behind this assessment is that the heart rate of the patient was very high and irregular.

 

 

4. The following nursing assessment could be assessing the body temperature every hour, as often as recommended, or whenever the patient's condition changes, take an accurate temperature reading (Schneiderbanger et al., 2014). Making correct treatment recommendations and identifying temperature trends will be made easier by using a constant temperature measurement technique, location, and tool. If needed, use two different temperature monitoring modes. Compared to core temperature measures, all non-invasive methods for determining body temperature have both precision and accuracy variations that are specific to each kind and method.

 

 

As a part of the pediatric nursing as well as family-centered nursing it is crucial that the nurse must involve the parents on the planning process. In this context, the plan that the nurse could take in to stabilize the condition of Easton are:

 

The first objective or the plan that was established is related to the increased body temperature of the patient and the aim was to: Stabilizing the body temperature of Easton within 37 degrees Celsius within 4 hours of the intervention.

 

The following nursing goal that has been established in this context is that: “Reducing the body fluid deficit in the patient’s body and helping the patient in regaining the normal body fluid level within 4 hours – 6 hours from intervention started.

 

The nurse executes the treatment plan throughout the nursing procedure' implementation phase. It entails taking action or executing and executing out the intervention strategies specified in the care plan (Toney-Butler & Thayer, 2022). In this case of Easton, the intervention that was developed and need to be implemented are mentioned below:

 

1. The first intervention could be assisting all the signs within 4 hours. The rationale behind this intervention could be it might help the nurses and physicians to make an accurate diagnosis, and effectivity of the drugs administered.

 

 

2. Nurses must administer the anti- pyretic medication and antibiotic medication that is prescribed for high fever. The rationale behind this intervention is that usage of the antipyretic medication has been very effective in reducing the high temperature by stimulating the hypothalamus (Ma et al., 2021), whereas antibiotics are often prescribed to pediatric patients to treat bacterial infection (Karinauske et al., 2018).

 

 

3. Removing excessive clothes or blankets from the patient and helping to adjust the room temperature. The rationale is that this might help the patient by effectively regulating the body temperature with the environment and giving comfort to the infant (Wasserman, Creech & Healy, 2017).

 

 

4. Since the capillary rate is 3 and a symptom of frequent urination has been seen in Easton, hence intravenous therapy could be applied. It has been seen that intravenous therapy could replenish the fluids that were lost because of urination or other processes (Castera & Borhade, 2018).

 

 

5. Another major plan would be educating the parents of the patient to maintain the fluid level in the body as the parents are the responsible ones who can take care of the infants or pediatric patients

 

 

A successful patient outcome depends on this last nursing step. Any time a healthcare professional intervenes or administers treatment, they must conduct a follow-up assessment or evaluation to make sure the intended result was achieved. Depending on the overall state of the patient, frequent reassessments may be required. Based on fresh evaluation results, the care plan may need to be modified (Toney-Butler & Thayer, 2022). In this case, as a part of the pediatric nursing process and care plan the nurses must assess or evaluate the patient condition by monitoring the vital signs and dehydration status of the patient. The positive outcome or positive evaluation could be obtained if the fever or body temperature of the patient is reduced and falls below 37-degree C. Another positive indication of the nursing intervention could be improved body fluid condition of the patient and reduced dehydration condition.

 

As a part of the family-centered care process, it is very important to consider the well-being of the family. While treating an infant like Easton, the needs of the family must be addressed. In the case of Easton, it can be seen that both his parents are very concerned and hence they must be informed consistently about their child and the treatment strategies which would promote family wellness.

 

A spiritual history of the patient and their family invites discussion about morals and principles, shows coping strategies and support networks, reveals both effective and ineffective spiritual coping, and offers a chance for tenderhearted care. Moreover, as a part of family-centered care, the doctors and nurses must listen to the family about their values, beliefs, and other facts which could be beneficial for pediatric care.

Since Easton is 6 months old, hence the preference of his parents and their opinion values the most. The nurses and other practitioners must get informed consent before proceeding with any treatment program to avoid any legal complications and promoting ethical principles of nursing

 

In this study, a thorough pediatric nursing care plan was described, in which the main focus was on pediatric nursing, which is a subspecialty of the nursing profession. The nursing care plan was focused on Easton, who was suffering from fever and his body temperature was quite high was 39.8 C. The goal of the nursing care plan was to reduce his increased body temperature, then minimize the dehydration and maintain normal fluid status in the body. To achieve these goals the nurses must administer the anti- pyretic medication and antibiotics, remove excessive clothes or blankets from the patient to maintain temperature gradient, administer intravenous fluid therapy for maintaining the normal fluid level in the body, and educating the parents of the patient to take care of the patient post-discharge as a part of the family-centered care.

Berger, L. M., & Font, S. A. (2015). The Role of the Family and Family-Centered Programs and Policies. The Future of children, 25(1), 155–176. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342196/

 

 

Castera, M. R., & Borhade, M. B. (2018). Fluid Management. https://www.ncbi.nlm.nih.gov/books/NBK532305/

 

 

Cleveland Clinic. (2022). Hyperthermia: Symptoms, Causes, Treatment and Recovery. Cleveland Clinic. Retrieved 4 August 2022, from https://my.clevelandclinic.org/health/diseases/22111-hyperthermia#:~:text=What%20is%20hyperthermia%3F,is%20about%2098.6%20degrees%20Fahrenheit.

 

 

Jarczak, D., Kluge, S., & Nierhaus, A. (2021). Sepsis—pathophysiology and therapeutic concepts. Frontiers in Medicine, 609. https://doi.org/10.3389/fmed.2021.628302

 

 

Karinauske, E., Kasciuskeviciute, S., Morkuniene, V., Garuoliene, K., & Kadusevicius, E. (2019). Antibiotic prescribing trends in a pediatric population in Lithuania in 2003-2012: Observational study. Medicine, 98(46), e17220. https://doi.org/10.1097/MD.0000000000017220

 

 

Ma, L. L., Liu, H. M., Luo, C. H., He, Y. N., Wang, F., Huang, H. Z., ... & Zhang, D. K. (2021). Fever and antipyretic supported by traditional Chinese medicine: a multi-pathway regulation. Frontiers in Pharmacology, 12, 583279. https://doi.org/10.3389/fphar.2021.583279

 

 

Schneiderbanger, D., Johannsen, S., Roewer, N., & Schuster, F. (2014). Management of malignant hyperthermia: diagnosis and treatment. Therapeutics and clinical risk management, 10, 355. https://doi.org/10.2147%2FTCRM.S47632

 

 

Toney-Butler, T. J., & Thayer, J. M. (2022). Nursing process. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499937/

 

 

Walter, E. J., Hanna-Jumma, S., Carraretto, M., & Forni, L. (2016). The pathophysiological basis and consequences of fever. Critical care (London, England), 20(1), 200. https://doi.org/10.1186/s13054-016-1375-5

 

 

Ward, M. A. (2019). Fever in infants and children: Pathophysiology and management. UpToDate [Internet]. https://www.medilib.ir/uptodate/show/5989
Wasserman, D. D., Creech, J. A., & Healy, M. (2017). Cooling techniques for hyperthermia. https://www.ncbi.nlm.nih.gov/books/NBK459311/