The Child Client - Question 1

According to Locke et al. (2016), patients with a high level of illness should have access to relevant healthcare setting. The patients of emergency departments should be provided with appropriate facilities. It is also assumed that the quality of care for pediatric patients should be in regular continuity and timely access to services or care should be available for the patient. In this case, as the patient is a 6 months old baby girl named Prati and she was presented to the emergency department (ED) with lethargy and pallor. Since she was in a critical condition with continuously vomiting and was diagnosed with oesophageal stenosis. For such a small baby it is important to consider the form of care chosen for the family-centered care for her in this case because a 6-months old baby girl cannot speak up and tell the pain and sufferings of the issues she is going through. The involvement of her mother here plays a key role because the mother can take care of her child with utmost concerns and alertness. The importance of family-centered care in the pediatric patient is of great concern.

According to Byczkowski et al. (2016) found that the role of family-centered care in pediatric patients not only acknowledged the efforts of health professionals but make the family an important constant in the life of the pediatric patient. This also improves the collaboration among the patient, his/her family, and health care staff members. Specifically, in the cases of pediatric patients, the family members or the parents of the patient are always willingly available for their contribution to their child’s health improvement and in medical decision making. The authors found that if the patient and family-centered care is established then the families are comparatively more satisfied with the care being provided to their child than those families who were not provided with the benefits of patient-centered care services.

The patient Prati in this case is not originally Australian as her name and her parent's name seems to be of non-Australian citizen thereby; the medical policies for a migrant would be different than those for the original citizens of the country. According to Migration Council Australia (2015), the migrants who are from non-English speaking countries face many barriers like cultural barriers and language barriers, to access the medical facilities, information, and related services. Although there are many barriers majorly due to cultural and language barriers, access to health services and information is quite difficult for migrants that are not originally Australian. This results in less involvement in health services and related information or facilities. Yet in Australia, almost all the migrants get access to good health services and facilities after their arrival into the country in comparison to the original citizens of Australia. But they are made available to these services only if they complete the 104 weeks of the waiting period. The migrants with 457 visa are supposed to have their private health insurance because they are not made available with any help under Medicare. Moreover, many other migrant populations are unwilling to use the health services that are available for them, due to perceived racism, cultural differences, misunderstandings, or misconceptions concerning the facilities.

The Child Client - Question 2

The registered nurse Lee stopped the feeds for some time but then resumed it, although she managed the NG feeds overnight in response to the patient’s vomiting. She also noticed that Prati is pale but did not take any actions like informing Dr. Boucher, thus putting risk to the patient’s safety. Moreover, it was stated that the observations were documented every 30 to 60 minutes, but actually, the health staff was reviewing the patient 1-2 hourly. This possesses Prati to high health risks that might have been resolved if assessments were done and analyzed timely. Another issue in Prati’s case was as she is a 6-months old baby girl it is highly recommended to check and assess every detail of her vital signs because she cannot speak up about her pain and sufferings. According to Perkins et al. (2016), the establishment of fluid and electrolyte balance in the pediatric patient is a very crucial point whiles their health care management in the cases where the patient vomits repeatedly or loses body fluids.

The electrolyte and fluid therapy are very important in the case of the dehydrated pediatric patient. The fluid therapy is split into three parts deficit, maintenance, and replacement requirements. Not only this, but fluid therapy is also found to have impacts on drug therapies as well. Physiology related differences play a key role in fluid therapies. Once, the therapy has begun it is required to conduct regular assessments to make necessary changes as required according to the patient’s needs. Besides this, no pain assessment was performed by Lee as she thought that the baby is not exhibiting any pain symptoms or signs. The nurse did not convey the severity of the situation and was only waiting for Dr. Boucher to come and analyze the situation that appears a problem to harm the patient’s health and worsen her condition.

 Prati showed signs of severe dehydration and hemodynamic instability because the nurse took no steps even after knowing about her fluid intake-output imbalance issues. The hemodynamic instability symptoms are decreased urine output, restlessness, chest pain, loss of consciousness, and pale and cold skin. All these faults can together harm the oxygenation levels, circulatory issues, lethargies, and fluid-electrolyte imbalances. These will ultimately increase the severity of the case and the major negative impact on body organs and functioning. If proper measures and steps would have been taken then, the hospitalized for 3 more days might not be recommended. According to Kuiper et al. (2016), hemodynamic monitoring is the prime step in the cases when the patient is not stable hemodynamically. During hemodynamic monitoring, the first step is to report the physician regarding the upcoming cardiovascular issues that later might result in major injuries in vital organs. The main goal is to detect adequate oxygenation levels and tissue perfusions as early as possible so that the patient’s case could be handled before it enters the critical stages. The results should be reproducible and reliable because it also required to analyze the response to the therapy in cases with cardiovascular-related issues.

The Child Client - Question 3

According to Häggman-Laitila et al. (2016), evidence-based studies are very important. The concept of evidence-based practice is to provide health staff members with the power to source, identify, and integrate the pieces of evidence into decision making. As Prati was repeated vomiting that results in her hemodynamic instability which could be treated with electrolyte-fluid therapy. According to Locke et al. (2016), if the patient is suffering from dehydration then the initial steps include generating clinical stability for the patient so that they achieve fluid-electrolyte balance. Often, oral or intravenous administrations will help in resolving vomiting issues. The morning shift nurse Sharma also found that Prati was pale, lethargic, and had decreased bowel sounds because she was having episodes of vomiting and did not seem to be tolerating oral fluids. IV access was not provided to the patient that could have balanced her instability.

 According to Shields & Lightdale (2018), vomiting may not present the actual emergency but in some cases, if there is a huge loss of fluid from the body of the patient then in such cases severe abnormalities of electrolyte balance and dehydration including hypokalemia may occur. One of the approaches to organizing the diagnosis of vomiting in a pediatric patient can be a symptom. Like in the case of Prati the vomit was yellow-tinged when on clear fluids. According to Tello & Perez-Freytes (2017), the color of the vomiting can give useful insights into the patient’s conditions. The yellow-colored vomit represents the abnormal backward flow of the digested bile from the gut. The practice of evidence-based involves critical thinking and have five important steps: first, information is reframed into answers of the questions, second is, coming up with the best evidence to solve and answer the questions or queries, third is, for ensuring the validity of the evidence it is critically appraised, fourth is, the results obtained from appraisal are applied to medical practice, the fifth is, evaluation of the performance. In the case of Prati, if the nurse has provided her with timely assessments without any delay then her health would have improved and there was no need for her to stay in the hospital for the rest of three days. So the role of nurses in patient safety is a key point that has the potential to either improve or worsen the patient’s health.

According to Foronda et al. (2016), effective communication among the nurses and their other health staff officers can highly impact patient’s safety and care. Moreover, they should timely take actions and give complete details and related information about the patient to the other doctor or health care staff member this ultimately helps in improving the health status of the patient. According to Häggman-Laitila et al. (2016), nurses play a major role in providing patient safety. The concept of patient safety involves no potential harm or undesired patient harm. A proper patent safety care provided to the patient can strengthen his/her health status and reduce the chances of harm to the health or the environment of the patient.

The Child Client - Question 4

According to Smith et al. (2015), the multidisciplinary team includes nurses, social workers, podiatrists, and many others. This team with the help of the patient’s parents manages the care of the patient. This enables the parents and health care providers with multiple chances to interact among themselves and exchange their feedbacks resulting in improved and effective care to the patient. This approach of the multidisciplinary team helps in embracing the quality of health care provided to the child by shared caring with the involvement of their parents. A multidisciplinary intervention identifies the need of the parents and supports the parents.

In the case of Prati, the nurses were allotted one for night shift and other for the morning shift for the baby. The multidisciplinary team ensured that referrals were made to support services to ensure ongoing care and support. They taught the parents of Prati about how to use NG tubes for her at home so that they can take care of their child in their home effectively. The parents actively participated in taking care of their child by getting involved in decisions making steps for the child because the child is too young to make decisions for herself. According to Shields & Lightdale (2018), pediatrists provide help to the patients by full-time services in the hospitals or by providing guidance or services on call if the patient is in her home. Pediatrics provides care by working in clinics or giving community care services. According to Byczkowski et al. (2016), mutual communication between the parents and the nurses to build trust and cooperation. This also reduces the stress and anxiety that develops in the mind of the parents those have to hospitalize the child.

References for The Child Client

Byczkowski, T L, Gillespie, G L, Kennebeck, S S, Fitzgerald, M R, Downing, K A & Alessandrini, E A 2016, ‘Family-centered pediatric emergency care: A framework for measuring what parents want and value’, Academic Pediatrics, vol.16, no. 4, pp. 327–335. doi:10.1016/j.acap.2015.08.011 

Foronda, C, MacWilliams, B & McArthur, E 2016, ‘Interprofessional communication in healthcare: An integrative review’, Nurse Education in Practice, vol. 19, pp. 36–40. doi:10.1016/j.nepr.2016.04.005

Häggman-Laitila, A, Mattila, L R & Melender, H L 2016, ‘Educational interventions on evidence-based nursing in clinical practice: A systematic review with qualitative analysis, Nurse Education Today, vol. 43, pp. 50–59. doi:10.1016/j.nedt.2016.04.023

Kuiper, J W, Tibboel, D & Ince, C 2016, ‘The vulnerable microcirculation in the critically ill pediatric patient’, Critical Care, vol. 20,352, viewed 13 July 2020, https://doi.org/10.1186/s13054-016-1496-x

Locke, T, Rekman, J, Brennan, M & Nasr, A 2016, ‘The impact of transfer on pediatric trauma outcomes’, Journal of Pediatric Surgery, vol. 51, no. 5, pp. 843–847. doi:10.1016/j.jpedsurg.2016.02.035 

Migration Council Australia 2015, ‘The health outcomes of migrants: A literature review’, viewed 13 July 2020,

http://migrationcouncil.org.au/wp-content/uploads/2016/06/2015_Smith.pdf

Perkins, J, Aguado-Lorenzo, V & Arenas-Lopez, S 2016, ‘Standard concentration infusions in paediatric intensive care: The clinical approach, Journal of Pharmacy and Pharmacology, vol. 69, no. 5, pp. 537–543. doi:10.1111/jphp.12604 

Shields, T M & Lightdale, J R 2018, ‘Vomiting in children’, Pediatrics in Review, vol. 39, no. 7, pp. 342–358. doi:10.1542/pir.2017-0053 

 Smith, J, Swallow, V & Coyne, I 2015, ‘involving parents in managing their child’s long-term condition—A concept synthesis of family-centered care and partnership-in-care’, Journal of Pediatric Nursing, vol. 30, no. 1, pp. 143–159. doi:10.1016/j.pedn.2014.10.014 

Tello, L & Perez-Freytes, R 2017, ‘Fluid and electrolyte therapy during vomiting and diarrhea’, The Veterinary Clinics of North America, vol. 47, no. 2, pp. 505–519, , viewed 13 July 2020, https://doi.org/10.1016/j.cvsm.2016.09.013

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