Integrated Nursing Practice
Miss Amelia Taylor is a four-year-old female who has reportedly been suffering from asthma for some time as depicted from her previous hospital admissions and medical reports. Upon interviewing her mother, it is evident that the child has no succinct asthma management plan. As such, she is only given Ventolin when her mother depicts signs of asthma affecting the child. Upon evaluating the medical records, it is evident that both Amelia’s parents had discussed with the respiratory nurse on ideal asthma management plan before discharging Amelia. Therefore, it is evident that the parents may be ignorant or still not yet well informed about the management plan. Besides, the child seems to be hopeless about her treatment since she is teary and clings to her mother without answering questions as it would be expected. Her mother also reports on the child’s fear of having an IV inserted into her. Based on the prescription, she is to be inserted for IV Hydrocortis. It would be necessary to change the medication this time to realize changes unlike from her previous admissions. Among the nursing priority problems identified include inadequate knowledge which is related to lack of information regarding the treatment, disease process and self-care. According to Shanahan et al. (2013), hopelessness connected to long terms stress is another priority problem pointed out.
Nursing Priority Problem 1
Lack of adequate knowledge regarding self-care and disease process is one of the issues identified from the case. Leung et al. (2015) argue that this is mainly linked to the deficiency of information related to the specific problem. Lack of the information leads to making poor choices regarding the lifestyle changes and the condition. Amelia’s mother states that she does not think Amelia has an asthma management plan. This is one of the reasons as to why the child is frequently admitted to the hospital since the parents are not well informed on the choices to make regarding managing the child’s condition. According to CDC (2017), all the patients with asthma should have an action plan on how to manage their condition. The action plan is considered to be a written plan that is developed with both the patient and the doctor or the caregiver and the doctor that helps to control the condition (Mansfield et al., 2015). In this case, it would be appropriated to engage both the caregiver who include both parents and the child since a four-year-old can understand some of the important information incorporated in the asthma action plan. The action plan is necessary in informing the patient of the daily treatment plan such as they type of medicine to take and the ideal action to take in case of a worsening asthma attack. Such acute exacerbation of asthma depicted by Amelia could even lead to death if not immediately treated (Leung et al., 2015). As such, it is important for both the caregivers and the patient to be informed on the ideal measures to take in case of such exacerbations. Moreover, this will reduce the cases of hospital admissions as depicted from the cases. Such admission accompanied by some treatment such as the use of IV add to the long term stress depicted on the teary child who seems not ready to receive treatment as portrayed by the way she clings fearfully on her mother. Based on the action plan aimed at managing the asthma condition, the caregivers can know when to call a doctor to administer the necessary health services to the patient, when to use the gained knowledge from the discussion with respiratory nurse and when to go to an emergency room (Carroll, Wildhaber & Brand, 2012). It is the role of the caregivers to ensure that the child adheres to the guidelines pointed out in the management plan.
The two priority nursing interventions that I would use in this problem include independent and dependent nursing interventions as discussed by Kenyon et al. (2014). In the independent nursing interventions, I would use actions that I can initiate independently such as explaining the relevance of an action plan to the parents. Using a dependent nursing intervention, I would forward the issue to the appropriate physician to make a plan with both the parents and the child. According to Leung et al. (2015), explaining the relevance of an action plan to the caregivers would be the first step before recommending them to actualize the action plan by consulting the pediatrician asthma physician. The importance of having a management plan is that the patient will be sure on what medication to take and what to do if the symptoms of asthma start showing up (CDC, 2017; Mansfield et al., 2015). The plan is also essential in avoiding hospital admissions as depicted from Amelia Taylor who has had three admissions in the previous six months. As seen in the medical report, the respiratory nurse had discussed with the parents on managing the condition before discharge of the child in the previous admission. However, the parents may have been ignorant on the relevance of the management plan. As such, they may have deemed the paper to be of no use hence wondering the difference the paper could make on the condition of the child. The independent intervention I would use in this case would be educating the mother on the significance of the management plan.
An asthma action plan formulated by a physician in the presence of the caregivers has all the information necessary for looking after the asthma condition well (Leung et al., 2015; Sheares et al., 2015). By adhering to the asthma management action plan, the symptoms will be significantly reduced, and the risk of having an asthma attack will be minimal. Based on the study conducted by Stelmach et al. (2012), having a written asthma action plan is a simple way of preventing asthma into negatively affecting the daily life of a patient and ensuring that the patient remains symptoms free. For a four year child such as Amelia, it is necessary for ensuring that the child can do most of the things that she wants to do but could not do because of her condition. Khan et al. (2014) state that the action plan can help the caregivers and patients understand how to take the medication and when to take the medication in managing asthma. Such incidence is pointed in the case where the patient takes her medication at irregular time which is not recommendable. The patient to Ventolin via her spacer at 6.30 am and paracetamol tablet at 8.00am rather than taking the medication within specified time as per the prescription. Using a dependent intervention, I would urge the parent to consult the physician at least one a year to review the asthma management plan as a way of evaluating how effective this intervention measure works and what needs to be added to ensure that the patient avoids asthma symptoms and any attack witnessed under management plan period (Kenyon et al., 2014). In case the patient is unable to speak as portrayed by Amelia who answers all the questions with either a yes or a no due to either the symptoms or long-term stress, the action plan can be essential in giving the health care service providers information regarding the condition. The intervention plan can be considered to be effective if, upon evaluation of the child after some time, the symptoms are alleviated. A reduction in hospital admissions and doctor’s visits can be used to dictate whether the management plan has served its purpose or not.
Nursing Priority Problem 2
Hopelessness, which Carter and Grant (2012) state to be often related to long-term stress, is another issue pointed out from the case. This is evidenced in the case where the patient fears medical intervention in the hospital where the mother reports that Amelia Taylor dreads and IV. Similarly, the past three admissions within six months my attribute to lack of enough mobilized energy to tackle the challenges brought about by the disease. It is important for the parents to be well informed about the condition and its management. Shanahan et al. (2013) and Amer et al. (2013) opine that motivating the child by giving her hope on recovering from the symptoms and asthma attacks can be an ideal way of ensuring that she mobilizes energy to ensure that the medication alleviates the symptoms. Amelia’s respiratory rate and heart rate are beyond the normal which should be 25- 35 breaths per minute and 60-100 heart beats per minute (Wildhaber, Carroll & Brand, 2012). This depicts that the symptoms are negatively impacting on the child which leads to deterioration in her health. The priority nursing interventions to take in this particular case include interdependent nursing intervention and independent nursing intervention. The interdependent nursing intervention will require the participation of various health personnel in concern with managing the asthma condition. On the other hand, based on independent nursing intervention, I will be in a position to advise the parents on the relevance of adhering to the prescription dosage and motivate the child which will help revive her energy which is essential in the management procedure (Kenyon et al., 2014).
Through independent nursing intervention, I will educate the parents about asthma with an intent of showing them the normality associated with the condition as a way of kindling their hope. Asthma is a common condition in children which is mainly listed in the chronical conditions. The primary cause of asthma is inflammation of the mucous membrane of the different breathing organs (Schifano, Hollenbach & Cloutier, 2014). It is also caused by bronchoconstriction which involves tightening of the smooth muscle of the airway pathways and the secretion of thick mucus which makes it hard for the patient to breath by clogging the airway (Schifano et al., 2014). There are different forms of asthma which include mild and severe attacks. Patients can cope up with mild asthma, but severe asthma that leads to asthmatic attacks can be life threatening (Schifano et al., 2014). As such, the severe asthma attack can occur at any moment, and if not immediately administered to, it can be life threatening. Although asthma cannot be treated, Feng, Miller, and Simon (2012) argue that it can be manageable if the patient learns to control the condition based on the doctor’s prescription and recommendation. Although Amelia Taylor is diagnosed with asthma attack, there is still hope in turning the condition to milder form. Such cases of turning asthma attacks into milder forms have been mentioned in some cases during puberty as mentioned by Burks et al. (2013). Informing the patient and the parents about the condition will equip them with the necessary knowledge that will ensure effective living with asthma and prevention of attacks and hospital admissions.
By helping the parents understand the different complications associated with asthma and their remedies, the negative effects associated with the condition can be mitigated. Gupta et al. (2012) state that air blockade is one of the effects that leads to most of the symptoms including asthma attack. Air blockade is caused by bronchospasm which means that the smooth muscles of the trachea and other airways are constricted. Papadopoulos et al. (2012) state that the constriction of these muscles can be triggered by different allergic reactions which result from exposure to respiratory substances such as mites and dust among other allergens. Mucus secretion also attributes to airway blockade (Papadopoulos et al., 2012). Among the symptoms that are associated with air blockade include coughing, breathing difficulty, cold sweat, anxiety, chest tightness, wheezing sound of breathing and altered consciousness (Sonnenschein-van der Voort et al., 2012).
In case the child exhibit such symptoms, the parents should be informed on the ideal measures to take which include ensuring the patient maintains a postural drainage position where they can lean forward as a measure for ensuring improved expectoration (Asher and Pearce, 2014). The patient and the parents should be informed of different breathing exercises that the patient should adapt in case of the symptoms show up. The parents should be informed of the proper medication to give to the patient and assist the child to use the appropriate nebulizer (Burks et al., 2013). This will be ensured through interdependent intervention where both the physician and the respiratory nurse should be involved in educating the parents and the patient on the same. Another intervention that can help in mitigating the symptoms and attacks is avoiding the allergens and respiratory irritants that lead to asthma attack such as cigarette smoke, irritating aerosols and fumes (Papadopoulos et al., 2012; Gasana et al., 2012). If the parent and the child are informed of such causes, they can easily avoid the attacks and symptoms.
Compromised gas exchange can be caused by constriction or mucus clogging (Elbehairy et al., 2015). Some of the symptoms that are associated with compromised gas exchange include fast pulse as evidenced by Amelia’s heart rate of 136/min, fast and shallow breathing, anxiety, short breath and wheezing (Weinmayr et al., 2013). The parents can be educated on how to intervene such symptoms through home remedies such as keeping the patient lying down with the upper body elevated and enough hydration. The prescription of administrating 6 litres of oxygen via the face mask is recommendable since it produces an oxygen concentration of 24%- 44% which is enough to mitigate the symptoms (Gershwin & Halpern, 2012). It is necessary to educate the parents on how to intervene other conditions such as anxiety, taking appropriate nutrition, decrease activity tolerance and ineffective breathing pattern.
Through interdependent invention, it would be necessary to assess the medications given to the patient such as identifying the medication that the patient is currently taking which include pain killers and Ventolin took via the spacer. Change of medication from what was previously described in the earlier admissions to new medication can help improve the condition (Kenyon et al., 2014). It would be relevant to seek an alternative way of administering alternative drugs rather than using IV to eliminate the long-term stress depicted from Amelia Taylor. According to Gershwin and Halpern (2012), administering antibiotics that could help in management of the underlying respiratory infection would be recommendable. Monitoring the response of the patient to the medication is an ideal way of evaluating whether the intervention helps in improving the identified problem.
Conclusion
Based on the discussed interventions, the symptoms portrayed by the patient such as expiratory wheezes, frequent moist cough, clear rhinnorrhoea and moderate tracheal tug can be mitigated. By motivating and giving hope to the child as earlier discussed will help reduce or eliminate hopelessness that concurrently leads to long-term stress. This will ensure that the child has revived energy needed for the recovery process. By educating the parents on the asthma management plan, the patient will benefit from easy and fast identification of the symptoms. This is necessary for preventing severe attacks since while the symptoms are still mere, it will be easy to use home remedies in solving them. Moreover, use of management plan will help prevent frequent admissions. In essence, lack of adequate knowledge regarding asthma condition is the main attribute to frequent hospital admissions and severe attacks. If the parents had adhered to the management plan given to the child by the respiratory nurse before her previous hospital discharge, the symptoms would have been managed without a need of being presented to the emergency department.
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