principles of acute paediatrics
Question One. Regrettably, fever management is generally founded on irrational discernments of risk. Health care providers generally link the degree of fever to the harshness of the illness, even though the relationship between both these factors is weak and of doubtful clinical effectiveness. Existing suggestions indicate that clinical presence and actions are the ideal gauges of the extremity of sickness in paediatrics. It is thus evident that the handling of fever is not essentially based on evidence (refs). There is proof to insinuate that mothers, fathers, and health careproviders suffer from great degrees of anxiety and possess poor tactics to the handling of cases of feverü. In the context of paediatric nursing, it is common for nursing professionals to habitually deal with parental stress concerning fever. The cause of concern here is how health care providers can minimise parental stress and boost parental skill to react suitably toinstances of feverü. The solution to this situation is even morecomplicated. It is thus necessary to educate parents on the details concerning existing research on the topic of fever management. However, another complicated aspect is that it is not possible to prevent families from founding their feverprocedures on old myths and ‘wives tales’ or to hinder the mass media or drug corporations from determinedly demonstrating antipyretics as beneficial medication. (Hockenberry et al. 2012)ü Good intro, however, your introduction should address the actual question, which asks ‘what are the complexities of fever management?’ So your introduction should say somewhere that in this essay you will be exploring or discussing the complexities of fever management. Despite the presence of side effects, nurses in local practice continuously make use of antipyretics to counter fever (ref). There could be a number of reasons for such actions, inclusive of a want of knowledge pertaining to the composition of fever, anotion that even slight to moderate fever is not good, force from parents to get treatment for the fever that their children might be suffering from, apprehensive of the febrile convulsions that could take place if the fever is not treated, coupled with theconcept that antipyretics are devoid of harmful side-effects.(Sullivan and Farrar 2011) A major Australian analysis audited nurses’ antipyretic usage in the handling of youngsters with fever, which was backed up byone more piece of research by the same authors (ref the study here, and other studies by same authors here). This looked at how information and outlook influenced fever managementprocedures. The data that was collected was vital tocomprehending nurses’ inspiration to employ antipyretics for the treatment of fever. The current best practice for fever is in conflict with the existing methodology. The current best practice encourages nurses to consider protocols that can be used as a guide while treating patients with fever. It is advisable that the current practice be modelled in such a way so as to prevent nurses from treating every fever patient in an identical manner(ref). Care must be taken to consider every symptom, along with the background of the situation, before deciding on a course of treatment in the individualised case of fever management. Nurses would then require training on the varied options that are available for the management of fever among children and older people in different parts of the world. This would strengthen the current practice by allowing it to be precise in nature, contrary to its current and comparatively inefficient manner of treatment.(Walsh et al. 2007) The complexities of fever management are many, but include: no consensus about what temperature constitutes a fever, how correct are our measuring devices, is fever good or bad, should fever be treated at all, what treatment is appropriate for a child with a fever (consensus in literature), fever phobia in parents and nurses – and how it affects nurses decision making processes re treatment, appropriate use of “antipyretics”, parent and health care worker knowledge of fever, myths about fever, febrile convulsions, cultural beliefs and habits in fever management, does treating a fever delay recovery fromunderlying illness, etc etc……………………………………………….feedback Question One The question asks you to explore these concepts, then provide a brief description of evidence based management, and compare that with your workplace (what guideline do you follow) – I know the wordcount is only 500words, but dear you have not addressed the second part of the question, the evidence-based practice for fever management, and comparison with what you do in your workplace, please re-read the question. For evidence-based practice, try NSW Health Paediatric Clinical Practice Guideline on fever, at this website:http://www0.health.nsw.gov.au/policies/pd/2010/pdf/PD2010_063.pdf Otherwise good work. Question 2. The patient being considered in this case is Kent Smith, who is 6 years of age. He is the son of a professor and lives with hisfather. He is not an active child and often has hyper-reflexicdeep tendon responses. He has been enjoying life in a state of sound health until the last three days. He shows no sign of a prominent health history with the exception of suffering from mild irritability. This condition is currently being handled with the help of corrections being made to his everyday diet, along with certain exercise routines – you should clarify who/or what team is responsible for diet/exercise routines, eg has he seen a paediatrician? It is not clear what is wrong with him, or why he has been prescribed diet and an exercise plan??. Kent does nottake any medication, besides two multivitamin capsules on an everyday basis. However, he has now been vomiting at regular intervals for the last three days, with an additional issue being that of watery diarrhoea. (Goldman et al. 2008) This caused hisfather to bring him to be admitted to the hospital’s emergency room. At the time of being admitted, his weight was 60 pounds.It was noted that he originally weighed 65 pounds, which isaround 30 kgs. The nurse evaluated his fluid condition andhighlighted that his mucous membranes and his skin wereparched. His body temperature was 99.4 degrees Fahrenheit(37.5 degrees Celsius), his pulse was 112, his respirations were32, his blood pressure was recorded at 110/88, and urineproductivity in a span of 8 hours was 125 mL, which had a specific gravity of 1.032. His electrolyte analyses were serum K+ 3.5 mEq/L; Na+ 159 mEq/L; and Cl- 120 mEq/ L. Mr Smith’s haematocrit and BUN levels were also higher than usual. His serum glucose measured 72 mg/dl. 1. The nurse analyses Kent Smith’s body fluid condition. There are four symptoms and laboratory analyses that are indicative of the fluid disproportion (possibly dehydration): Serum electrolytes: Na+ 159 mEq/L; Cl- 120 mEq/L Necessary life-signs: tachycardia, tachypnea, low-grade fever Loss of body weight (65 to 60 lbs in a span of 3 days) anddecreased urinary output (125 mL in a time period of 8 hours) Overall appearance: sluggish, parched mucous tissues and skin Variant laboratory standards: Hct, BUN, urine SG 2. Determination of the overall percentage of Mr Smith’s loss of body weight: (65 – 60) = 5 = 3.25% 3. Mr Smith’s complete fluid loss amounts to: 65 – 60 lbs = 5 lbs 4. Clinically speaking, Kent Smith has been diagnosed with: Moderate dehydration (which is greater than 8%) 5. The kind of hypernatremia that Kent Smith is suffering from(water losing or the gain of sodium)? Water loss hypernatremia 6. The kind of dehydration that Kent Smith suffers from: Hypertonic dehydration 7. The justification for this choice is: A greater volume of water that is lost, as compared to sodium; hypernatremia. 8. The urgency as far as nursing diagnosis is concerned, in the case of Kent Smith: Deficient Fluid Volume r/t extreme hypotonic fluid losses giving rise to increasingly solute, smaller volume of body water, 2 degrees to obstinate queasiness and watery diarrhoea, AEB:losing body weight, reduced skin turgidity and parched tissues, lab figures, along with tachycardia. 9. An analysis by the emergency room nurse in order to expectwhat can be the main concern in nursing and co-operativeinvolvements for Kent Smith. This would require an assessment of the vital signs (principally orthostatic blood pressure and the pulse) in the beginning, tocontrol starting position, and after that at regular time spans all through the course of the therapy. Fluid Management Plan for the Patient Initialise and uphold an IV line and oversee the administration of fluids at the rates that have been decided upon. Rehydration that is done at a rather gradual rate with the help of hypotonic IV fluids. The treatment of the essential source (treatments that are given for the treatment of vomiting and diarrhoea) Ensure that there is a ruling out of an infection of any kind. Close observation of client reaction to the rehydration therapy, which is inclusive of Blood pressure, pulse, stringent I & O,everyday body weight, skin tightness and firmness, state ofrealisation, electrolytes (particularly that of serum sodium), urine SG, Hct, and BUN. It is of vital importance to ensure that all of the safety safeguardsare complied with at all costs for the wellbeing of the patient, right till the time he recovers completely (his bed must be placed at a low level, the bell that is to be used for calling must be placed well within reach, the side railings must be up by X 3).The postural heart rates must be closely monitored by the nurse who is in charge, along with the blood pressure that must also be observed carefully at the time when Kent Smith is leaving thebed. It is also recommended to allow the patient to take a couple of minutes more than usual to get out of bed, after which he can move in small and steady steps from a relaxed position to a seated position, after which he can reach a standing place. It is necessary to ensure that any person is present near the patient at the time when he makes his way out of bed. (Thomas et al. 2008) 10. The two laboratory grades that indicate the state of dehydration, as compared to other electrolytes? Hct, BUN; and SG of 1.032 11. The preferred option regarding intravenous solution(s) that might be most suited for Kent Smith’s treatment. D5W, 0.45% NaCl An analysis of this case study reveals just how dehydration must be handled in an individualised manner, with careful consideration of the needs of the patient. In this case, the patient is a young boy who would need careful monitoring in order to help him recover from the moderate case of dehydration. The extra care taken to ensure that Kent Smith was not left unattended helped in hastening the recovery process considerably. (Diggins 2008). ……………feedback Question
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