Case study analsis Essay Example

  • Category:
    Nursing
  • Document type:
    Case Study
  • Level:
    Undergraduate
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    4
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    2255

Case Study Analysis 8

Case study Analysis

Case Study Analysis

Lecturer

Gastroenteritis is a common illness that is characterized by the irritation, inflammation and infection of gastrointestinal tract. It is caused by pathogens ranging from viruses, bacterias as well as parasites. Children are at a higher risk of getting gastroenteritis with the rota virus being the most notifiable viral cause of gastroenteritis. The rota virus normally leads to serious out breaks hence it is important to implement infection control strategies to avoid further spread of the disease. Major presentations of gastroenteritis would include diarrhea, vomiting, abdominal cramps, nausea and in some cases it could be accompanied by a fever, headache and general body malaise. Transmission of gastroenteritis will normally occur from person to person spread. It could also occur via air borne means and consumption of already contaminated food or water (National Institute for Health and Clinical Excellence 2009).

Management of gastroenteritis is mainly governed by use of the formulated guidelines. The various guidelines enable the clinicians as well as the patients or care givers to be able to make decisions on the appropriate treatment of a specific condition. Guidelines also provide the basis upon which appropriate diagnosis, assessment as well as management is to be achieved. Infants and children with gastroenteritis are often dehydrated due to the ongoing losses though diarrhea and vomiting and will also have electrolyte loses in the process. There is need therefore to carry out an assessment to the level of dehydration they present with. Dehydration will be assessed by checking for the signs of dehydration by physical examination of the patient (World Health Organization 2005).

Assessment of the children will begin by the checking of the presence of symptoms or signs in relation to the severity of the patient’s dehydration levels. This will involve the general observation of the patient in appearance as well as the level of consciousness. The patient’s skin color, skin turgidity and temperatures of the body have to be assessment will be vital too. Features such as sunken eyes, capillary filling rates, breathing patterns, presence or absence of peripheral pulses and normal blood pressures are normally assessed. Assessment will enable the classification of the level of dehydration of the child to be made. Dehydration levels will then have to be classified. There are four main categories of dehydration starting with no dehydration, then some dehydration, severe dehydration and finally shock (Paediatric Accident and Emergency Research Group 2003).

Patients with no dehydration will have vomiting and diarrhoea but no visible signs yet. Those children with some dehydration will be irritable, have sunken eyes, eagerness to drink or are thirsty and will have a skin pinch that goes back slowly. Children with severe dehydration on the other hand will have two or more signs of lethargy, unconsciousness, sunken eyes, unable to drink properly and a skin pinch whose retraction time is greater than 2 seconds. Dehydration levels will determine options to take in order to restore the rehydration status of the patient. Fluid management will be used to correct the dehydration. Fluid management will be grouped into two that is basing on the presence or absence of clinical features of dehydration (Paediatric Accident and Emergency Research Group 2003).

Rehydration will be done through intravenous route, nasogastric tube or just given orally basing on the level of dehydration. Fluids to be used in rehydration will range from normal saline/ringers lactate, oral rehydration solution (Cincinnati Children’s Hospital Medical Center 2006).

Those children who will have or are suspected to have clinical shock should be put on intravenous therapy for shock. A rapid infusion of 20 ml/kg 0.9% sodium chloride solution will be used. The infusion should be repeated if shock remains after the first infusion and while other possible causes of shock should also be considered. When the child shows signs of resolving from shock, isotonic solution should be given for fluid deficit replacement and maintenance purposes. There will be need to monitor regularly levels of sodium, potassium, urea, glucose and creatinine levels for any forms of derangements. Intravenous potassium supplementation and continued breast feeding should be considered at this stage. When signs of improvement have been noted, there will be need to now change to ors for complete rehydration to be achieved (Cincinnati Children’s Hospital Medical Center 2006).

30minutes and 70mg/kg body weight to be given in the next 2 and 1/2 hours. If the intravenous line cannot be traced, these patients will be given ors .the infants will be given at a rate of 20ml/kg body weight 6 hourly while those greater than 12 months will be given ors at the rate of 20ml/kg body weight 3hourly (Cincinnati Children’s Hospital Medical Center 2006).st one hour and 70mg/kg body weight in the next 5 hours while those at ages greater than 12 months 30mg/kg/body weight in the 1stChildren with severe dehydration will be required to be admitted and put on intravenous ringers lactate or normal saline. Giving of the intravenous fluids will vary depending on the ages of the children and body weight as well. Infants will be given intravenous fluids at a rate of 30mg/kg body weight in the 1

For children with no dehydration, efforts to prevent dehydration will be instituted. There will be continued breast feeding and encouragement of the children to take more fluids. Oral rehydration solution will also be offered where risk of increased dehydration is evident (Cincinnati Children’s Hospital Medical Center 2006).

Reassessment of these patients with severe dehydration should be done to check for signs of improvement. If patients on intravenous rehydration therapy are noted to have improved, they will be put on ors at the rate of 5mg/kg body weight 4 hourly in the infants while those above 12 months will be given at the rate of 5mg/kg body weight 2 hourly (Cincinnati Children’s Hospital Medical Center 2006).

The two important clinical interventions for Kane will include fluid and nutritional management. Fluid management will be aimed at correcting the ongoing losses that result from vomiting and diarrhoea which bring about dehydration (Cincinnati Children’s Hospital Medical Center 2006).

Kane is pale in appearance, dry tongue and mucous membranes, tearful, is lethargic, refusal to drink and has had four episodes of offensive watery stool in the last 12 hours. Basing on the classification of dehydration, Kane exhibits features of severe dehydration. Two priorities for the management of Kane’s condition shall be fluid and nutritional management. Fluid management will be aimed at correcting the on going losses and also to correct the levels of electrolytes (Cincinnati Children’s Hospital Medical Center 2006)

30 minutes. This will be followed by a maintenance dose at the rate of 70mls/kg bodyweight for the next 2 and 1/2 hours. During this period, Kane will be assessed from time to time at intervals of 30 minutes apart to check for the signs of improvement or detoriation. If the Kane shows signs of improvement, meaning features of dehydration are absent, he will be put on ors at a rate of 5mls/kg body weight 2 hourly until complete rehydration is achieved. However if accessing the intravenous line of Kane fails, Kane will be put on oral rehydration solution at the rate of 20mls/kg body weight 3 hourly until resolution is achieved (Cincinnati Children’s Hospital Medical Center 2006).stOn fluid management, if an intravenous line can be traced, Kane will be put on intravenous rehydration therapy to correct the dehydration. This will involve the use of normal saline or ringers lactate solution. The intravenous fluid will be given at in two phases. The two phases will include a loading dose and a maintenance dose. Intravenous rehydration therapy will begin with the loading dose where Kane will be given either ringers lactate or normal saline at the rate of 30ml/kg bodyweight in the 1

Nutritional management of Kane will involve restriction on the intake of solid foods. Kane will be encouraged to take fluids such as milk feeds or water. Use of specialized soy protein or protein hydrolase formulas should be encouraged in order to reduce complications resulting from recovery from gastroenteritis. Soy supplementation reduces diarrhea due to it containing the dietary fibers. The diet should also be lactose free or have lactose reduced formulas in order to avert the risks of diarrheas due to lactose malabsorption. Solid foods will also be given in the recovery period to prevent the occurrence of malnutrition and promote mucosal recovery within the gastrointestinal tract. On achieving rehydration, there will be need for Kane to be reintroduced back the normal solid foods. Fruit juices and carbonated drinks should be avoided during this period until the diarrhea stops. Micronutrients will also have to be given to Kane for they will enable promotion of restoration of the epithelial barrier integrity, tissue repair and immune function as in the case of Zinc. Zinc will be mainly given because it is normally lost during episodes of diarrhea. Zinc therapy will thus be essential for Kane. Folic acid and vitamin A supplementation should also be considered (Cincinnati Children’s Hospital Medical Center 2006).

In the nursing plan, the Parents and carers of Kane should also be informed on how to take care of theses patients at home. This will enable them to be able to manage the patients safely at home. Health care professionals should be able to advice and offer support to carers and parents on how to provide rehydration for the patients by giving of ors and other fluids. Parents and carers should also be informed of the signs or symptoms of dehydration such as decrease in urine output, pale or mottled skin, cold extremities or changing responsiveness for instance irritability so that they are able to contact the health care professionals when they observe them. Informed on the care to be given to the child after rehydration has been achieved should be availed to the parents and carers such as feed the child of the child. The time frame of diarrhea and vomiting should be made known to the mother for instance Diarrhoea in this children will normally last for 5 to 7 days and stops within 2 weeks whereas vomiting will normally last 1 to 2 days and stops in the third day. In both cases of vomiting and diarrhoea, if the symptoms fail to resolve within the expected time frame carers and parents should seek medical care immediately since dehydration is associated with multiple organ failure which leads to high mortality being recorded among children (National Collaborating Centre for Women’s and Children’s Health 2009).

In order to prevent primary spread of diarrhea and vomiting, parents and care givers should be well informed on hand washing practices with soap (liquid if possible) in warm water that is running and thereafter carefully drying them in order to prevent the spread of gastroenteritis. They should also practice hand washing by washing hands immediately after going to the toilet (both parents and children) or changing nappies (parents/carers), before starting to prepare, severe or even eat meals. Sharing of towels with the infected children or even attending school or child care facilities and swimming should be discouraged to avoid further spread of the illness. The parents should also be informed of the nutritional management after rehydration has been achieved, nutritional management will now have to be considered. Full strength milk should be given straight away and the child should be re introduced to the normal solid foods (National Collaborating Centre for Women’s and Children’s Health 2009).

In summary, Gastroenteritis is the leading cause of diarrheal diseases and key consideration has to be given due to mortalities associated with it. Patients with gastroenteritis tend to be affected by dehydration due to continued loss of fluids through vomiting and diarrhoea. Fluid and nutritional management of the patients who have gastroenteritis has to be done. Fluid management will enable the reduction of the complications that result from gastroenteritis such as dehydration. It is therefore necessary to have effective protocols which will guide health workers and the carers or parents to enable them offer effective care to the patients who have gastroenteritis. Guidelines for management of gastroenteritis should be able to outline the classification of dehydration levels and the management of every class of dehydration with specific consideration being given to the amount of fluids to be given to the patients. Care aimed at prevention of the spread of gastroenteritis should also be out lined in the protocols to prevent an out break from occurring. Micronutrient supplementation should be considered for patients with gastroenteritis to facilitate the healing of the gastrointestinal mucosa and also boosting the immunity.

References

Centers for Disease Control and Prevention, 2004, Managing Acute Gastroenteritis Among Children: Oral Rehydration, Maintenance, and Nutritional Therapy, Atlanta, U.S.A.

Cincinnati Children’s Hospital Medical Center , 2006, Evidence-Based Care Guideline for Children with Acute Gastroenteritis (AGE) Acute Gastroenteritis (AGE), In children aged 2 months through 5 years, U.S.A.

National Collaborating Centre for Women’s and Children’s Health, 2009, Diarrhoea and vomiting caused by gastroenteritis diagnosis assessment and management in children younger than 5 years, RCOG Press,London.

Holborn, London.
,Diarrhoea and vomiting caused by gastroenteritis: diagnosis, assessment and management in children younger than 5 yearsDiarrhoea and vomiting in children, NICE clinical guideline 84 – National Institute for Health and Clinical Excellence, 2009,

Paediatric Accident and Emergency Research Group (PAERG), 2003, Guideline for the management of children presenting to hospital with diarrhoea,with or without vomiting, University of Nottingham.

http://whqlibdoc.who.int/publications/2005/9241593180.pdf August 11, 2011 from th, Accessed on 11a manual for physicians and other senior health workersWorld Health Organization, 2005, The treatment of diarrhoea: