Child Health Care Essay
Ailments such as stomach disorders are more common especially to the young children. This is due to their body immune systems that have not yet fully developed. This paper elucidates the illness that has befallen Bradley, and the diagnosis procedures that should be taken. Bradley might be having diseases of the gastrointestinal system such as dysentery and also the presence of internal parasites such as worms. The use of this is in line with the fact that, the baby has diarrhea, vomiting and red anus from scratching Willard (2008, pp162-168). Dried feces, dust, scaled skin cells, and sweat may be the cause of itchy skin around the anus, diarrhea and frequent wiping may cause anal itch. The nurse has to determine the actual cause. Some of the causes may include: Fungal infection with Candida albicans. The symptoms of fungal infection are red or brown, scaly, itchy rashes that affect areas of inner thighs, groin or buttocks. Secondly, there is also the Bacterial Infection.
This is evidenced by bright red, itchy rashes appearing in the groin area. Blood streaks may appear on the stool and the nurse should find out from Dorris whether this is the case for Bradley. Intestinal Parasites such as Pinworm (Threadworm) may also be exhibited. These are intestinal parasites that often live in the colon or rectum in children Forsyth (2008, p83). They sometimes leave the rectum during the night and deposit eggs on the surrounding skin which causes anal itch. Diagnosis for this is with the stool test for ova and parasites. Blastocysis Hominis may also be observed. This is a microscopic parasite that causes diarrhea, nausea, fatigue and anal itching, but oftenly this parasite does not present any symptoms. Its diagnosis is by a stool test for ova and parasites.
Consequently, diagnosis of skin diseases should be made by physically examining the skin for rashes and skin sores and taking patient history on the itching and irritation, also a laboratory examination should be carried out by scraping off a sample from the skin, mounting in potassium hydroxide and examining under a microscope to check the presence of the sarcoptes scabiei mites which cause scabies. If the skin scraping taken and returns negative, it is possible that the patient may still be infested because typically, there are less than 10 mites on the whole body of an infected person which makes it likely that an infestation may be missed.
The other diagnosis is for intestinal obstruction due to the vomiting and, distended abdomen this will be achieved by listening to the abdomen with a stethoscope the nurse may hear a high-pitched sound in the bowel incase of mechanical obstruction. Ileus is another condition where the bowel doesn't work correctly but not due to any structural problem, also called pseudo-obstruction, it is one of the major causes of intestinal obstruction in infants and children and the causes may be; Chemical or mineral disturbances (e.g. low potassium levels), decreased blood supply in the abdomen, injury to the abdominal blood supply, abdominal infections, kidney or lung diseases Turkoski (2008, pp318-320). It may also be a symptom of bacteria or virus infection or food poisoning. This can be diagnosed by decreased or absent bowel sound. Tests to show this type of obstruction are an abdominal scan or abdominal x-ray
The related nursing actions that would help determine a definitive medical diagnosis for Bradley would entail; listening to the abdomen with a stethoscope, the nurse will be checking for the pitch and consistency of the bowel sounds, if the sound is high pitched is a sign of physical obstruction such as swallowing foreign things, decreased or absent bowel sound is a sign of pseudo obstruction and will require further tests to determine the exact cause of the obstruction. These tests may include an abdominal CT scan or abdominal x ray. The nurse will require taking a stool sample to test for any signs of food poisoning, viral or bacterial infection. A blood test may also be necessary to test chemical or mineral disturbances or any kidney or lung diseases which may be the underlying cause of pseudo obstruction Patel (2005, pp123-124). A stool test for ova and parasites will also necessary to find out if Bradley has any intestinal parasites such as roundworms, pinworms or blastocysis hominis. A definitive diagnosis of the presence of intestinal parasites will be made if there is evidence of the parasites or their ova in the stool specimen and the nurse will be able to determine the species of the parasite and the seriousness of the condition which will be the basis of the intervention suggested by the nurse.
An examination of the irritated skin around the anus will be helpful in determining the definitive diagnosis of the cause of the irritation, examination of the rashes if any will help narrow down the causes of the itch , is the rash brown or bright red, is it scaly or not and whether there are other parts of the body where the rashes appear such as the thighs, groin or the head are some of the questions that will enable the nurse to determine whether the irritation is due to intestinal worms, bacterial or viral infection or whether it is just as a result of the diarrhea and frequent bowel movement causing the itching Ball &Ruth (2006, pp25-29). The nurse should also try to find out from the parents whether the stool has any blood streaks in it. Also finding out if the irritation occurs at night or during the day will be helpful in determining whether it is a problem of pinworms or not.
Conducting examination of the skin on the parts infected with scabies is necessary to give an accurate diagnosis of the problem, the skin can be examined for trails of burrowing mites which show burrows in the skin and are often accompanied by what looks like rows of small pimple-like insect bites to detect the burrow the infected part of the skin is rubbed with a topical tetracycline solution, it is then wiped with an alcohol pad and put under a special light. If there is an infection of scabies, the characteristic zigzag pattern of the scabies burrows will be seen on the skin; however, this test may be inaccurate since the burrows may be scarce and obscured due to scratching thus the need for a further test which involves using a powerful magnifying glass to check for the presence of the sarcoptes scabiei mites on the skin or by scraping a sample from the infected skin, mounting on a slide and irrigating with potassium hydroxide and looking under a microscope.
In order to measure the level of dehydration, urinalysis is the most valid and reliable way of determining moderate changes in fluid balance. The nurse can use the simple method of looking at the urine color, the darker the urine, the more dehydrated the patient is. A more scientific urine test that can be used is testing the specific gravity of urine using a refractometer. This can be done by placing a drop of urine on the glass plate closing the flap and holding the refractometer up towards an area of natural light, then read the specific gravity level off the scale. The nurse can also estimate dehydration using these four signs, decreased skin turgor, dry oral mucosa, sunken eyes, absence of tears, and an overall appearance of illness in the patience. After determining the level of dehydration the nurse should focus on the administration of sufficient fluids to replace the losses meet maintenance requirements of the patient Gschwentner &Gottfried (2007, pp51-54). The nurse can result to the use of oral rehydration salts and feeding to the patient orally since the case is mild she should show the mother and aunt how to give the ORS solution a teaspoonful every 1-2 minutes, monitor treatment and reassess the child until rehydration is complete and if the child vomits wait for ten minutes them continue. Achievement of rehydration will be based on observations of urine-specific gravity and the rate of fluid administration. A child should be considered to be rehydrated in the first 4-hour period when isotonic or more dilute urine is documented.
Consequently, it is vital to keep the family members informed of the causes and, probable mitigation measures that may be done by the family members to avert such scenarios. The nurse should let the family know the problems associated with dehydration as, it is a common cause of death in children, it is caused by diarrhea and vomiting and in children it is mostly due to infection with rotavirus. The family should be educated on the amount of ORS to be given which can be estimated using 75ml/kg as the approximate deficit. However, this approach tends to be less precise. Alternatively, the approximate ORS volume (in ml) can be calculated by multiplying the weight (in grams) times 0.075. Thus, a child weighing 8000 grams would require about (8000 x 0.075) 600 ml of ORS solution Hagedorn (2006, pp186-189). The amount given is determined by how thirsty the patient is and monitoring the signs of dehydration, considering that larger patients will require higher volumes. Patients should be given as much ORS solution as they can drink, and the vital signs of dehydration should be closely monitored, to ensure that they are improving.
The medical and nursing interventions that would be used to best treat Bradley’s problems include; carrying out thorough hygiene process that would entail washing of clothes, bedding, and towels that were being used by the Bradley in hot water. Particular lotions should be used to treat the infection and they consist; sulfur, permethrin, and lindane. Directions provided by the physician should be followed clearly to make Bradley recover fully. Lotion should be applied to Bradley’s body only when from the neck down to the toes, and he should be left overnight (eight hours). After eight hours, he should be bathed or showered to wash off the lotion. A second treatment of the body with the same lotion should be applied 7 to 10 days after the first application. The main aim of treating scabies in Bradley should be; to kill the mites (Sarcoptes scabiei), treat any family members who have been in close contact with Bradley and also to prevent scabies from returning Jayakumar & Nicole (2008, pp13-15).
A dermatologist should be consulted before using any treatment on Bradley. Bradley’s parents should understand that scabies does not indicate anything about personal cleanliness and they should not fear or be ashamed. Washing should be done on clothing, beddings, and towels on the hot cycle, or have personal all Bradley and family items professionally dry cleaned. If some of the clothing cannot be laundered or dry cleaned they should be stored in plastic bags for several days to kill the mites. To prevent later transmission of scabies measure should be taken by Bradley’s parent that is, physical contact with infected persons and their belongings should be avoided and mostly their clothing and bedding. All family and household members should be cleaned, whether or not they are itching or have a rash. Vacuum rugs and discard them. The family should understand that they cannot treat scabies with home remedies only. A doctor should be consulted at any detection of the disease.
In addition, Bradley’s hair should be washed to remove the nits and lice with a shampoo containing anti-louse medication. These shampoos usually contain benzyl benzoate, pyrethrins or lindane, after treating head lice, the nurse should comb his hair with a fine-tooth comb to remove the nits and dead lice in the hair. If Bradley has lice in other parts of his body she can simply remove them, apply anti-louse medications directly on the infested area and sterilize his clothing, this can be done by ironing the clothing well afterwards. It is also advisable to use an antibiotic cream which can be used directly on the skin to prevent infection. Bradley should also be given a dose of deworming medication since it is possible that he has intestinal parasite infestation, for example a single dose of Albendazole (400mg pills), will kill the adult worms Mercer (2007, p145). This intervention will be helpful in combating the likely malnutrition in him caused by the parasites. As reinfection may occur treatment is advised once a year. The nurse should wash Bradley’s anus with warm or lukewarm water without soap and use moistened tissues to wipe him since the anus is sensitive, this will take care of his itch.
To ensure these treatment measures function effectively, there should be some follow up assignments. The weekly follow up should be initiated to check whether Bradley has been reinfected with lice or scabies, this is because Ron and his family live in a congested house and have pets therefore maintaining hygiene in the home may be a problem for them therefore increasing the chances of reinfection of scabies and lice. Follow up is also necessary to monitor the progress of Bradley's development, this is due to the fact that he is small for his age, underweight and has not developed his motor skills properly this is most likely due to malnutrition and the fact that he was breastfed for only ten months. The nurse should monitor the kind and quality of food that is fed to Bradley and ensure that his parents understand the importance of feeding him properly balanced meals.
The nurse should initiate a follow up visit after twenty four hour to check on the hydration status of Bradley, he should take the weight of Bradley during the initial examination and compare with the weight during each of these follow up visits. These visits should be on an interval of twenty four hours for at least three days to ensure that the situation is under complete control and also to be informed if the runs are still occurring and whether he has vomited again after the last visit. A follow up visit should also be initiated for a stool analysis to check for any signs of infestation by intestinal parasites and to administer a follow up dosage of the worm medication. This will help ensure that the child is free of any intestinal worms and reduce the chances of getting reinfected.
The family may also get assistance from the community around them. They may get support on matters of nutrition from the social welfare agents. They might also be provided with information on feeding their child healthy food and giving supplements. They could be given coupons each month which will be used to buy nutritious foods including iron-fortified infant formula and infant cereal for Bradley and Dave, they should be trained on the proper ways of preparing the food to maintain its nutritional value and, on the nutritional value of different types of foods and, the body requirements of nutrients for both growing children and adults Huq &Tarana (2008, pp45-53). The importance of mineral supplements and the amounts they should be administered and the proper way of administering them to the children.
The family should be visited by a specialist on children with special needs or development problems. The specialist should examine the conditions in the home and decide if they are conducive for Bradley or whether he needs to be admitted in a baby clinic that will cater for his special needs. They will also be advised on how to relate with him on a day to day basis, the doctor will determine whether Bradley requires any special attention or equipment and how they can help him grow and develop properly.
The family has to be provided with support on matters of hygiene since their house is congested and has pets, this makes the conditions in the home unsanitary especially for growing children. The family should be taught some basic skills of maintaining hygiene in the house and preventing illnesses such as washing all fruits and vegetables, thoroughly cooking meats and fish and not eating undercooked meats or fish Davis (2007, pp76-79). Practicing good personal hygiene such as; washing hands before eating and after going to the toilet, changing diapers, or handling pets, keeping fingernails short and clean.
They should get support services from a veterinary doctor for their three dogs. He will help them clean the dogs and sterilize them to get rid of mites and lice and also to educate them on how to keep the dogs clean by washing them regularly with an acaricide, the family should also get educated on how deworming the animals and prevent their children from contracting any intestinal parasites from them. The veterinary doctor will also show them how often to deworm the animals and the best way to do it also how often to wash the dogs and the best agent to use. These measures will help protect the children and other residents of the house from infestation of external parasites such as mites or from intestinal worms from the dog’s feces by quarantining the animals and training them on how to use the litter box and how to empty the litter box and prevent contracting any diseases during the exercise.
In conclusion, Ron and Dorris should be given counseling on family planning, this is due to the fact that they are from an indigenous community therefore they may not have any information on family planning or may be misinformed on the same therefore they may suffer from myths perpetrated by the community. This information will give them an insight on the available methods, how they work, when it is best to use them and how safe or dangerous each method is. Ron and Dorris will be educated on how to raise a healthier family and to decide on the number of children they want to have and it will give them the choice to decide when to have the children.
Immunization services should be provided to the family and they should be advised to have their children vaccinated against some of the common childhood diseases such as infection from rotavirus, pneumonia and other diseases. Vaccination will lower their expenses on medical care and, they can be able to focus on other important things such as taking care of the family's nutrition.