Managing Children With Croup in Emergency Departments - Essay Example

Nursing Case Study Question Since Nancy is only 8 months old, she is within the oral stage of psychosexual development as postulated by Sigmund Freud. This stage is characterized by oral pleasures of a child such as sucking. Too little or too much gratification within the oral stage may lead to fixation. Such fixation causes a child to have a tendency for overeating, smoking or drinking later in life. Fixation at this stage would also lead to dependence on others. In order to help Nancy to master this stage and avoid being fixated, she would be introduced to weaning to allow her become aware that she does not control the environment and as a result develop a sense of independence. Question 2 The fine motor milestones that Nancy would have at her age include the reaching objects with arms, playing with small toys, playing with objects, wrist movements, picking objects and working with her meal. In order to help the child to develop fine motor skills, she would be presented with objects such as food so that she would try to reach them. In addition, the child will be provided with small toys to develop fine motor skills with these toys. The gross motor milestones that Nancy is facing at this age include independent sitting and she would be helped to achieve this through trunk and arm support. Question 3 Playing with Nancy will be characterized by a presentation of various toys of small size and encourage her to play with them. In addition, the child will be presented with various objects so that she would try to reach them and in this sense be allowed to develop her motor skills. Question 4 The clinical presentation describes her symptoms such as the barky cough which is significant in reaching a diagnosis. Other symptoms such as the clear nasal discharge and lack of a fever are also significant in assessment and diagnosis of her condition. More importantly, her physical examination results and vital signs are significant data for diagnosis and planning for therapeutic intervention. Question 5 Additional questions that would be useful to ask in Nancy’s case include her medical history and if she was prescribed to any other drugs. This would help to determine possible contraindications that would result from her treatments. In addition, questions on her behavior will be helpful in determining her psychological needs within the oral stage of development. Question 6 The differential diagnosis for Nancy’s condition is Croup. This is attributed to her symptom of a barky cough and runny nose with a clear discharge which characterize this type of upper respiratory viral infection (Tibballs and Tom 78). Parainfluenza viruses are the causative agent for Croup. It is through this differential diagnosis that various tests would be ordered in order to achieve a conclusive diagnosis for the condition. Question 7 In order to reach a conclusive diagnosis for Nancy’s upper respiratory infection tests can be orders such as determining whether she is getting sufficient amount of oxygen through a pulse oximeter. This test involves a skin sensor that is attached to the ear, toe or finder and connected to the oximeter. Level of oxygen below 95% within normal room air will reflect that the child has Croup. X-rays can also be ordered so that Croup can be differentiated from epiglottitis (Tibballs and Tom 80). An upper airway narrowing is observed in an X-ray in cases of Croup. However symptoms alone can be used for diagnosis. In this condition, blood tests are often unnecessary. Question 8 Asthma severity among children is classified through the use of the current guidelines which are used to diagnose the severity of asthma. The first classification of asthma severity is based on the frequency of appearance of the asthma symptoms. This means that frequent onset of the systems reflects a very severe case of asthma. In addition, the use of medication is also used to define how severe the asthma of a child is. This is due to the fact that the medications used by children with asthma vary with the severity of the condition. In addition, measures of lung function are used in determining and classifying the severity of asthma among children. Question 9 The medication management for the Croup that Nancy has would be achieved through various therapeutic drugs depending on the severity of the infection. Epinephrine would be prescribed to manage her infection if it is determined to be between moderate and severe. Corticosteroids such as intravenous, oral and intramuscular steroids are also effective in the management of Croup (Dykes 18). These medications would be prescribed as provided by the prescription guidelines and the code of professional ethics in nursing as regarding to the prescription and use of various drugs among children. Question 10 Non pharmacological treatment has been demonstrated to be effective in the management of Croup among children. Non pharmacological approaches to the treatment of Nancy include keeping her in a calm and comfortable position. This will prevent crying which will worsen her symptoms. In addition, humid air conditions would be used to make her more comfortable. This can be achieved through the use of a humidifier (Dykes 16). Frequent intake of water will also be used to prevent dehydration that is associated with Croup. The non pharmacological treatment is aimed at managing the symptoms of the infection and can be done at home. However the non pharmacological management approaches should be combined with medications for effective management of Nancy’s condition. Question 11 The follow up treatment will be targeted at determining if the recommended interventions, both pharmacological and non pharmacological, are being followed by the parents of the child. In addition a follow up treatment will be employed to monitor the symptoms of the condition so that in case of any complications or worsening of the Croup, proper interventions can be recommended and implemented. Follow up interventions represent a demonstration of high quality nursing care. Question 12 Nancy’s parents will be taught on how they would successfully manage the symptoms of her Croup so that these symptoms do not worsen. This includes instruction on how the prescribed medication is to be provided to the child including the frequency of medication. More significantly, the non pharmacological home management of the Croup will be instructed to the parents. The parents will also be informed that they should anticipate crying from the child and as a result made aware that crying may cause the condition to worsen. In this regard, the parents will employ necessary methods to ensure maximum comfort to the child. More importantly the parents will be informed on the need to report any form of complications immediately for further nursing intervention. Question 13 Hospitalization for Nancy will be guided by the severity of her condition. This means that an outpatient or inpatient programs could be employed in this case as necessary. In addition, any form of underlying condition or problem would be used to make decisions for hospitalization of this patient. The hospitalization decisions will be made by the relevant personnel or authority within the health care facility to ensure responsibility and accountability for Nancy’s treatment. Question 14 The referral of the child will also be influenced by the severity of her condition and symptoms. In this sense, the nurse would refer the patient to a senior medical professional or a pediatrician who has expert knowledge and experience for effective management of Nancy’s condition. In addition, possible worsening of her symptoms will attract the need for a referral. If other psychological or developmental issues and needs are identified within the child, a referral would be necessary. Works Cited Dykes, Juliet. "Managing Children With Croup In Emergency Departments." Emergency Nurse 13.6 (2005): 14-19 Tibballs, James, and Tom Watson. "Symptoms And Signs Differentiating Croup And Epiglottitis." Journal Of Paediatrics & Child Health 47.3 (2011): 77-82 Read More