Introduction
The Intussusception remains as the most common problem of bowel obstruction in children and infants which needs an immediate medical attention and could be resulting in severe morbidity in children when ignored (Jiang, Jiang, Parashar, Nguyen, Bines & Patel, 2013). The given case study focuses on the Intussusceptions faced by Jayadha, a 4 months old girl, and the given case study analyses the associated pathophysiology and nursing care plan for the child in order to ensure proper adherence to the evidence based practice. The essay will start with pathophysiology and then discuss the role of nurses in the effective use of developmental care based plan which will be followed by the family centered care for the child and the family.
The science of Pathophysiology unites the two disciplines of pathology and physiology to examine the various medical and biological implications for a disease. The medical science of pathology is combined with the biological science of physiology to examine the various aspects of a disease (Rogers & Scott, 2011). Thus, as a hybrid discipline, Pathophysiology guides how the pathogens infect the organ systems in causing the disease and their respective impact on the physical attribute of the diseased individual. Thus, application of this science for a specific disease helps in developing the medication based treatment and nursing care plan for the specific ailment under consideration (Rogers & Scott, 2011).
Intussusception is most common in the children aged less than 2 years and is marked by symptoms such as inflammation, vomiting, obstructed bowel movement, dehydration, abdominal distension, etc (Arbizu et Al., 2014). The pathophysiology study of the disease explains that almost 90% of this disease is associated with a gastrointestinal tissue called the hyper- plastic lymphoid and this implies the infection causing microorganisms behind the disease. Further, the pathological studies conducted for the disease find presence of species C adenoviruses infection (Arbizu et Al., 2014). Consequently, the infection leads to accumulation of gases and fluids in the region close to the blocked and this blockage leads to rising bacterial infections in the intestines. The rising pressure in the lumen causes higher level of secretions which compress the veins and walls of the intestine, resulting in distension. This intestinal distension causes rapid vomiting and causes the loss of electrolytes and fluids (Vanmeter & Rubert, 2014). If the obstruction present in the bowel region is not removed, the arterial blood supplies to the tissue will be reduced due to high pressure. The obstruction further results in rise of intestinal bacteria that start producing endotoxins (Vanmeter & Rubert, 2014). This causes hyper permeability of the intestinal walls and increases the chances of fluids leaking into the blood supply and causes Peritonitis.
The symptoms for this state are marked by severe abdominal pain which tends to rise with bodily movement and the individual tries to suppress breathing to lessen the pain. Decreased bowel and signs of dehydration are further accompanied with fever and abdominal distension in the children (Gould & Dyer, 2011). In terms of developing a treatment plan, the use of surgery or enema to release the mechanical blockage is decided (Gould & Dyer, 2011). In the meanwhile, antimicrobial drugs are to be given to the patient to ensure a check on the microbial growth and recurrent intake of electrolyte is must to ensure dehydration and mineral balance.
Role of nurses in the care of child and family: Applying growth and developmental theories
The growth and development phase of a child can be divided into five main aspects which can be classified as the psychosocial, cognitive, biophysical, spiritual and moral components of the overall development. There are specific theories which explain the various stages of growth and development in children as the given case has a 4 months old child (Jayda) who falls under the infancy stage of the physical growth.
In the given case, there are a few development theories applicable for the infant stage of growth. As per the Gessel’s Biophysical theory and Erikson’s theory of development, the nursing care during the biophysical stage has the specific regulatory implications regarding controlling the infant’s external environment so that his/her physical and psychological demands are thoroughly met (Ahmed & Richardson, 2014). This theory is relevant is to the case as the nursing care can change the infant’s environment to promote the maturational milestones for this stage of development which are governed by movements such as moving, sliding, rolling and treading at specific times. As per the Freud’s theory of development the infant falls under the oral stage of development when the mouth provides sensory pleasures and feeding should be adequately provided at optimum times to the child (Berman et al., 2015). Similarly, Havighurst’s theory of learning describes this stage of learning how to walk, walk, eat, and eliminate wastes, and psychological stability during the infant stage of development. The temperament theory describes the phase as temperament driven phase when maximum activity should be developed for the infant and he should try to move as much as possible (Berman et al., 2015). Lastly, Skinner’s theory of behavioral learning explains that the nursing care should focus on positive enforcing the stimulus on the infant’s body as the body serves as a medium of learning during the phase (Berman et al., 2015).
It can be concluded that the nursing care should ensure the development of self controlled eating and excretion abilities in the infant as a part of the nursing care plan and specific timetable for monitoring these activities need to be prepared and executed by the nurses. Also, the child should be fed adequately and kept in social-learning oriented environment where he can develop his organ system to maintain the routine metabolic activity cycle (Ahmed & Richardson, 2014).
Role of nurses in the care of child and family: Ensuring developmentally appropriate care
In continuation with the application of development and growth theories to the infant, the next stage comes in form of the developmental milestones. These milestones are the age-specific skills that are generally attained by maximum children reaching the respective ages. Thus, the developmental milestones can be used as a natural indication of the success for applied growth and development theories regarding making the child gain a normal life (Jane, 2011). The five basic segments of developmental milestones for children are classified as physical growth, motor skills, language learning ability, sensory skills, psychosocial skills, and spiritual development skills (Ward, 2013).
The nursing care should ensure that the developmental milestones specific to the infant in the case. The physical growth skills ensure that the infant should gain wait at the rate of 1.5 pounds per month and should grow in height by 1 cm per month. Similarly motor skills of firm grip, trying to reach objects, liking mirror images, ability to slide, etc are the milestones for infancy. Responding to sound and sudden changes in the surroundings should develop as a part of the sensory perception skills (Ward, 2013).
The nurses should develop an evaluative framework to assess the attainment of all the above mentioned skills for Jayda and any significant gap in acquiring these skills will expose a delay in the development and growth care plan. It can be concluded that the nursing care should adhere to the adequacy of deployed development and growth strategies to ensure that the treatment and care are maintaining with the required natural growth needs of the infant (Jane, 2011).
Role of nurses in the care of child and family: Family centered care
Along with the ratification of the developmental plans via attainment of their milestones, the neo natal and pediatric nurses are also supposed to provide a family centered care for the patient(Gill, Pascoe, Monterosso, Burr & Shields, 2014). This philosophy of nursing analyzes the role of families in affecting the treatment and care of child and develop special communication techniques with the family members on the basis of a belief that inclusion of the family can always boost the overall treatment efficiency for the infant (Harrison,2011). Thus, the responsibility of the nurses gets appended with the prime role of caring the infant in not only physical and medical contexts but also ensure a health emotional and psychological development in context of their families.
In the given case of Jayda, the parents (specifically mother) need to be taken into consideration for gaining their consent over the applied treatment, securing their compliance with the recommended treatment schedules, and ensure a satisfaction in the presentation of the nursing care for the child. Apart from this, there should be proper inclusion of the family members in all the medication and treatment for the infant.
It can be concluded that the nursing care should not only focus on the inclusion of the family’s consent and their compliance with the applied developmental care plans but it should present the treatment in a very convincing way to the family members so that their emotional faith is retained on the treatment (Harrison,2011).
Role of nurses in the care of child and family: Reference to the child and family
The family centered care needs to involve the notion of convincing presentation of the infant to the treatment and nursing care provided in the hospital environment which focuses on not only the child but also the family (Kuo et al.,2012). The most adequate form of presentation is an environment where the nursing care is fused with the help from family members in specific tasks so that they have a closer observation of the overall care provided to their child (Kuo et al.,2012).
In this case of Jayda, the presentation aspect of the treatment services should ensure detailed discussions with her family, specifically her mother should be made aware of potentially safe vaccinations for Rota virus which have been permitted by WHO. Also, the effectiveness of presentation is directly proportional to the amount of patient information shared with the family members, specifically parents (Hockenberry & Wilson, 2014).
It can be concluded that the treatment presentation should seek enough observation from the family of the patient so that they have full faith on the productivity of the undergone treatment (Gill, Pascoe, Monterosso, Burr & Shields, 2014).
Conclusion
The essay has utilized the case to show the basic understanding of the pathophysiology of Intussusception in infants where the 4 months old child Jayda is said to suffer with the disease and is brought in by her mother. The role of nursing is discussed in preparing the development and growth plans which needs to be evaluated by the attainment of developmental milestones by the infant. The following segments have elaborated the role of nurses in developing a perfectly family centered care for the background of the case study. The conclusion is focused on the recapitulation of how the various theories of nursing are found applicable in the scenario.
References
Ahmed, A.J. & Richardson, C. (2013). Child growth and development knowledge among senior nursing students. Journal of Nursing Education and Practice, Vol. 1: 82-86.
Berman et al. (2015). Kozier & Erb's Fundamentals of Nursing Australian Edition. 3rd ed. Pearson Australia group: 386-420. Print.
Gill, F. J., Pascoe, E., Monterosso, L., Young, J., Burr, C., Tanner, A., & Shields, L. (2014). P
arent and staff perceptions of family-centered care in two Australian children’s hospitals.
European Journal for Person Centered Healthcare, 1(2), 317-325.
Gould, E.B. & Dyer, R. (2011). Pathophysiology for the Health Professionals- E- Book. 4th ed. Elsevier Saunders Publications: 427-439.
Harrison, T.M. (2011). Family Centered Pediatric Nursing Care:State of the Science. Journal of pediatric nursing. Vol.25(5): 335–343.
Hockenberry, M.J. & Wilson, D. (2014).Wong's Nursing Care of Infants and Children, 9th ed. Mosby Elsevier Publication: 826-833.
Jane, D.A. (2011). Developmental Milestones: Maternal & Child Health Nursing. Nursing Crib. Retrieved online from http://nursingcrib.com/nursing-notes-reviewer/maternal-child-health/developmental-milestones/
Jiang J, Jiang B, Parashar U, Nguyen T, Bines J, Patel MM (2013). Childhood Intussusception : A Literature Review. PLoS ONE 8(7): e68482. doi:10.1371/journal.pone.0068482
Kuo et al. (2012). Family-Centered Care: Current Applications and Future Directions in Pediatric Health Care. Maternal and child health journal. Vol. 16(2): 297–305.
Rogers, K. & Scott, W. (2011). Nurses! Test Yourself In Pathophysiology. 1st ed. McGraw-Hill Education: 2-15. Print.
Vanmeter, C.K. & Hubert, J.R. (2014). Pathophysiology for the Health Professions. 5th ed. Elsevier Saunders Publications: 481-490. Print.
Ward, S.L. (2013). Pediatric Nursing Care: Best Evidence-Based Practices. 1st ed. F.A. Davis Company: 4-12. Print.
