Diagnosis And Clinical Assessment

This paper evaluates a case study of a child. It aims to evaluate the child’s health issue and recommend an appropriate course of action based on the best practices. In this case study, the patient is a five months old child who has been diagnosed with moderate viral bronchiolitis. Amar has different symptoms and signs that the nurse has recorded during the assessment. After analysing the clinical diagnosis, the doctor has stated to admit the child to the hospital immediately.

It is stated by Biagi et al., (2018) that clinical diagnosis is the procedure of using the data of assessment to determine the symptoms and signs of the person. It helps to identify the disease which is associated with signs and symptoms. In this case, the child is diagnosed by testing the mucus sample and urine. The pulse oximeter test is also implemented in the diagnosis process as the patient is a child. During auscultation, the nurse has diagnosed the situation of the lungs. There are widespread crackles that are audible throughout the lungs’ fields (Cai, Lin & Liang, 2020). After performing the clinical diagnosis, it results in moderate viral bronchiolitis.

Figure 1: Bronchiolitis in infants

As per Cai, Lin & Liang (2020), maximum cases of bronchiolitis occur due to the respiratory syncytial virus. This is a common virus that infects every child by two years of age. According to Fretzayas & Moustaki (2017), certain risk factors can make severe bronchiolitis. Dysmaturity, related neurological diseases, immunity deficiency, chronic lung diseases, RSV infection and formula feeding. In this scenario, the patient may develop an RSV infection and airway anomalies (Florin, Plint & Zorc, 2017). As per the case study, the patient has different health issues related to a lung condition and a depressed immune system. Sometimes contact with their children can be a risk factor for viral bronchiolitis. According to the case study, the elder sister of the patient also has a cold and has bitten her younger brother. It can be one of the risk factors for this chronic illness (De Onis, 2017).  Case Study Evaluation Of Moderately Viral Bronchiolitis In A Five-Month-Old Child Essay Paper

However, some RSV factors are infants six months old or premature infants are more prone to be infected by this virus. Children who have heart disease or chronic lung disease are more prone to be infected. Children with weakened immune systems are at risk of this RSV infection. According to the scenario, the patient has been infected by RSV as he has a defective immune system and suffers from lung disease.

Figure 2: Pathophysiology of Bronchiolitis

(Source: Jartti et al., 2019)

Viral bronchiolitis mainly starts with replicating the virus in the portion of the nasopharynx (Golan?Tripto et al., 2018). The virus has spread to the small type of bronchiolar epithelium lining the small type of airways within the lungs and then a lower type of infection in the respiratory tract begins in one or three days (Jartti et al., 2019). This state leads to an imbalance between the gases respiratory and leads to a decreased amount of oxygen supply in the blood. After a few weeks, it also results in respiratory distress and the belly pulls in-breath the patient’s rib cage. The muscles between the ribs have pulled inward. This sign indicates that the patient has a breathing issue.

Causes And Risk Factors

Figure 3: Signs and symptoms of bronchiolitis in infants

(Source: Kua & Lee, 2017)

It is identified by Kirolos et al., (2020) that a maximum of children who have bronchiolitis have a runny nose, cough, wheezing, cough. These children may be facing issues with breathing and also have a fever. Bronchiolitis is the acute type of viral infection of the lower respiratory tract that can affect infants who are younger than 24 months (Kua & Lee 2017). However, it is characterised by respiratory distress and crackles. The low pitched sounds of wheezing feel like snoring and are generally found when the patient is breathing out. As per the scenario, the patient had a moist cough and tachypnoeic. The patient also had a mild type of nose flaring. He had retractions of subcostal and intercostal. On the auscultation of the chest, it was identified that the patient also had wet types of crackles that were audible from the lung fields. In this case, the patient has trouble breathing and starts wheezing, which sounds like crackles in both lungs.

Children at this age are starting for giving effort or pushing themselves up into the crawling position and enable them to rock back and forth on their knees and hands (Lavilledieu et al., 2020). At this age, the infants can push up and down and start to sit with support. They are enabled to turn themselves in the direction they prefer to go (Lines, Hutton & Grant, 2017). They also start using the sounds for expressing their emotions. In the growth chart, the average length and weight are 65.9 cm and 7.5 kg at five months of age, whereas, in the scenario, the patient has a 4.5 kg weight and 55.9 cm length. The patient has no normal growth and development. He is underweight and also smaller than other children in length.

Registered nurses play a major role in safeguarding. Their role is to advocate for the vulnerable kids and identification safeguarding the concerns and can take action in the form of timely referrals to the social care of children and services of specialist support. Registered nurses have been identified as having a key role in protecting and detecting child abuse (Norful et al., 2017). The registered nurses are mainly responsible for protecting children from maltreatment and preventing the impaired development of health. The responsibilities are

• Advocating on behalf of the child
• Keeping them in a comfortable and safe place
• Attending the case conferences (Piedra & Stark, 2017)
• Helping to develop and provide the multi-agency protection plans

They are accountable for taking actions to make enable all children to have the best possible outcomes. Nurses are main accountable to provide support and assessing the children (Piedra et al., 2017). In the list of responsibilities of the nurse, they need to support the families, giving the proper education to the parents about how to manage the children’s health. They are involved in identifying and detecting abusive activities for children and can change their traditional role of supporting the families.

In order to meet the safeguard requirements of the child in the case study, there is a need to include GP, a health visitor and a nurse. In order to maintain the safeguard of the child, the health visitor needs to involve in regular checkups of the child (Tham, Schneider & Broekman, 2017). The health visitor needs to report the child’s health status to the doctor. In a multidisciplinary process, the nurse can work together with the other health staff to ensure the joined-up response reduces the risk of harm to children (Rainisch et al., 2020). In this case, the most important thing that needs to be monitored is the environment and temperature. As per the scenario, the patient is already suffering from bronchiolitis and the patient needs to be treated in a clean and hygienic environment. The patient has weak immunity which would be a risk for him to get infected with another virus very quickly.

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Pathophysiology Of Bronchiolitis

Medications are limited in managing bronchiolitis. As per Tham, Schneider & Broekman (2017), antibiotics are not preferable for bronchiolitis as they may increase complications or make a failure in the respiratory system. On the other hand, antibiotics are needed to treat cough and fever.  In most cases, the doctors have prescribed the nebulised albuterol to treat the illness. Oral corticosteroid type of medications is given to lose the chest muscle. In this case, most of the medications have been given through fluid (Zhang et al., 2017). The patient has different complications such as respiratory issues, fever, cough and abnormal growth and development. However, in this severe case, the doctor has prescribed the nebulized albuterol in the care plan intervention.

There are four common risk assessment tools present that can be used to analyse hazards and failure of care plans. Examples include the Barden scale, johns Hopkins fall, questionnaire, malnutrition, caries risk assessment, fall risk assessment tool, fall score, the risk for injury, infection control assessment tools and others. These assessment tools are used in medical practice although each assessment tool is used for different diseases. Barden scale is used for ulcer infection; the nursing diagnosis assesses the risk for injury and infection. After the admission of the elder people or adults, the fall risk assessment tools are used to check whether the patient can walk appropriately or not (Zhang et al., 2017). However, for this case scenario, the infection control assessment tool is used to identify if there is any risk related to infection of the respiratory system and to make a care plan for the child. The Modified Tal Score is used for predicting the severity of the Bronchiolitis Scoring Tool and also can be used in this case.

Patient Care Plan

(Source: self-created)

Conclusion

It can be concluded that the above intervention can help the patient to improve their health condition. This analysis of the case study gives information about that how the infants are vulnerable to bronchiolitis or any other viral infection as they do have not that strong immunity. Moreover, sometimes contact with other children may fall the child at risk of vulnerable health conditions. Therefore, the parents need to be aware of this health condition. Specially infants are more vulnerable to getting respiratory infections for this reason. There is a need to take care of them properly. However, the nurses play a major role in the assessment, diagnosis and intervention of the children. They are also responsible for maintaining safeguards for children by giving proper direction to the parents. In this scenario, the nurse has completed all her responsibilities in order to improve the health condition of the patient.

References

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https://link.springer.com/article/10.1186/s12890-018-0750-1

Cai, Z., Lin, Y., & Liang, J. (2020). Efficacy of salbutamol in the treatment of infants with bronchiolitis: A meta-analysis of 13 studies. Medicine, 99(4). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7004745/

De Onis, M. (2017). Child growth and development. Nutrition and health in a developing world, 119-141.

https://link.springer.com/chapter/10.1007/978-3-319-43739-2_6

Florin, T. A., Plint, A. C., & Zorc, J. J. (2017). Viral bronchiolitis. The Lancet, 389(10065), 211-224.

https://doi.org/10.1016/S0140-6736(16)30951-5

Fretzayas, A., & Moustaki, M. (2017). Etiology and clinical features of viral bronchiolitis in infancy. World Journal of Pediatrics, 13(4), 293-299. https://link.springer.com/article/10.1007/s12519-017-0031-8

Golan?Tripto, I., Goldbart, A., Akel, K., Dizitzer, Y., Novack, V., & Tal, A. (2018). Modified Tal Score: Validated score for prediction of bronchiolitis severity. Pediatric pulmonology, 53(6), 796-801. https://doi.org/10.1002/ppul.24007

Jartti, T., Smits, H. H., Bønnelykke, K., Bircan, O., Elenius, V., Konradsen, J. R., … & EAACI Task Force on Clinical Practice Recommendations on Preschool Wheeze. (2019). Bronchiolitis needs a revisit: distinguishing between virus entities and their treatments. Allergy, 74(1), 40-52. https://doi.org/10.1111/all.13624

Kirolos, A., Manti, S., Blacow, R., Tse, G., Wilson, T., Lister, M., … & Campbell, H. (2020). A systematic review of clinical practice guidelines for the diagnosis and management of bronchiolitis. The Journal of infectious diseases, 222(Supplement_7), S672-S679. https://doi.org/10.1093/infdis/jiz240

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Lines, L. E., Hutton, A. E., & Grant, J. (2017). Integrative review: nurses’ roles and experiences in keeping children safe. Journal of advanced nursing, 73(2), 302-322. https://doi.org/10.1111/jan.13101

Norful, A., Martsolf, G., de Jacq, K., & Poghosyan, L. (2017). Utilization of registered nurses in primary care teams: A systematic review. International Journal of Nursing Studies, 74, 15-23. https://doi.org/10.1016/j.ijnurstu.2017.05.013

Piedra, P. A., & Stark, A. R. (2017). Bronchiolitis in infants and children: Treatment; outcome; and prevention. UpToDate. Alphen aan den Rijn, the Netherlands. https://www.medilib.ir/uptodate/show/6020

Piedra, P. A., Stark, A. R., Redding, G., & Edwards, M. S. (2017). Bronchiolitis in infants and children: Clinical features and diagnosis. UpToDate [Last updated March 13, 2013]. https://www.medilib.ir/uptodate/show/6018

Rainisch, G., Adhikari, B., Meltzer, M. I., & Langley, G. (2020). Estimating the impact of multiple immunization products on medically-attended respiratory syncytial virus (RSV) infections in infants. Vaccine, 38(2), 251-257.    Case Study Evaluation Of Moderately Viral Bronchiolitis In A Five-Month-Old Child Essay Paper