Fundamentals of Clinical Care

Firstly, in this essay, the author will be discussing the clinical and theoretical methods of diagnosing and managing pediatric gastroenteritis. Secondly, the author will also be discussing professional values for NHS staff when caring for patients and their families, such as the NMC code. Furthermore, the author will be analyzing the essay scenario and will be applying a range of theoretical principles of caring for a child, such as Emily, a 4-year-old child who is diagnosed with Gastroenteritis. In addition to, the author will then be moving forward to discuss NICE guidelines in relation to Emily’s case. Lastly, the author will discuss various topics throughout to provide as much information and understanding on caring for a child with gastroenteritis.

Gastroenteritis, which is also referred to as infectious diarrhea. It is a very common condition in children which causes severe diarrhea and vomiting. It is caused by tummy bugs or by a bacterial state. There are various precautions which need to be implemented to control outbreaks in healthcare environments, such as isolation precautions as, without proper precautions and guidelines, gastroenteritis can easily be passed on. Patients should be placed on contact precaution for at least 48 hours before it is determined if they have gastroenteritis as it may be norovirus and that is highly infectious. The second major precaution is hand hygiene. Staff should strongly promote hand hygiene within the healthcare environment to reduce the outbreak of gastroenteritis as hands are known for carrying the most bacteria on the human body. liquids and foods can easily be contaminated if hands are not washed thoroughly, therefore, a step-by-step picture hand washing guide should be placed around the hospital such as toilets, corridors, and cubicles. There should also be a sign upon entering the ward asking visitors to thoroughly gel their hands with the gels provided in corridors. The third precaution which needs to be issued is ensuring a clean hygiene environment. Medical environments that are treating gastroenteric will need to increase and perform daily cleaning and disinfection of areas and equipment used. During the outbreak of gastroenteric ward, cleaning should be done twice a day to ensure cleanliness, with surfaces that have been touched numerously to be disinfected approximately three times a day. Lastly, if there is suspected infection of gastroenteric staff should utilize PPE (protective personal equipment) which is highly recommended for people entering the patient care area. Example of the equipment is gloves and gowns being worn during entry. If the patient has been discharged, the cubicle which the patient has spent the duration of their treatment in should be booked for deep cleaning. This is a thorough clean of the room using disinfectants such as bleach before another patient is admitted into the cubicle.

Monitoring and managing fluid input and output is important when treating gastroenteritis as patients lose lots of fluid through vomiting and diarrhea, decreased urine output is a sign of dehydration. With fluid management, healthcare staff needs to make sure that the number of fluids going in is also coming out in equal amounts. More importantly, dehydration caused by diarrhea statistically is one of the largest single killers of young infants and children in the modern world. It is also one of the severe cases of poor growth and nutritional loss. A fluid chart will be used and filled in when Emily's observations are due to keep track of her input and output.

The Bristol Stool Chart (BSC) is used to describe the consistency of stool where pictures and words are included. Health professionals use this to help patients indicate what their stool is like, this will help patients know if they have constipation, normal stool or diarrhea. Emily’s stool consistency will need to be noted down to see if there are changes in the next observation, it is important to ask about her stool as the consistency could have changed significantly since the last observation. Healthcare staff may leave a Bristol Stool chart for children to help Emily describe and identify her stool consistency when she uses the toilet.

Dehydration is caused when an individual’s body doesn’t have much water as the body requires. Without the appropriate amount, the body is unable to function properly. An individual can suffer from mild, moderate or severe dehydration depending on how much fluid is missing from the individual's body. There are numerous dangers of dehydration to children such as very high temperatures, swelling of the tongue, the skin will become scaly and loose, and longer capillary refill time (CRT). The major organs such as the heart and lungs will start to fail hence causing the death of the patient. The doctors have prescribed Emily IV fluids for her dehydration through cannulation. Emily’s consent would not be needed for this as she is too young to consent although explaining the procedure of cannulation to Emily’s level of understanding might make her less frightened. The consent of Emily’s parents will be needed. The shock will be treated through rapid intravenous infusion 20 ml/kg of 0.9% sodium chloride solution. in Emily’s case, IV infusion would be the best solution as she is unable to tolerate oral fluids so oral fluids will be of no help if she keeps vomiting. A fluid chart will be kept, and the IV pump will be checked hourly, this is to ensure that there are no occlusions and to see how much of the treatment is remaining until the end. Signatures for every check and the date will be required as charts are a legal document.

Pain is an uncomfortable feeling, there are different types of pain such as throbbing and stabbing. Pain score charts are used to determine a patient’s level of pain. There are 2 types of pain score charts, one with faces showings various emotions and another with numbers from 1-10. Emily is in the Peri-operational stage of Piaget’s stage of developmental theory. The pre-operational stage (2-7years) is the 2nd stage in the developmental theory, this is a stage where at the beginning children are unable to use logical thinking but towards the end can make simple decisions using logical thinking, they build towards being able to logically think. Emily is at the beginning of this stage; the author thinks it is best to use the faces pain score when asking Emily about her pain as the faces with emotions will make it easier for her to decide instead of using numbers as she is more familiar expressing herself through emotions instead of numbers.

To distract Emily from pain, the best techniques to use would be through symbolic play. The author suggests using characters from movies, T.V shows and Emily’s interests to distract her from pain and certain procedures, reading books could also be used to catch Emily’s attention. Animism and constructive play would also be great techniques to distract Emily. If there is a specific toy she has created a bond with during her stay at the hospital, staff taking care of her can make it come to life using Emily’s imagination by role play. Hard toys which belong to the hospital and are easy to clean should only be used with Emily as she can easily pass on gastroenteritis to another person. Good examples of hard toys are Lego blocks and other plastic toys. Emily can bring her own soft toys such as stuffed animals but will have to take them home with her when she leaves as it will be contaminated. A lot of children like to hug and carry stuffed toys such as teddy bears as this gives them the feeling of comfort and that is what needs to be achieved. Another useful distraction technique would be talking to Emily and asking her question about school, friends, hobbies and her siblings as these will most likely be positive topics for Emily to discuss so she won’t be too anxious when a procedure is taking place. Creating a stimulating environment for children within the ward will help engage their mind such as a number and alphabet line across the corridor and previous work patients have done put on display.

Managing Emily’s pain should also be a priority to ensure no discomfort is caused. Emily is suffering from tummy pains due to diarrhea. There are many painkillers such as paracetamol, ibuprofen, and codeine which she can take to reduce her tummy pains. Paracetamol would be the best as it can be taken on an empty stomach and get rid of pain and temperature whereas ibuprofen would need to be taken after meals as it can cause more pain to Emily if taken on an empty stomach. Codeine is not appropriate for Emily’s age as it cannot be taken by individuals under the age of 12 years. Medication should be given carefully to Emily. Healthcare staff should make sure to avoid medication for diarrhea as it is not advised for individuals under 12 years to take anti-diarrhoeal medication.

Anne Casey created a theory called Casey’s model on nursing in 1988. It is a model on family-centered care, meaning that the family is included so they have an active role towards the well being of the patient as nurses cannot take over the role of family members. Over time, the model has been developed in other areas of England. This model shows that the best individuals to take care of a pediatric patient are the family members with help from various health and social care professionals.

Emily’s condition will mean that she will have to stay in the hospital for a while, this may lead to her feeling isolated due to limited interaction with friends and family. No child desires to be away from their siblings and family and especially being in a different environment and not being able to see familiar faces may lead Emily to feel lonely and scared. To tackle this the medical staff can ensure she’s happy by bringing her toys/games to engage her mind. Emily’s relationship potentially may be impacted as siblings may become jealous due to the amount of attention that Emily is receiving from her parents, causing sibling rivalry. Overall Emily will feel more isolation as she is unable to interact with friends and family as much, she will also be limited to physical activities and children at a young age tend to be very enthusiastic and energetic.

Emily’s condition causes her to be very dehydrated and tummy pains in her stomach, this, therefore, causes Emily to feel fatigue; discomfort, headaches, loss of appetite, fever and abdominal cramps. Providing Emily’s parents with beneficial information ensuring hygiene levels and infection control are kept to a high standard to reduce the risk of spreading. Parents can restrict things such as fizzy drinks as they will not keep her hydrated and avoiding dairy products until her gastroenteric improves but this may be difficult as she is a child and milk is often the only thing children are keen to have. Emily’s parents need to be made aware that she cannot go swimming 2 weeks after she has been discharged to ensure that she doesn’t pass it onto others.

Emily will be missing out on her education, which she will need to catch up with after once she starts feeling better although she will be given some sort of education to keep her occupied such as coloring books and games. Also providing her mother and family members who visit within the ward magazines and newspaper to ensure they are also occupied as being in a ward for long period can cause them to be disengaged. The medical staff can also encourage Emily’s mother to take her to the playroom when she’s feeling physically active, this will stimulate her mind as she will be playing and it will keep Emily occupied if her mother wants to go to the parents room for a little break where she can make herself a hot drink and relax.

Depending on the patient’s culture, female patients may request having healthcare staff who are the same sex look after them as it is inappropriate for a man and woman who are not married and related by blood to have contact. Patients requests and culture should be respected as it is part of the NMC code to show respect towards others. Multi-faith prayer rooms are provided to make patients feel comfortable to pray in private. Imams, priests, and rabbis are sometimes available. Prayer rooms include religious books such as the Bible, Quran, and Torah.

Emily’s mother is resident during her care at the hospital. She will most likely become stressed and worried as being a parent and seeing your child go through pain and not being able to do anything to fix and reduce the pain makes parents feel helpless. She is concerned about whether her health may worsen hence she may become depressed and anxious from overthinking about the outcome. Emily’s mother also has other children apart from Emily to take care of, her mind will be in two places, trying to make sure Emily is fine and that her siblings at home are getting on well.

The nursing and midwifery council have set up rules and regulation which nurses have to comply with as it is a part of their contract. The standards set by the NMC is to ensure that good quality of care is given to the public and that they are protected from harm. When taking care of patients, professional values and beliefs should be kept in mind such as the NMC code. It is important that staff uphold Emily’s dignity when an accident takes place as it will be hard for Emily to control her bowel movement and vomiting. Staff should reassure her to give her comfort, so she doesn’t feel embarrassed. If she is told off or staff shows disgust when an accident takes place, Emily will be less likely to tell staff anything as she will be afraid. The way the staff communicates with Emily is also important, the staff should show kindness and communicate with respect when attending to her needs. Patient autonomy is when patients can make their own decisions without nurses caring for them trying to influence their decisions. Healthcare staff can give advice such as advantages and disadvantages, but patients should be allowed to make decisions using the information provided. In Emily’s case, her parents will be informed and given advice about treatment, they will then choose what they think is best for Emily which should be respected. Nurses taking care of Emily should be able to advocate Emily’s needs, this is to ensure that care is delivered successfully and communication between staff and patients are clear. Healthcare staff will need to work together to ensure the effective delivery of care and that no mistakes are made. Communication between nurses, doctors, and pharmacy is crucial as nurses spend the most time with patients so they can update doctors on their health. Doctors oversee prescribing medicine for patients and the pharmacy is in charge of delivering the right medication prescribed. Everything should be noted down with signature and date to avoid mistakes.

Emily’s parents should be made aware of her rights as a patient. Individuals above 16 can consent to their own treatment. If a child under the age of 16 shows understanding, they can also consent to their own treatment, this is called Gillick Competent, if not, an individual over the age of 18 who has responsibility for the child such as parent or guardian can consent on behalf of the individual. If the individual with parental responsibility refuses treatment for the child which could be beneficial towards health, judges within a court can make a decision.

Within this report, the author identifies and acknowledges the cause and how to treat pediatric gastroenteritis founder 5s. The author was provided with a scenario of a young child called Emily who was diagnosed with gastroenteritis, being the age of 4. The author used professional values and the NMC code which are implemented by the NHS staff when caring for the patient and their families. The author also discussed potential risk factors whilst taking care of Emily such as emotional factors and social factors. It’s crucial that medical staff take the risk factors discussed into consideration as they desire to provide the best service possible to help the patient recover and give them a positive experience. Furthermore, staff will need to identify possible health factors after discharge to prevent the patient and the individuals around them from developing gastroenteritis. This will, therefore, benefit Emily and the medical health facility as the medical staff would provide them with a guide to manage and supervise pediatric gastroenteritis at home and when to bring in a child if their condition has deteriorated. In addition to, the author goes on to discuss the significance of maintaining hygiene level when caring for a highly infectious patient in a medical environment. This is crucial in order to prevent the outbreak and spread of gastroenteritis within the ward. Also, the Author discusses the criticality of managing the input and output of fluids for Emily as patients such as Emily lose a lot of fluids and tend to be extremely dehydrated. Overall the author has identified relevant knowledgeable information for gastroenteritis and how to treat a patient with pediatric gastroenteritis. Lastly, this information helps medical staff develop their understanding on gastroenteritis for future cases and how to challenge it to the best of their ability.