Question

Rachel Singer is a 5-year-old girl who is brought to the emergency department by her parents, Lucas and Veronica. They report that Rachel has been experiencing vomiting and diarrhea for the past 36 hours. “She hasn’t been able to keep anything down. We tried sips of liquids and even that didn’t help.” She is lethargic and her mucous membranes are dry and pale. Rachel is to be admitted. Her orders include intravenous fluid therapy and nothing by mouth (NPO).
a. What measures would be appropriate to help Rachel and her parents cope with the emergency admission?

b. What areas would be a priority for the nurse to address when caring for Rachel?

Answer 1

ANSWER 1: Of course admission of their child in any hospital will lead to several worries, questions, and anxiety in parents. For patients of any age, a trip to the hospital can be uncomfortable. However, for pediatric patients, it can be especially traumatic. Therefore it is a duty of every nurse to help the parents as well as child to cope up with crisis by following methods:

• Practice Calmness    A healthcare provider who shows anxiousness only serves to enhance the nervousness of young patients and their parents. They count on you to remain strong and composed, no matter the situation.

• Talk Through the Experience The best way to assuage their fears is by recognizing and communicating with them. Instead of talking only with the parents, include children in the conversation as much as is appropriate for their age and level of understanding.

• Provide assurance but not a false hope it is a best way to develop a good harmony and interpersonal relation with parents as well as with their child. Never give false hope or any false information regarding their child's progress or condition.It can be poisonous that can spoil all the reputation of you and lead to anxiety and worries in parents.

• ask questions: clearly ask questions from parents about their worries and encourage them to share their feelings and anxieties. Use clear, easy, short sentences in non medical term to explain them about their child.

• Employ Distractions  help the children by asking about school, their favorite TV shows, their pets and their friends. Encourage them to share stories. The more they concentrate on these subjects, the less they’ll dwell on their fears.

• Be Educational  Take time to explain various instruments and machines. Allow them to listen to their child own heartbeat through your stethoscope. In addition to feeling pride in her new knowledge, they feel more comfortable with her surroundings.

• Make Physical Comfort a Top Priority  provide orientation to parents regarding hospital policies, rules and regulations, all about services that will be provided to their child.

• share feelings: the most comman reason of anxiety among parents is feeling of guilt. sometimes parents take all the fault in their head and start thinking that all is their's fault, because of their sins child has to suffer. So it is an important role of nurse to help the parents in share feelings and advice them to not to think about such things.

ANSWER 2: PRIORITIES TO CARE A CHILD WITH VOMING AND DIARRHEA FOR A NURSE WILL BE:

• deficient fluid volume
• imbalanced nutrition intake: less than body requirement
• risk of impaired skin integrity
• risk of infection
• risk of developmental delay

NURSING CARE:

• measure each voiding in the older child; document the number and character of the stools, as well as the amount and character of any vomitus.
• Weigh the child daily on the same scale; take measurements in the early morning before the morning feeding;
• good mouth care is essential when the child is NPO
• when oral fluids are started, the child is given oral replacement solutions
• Monitor vital signs at least every 2 hours if there is fever; follow appropriate procedures for fever reduction, and administer antipyretics and antibiotics as prescribed.
• To reduce irritation and excoriation of the buttocks and genital area, cleanse those areas frequently and apply a soothing protective preparation such as lanolin A or D ointment;
• change wet undergarments as quickly as possible, and placing disposable pads under the child can facilitate easy and frequent changing
• All caregivers must wear gowns; gloves are used when handling articles contaminated with feces
• place contaminated linens and clothing in specially marked containers to be processed according to facility policy
• visitors are limited to family only
• teach the family caregivers the principles of aseptic technique and observe them; and good handwashing must be carried out.
• provide IV fluid according to Dr. order and calculation should be accurate.