Pediatric case study
When assessing a child in the clinical context as a nurse clinical reasoning is a vital important skill which nurses continually develop. Clinical reasoning can be defined as:
The process by which nurses collect cues, process the information, come to an understanding of a patient situation, plan and implement interventions, evaluate outcomes and reflect and learn from the process. (Levett-Jones et al. 2010, Hoffman 2007).
Using the clinical reasoning cycle developed by Tracey Levett-Jones we can work our way through the case going through the stages of considering the patient, collecting cues and information, processing information, identifying problems and issues and establishing goals for the patient. Using this together with relevant anatomy and pathophysiology will help establish a thorough picture of the patient and help to initiate appropriate care.
George is a 3 year old boy who is admitted with a respiratory illness. Brought in the early morning with increased work of breathing, with a persistent cough and lethargy and speaking in short sentences. A comprehensive respiratory assessment of the patient is needed to build a clearer picture of what is going on. Respiratory assessment is challenging in the younger child due to inability or unwillingness to cooperate. If the first step of assessment is inadequate, the process of clinical decision making and quality of care is at risk (Thompson and Dowling 2001). Best practice guidelines suggest that clinicians count the number of breaths over a full minute, also noting any abnormalities in the depth, rhythm, quality and effectiveness of respirations (Jevon, Ewens, and Pooni). It is important to look at and feel the chest in a child with asthma as it is common to see decreased air movement in one or both of the lungs. If the chest expands unequally, and there is no structural abnormality then air is not entering the lung effectively. In the infant and young child, most resting inspiration is due to diaphragmatic contraction (Rudolf and Levene 2006).
It is to be noted that George?s SPO2 is 91%. Oxygen saturation is particularly sensitive in exacerbations of Asthma. Oxygen saturations should be monitored during an exacerbation to assess severity of disease and response to treatment. George?s spo2 of 91% put him in the category of moderate exacerbation with spo2 values of 90-95% (National Asthma Education and Prevention Program 2007). Oxygen should be administered only to maintain a saturation of greater than 92-94% (The British Thoracic Society 2009) Because of this level of oxygen saturation we would apply nasal prong oxygen at 1-2L to keep oxygen saturations at the level that the team see appropriate. This saturation in combination with his tachypnea of 66 breaths per min and his ability to only talk in short sentences we would expect to classify as moderate Asthma (Ministry of health 2012). With work of breathing showing tracheal tug and intercostal...