Table of Contents
Integrated nursing is such a practice in which the caregiver should apply interdisciplinary knowledge reading the management of the illness of the patient. The chronic illness along with chronological and developmental age, gender and life experiences have a contribution behind the cause of a disease. However, the application of patient centered care always helps to provide the best clinical support to the patient. In the cases of Poppy Sutherland and Mary Smith, both the parties have different age and medical background. However, the current clinical condition and acute issue of diarrhea have triggered quick hospitalisation. The nurses have to implement interdisciplinary and patient centered skills to make the clinical acuteness of both the patients. This study is focused on the identification of similarity and differences between the two cases and development of patient specific nursing goals for them. The study should also outline effective nursing intervention for the priory problem of electrolyte balance and impaired fluid to address the nursing goals.
Clinical data identification and analysis
In the introductory section, ithas been mentioned that both the patients are suffering from diarrhea. Additionally the issue of vomiting has also been noted for the patists. As per the case study of Poppy Sutherland, a girl of 4years old has a history of diarrhoea for the previous 30 hours. As per the viewpoint of Goldenberg et al. (2015), acute diarrhoea lasts for a short time and it is about 2 days.the same thing has been noticed for the patients. However, Thongprachum et al. (2015) has mentioned that the support of healthcare professionals should be taken for the paediatric cases, when the diarrhea stands from more than 24 hours. In this case of Poppy,the patient has been admitted after 30 hours which invoked a little delay to the initiation of proper treatment. In this context, the pathophysiology of diarrhoea should be analysed. Shrivastava et al. (2017) has research about paediatric diarrhoea and has mentioned that secretion and absorption of fluid along with electrolyte in the human gut remains in a balanced position. With the loss of this balance or interruption of this balance, this dynamic process of absorption and secretion get hampered. This is the major pathophysiology behold the occurrence of diarrhoea. However, there are multiple causes behind the courance of diarrhoea. Muktar et al. (2015, p. 175) has stated that bacterial, viral or other microbial infection in the body invokes diarrhoea and the entry of toxin into the human gut also creates such clinical conditions. This triggers frequent bowel movement. The patient has faced the urge of bowel movement for 3 times in the morning.
As per the case study, it has been identified that 3 other children of Poppy’s day care are also suffering from the same symptoms. Hence, from this angle, it can be mentioned that thepatist have acute diarrhoea which has happened from a common source of infection. The pathophysiology of child diarrhoea also includes the issuer chronic secretory diarrhoea in which the gut mucus secretes excessive fluid due to any enterocyte abnormality or due to intolerance of particular substances like gluten, lactose (Yang et al., 2013, 265). In this case no such aspect has been reported by the patient's family which confirms that the patient has no issue of chronic diarrhoea. It has been reported that more than 3 million lives of children get lost for the burden of diarrhoea on a global level (Paediatrics and Child Health, 2020). Hence, the management of the case of Poppy is needed to be done with promptness. The symptoms of dehydration and vomiting have also been noted for the patient. As per the case study, the patient is not able to take fluid and vomits up within a short period of time As per the research papers of Body, C., & Christie (2016, p. 270), vomiting and nausea is tagged with acute diarrhoea and indicates the occurrence of gastrointestinal infection. In this case also the same thing has happened.
On the other hand, Mary Smith is an older adult with the age of 5 years and is a female patient. She has also admitted to the emergency department with the clinical issue of diarrhoea and vomiting. As per the case study, it has been reported by her husband that the grandchildren of the patient are also suffering from the same symptoms. Hence, from this angle, it can be commented that this is also a case of acute diarrhoea occurred due to any infection. The source infections is common for the patient and her grandchildren. As per the idea of Modi et al. (2016) the occurrence of dehydration takes place with repeated bowel movement and she is not able to tolerate any food or fluid which leads to the urge of vomiting. Hence, the lack of proper fluid intake in the body along with the loss of fluid due to watery bowel discharge and vomiting are the major causes of dehydration. Rosinger (2018, p. 198) has mentioned that, in the case of an adult patient, admission can be done after observation of 2 days. Hence, Mary has been admitted in the initial stage, just after 30 hours of the occurrence. The pathophysiology of adult diarrhea also includes any enteric infection, from contaminated water and food along with virtual infection. Nolan et al. (2015, p. 130) has further added that chronic disease in the colon, stomach or small intestine like Crohn disease often invokes the episode of diarrhoea. However in the case of this patient no such medical history has been reported. The issue of chronic irritable bowel syndrome also created diarrhoea which is not applicable for Mary as this has also been reported by the patient associates. The patient has been identified with nausea and this is one of the classic symptoms of enteric infection. Priyamvada et al. (2015, p. 2027) has added that mild fever indicates the association of infection in the body. Mary’s body temperature is about 37.8 degree celcius which indicates she has no such fever.
Difference and similarity of the patients
The major similarity of the two patients, that is May and Popins are in the symptoms and infection. The analysis of the previous section has helped to identify that both of the patients have some enteric infection which has triggered diarrhoea and vomiting. The issue of dehydration, impaired fluid and electrolyte imbalance has been noticed for the artists. The case study has reported that the patent has no renal output for the previous 8 hour of check-up. As per the viewpoint of Ballal & Martena (2013), the renal output in the time of diarrhoea is needed to be noticed by the GP or the caregiver as it is one of the key aspects to identify dehydration in the patient's body. This is also true for Popins. Hence, irrespective of the age and gender , the application of rehydration therapy is needed. Another similarity between the two patients is that,in both of the cases, the IV administration of fluid is not permitted. Hence, the application of oral route is needed to be selected for the management of fluid and electrolyte balance in the body. Holbein et al. (2014, p. 3785) has stated that blood pressure gets decreased with the issue of dehydration and this initiates serious deterioration of the clinical condition. For both of the patients, the pressure is quite low as per their age and body weight. Hence, this aspect is needed to be considered in the nursing intervention.
There is also dissimilarity between the two cases, in which the occurrence of fever is needed to be included. Poppins have the body temperature of 38.2 degree Celsius which indicates the concurrence of mild fever due to the infection in the GI tract. This is not applicable for Mary as she has not shown the same. However, the cognition of Mary has little beet disoriented. As per the viewpoint of Priyamvada et al. (2015, p. 2934), electrolyte imbalance for older adults invokes cognition issues including disorientation of speech, place and time. This is applicable for Mary but not for Poppins as she has been identified as rousable, in spite of being drowsy and has cried as well.
Identification of Nursing goal for the identified clinical problem
The goal is to continue the process of rehydration in the home set-up after the discharge of the patient.
The volume of renal output and blood test helps to identify the degree of rehydration
The initial imbalance of fluid in the body along with dehydration issue has been managed with fluid challenge. Hence, after the management of the initial crisis, this goal is easily achievable.
Patients are needed to be administered with oral rehydration regularly after an episode of diarrhoea. This is widely practiced around the world. Hence, it is quite realistic.
For coming 3 weeks after discharge
Table 1: SMART goal for the management of patient in home setup
Nursing Intervention for Poppy Sutherland
Intervention for Poppy:
As Poppy is a 4-year-old girl, she could be provided with extra fluid meals in order to work on her Fluid Volume Deficit issue. In between meals soup, ice cream, gelatine and popsicles can be offered. As she is intolerant to oral fluid and no IV can be prescribed, she can be provided with popsicle and sweets so that she can crave for water. Along with his, the sweet intake can restore the saliva secretion and can wet her tongue and oral environment. This can increase her tendency to intake water orally. On the other hand, she can be provided with electrolytes orally in order to restore the fluid balance as well as electrolyte balance. This can mitigate the issue of dry mucous membrane of nose, month and epiglottis. She can be diverted to other things and provided with sweet, popsicles, confectionaries and other water demanding diets. These can ensure the water craving of Poppy in continuous way. In the meantime, proper monitoring is required about her urine discharge and based on this, the water intake needs to be modified. Additionally, she needs to be provided with gelatinous food for restoring water balance (Brandstrup & Møller, 2019).
Interventions for Mary:
Being an elderly person, Mary is to be instructed to intake 180ml water with her medications. This much water can be provided with added electrolytic solutions available in the medicine store. Within the help of this intervention; she could be able to take the water in normal procedure. As a result, she could initiate her normal life. However, being oral water intolerant, she could be provided with multi-component interventions like juice, electrolytes, and others. On the other hand, she could be provided with suboptimal hydration care at home which should be prescribed by the nurses. This can remodel the metabolism and the motility needs to be restricted that her energy level can be improved (Armstrong et al. 2016). The blunted thrust response for some hypovolemic stimuli needs to be changed in a normal osmotic thirst by providing multi-component hydrating meal as well as taking suboptimal hydration care with alternative enteral or parenteral support.
NMBA nursing standards always give stessoverhe management safety and security of the patists. As per the official report, the deterioration of patsy includes dehydration, lowering of pressure and more. In the case, both the issue has been identified. Howber, with the implementation of fluid challenge, the initial crisi has been managed. The application of critical thinking and plan development for nursing practice has been mentioned in the standard 1 and 5 by the NMBA as the guidelines for registered nurses (NMBA, 2019). In this case this aspect has been followed which helps to justify the decision to take to mage the critical condition of Popins and Mary.
At the end of the study, it can be concluded that diarrhoea is such a clinical condition which invokes dehydration and electrolyte imbalance for the older patients. The BP of the patient also decreases with frequent bowel movement and loss of fluid. Hence, rehydration therapy is essentially needed for the long term with a patient cantered approach. Poppins is a patient of 4 years who can be managed with the administration of ORS along with chocolate and candy. In the case of the aged patient rebalancing should be done with an electrolytic solution for long term. The patient should be assisted by the nurse in the regular activity to manage any further clinical issue of fall due to dehydration.
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