Case study analysis on: Biology assignment on Hypotension
The case study is regarding Liam, a three month old boy being admitted to ward under the care of the General Practitioner. The medical records indicate the medical history of intermittent cough, rhinorrhoea and poor feeding. The physical assessment indicates low grade body fever of the patient, normal pulse rate of 152 beats per second, severe hypotension due to very low blood pressure if 74/46 mm Hg. Further observing the oxygen saturation rate of 91% SpO2 indicates the worsening condition of the patient and the need to commence oxygen therapy immediately. Moreover, the physical examination findings indicate sunken anterior fontanelle, injected conjunctiva, rhinorrhea, tympanic membrane with erythema and tacky mucous membrane. Consequently, Liam indicates bilateral lung coarse sounds, aeration, wheezing with mild to moderate intercostals retractions, nasal flaring and indication of tachycardia.The nutritional status indicates that the baby is not completing the feed with reduced oral intake, diminished urine output and observation of drier nappies than usual (Medscape, 2012). All these symptoms indicate the typical symptoms of Respiratory Syncytial Virus. Further observing the social history of the patient, the patient is indicated to have a family history of Asthma and this is correlated with severe form of respiratory Syncytial Virus. Respiratory Syncytial virus is a virus which commonly affects the respiratory tract and lungs of children infected with virus in infants and children. Further, this manifests as the clinical entity of bronchiolitis (Hecht, 2004). Inoculation of virus occurs in the respiratory epithelial cells present in the upper respiratory tract and the virus is spread down the respiratory tract through the virus cell-to cell transfer along with the intracytoplasmic bridges from the upper to the lower respiratory tract (NSW Health, 2012).
Identification, interpretation, prioritisation and overview of the chief complaints/health issues.
- Two key problems and discussion of planning, implementation and evaluation of care:
Two key problems include indication of Respiratory Syncytial virus infection and Severe Hypotension.
Assessment and diagnoses of the child’s needs
The physical assessment and medical records of Liam indicates severe symptoms of Respiratory Syncytial virus. This needs to be addressed immediately. RSV is a common virus which leads to cold and mild symptoms in infants and adults. It is seen as seen as a serious condition in babies which leads to airway and lung infections. The virus is spread through the tiny droplets which spread in the air through coughing and sneezing (Chan, 2007). The common treatments for Respiratory Syncytial virus include Liam being admitted in the hospitals .Few treatments include administration of oxygen, moist humidified air and fluids through vein via intravenous fluid administration (Mayo Clinic, 2013). As Liam faces symptoms of wheezing and other symptoms of brochospasm, this needs to be also addressed. Relieving bronchospasm and increase airflow can be achieved by intake of salbutamol and nasal cannula. Further, breathing machine or ventilator may also be used as adequate intervention. Moreover, the treatment for respiratory syncytial virus involves measures of self-care such as supportive care such as physician prescribed over the counter medication such as ibuprofen and acetaminophen for reducing fever and other bacterial complication in case of Liam (Medscape, 2012). Also in severe cases the patients are also administered nebulized bronchodilator such as albuterol to relieve wheezing. This medication opens the air passage in the lungs and additionally nebulized form of ribavirin or epinephrine can also relieve symptoms of RSV infection.
In case of Liam the blood pressure value of 74/46 indicate low blood pressure or severe hypotension. Hypotension is low blood pressure which occurs when the blood pressure after each heartbeat is lower than usual and when the brain, heart and other body parts do not get enough blood. The symptoms of blood pressure include fainting, dizziness and light-headedness. The treatment in case of Liam for blood pressure depends upon the cause. Few nursing interventions include addition of electrolytes which can reduce symptoms of mild hypertension. Moreover, the patient can be advised to have morning dose of caffeine which can be effective in cases where the affected patient is responsive (Cooper, 2004). Further, the patient can be made to lie down in dorsal decubitus position and with leg lifting can increase the venous return. This will bring the blood available to the critical organs such as head and chest. Research indicates that the treatment for severe hypertensive shock follows four steps. This includes provision of septic shock, volume resuscitation by using crystalloid, blood pressure support with vasopressors2, adequate tissue perfusion, and addressing underlying problem.
Pharmaceutical interventions for treatment of hypotension include use of abdominal binder or compression stocking which may help in returning blood to the heart and decreasing blood pressure and administration of medications such as steroids and alpha-adrenoreceptors agonists which can prevent salt loss from the baby’s body, increase fluid amount in the body of the patient, raise blood pressure. Further intake of antidiuretic medication can control the blood pressure (Drugs.Com, 2013). Additionally, the mid-term treatment for hypotension includes controlling blood sugar, steroid support and early nutrition .Consequently the health care professionals can advice or suggests various self-help treatments to the parents of the child (Mayo Clinic, 2013).This includeswearing supporting stockings, avoiding caffeine, eating fewer meals rich in healthy diet.IS THIS FOR A CHILD??? Thus the baby needs to be fed well to avoid bring about optimal blood pressure rate. Sofollowing such interventions can help in alleviating the hypotension in the patient, Liam.????????
Discussion/ rationale of planned management and interventions for the two problems that you have prioritised, including the family centered care considerations…..USE OF HOLISTIC HEALTH CARE, PARENTS BE INFORMED AND ALLOUD TO MAKE DESCISIONS ON CHILDS CARE
- Family-Centred considerations:
Most infants with RSV infection generally recover with no such problems. In children and infants with lower respiratory problems, the supportive care provided is vital. In case of Liam, the patient outcome should be the ability to act normally as a baby with optimal respiratory or cardiac response. Second, to have normal feeding pattern, maintain normal skin colour and verbalize an understanding for normal regular activities in case of Liam.
Treatment considerations for RSV include quick interventions upon diagnosis to prevent the development of life-threatening respiratory complications. With regards to the case study, Liam being admitted in the hospital for RSV treatment needs to be monitored carefully for their initial response to treatment under the standardized protocol. Few treatment considerations include administration of antibiotics which can treat bacterial infections. In most cases as RSV is self-limiting and mild, so treatment efforts should include management of symptoms and assuring that Liam can drink, breath and sleep comfortably. Moreover, intake of non-aspirin medications such as Tylenol and other non-steroidal anti-inflammatory agents such as advil or motrin can cause fever and discomfort. Liam needs to be well hydrated and relief from congestion can be achieved with bulb suction, endotracheal and
Summary of key points and evaluation of the interventions with evidence of learning.
nasopharyngeal suctioning. Additionally nebulizer treatments can provide easier breathing and corticosteroids for reducing inflammation of the lung bronchus. Research indicates that an anti-viral agent Ribavirin is been acceptedas a standard for the treatment of RSV infection. Further for hospitalized infants affected with RSV, ribavirin is administered by aerosol via ventilator. This drug needs to be administered for 12 hours per day for 3-5 days and it is beneficial for clinical improvement and improves the oxygen saturation level. Furthermore, the ribavirin aerosol is researched to not be linked with any toxicity too (virology-online 2013). Furthermore, nasal products containing polyethylene glycol or sodium chloride can keep the nasal passage moist and open in the baby.
If Liam shows no or very little improvement from RSV within a reasonable period, they many benefit from continuous racemic epinephrine which will require admission to the PICU (Hudson 2013). Alternative interventions include mechanical ventilation and intubation in case of severe condition shown by Liam.
According to Bird (2012) infants who are at the highest risk of RSV can also be recommended RSV. Synagis or Palivizumab are RSV vaccines are given monthly during the RSV peak season. It is researched that synagis can prevent about 55% of pre- hospitalization and brings about effective prevention of RSV infection. Few preventive measures include frequent and timely hand-washing and elimination of risk factors such as daycare, low birth weight, crowded living conditions, multiple-births, chronic lung disease, exposure to pollutants of the environment etc.
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