Family-Centered Care Plan for a Child with Acute Bacterial Meningitis

QUESTION

– Case study/ scenario Visualise yourself in the role of a second year BN (Bachelor of Nursing) student on the last week of clinical placement in a busy Paediatric Emergency Department (PED) providing care for the following patient in the afternoon shift along with your mentor RN (Registered Nurses). Patient information Name: Oscar Wilson Age: 4 years Sex: Male Accompanied by: Meghan Wilson (mother) and Patricia Foster (Grandmother) Present Medical History Oscar presented to Paediatric Emergency Department (PED) at 1400. Chief complaints included lethargy, fever (very high temperatures), runny nose, and productive cough for the past three to four days. Oscar appeared to be very sleepy and stayed in bed all the time over the past two days. His oral intake was poor during the past week. Oscar has complained of nausea, refused oral food/fluids and had two episodes of vomiting since this morning. He also had one episode of seizures (generalised tonic clonic seizures) this morning @ around 1000. Past Medical History History of recurrent cold and cough, latest occurrence approximately 4-6 weeks ago Hospital admission X 5 days for Acute gastroenteritis 2 years ago Allergies: Nil known Perinatal History First baby, Antenatal period was uneventful Vaginal birth at 38 weeks, Birth weight: 3.5 Kg, Length & Head circumference: data not available Postnatal: Developed neonatal jaundice, received phototherapy Developmental History Summary based on family report: Oscar can walk around in the house and lawn, have started to run around for short distances, however, is not confident to use stairs. Oscar is not toilet trained by day and need diapers. Oscar can scribble on paper or a board, however, is not able to draw lines or circles. Oscar can put words together to communicate, however his speech is difficult to understand. can Immunisation History Unvaccinated due to cultural reasons Nutritional History Predominantly bottle-fed in infancy, semi-solid food started at 4 months of age, mealtime is usually extended due to poor acceptance (need coercion/distraction), prefers finger foods. Family History Meghan (Oscar’s mother) has a history of depression, management has been irregular in the past one year; Oscar’s Dad has history of asthma, diabetes. Social History Oscar has not been enrolled to childcare/ Early Learning Centre. Meghan does not work. Oscar’s Dad works as a truck driver and will be home only for a few days in a month. Meghan’s mum lives close by and was summoned for help when Oscar had the seizure episode this morning. Torrens University Australia (TUA) CCA206_Assessment_2_ Case study analysis and developing a care plan (Case study) © Torrens University Australia 2023 Page 2 of 2 Physical Examination General appearance Oscar appears very tired, drowsy and unsettled. He also appears underweight, skin is smudged with dirt, and clothes are smelly Anthropometry Length: 98.0 cm Weight: 12.2 kg Vital signs Respiratory rate: 34-38 breaths per minute Oxygen saturation: 95-97 % on room air Heart rate: 150-160 beats per minute Blood Pressure: 90/58 mm of Hg Capillary refill time: 3 seconds Temperature: 39.1°C Neurological GCS 13/15 (E3V4M6), Neck stiffness++, Pain, associated involuntary effort to reduce meningeal stretching (Brudzinski sign +, Kernig sign+), Pupils bilaterally equal and reactive, History of one episode of seizure Respiratory Rhinorrhoea and occasional productive cough Mild increased work of breathing Cardiac/Abdomen/Musculoskeletal: Nil issues noted, abdomen soft, non-tender Renal: last diaper change was 14 hours ago (small amount of urine, yellow) Skin and mucous membranes Dry lips and mouth Few petechial spots on trunk Medical diagnosis ? Acute Bacterial Meningitis Treatment plan Admission Contact and Droplet precautions Continuous monitoring of RR, HR, SpO2 Hourly (and PRN) monitoring for – full neurological observations, seizures, blood pressure, temperature and Fluid Balance Chart (FBC) Nil by Mouth until review Blood sample for Venous gas, Full Blood Evaluation (FBE), Biochemistry, Culture Lumbar puncture – Cerebrospinal Fluid (CSF) for biochemistry, microscopy, and culture (before commencing antibiotics) IV cannulation, IV fluids – 0.9% sodium chloride + 5% glucose for maintenance (consider 2/3 of maintenance volume. To be revised based on hydration status, Na+ levels, and acid-base status) IV Antibiotics, steroids, paracetamol Seizure management Paediatric Medical team to review Consider CT /MRI (Magnetic Resonance Imaging) and further management after Paediatric Medical Consultant’s review

Define and apply the key concepts related to the growth and development of children and adolescents to nursing assessment and care planning c) Critically analyse the psychosocial and cultural needs of the child or adolescent and their significant other and essential support in relation to acute illness in child and adolescent primary health care. d) Explore the complexities of medication management with children and adolescents and interpret and apply to care planning. e) Recognise child protection responsibilities and collaborative processes with a multidisciplinary team. f) Identify and determine suitable risk assessment tools for use within children’s health care (as outlined in the National Safety and Quality Health Services (NSQHS) Standards).

Define the clinical diagnosis/es. 2. Describe the pathophysiology of the clinical diagnosis. 3. Analyse the aetiology, risk factors, signs, and symptoms of the clinical diagnosis in relation to the current clinical presentation of the child 4. Analyse the growth and development of the child in the case study and identify specific requirements for care during hospitalisation (based on age/ developmental stage) 5. Identify any complex safeguarding issues related to the child in the case study. 6. Describe the multidisciplinary processes for managing any complex safeguarding issues related to the child in the case study, based on the child protection responsibilities of a Registered Nurse in your State or Territory. 7. Identify and discuss the medication management complexities in the case study scenario and include in care planning. 8. Appraise suitable risk assessment tools, and apply one tool to determine the risk management measures to be integrated into the child’s care plan. 9. Based on your analysis above, develop a family centred care plan for the child in the case study highlighting FOUR care priorities/problems identified. In your care plan, include assessment data, problems or issues identified, goals/expected outcomes, nursing interventions/actions, and evaluation. As you are not providing care in the real world, to write your evaluation, consider that the child’s condition is improving after your interventions.

ANSWER

Family-Centered Care Plan for a Child with Acute Bacterial Meningitis

Introduction

This family-centered care plan is developed for Oscar Wilson, a 4-year-old male presenting with symptoms suggestive of Acute Bacterial Meningitis. The plan is designed to address Oscar’s specific healthcare needs, taking into consideration his age, developmental stage, and complex safeguarding issues. The aim is to provide comprehensive and individualized care, involving both Oscar and his family in the decision-making process.

Clinical Diagnosis and Pathophysiology

Clinical Diagnosis: Acute Bacterial Meningitis

Pathophysiology: Acute Bacterial Meningitis is an inflammatory condition characterized by infection of the meninges, the protective membranes surrounding the brain and spinal cord. In this case, the infection is bacterial in nature, leading to inflammation and swelling of the meninges. The causative bacteria can enter the central nervous system through the bloodstream or direct invasion from nearby infections.

Aetiology, Risk Factors, Signs, and Symptoms

Aetiology: The bacterial pathogens causing meningitis can vary, with common culprits including Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae.

Risk Factors: Oscar’s lack of immunizations puts him at higher risk of developing bacterial infections, including meningitis. His history of recurrent cold and cough may also contribute to a compromised immune system.

Signs and Symptoms: Oscar’s symptoms include lethargy, high fever, runny nose, productive cough, nausea, vomiting, and a history of generalized tonic-clonic seizures. Neck stiffness and positive meningeal signs are indicative of meningeal inflammation.

Growth and Developmental Considerations

Based on Oscar’s developmental stage, he is at a crucial age for cognitive and physical growth. However, his lack of confidence in using stairs and delayed speech development may require additional support during hospitalization. The care plan should consider age-appropriate activities and communication techniques to address Oscar’s needs effectively.

Complex Safeguarding Issues

Oscar’s family dynamic, with his mother’s history of depression and irregular management, may impact his care. The care plan must consider support systems for Meghan to ensure consistent involvement in Oscar’s treatment. Collaboration with mental health professionals is essential to address the psychosocial needs of both Oscar and his mother.

 Multidisciplinary Processes for Complex Safeguarding

The care team should involve social workers, child protection services, and mental health specialists to address the complex safeguarding issues. Regular communication and assessment of Meghan’s mental health status will be vital in ensuring her ability to support Oscar during hospitalization and beyond.

Medication Management Complexities

Oscar’s lack of immunizations requires careful consideration of the medications administered, especially in cases where vaccination-preventable bacteria may be involved. Additionally, age-appropriate dosages and administration methods should be considered to ensure medication compliance.

 Risk Assessment Tool and Management Measures

The Pediatric Early Warning Score (PEWS) will be used to assess Oscar’s risk for clinical deterioration. Based on PEWS assessment, the care plan will include measures for early recognition of deterioration, such as frequent neurological assessments and vital sign monitoring.

Family-Centered Care Plan – Four Care Priorities/Problems

Priority 1: Infection Control

Goal: To prevent the spread of infection and protect vulnerable patients.
– Nursing Interventions: Implement contact and droplet precautions, perform proper hand hygiene, and educate family members on infection control measures.

Priority 2: Seizure Management

Goal: To minimize the risk of seizures and prevent injury.
Nursing Interventions: Administer anticonvulsant medications as prescribed, closely monitor for seizure activity, and ensure a safe environment.

Priority 3: Nutritional Support

Goal: To improve oral intake and hydration.
Nursing Interventions: Offer small, frequent meals and encourage fluid intake. Provide age-appropriate finger foods and monitor hydration status.

Priority 4: Psychosocial Support

Goal: To address Oscar’s developmental needs and support his family.
Nursing Interventions: Facilitate age-appropriate activities and play, involve child life specialists, and provide emotional support to Meghan.

Conclusion

This family-centered care plan addresses the specific healthcare needs of Oscar Wilson, considering his age, developmental stage, and complex safeguarding issues. By focusing on infection control, seizure management, nutritional support, and psychosocial support, the care plan aims to promote positive outcomes for Oscar and his family during his hospitalization. Collaboration with a multidisciplinary team and use of risk assessment tools ensures comprehensive and individualized care, adhering to the principles of family-centered nursing practice.