Case Study Analysis and Developing the Care Plan

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Case Study Analysis and Developing the Care Plan

Introduction

The present case study deals with a five-year-old child named Jim Thomas. He is accompanied by his mother Stephanie. The child has had a runny nose and cough for the past four days. He has been having wheezing and shortness of breath since last night. He has a very poor oral intake and used a Ventolin puffer for the past two to three days. During the time of physical examination, his temperature is 39.2 °C. His respiratory rate is 38 breaths/minute. His oxygen saturation is 88-90% on room air and his heart rate is 154 beats/ minute. His BP is 92/54 mm Hg. The medical diagnosis, in this case, is acute asthma exacerbation. This case study intends to provide a care plan for the child to help him with the challenges he is facing right now. This case study analysis aims to provide an individual family-centered care plan to the child for the betterment of his well-being and health.

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The case study analysis

The clinical diagnosis

The child has been diagnosed with acute asthma exacerbation. His father has a history of asthma. Asthma is a non-communicable disease (NCD) that can commonly be observed in adults and children. It is a chronic disease that results in inflammation, swelling, or narrowing of the airways and leads to the production of extra mucus (Dharmage et al., 2019). Three-fifths of the cases of acute asthma are hereditary so, as Jim’s father has a history of asthma, it increases the chance of Jim getting affected with the same. However, the inheritance pattern of asthma is not known.

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Pathophysiology of the clinical diagnosis

The major abnormalities that can be observed in the pathophysiology of Asthma are mucus impaction and inflammation or narrowing of the airways (King et al., 2018). Bronchoconstriction can also be considered one of the major pathophysiologies of the disease (Yamauchi & Ogasawara, 2019). The respiratory muscles get tightened up. The symptoms in the patient like shortness of breath, runny nose, higher heart rate, lower oxygen saturation, and higher respiratory rate indicate airway obstruction and airway hyperresponsiveness, caused by Asthma (Hammad & Lambrecht, 2021).

Case study analysis and developing the care plan

Figure 1: The pathophysiology of Asthma 

Source: Gao et al., 2021  

Etiology, risk factors, signs, and symptoms

The patient has a lower oxygen saturation of 88-90% in normal room air. His respiratory rate is higher than the normal respiratory rate. The normal range of respiratory rate is 20-27 for five-year-old children and Jim has a respiratory rate of 38 breaths/ minute. His heart rate is also higher than the normal etiology beats/ minute. His heart rate was during the time of the examination 154beats/ minute. He has a decreased air entry bilaterally. The increased work of breathing was also marked and audible wheeze and moderate intercostal retraction of the tracheal tug was observed. During the time of physical examination, he has Rhinorrhoea. All of these symptoms indicate the pathophysiology of Asthma of airway inflammation. The patient can run out of breath if not treated and a lack of flow of oxygen can lead to cardiac failure (Lambrecht et al., 2019). Exposure to irritants can trigger the signs of asthma. His elder siblings suffered from influenza in the past week so that can be a trigger for Jim’s asthma as well. The risk factors for asthma include genetics and environmental factors. In this case, his father has a history of Asthma and his sibling suffered from influenza and took care of him.

Case study analysis and developing the care plan

Figure 2: Airways during asthma 

Source: Bergeron et al., (2010)  

Analysis of the growth and development of the child

The patient’s birth weight was 3500g which is normal and he was born by spontaneous vaginal delivery in the 38th week of pregnancy. Right now, his weight is 13.5 kg and his height is 98cm. His BMI, 14.1kg/ m2 is normal and considered as healthy as per his age. However, he has a very poor immunization history. He is unvaccinated. The child has a history of asthma that was detected at three years of age. He was hospitalized for ten days due to asthma, for two months. The growth and development of this child are interrupted due to family conditions.

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Specific requirements for care during hospitalization

The patient is allergic to nuts and penicillin; this should be handled while handling the patient. He is a five-year-old boy and looks distressed at the time of admission. He has bruises that are considered finger marks on the left upper arm; those should also be treated specially. Apart from this, he needs pediatric treatment as he is from the age of five. He has a normal BMI so a diet plan applicable for the asthma patient can be applied to him as well. Better communication should be maintained with the patient and any adult drugs for asthma cannot be given (Kim et al., 220). A 20-22 gauge cannula should be used for the IV channel as he has scars on the left upper arm. The IV channel should be made in the right hand depending on the availability of the vein.

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The complex safeguarding issue and the multidisciplinary process of safeguarding the issue

The child may have suffered traumatic child abuse in the home. He has bruises, welts, and marks over his arms and body. As a part of the multidisciplinary process, a nurse can help the child by providing him with an adequate investigation regarding the treatment, and coordinating procedures that should be implemented (Newman & Vasey, 2019). The impairment of health and development of the child should be prevented by the nurse. The nurse should ensure that the child grows up in the circumstances that provide him adequate effective care intending the best outcome (Glasper, 2020).

Case study analysis and developing the care plan

Figure 3: Safeguarding procedures to be followed as a nurse

Source: MAG Online Library, (2022) 

Discussion on medication management

Anti-inflammatory drugs are commonly used to treat asthma. The child needs constant monitoring and humidified oxygen (Choi et al., 2021). He will be provided with nebulized salbutamol and ipratropium. The IV fluids were 0.9% sodium chloride + 5% glucose. Along with this, oral paracetamol and prednisolone will be given to him.

The IV cannulation can be challenging as the patient has bruises and scars all over his body. He is also dehydrated and that is why this process can be challenging. The parents have an allergy to penicillin so any drug that contains penicillin cannot be given. The drugs for bronchial infection have penicillin in them, so the medical team has to be careful about it.

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Implementation of the risk assessment tool in the case study

Risk assessment tools are highly essential for clinical care studies. It helps to analyze potential risk factors of a patient that can create hindrances in their health and well-being. The Asthma Control Test is the risk assessment tool that can be used in this case the asthma control test. It helps to analyze the risk of the patient by regularly monitoring his breath sound, oxygen saturation, heart rate, and respiratory status. A respiratory team can review this assessment procedure. Peak flow monitoring can also be conducted with the help of the peak flow meters. The PEF chart can help to assess the risk factors, in this case, the study (Arnal et al., 2018).

Case study analysis and developing the care plan

Figure 4: PEF chart

Source: rch.org.au, (2021)

Family-centered care plan

Assessment data

This plan has assessed the data regarding this child’s past and present medical history. His birth history has been analyzed along with his present physical condition. His mother’s verbal reporting is also analyzed to identify the issues.

The four major priorities and problems

The major problems and the priorities of this case study are,

  1. The child has a history of chronic diseases like asthma, eczema
  2. He is poorly managed. He does not take his inhalers regularly. The child was not even vaccinated.
  3. Right now he is having terrible breathing issues, audible wheeze, and other symptoms of acute asthma.
  4. The child also has a history of problematic family and may have faced issues regarding child abuse as he has marks and bruises over bodies.

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Goals and expected outcomes

The expected goals and outcomes of this care plan are the health and well-being of Jim. He should get proper treatment and doses and not face the complexities of his chronic asthma.

Nursing interventions

Here are a few nursing interventions that should be included in the care plan.

  • The daily medication schedule should be maintained with the help of the medical chart that may include the dosage, and timing of all medications that are being used for James (Gao et al., 2021).

Case study analysis and developing the care plan

Figure 5: Daily medication chart

Source: BMJ Open Quality, (2022)

  • Assess the history: The patient has a history of acute asthma and is allergic to nuts and penicillin. These histories need to be noted. His father also has a history of asthma and eczema like the child (McCabe et al., 2019).
  • Assessment of respiratory status: His respiratory status should be monitored thoroughly during the care process regularly.
  • Collaboration with family: The nurse needs to maintain proper collaboration with his family members to successfully implement the care plan.

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Evaluation and analysis

The family-centric care plan helps the patient restore his well-being with the support of his family members. This helps the healthcare decision-maker to be involved in the partnership with the family members for the betterment of the child (Lloyd et al., 2018). It focuses on four major attributes that are respect, value, support, and empathy.

Case study analysis and developing the care plan

Figure 6: Family-centered care plan

Source: BMJ Open Quality, (2022)

It is going to be the most effective practice in this case, as the patient has family issues (Jack et al., 2018). He is not managed properly as he is supposed to use Ventolin puffers and Symbicort puffers regularly but does not use them. A regular medication chart can help them to monitor his medications. His father has anger issues and does not work. The family orientation has hampered his growth. His mother is also worried about it and reported that the patient is scared about his father and that his father has mental health problems. His father does not take medication for his illness and has anger issues. So, family-centered care is highly essential in this case. The report followed the Clinical Reasoning Cycle where the information was gathered and the problems were diagnosed with the help of that. The present result of the physical examination and past medical records of the patient has to understand the situation of the patient.

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Conclusion

The patient is diagnosed with asthma at three years old. His father has a history of asthma and eczema. The child was admitted two times to the hospital last year. The last hospitalization was two months back for ten days. He is unvaccinated and allergic to nuts and penicillin. His height is 98 cm and his weight is 13.5kg. Hence, his BMI is 14.1kg/ m2. The child doesn’t get proper care in the home and stays with his elder siblings. His shortness of breath has not been relieved by puffers since last night. Right now, is having shortness of breath and he is not even able to talk. The interventions are suggested and their outcomes are evaluated. It helped the nursing individual to learn about the disease and its care plan. The intention of using the clinical reasoning cycle is to reflect and learn from this case study analysis.

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Reference

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Bergeron, C., Tulic, M. K., & Hamid, Q. (2010). Airway remodeling in asthma: from bench side to clinical practice. Canadian Respiratory Journal, 17(4), e85–e93. https://doi.org/10.1155/2010/318029

Choi, Y. J., Park, J. Y., Lee, H. S., Suh, J., Song, J. Y., Byun, M. K., … & Park, H. J. (2021). Effect of asthma and asthma medication on the prognosis of patients with COVID-19. European Respiratory Journal57(3). https://erj.ersjournals.com/content/57/3/2002226

Dharmage, S. C., Perret, J. L., & Custovic, A. (2019). Epidemiology of asthma in children and adults. Frontiers in pediatrics7, 246. https://www.frontiersin.org/articles/10.3389/fped.2019.00246/full

Gao, F., Wang, H., & Wang, H. (2021). Study the effect of one-stop service combined with a clinical nursing path on patients with acute bronchial asthma. American journal of translational research13(4), 3773. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129301/

Glasper, A. (2020). Safeguarding children with long-term conditions from COVID-19. British Journal of Nursing29(9), 533-534. https://pubmed.ncbi.nlm.nih.gov/32407230/

Hammad, H., & Lambrecht, B. N. (2021). The basic immunology of asthma. Cell184(6), 1469-1485. https://pubmed.ncbi.nlm.nih.gov/33711259/

Jack, B. A., Mitchell, T. K., O’Brien, M. R., Silverio, S. A., & Knighting, K. (2018). A qualitative study of health care professionals’ views and experiences of pediatric advance care planning. BMC Palliative Care17(1), 1-9. https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-018-0347-8

Kim, C. H., Lieng, M. K., Rylee, T. L., Gee, K. A., Marcin, J. P., & Melnikow, J. A. (2020). School-based telemedicine interventions for asthma: a systematic review. Academic pediatrics20(7), 893-901. https://pubmed.ncbi.nlm.nih.gov/32446856/

King, G. G., James, A., Harkness, L., & Wark, P. A. (2018). Pathophysiology of severe asthma: We’ve only just started. Respirology23(3), 262-271. https://pubmed.ncbi.nlm.nih.gov/29316003/

Lambrecht, B. N., Hammad, H., & Fahy, J. V. (2019). The cytokines of asthma. Immunity50(4), 975-991. https://pubmed.ncbi.nlm.nih.gov/30995510/

Lloyd, B., Elkins, M., & Innes, L. (2018). Barriers and enablers of patient and family-centered care in an Australian acute care hospital: Perspectives of health managers. Patient Experience Journal5(3), 55-64. https://pxjournal.org/journal/vol5/iss3/9/

McCabe, E. M., McDonald, C., Connolly, C., & Lipman, T. H. (2019). A review of school nurses’ self-efficacy in asthma care. The Journal of School Nursing35(1), 15-26. https://pubmed.ncbi.nlm.nih.gov/30376756/

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Newman, J., & Vasey, J. (2019). An exploration of support systems for nursing staff working in safeguarding children. Nursing children and young people. https://www.semanticscholar.org/paper/An-exploration-of-support-systems-for-nursing-staff-Newman-Vasey/357e398e99bf6e460decc77dd3940b61050cefd3

Yamauchi, K., & Ogasawara, M. (2019). The role of histamine in the pathophysiology of asthma and the clinical efficacy of antihistamines in asthma therapy. International journal of molecular sciences20(7), 1733. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6480561/

BMJ Open Quality. (2022). Retrieved 18 July 2022, from https://bmjopenquality.bmj.com/

MAG Online Library. (2022). Retrieved 18 July 2022, from https://www.magonlinelibrary.com/

rch.org.au. (2021). Clinical Practice Guidelines: Acceptable ranges for physiological variables. Rch.org.au. Retrieved 18 July 2022, from https://www.rch.org.au/clinicalguide/guideline_index/Normal_Ranges_for_Physiological_Variables/.

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