NRSG257 Child Adolescent and Family Nursing

Describe the pathophysiology of the presenting complaint in the case study.

Evaluate the nurse’s role in delivering developmentally appropriate nursing care in relation to your chosen case study.

What age do you include a child/adolescent in medical related conversation?

How does a child/adolescent make decisions based on their developmental level?

Pathophysiology

Pathophysiology refers to changes in the functions of organs due to infection. Intussusception is a disease that affects the anatomy of the small intestines. The ileum is a tube-like organ that approximately six meters in length. Intussusception makes a section of the guts to move inwards into another part of the same intestine (Applegate, & Sadigh, 2018). The process of inward sliding is known as the telescopic movement. Intussusceptions occur in a similar way to the folding together of a telescope in a collapsible manner. Abnormal intestinal growth is the primary cause of the condition. The unusual increase can be in the form of a tumor or a poly. However, the growth of a tumor is the leading point of the development of the complication.

The intestinal contractions grab the tumor making the interior of the ileum to resemble a bowl-shaped structure. Intussusceptions affect all gender and ages but are common in children. Jay is a four-month-old boy with suspected intussusceptions. The condition prevents the passage of fluids and food. The disease also precludes the supply of blood to the affected part of the small intestines (Wharton, Garcia, & Felix, 2016). Severe cases can perforate, infect the bowel and kill the bowel tissues. The obstructions of the intestines arise due to intussusceptions. Therefore, an appropriate remedy is necessary to correct the condition.

Jay experiences vomiting and abdominal pains which are symptoms of the disease. The adverse abdominal pains make children cry loudly for a long time. The children tend to raise their legs towards the chest in agony due to the complication. The case study supports the symptoms by indicating that Jay draws his legs up and down and has a high pitched cry. Abdominal lump and lethargy are other symptoms of the disease. The young patient also experiences decreased feeds and absence of bowel actions. Vomiting is due to the inability of food to pass through the ileum; hence, the content returns to the mouth (Hazra et al., 2015). The sliding of a section of the intestine into the other part causes the abdominal pains. The severe pains make the child cry when drawing the legs up and down.

Growth and Development Theories

Growth and Development theories explain the science behind the biological changes in an individual. Piaget’s Cognitive Theory of Development explores the stages of thought transition. The theory explains the processes that an individual's brain undergoes during growth. The thought processes dictate how a child or an adult interact with and understand the world (Karmiloff-Smith, 2018). Adults think differently in comparison to children. The theory explains and describes the process of thought development. The first stage is the Sensorimotor phase which is a period from birth to two years. Jay is in this phase as he is a four-month-old male patient. During the step, the child has limited knowledge about various concepts. The nurse and Jay's mother cannot involve him in medically related conversation. Preoperational phase accommodates children from the age of two to six years old. Children at the stage cannot make appropriate medical decisions.

Children learn about language usage in the Preoperational phase. However, they do not understand the logic of diseases and medication. Therefore, they cannot make important decisions on their medication. Healthcare professionals should not involve children in decision making at the preoperational stage. The next phase of development is between the ages of seven to eleven years old (Carey, Zaitchik, & Bascandziev, 2015). Children start having logical reasoning from the age of seven.  However, caregivers should not involve them in medical processes due to their limited understanding of the treatment methods.

The most appropriate age of involving children in medically related conversation is from the age of twelve towards adulthood. At this age, people can think critically about different concepts of medication. The adolescence above the age of twelve can conduct a systematic planning and deductive reasoning (Lourenço, 2016). The brain of children develops gradually that caregivers must respect before involving them in the decision-making process. Jay is young, and the mother and the care providers should make medical decisions on his behalf. However, when he reaches the age of twelve, the caregivers can involve him in decision making.

Family Centered Care

The Family Centered Care (FCC) improves the quality of medical care. It requires the nurse to involve the members of the family in providing quality healthcare to the patient. The family members and the caregivers should obey the consent of the patient before offering treatment (Smith, Swallow, & Coyne, 2015). However, Jay is four-months-old and cannot make informed consent about his medical attention. The nurses should liaise with the mother and other relations in medical decisions. The caregiver should explain the modes of treatment to the mother and allow her to make an appropriate choice on behalf of the child. Inappropriate choice of medication affects the well-being of the child. The decision-making process should also obey the cultural beliefs of the patient.

The Australian Health policies should recognize the fact that Jay’s mother is the only constant factor in Jay’s life. However, the health system and policies fluctuate with durations. Therefore, the nurses have the responsibility of explaining the treatment methods towards intussusceptions to the mother of the child (Ramezani, Shirazi, Sarvestani, & Moattari, 2014). The caregivers then allow the mother to make an informed decision on behalf of Jay. FCC requires caregivers to exchange unbiased and complete information between professional and family. The nurses should honor and recognize the culture of the patient before conducting treatment. Therefore, the methods of treatment should be in tandem with the cultural beliefs. Caregivers should know and obey the individuality and strengths of every family.

Care providers should also lobby for financial support from families who cannot pay the medical bills of their children. Hospitals should involve families at various levels of care. The health facility should also conduct educational and development support to assist the families of the patients. The caregivers should also encourage inter-family support and networking (Regan, Curtin, & Vorderer, 2017). The community services, homes, and hospitals should be accessible to the children and their parents. The care providers should also appreciate the status of children and the families. Additionally, the healthcare professionals should attend to the concerns and strengths of the patients appropriately.

Effects of Hospitalization on the Child

The effects of hospitalization of the child are both positive and negative. Jay is only four-months-old and has to stay in the hospital for two days to undergo a specialized treatment of intussusceptions. The hospitalization assists the child since it relieves the abdominal pain and corrects other symptoms such as vomiting (Pérez et al., 2014). Admission is a source of stress to the mother of the patient. The relationship between the mother and the child suffers a setback due to the separation between the two. Therefore, the process interferes with the proximity of the infant and the mother. Hospitalization denies the mother a chance to take part in decision making towards the child’s health. The early separation of the infant from her mother can disrupt his future behaviors. Therefore, hospitalization is disruptive to the mother-child relationship.

Hospitalization affects the mother to a greater extent in comparison to the father of the child. The family members take an extended time to adapt to the child due to the prolonged absence of the patient. Jay is young, and the nurse cannot notice the emotional changes due to the hospitalization. However, the child undergoes stress and anxiety due to the hospitalization (Foster, Whitehead, & Maybee, 2016). The process also consumes time for primary education for the child. The mother requires a lot of time to train the child on skills such as walking and eating. Therefore, hospitalization interferes with the development of the child.

Hospitalization challenges the child due to the change in environment. The hospital bed can be scary as opposed to the warmth of home. Therefore, the young child misses home but cannot express his feelings due to the tender age (Zhu et al., 2015). The establishment of the normal mother-son relationship is also a challenge after a long medication. The child can forget the mother due to the little advancement of his brain cells. The hospital environment also restricts the movement of the child from one place to the other. Therefore, the child takes an extended time to learn how to move from and towards positions.

Conclusion

In summary, intussusceptions cause a section of the intestine to fold into the other part. The disease causes symptoms such as vomiting and severe abdominal pains. The condition makes Jay cry due to the pain. Piaget's theory of development requires parents to make medical decisions for their children until the age of twelve years. Family-centered care ensures quality treatment to the patient. The attention needs caregivers to involve the family in decision making towards the well-being of the patient. A lengthy hospitalization affects both the child and the mother. The process interferes with the parent-child relationship. A hospitalized child also undergoes stress and anxiety among other effects.

References

Applegate, K. E., & Sadigh, G. (2018). Intussusception in Infants and Children: Diagnostic Evidence-Based Emergency Imaging and Treatment. In Evidence-Based Emergency Imaging (pp. 567-582). Springer, Cham.

Carey, S., Zaitchik, D., & Bascandziev, I. (2015). Theories of development: In dialog with Jean Piaget. Developmental Review, 38, 36-54.

Forati, S., Yaghmaii, B., & Allah-Verdi, B. (2017). The effect of early feeding after enema reduction of intussusception to investigate the rate of recurrence and side effects of reduction. Biomedical Research, 28(13).

Foster, M., Whitehead, L., & Maybee, P. (2016). The parents’, hospitalized child’s, and health care providers’ perceptions and experiences of family-centered care within a pediatric critical care setting: A synthesis of quantitative research. Journal of Family Nursing, 22(1), 6-73.

Hazra, N. K., Karki, O. B., Verma, M., Rijal, D., De, A., & Nath, B. (2015). Intussusception in Children: A Short-Term Analysis in a Tertiary Care Hospital. American Journal of Public Health, 3(4A), 53-56.

Karmiloff-Smith, A. (2018). Précis of Beyond modularity: A developmental perspective on cognitive science. Thinking Developmentally from Constructivism to Neuroconstructivism (pp. 64-94). Routledge.

Lourenço, O. M. (2016). Developmental stages, Piagetian stages in particular: A critical review. New Ideas in Psychology, 40, 123-137.

Pérez, M., Groeneveld, I. F., Santana?Sosa, E., Fiuza?Luces, C., Gonzalez?Saiz, L., Villa?Asensi, J. R., ... & Lucia, A. (2014). Aerobic fitness is associated with lower risk of hospitalization in children with cystic fibrosis. Pediatric pulmonology, 49(7), 641-649.

Ramezani, T., Shirazi, Z. H., Sarvestani, R. S., & Moattari, M. (2014). Family-centered care in the neonatal intensive care unit: a concept analysis. International journal of community-based nursing and midwifery, 2(4), 268.

Regan, K. M., Curtin, C., & Vorderer, L. (2017). Paradigm shifts in inpatient psychiatric care of children: approaching child?and family?centered care. Journal of Child and Adolescent Psychiatric Nursing, 30(4), 186-194.

Smith, J., Swallow, V., & Coyne, I. (2015). Involving parents in managing their child's long-term condition—A concept synthesis of family-centered care and partnership-in-care. Journal of pediatric nursing, 30(1), 143-159.

Wharton, K., Garcia, A., & Felix, M. (2016). Intussusception Mimicking Rectal Prolapse in a 5-Month-Old Infant. Journal of Pediatric Surgical Nursing, 5(3), 67-69.

Zhu, H., Das, P., Roberson, D. W., Jang, J., Skinner, M. L., Paine, M., ... & Berry, J. (2015). Hospitalizations in children with preexisting tracheostomy: a national perspective. The Laryngoscope, 125(2), 462-468.