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This unit aims to encourage and facilitate students to rationalise and critically examine the nursing management of the sick child/adolescent, and to generate and apply specialised paediatric nursing knowledge through the innovative and creative processes of linking theoretical into practice. The unit provides students with opportunities to further expand on the knowledge acquired in Paediatric Nursing Knowledge 1, develop appropriate strategies and clinical teaching skills in the provision of education for the sick child/adolescent, parents, other siblings and staff and ultimately develop skills and competence to function as an advanced paediatric nurse. It will explore further topics with reference to nursing care of children with health conditions.
After satisfactorily completing this unit students will have gained the ability to:
- Outline major health priorities and related strategies for children and adolescents and their families (4,5,7,8 & 9);
- Discuss anatomic and physiologic differences in children compared with adults and in relation to health disorders (1, 2, & 3);
- Identify nursing interventions related to common laboratory and diagnostic tests used in the diagnosis and management of infectious and health disorder conditions (4 & 5);
- Identify appropriate nursing assessments and an individualised nursing care plan for childhood health conditions (2, 3, 4, 5, & 6);
- Increase and enhance an awareness of the importance of the family unit in paediatric nursing (1 & 7);
- Increase the awareness of providing accuracy and quality of nursing decisions (8 & 13)
- Plan and evaluate safe, holistic, evidence-based nursing care for children and adolescents (2,3,4 & 5);
- Develop expertise, competence and excellence in paediatric nursing practice (8, 9, 10, 11, 13, 14 & 15).
The selected case study – 2 describes the describes the asthmatic state of a 15-years old indigenous patient (Daniel) who was presented to the hospital with the complaint of shortness of breath. He exhibited a history of smoking and appeared non-compliant to the asthma management plan. The presented formative assessment concisely describes the pathophysiology of Daniel's asthmatic condition and development stage while elaborating the care priorities, family-centered care, and impact of hospitalization (on the health and wellness of the child and his family members).
Pathophysiology of Asthma
The development of asthma in the pediatric population is based on the establishment of chronic airway inflammation, non-specific bronchial hyperreactivity, and reversible airflow obstruction (Kudo, Ishigatsubo, & Aoki, 2013). Hyperinflation of lungs occurs under the sustained impact of mucus plugging across peripheral, subsegmental bronchus, and segmental airways. Lung hyperinflation also occurs under the impact of pulmonary artery magnitude and gas trapping (Poor, et al., 2017).
The mucus across the respiratory passage entraps mucin, plasma protein exudate, neutrophils, eosinophils, lymphocytes, and cellular debris from the goblet cells, inflammatory cells, and necrotic airway epithelial cells. The airway mucus contains the polymeric mucins including MUC5B and MUC5AC (Bonser & Erle, 2017). The airway epithelium exhibits squamous and goblet cell metaplasia and ciliated columnar cells' sloughing. Asthma manifests through the elevation in the subepithelial basement membrane thickness with the accumulation of the inflammatory cellular infiltrates that contain mast cells, eosinophils, and T lymphocytes. The fatal exacerbation of asthma occurs under the impact of prominent neutrophil infiltrates. The airway thickening in the asthmatic patient occurs due to an elevation of mucus glands and airway smooth muscle mass. The extensive incorporation of the inflammatory exudate and mucus secretion limits the flow of air across the respiratory passage of the affected child.
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