Communication
Communication is an essential technique in nursing. While nurses can use verbal or non-verbal queues when communicating with patients, the nurse needs to choose the most appropriate technique according to a patient’s need. Therapeutic communication technique allows a patient to express their feelings, emotions, and convey acceptance. The three therapeutic communication techniques the nurse can use with Yasmin and her aunt are using touch, sharing feelings, and providing information. Yasmin’s parents are out of town and her aunt is the caregiver. Yasmin’s illness may cause her aunt anxiety, confusion, stress, and fear. Using touch, the nurse communicates affection, encouragement, and emotional support to Yasmin’s aunt. Through touch, the nurse communicates assurance and ascertains to Yasmin’s aunt that the baby is in good care. The nurse should help Yasmin’s aunt to express her emotions by observing and acknowledging feelings. Through acknowledgment of feelings, the nurse illustrates empathy and assures the aunt that she understands her position and is working to provide care and better Yasmin’s health outcome. Providing vital information to Yasmin and her aunt will enable them to make an informed decision regarding Yasmin’s health status and lessen their anxiety. However, regardless of the aunt’s right to information, the nurse should communicate any distressing information with sensitivity (Potter et al., 2018, p.283 & 284).
Yasmin is 20-months-old therefore she is admitted to the pediatric unit. Safety concerns related to her developmental age are falls, choking, and electric shock. Yasmin is at the toddler stage of development thus being curious to explore different areas due to her ability to perform tasks such as movement and opening doors. Since she does not have full mobility, she may stumble on obstacles and fall. Yasmin may also fall from her bed or chairs due to her immature depth perception. Toddlers tend to explore their curiosity with sensory organs such as taste. Yasmin is prone to choking due to putting objects in her mouth. Some objects might have small pieces that can get sucked into the airway thus resulting in choking (Leifer & Keenan-Lindsay, 2019, p.381). Another safety concern is electric shock. As mentioned above, Yasmin’s curiosity is explored through sensory organs. Therefore, Yasmin may insert her fingers into electrical outlets to poke and probe hence being susceptible to electric shock (Leifer & Keenan-Lindsay, 2019, p.382).
The findings in Yasmin’s assessment that are areas of concern are the temperature of 39°C, dry skin, and refusal of fluids. The assessment indicates that Yasmin is dehydrated and may have disorders associated with loss of fluids and electrolytes. Dehydration occurs when fluid output exceeds fluid input. Since Yasmin refuses fluids and has diarrhea, she is likely to be dehydrated and lose electrolytes in the stool. Yasmin’s high temperature also increases water loss. The nurse should administer fluids to the patient in intervals to ensure rehydration. While toddlers may refuse fluids, the nurse should practice patience and use her ingenuity to coax Yasmin into taking her fluids. The use of oral fluids should be prioritized over intravenous options because it is less traumatic and easy to administer. The nurse should use brightly colored containers and straws as ways to coax Yasmin into drinking fluids. Additionally, Yasmin should feed on an age-appropriate diet to promote her health and wellbeing. The nurse should record the intake and output of fluids to ensure rehydration is effective. Subsequently, general hygiene practices such as washing heads should be practiced to reduce the bouts of diarrhea and promote positive health outcomes for the patient (Leifer & Keenan-Lindsay, 2019, p.674).
Dehydration is an imbalance of fluids and electrolytes in the body that results from the excess output of fluids compared to input. Some of the clinical signs of dehydration are weight loss, skin turgor, thirst, behavioral change, urination frequency, and mucous membrane. The signs and symptoms of dehydration are detectable at an early or late stage. Early signs of dehydration in a pediatric patient are slight thirst levels and reduced urination frequency. Late signs of dehydration in a pediatric patient are sunken or dark circles under the eyes and increased irritability and lethargy. While conducting a patient assessment, the nurse should follow the ABCDE (airway, breathing, circulation, disability, and exposure) approach (Rosengarten, 2019, p.1366). While early symptoms of dehydration are difficult to detect, the nurse should consider the appearance, behavior, urination frequency, and heart and respiration rate of the patient if the nurse suspects dehydration (Leifer & Keenan-Lindsay, 2019, p.674).
Pediatric patients are susceptible to fever, vomits, and diarrhea due to exposure to germs and an undeveloped immune system. The fever vomiting and diarrhea cause an excessive loss of fluids and electrolytes from the body leading to dehydration. Therefore, dehydration is common in pediatric patients. However, since toddlers cannot effectively communicate whenever they feel dehydrated, it is the mandate of an adult caregiver to note any signs of dehydration and intervene to prevent adverse health outcomes. Dehydration in pediatric patients can range from mild to severe. Mild dehydration has symptoms such as slight thirst, a slight decrease in urination frequency, and slightly dry mucous membranes. Mild dehydration is also associated with 5% body weight loss. Moderate dehydration is denoted by irritable behavior, increased thirst, dry mucus membrane, decreased urine output, and fluctuating skin turgor. Moderate dehydration also causes a 10% body weight loss. Severe dehydration is life-threatening and has adverse effects on the patient’s health. Symptoms associated with severe dehydration in pediatric patients are hyperirritability, lethargy, intense thirst, parched mucous membrane, sunken eyes, decreased skin turgor, decreased urination frequency, and dark circles under the eye (Alberta Health Services). Dehydration causes adverse health outcomes such as shock thus it is vital for any suspected cases of dehydration to receive urgent intervention and treatment. While mild dehydration is treatable at home, caregivers and parents should keenly observe toddlers are present them to the emergency department in cases of mild and severe dehydration. Nurses should also educate caregivers on methods of dehydration interventions and treatment at home.
Upon Yasmin’s assessment, the nurse found that she had a fever, refused fluids, few wet diapers, warm and dry skin, sticky mucus membrane, and dark circles under her eye. The priority nursing actions are reducing Yasmin’s fever, increasing her fluid intake, and determining her cause of diarrhea. The nurse should conduct further tests on Yasmin to establish the underlying cause of diarrhea. These tests include stool and blood culture which would provide deeper insights into the underlying health issue thus help in the diagnostics and treatment process. According to the assessment, Yasmin has severe dehydration. The nurse should start her on maintenance fluid therapy and deficit therapy. Maintenance therapy replaces fluids already lost while deficit therapy restores and prevents loss of preexisting body fluids and minerals. The maintenance fluid therapy and deficit therapy are achieved through administering oral rehydration solutions (ORS) or electrolyte solutions depending on the relative loss of fluids and electrolytes (Leifer & Keenan-Lindsay, 2019, p.674). The nurse should accurately record the output and input quantities of fluids to ensure rehydration. The nurse can also administer acetaminophen to manage the fever. However, excess levels of acetaminophen can cause stomach upset. Therefore, the nurse should ensure that only the required amount is administered (Alberta Health Services).
Diarrhea is the excess passing of watery stool through the anus. When the body detects bacteria or viruses, the immune system works against it to maintain the body’s wellness. However, these germs cause an imbalance in the systems causing the body to employ mechanisms such as diarrhea to expel the germs. Diarrhea causes excess loss of fluids and electrolytes in the body since the intake of fluids is less than the output. Diarrhea also causes an elevation of the body temperature which results in excess water loss. Too much loss of fluids causes an imbalance in the homeostasis nature of the body. When there is an imbalance the body experiences dehydration. The signs of dehydration present as mild to severe depending on the level of dehydration. Mild dehydration shows symptoms such as reduced frequency of urine and slight thirst, while moderate dehydration shows signs such as irritant behaviors and dry lips. When dehydration is severe, signs as loss of skin turgor and sunken eyes are present. Subsequently, severe dehydration can lead to shock. Therefore regardless of the severity level, dehydration requires immediate medical attention.
The three common methods for dehydration treatment in young children are oral rehydration, maintenance fluids, and fluid resuscitation. The method of treatment depends on the severity of the dehydration. Oral rehydration is administered in children who represent with clinical signs of dehydration. Children with oral tolerance are given ORS with the recommended osmolarity level of 240-250 mOsm/liter. The recommended dosage is 50 ml/kg over 4 hours with a subsequent following of small doses until signs of improvement are noted. For children with the inability to orally intake the ORS, the IV method is recommended. Nurses can use fluid substitutes such as milk and water in case the child refused to take the ORS. Maintenance fluid is administered through IV for children who have severe symptoms of dehydration. The use of the IV method is selected to ensure quick restoration of balance in the body. The fluid recommended is an isotonic solution that contains sodium in the range of 131-154 mmol/liter. While administering fluids, boys and girls require a maximum fluid amount of approximately 2500 ml and 2000 ml respectively. Fluid resuscitation is administered to children who represent signs of hypovolaemic shock or children who have severe rehydration but show minimal signs of recovery. The fluid resuscitation therapy involves administering 20 kg of glucose dissolved in a solution with sodium in the range of 131-154 mmol/liter in ten minutes (Rosengarten, 2019, p.1367).
Yasmin has a problem with fluid intake and refuses to intake fluids orally. Due to her age, Yasmin may not know the impacts of rehydration and the importance of taking medication. It is therefore her aunt’s mandate to ensure that Yasmin takes her medication to improve her health. Yasmin’s aunt should assemble all medication to avoid distraction when she starts administering the drugs. She should maintain control of Yasmin’s arms and legs to prevent her from tipping or spilling the medication. Yasmin’s aunt should not dilute the medication and she should administer the right dosage using a cup or a syringe. The administration should happen in small bits to allow the child to swallow and prevent choking. Slightly tipping the child’s head upwards also prevents choking and facilitates swallowing. The aunt should consider offering a chaser such as a popsicle or water to reduce the residual taste of the medicine. Yasmin’s aunt should ensure that she practices proper hand and equipment hygiene to ensure positive health outcomes (Leifer & Keenan-Lindsay, 2019, p.474).
The three assessment findings that indicate improvement in the dehydrated child are weight gain, physical appearance, and frequency in the urine. Vomiting, fever, and diarrhea are some of the causes of dehydration in children. However, interventions such as fluid restoration therapy are countermeasures in the management of dehydration. Once a child is rehydrated, they regain their normal functionality and resume their normal routine. Weight gain is an assessment of improved dehydration since the child resumes normal feeding thus increasing weight. The physical appearance such as sunken eyes, skin turgor, and dry mucous membrane improves to indicate an improvement in dehydration. Other physical aspects such as lethargy also diminish due to a restoration of fluids and minerals in the body. When there is homeostasis in the body, the organs function as expected thus an increase in urine frequency. Therefore, the above mentioned assessments are indicators of improved dehydration.