The Case Study
An indigenous child, Sara aged four, has been admitted after fainting at the Early Childhood Centre (ECC) she attends for three hours, in the morning. She spends the afternoon in the crèche adjacent to the ECC. The child’s aunty comes to the clinic some hours after Sara’s admission and tells you that Sara is always difficult, and naughty, and is probably fainting for attention. Sara weighs 8.5kgs, height is 92 cm, her baby teeth are complete but have some cavities, and she is toilet trained. She was breast fed until her mother left home when Sara was four months old, and was then bottle fed. Her immunizations are incomplete.
Her teacher states that Sara has not eaten much today, and is not interacting well with the other children. On examination, Sara is slightly dirty, her hair is dry, dull and unkempt but she is dressed appropriately for the season. Her skin turgor is poor and there is evidence of pallor around the mouth and fingernails. Her pulse is thready and 120BPM, her temperature is 37.5 degrees Celsius and she has a history of low-grade fever, lack of appetite, myalgia and headache. Sara had scabies about six weeks ago, which was not treated.
Immediate Nursing Care Required by Sara
Sara’s immediate nursing care is multifaceted. First and foremost, she needs medical care for the scabies she suffered from six months ago and for which she was not treated. This would protect her from secondary infections and complications. Second, Sara needs nursing care to enhance her physical health. Her numerous symptoms such as fainting spells, under weight, poor skin turgor, poor appetite, myalgia, headache, cavities and history of fever are all manifestations of a health condition.
A thorough examination should thus be performed on her to establish the cause for the symptoms and appropriate medical measure should be taken to rectify her problem. Third, Sara is in dire need of the vaccinations she missed. The vaccinations will improve her immune system and protect her from serious incapacitating illnesses such as polio which can easily be prevented by vaccinations.
Psychological Nursing Care Required by Sara
The psychological growth and development of a child begins at home through attachment and bonding with his/her immediate family members. The first role model for any child is normally the mother. This process starts when the child is conceived and is strengthened through breastfeeding. The child later becomes attached to the other family members including the father and siblings. It is important to note that the type of relationship the family develops with the child affects the type of relationship the child will have with other members of the community including his/her peers. A child who grows up in a warm and secure family environment is more likely to grow into a happy and secure adult with high self-esteem.
On the other hand, a child who grows up in a family environment that is full of conflicts and violence is more likely to become a violent adult. Indeed, many of the social problems experienced in the society such as violence, substance abuse and psychological illnesses such as depression have a foundation in poor psychological growth of children (Luby, 2006, p. 6).
In the case of Sara, her poor psychological growth is manifested through her inability to cope with her peers, naughtiness and difficult to handle. The reason for this is obvious. Sara was only able to spend her first four months with her mother who later abandoned her. As a result, Sara did not have the opportunity to experience attachment and bonding with her mother. Since then she has been living with her relatives who seem to lack adequate time and attention for her. Therefore, Sara does not know what it means to grow up in a warm and secure environment. The nurse in charge of Sara can help her by involving her relatives in creating a warm and secure environment for Sara to grow up in. this would go a long way in addressing her psychosocial problems and in enhancing her psychological growth (Zeanah, 2009).
Social Nursing Care Required by Sara
By the time a child enters kindergarten he/she ought to have developed a vita set of social skills that will assist him to have healthy experiences in the school environment as well as in future. The social skills encompass cooperation, sharing, kindness, generosity, display of affection, conversation, expression of feelings, being helpful to others and making friends. Children at this age display strong emotions and tend to have mood swings. The children have a vivid imagination as well as real fears. At this age, children should have learned to control their feelings and should be in a position to name them instead of acting on them.
It is an age during which the development of identity is crucial in that they are able to recognize that they are boys or girls and the family, community or culture they belong to. It is thus important for parents to encourage and assist the children to develop the social and emotional skills that are useful for their children. Such children thrive on one-to-one communication with a parent. Such interactive communications help the children to learn how to express their feelings and ideas. Moreover, the communication nurtures not only emotional and moral growth in the children but also self-esteem and cognitive development (Zeanah, 2009).
Preschool children also have real fears as a result of their vivid imaginations. These fears may lead to numerous emotions and therefore parents ought to confirm the feeling or emotion and then hold a discussion with child about the options available for addressing the emotion (Ricci & Kyle, 2008, p. 836). In the case of Sara, the development of such crucial social skills may be hindered by several reasons. The chief reason is the fact that she lives with her relatives rather than her biological parents. Sara’s relatives may lack adequate time and affection to nurture Sara’s social skills. There may be lack of intensive interpersonal communication between Sara and her guardians which is manifested by the assertion made by her aunt that Sara is always difficult, naughty and striving for attention.
Children at this age also need to interact with friends. Learning how to make and keep a friend is a crucial part of social development. Friends may be in the child’s neighbourhood or in the child’s day care centre. Having friends not only helps a child develop social skills but also skills in solving conflicts because conflicts will inevitable occur. A child’s social flexibility is also manifested by this age. A child who is adaptable is able to deal with external stimuli pretty well rather than avoid it. When parents are aware of the children’s task orientation, social flexibility and reactivity, they are in a better position to help the children develop effective social and emotional skills (Ricci & Kyle, 2008, p. 836).
Sara’s inability to interact well with her peers is as a result of poor social skills. The nurse in charge of Sara should discuss with Sara’s guardians about the importance of nurturing crucial social and emotional skills in Sara which would help her in the future. This would entail holding numerous teaching and counselling sessions with Sara’s guardians and encouraging them to pay attention to her and treat her as if she were their own biological child. The social skills Sara learns at home will help her in having healthy and useful interactions with her peers at the day care centre.
Physical Nursing Care Required by Sara
Sara has several manifestations of poor physical health. One of these manifestations is the scabies she suffered from six months ago and which was left untreated. Scabies originates from itch mites that impregnate in the epidermis. Scabies often lead to secondary infections due to the scratching of the lesions. Sara can be treated using medications such as oral antihistamines. It is important to note that the compliance of the patient with the medications is important in preventing the transmission of the scabies to other members of the family. But since Sara is a young child, the compliance with the medications is the responsibility of her guardians. The nurse in charge of Sara should also be in a position to identify signs and symptoms that indicate potential secondary infections (White, 2004, p. 1665).
The most effective nursing care for the scabies involves a holistic health promotion and management strategy which promotes healing, teaching, prevention of secondary infections, and prevention of further transmission of the condition. The nurses should teach the patient and her guardians the infectious nature of scabies and that it is transmitted through close contact not only with the contaminated patient but also through sharing of personal items such as combs towels and beddings with the infected patient.
The patient and her guardians should also be taught how to identify the signs and symptoms of secondary infections related to scabies and to seek medical attention immediately. Most importantly, the nurses should educate the family on how to prevent secondary infections through maintenance of hygiene, isolation, disinfection and sterilization of rooms and personal items (Billings, 2008, p. 192).
Sara’s poor physical health is also manifested by the other symptoms such as low weight. Normal and healthy children who are in the same age bracket with Sara weigh between 13.6 to 15.6 kg and are 70 to 91 cm tall (Rosdahl & Kowalski, 2007, p. 104). This, couple with other symptoms such as lack of appetite, dry and dull hair, poor skin turgor, pallor around the mouth and fingernails, thready pulse, 120BPM, high temperatures, history of low-grade fever, myalgia and headache show that there is something physically wrong with Sara and she could be suffering from a serious illness. The evaluation of Sara’s physical health is thus important to determine what could be wrong with her.
This would require the nurse to obtain Sara’s health history and to carry out physical and development assessment. However, since Sara is a young child, this achievement would necessitate cooperation from her guardians. In assessing Sara’s weight and height, caution should be taken because she is an indigenous child and her physical structure may thus not conform to the standards which are usually based on Caucasian children (Littleton & Engebretson, 2002).
The nurse should also evaluate Sara’s general appearance, for instance, does she generally appear to be happy and content with life or does she seem sad and withdrawn? Such signs are crucial because they symbolize a deeper problem than it appears. For instance, Sara looks dirty and her hair is unkempt. This may mean that she does not receive proper and adequate care and attention at home. This is a great possibility because she does not live with her mother and instead lives with her extended family members who may not provide her with adequate attention because of the lack of maternal love. The nurse should thus engage Sara’s relatives in the care of Sara by encouraging and advising them on the importance of giving adequate care to Sara (Pillitteri, 2009, p. 863).
One of the most important physical nursing care needs of pre-schoolers like Sara is nutrition. The general appearances of Sara such as dry and dull hair and poor skin turgor are manifestations of poor nutrition. This situation is worsened by the fact that Sara did not receive exclusive breastfeeding for six months because her mother abandoned her at the age of four months. Exclusive breastfeeding of a child for six months is important for the growth, development and general health of a child. To make up for this and to improve Sara’s health, the nurse should advise Sara’s guardians on improving her nutrition through diet and supplements where necessary (Stanfield & Hui, 2009, p. 140).
Pre-schoolers like Sara are not old enough to differentiate between good and bad nutrition. Moreover, at this stage, children are good at imitating what others are doing including what others are eating at home. It is thus the responsibility of her guardians to ensure that Sara gets the appropriate nutrition by changing their diet and eating habits for her sake. Because children at the age of four have great needs for calories (due to their energetic nature), Sara should be fed on foods that will meet her caloric needs. The nurse in charge of Sara should discuss her nutritional needs not only with her guardians but also the day care centre which Sara attends during the day.
Sara’s physical health condition is also poor because she has not received all the immunizations a child is supposed to receive. As a result, she is at high risk of infections and grave illnesses which can easily be avoided by vaccinations. The nurse should therefore ensure that Sara gets the vaccinations she missed so as to protect her from serious illnesses. The nurse should also take into consideration Sara’s dental cavities. Just because her primary teeth will fall out someday does not mean that she should not receive dental care. If not treated, the cavities will go on to affect her permanent teeth. The nurse should therefore ensure that Sara receives dental care and that her guardians are part of this care by limiting her access to sweet things and providing her with nutritious foods (Lyebote, 1990, p. 44).
Planning for Sara’s Discharge and the Support Required by Her Extended Family
Planning for the child’s discharge and care at home begins early in the hospital setting. Nurses and other health team members must assess the levels of understanding of the child and family and their abilities to learn about the child’s condition and the care necessary after the child goes home. Giving medications, using special equipment, and enforcing necessary restrictions must be discussed with the person who will be the primary caregiver and with one other person, if possible.
It is necessary to provider specific, written instructions for reference at home. The nurse must be certain that the caregiver can understand the written materials too. If the treatment necessary at home appears too complex for the caregiver to manage, it may be helpful to arrange for a visiting nurse to assist for a period after the child is sent home (Jones & Jones, 2004).
Shortly before the child is discharged, a conference may be arranged to review information and procedures with which the family caregivers must become familiar. Questions and concerns must be dealt with honestly, and a resource such as a telephone number the caregiver can call should be offered for questions that arise after discharge. The return home may ne a difficult period of adjustment for the entire family. The preschool child may be aloof at first, followed by a period of clinging, demanding behaviour. The family may be advised to encourage positive behaviour and avoid making the child the centre of attention because of the illness. Discipline should be firm, loving, and consistent. The child may express feelings verbally or in play activities. The family may be reassured that this is not unusual (Hatfield, 2007, p. 70).
Summary and Conclusion
Sara is a 4-year-old girl from an indigenous community. She is an epitome of a child with poor physical, social and psychological growth and development. This is mainly due to the fact that her mother left her at the tender age of four months and is now being taken care of by her relatives. Sara’s poor physical health is a result of the lack of adequate exclusive breastfeeding and incomplete immunizations. She portrays a child with poor social skills through her inability to interact well with her peers at the day care centre.
This may result from the experience she is having at home. Without adequate time and attention, Sara’s relatives have failed to provide her with an environment that nurtures, stimulates and develops her social skills. This is evident from her aunt’s seemingly obvious irritation with her fainting spells claiming that Sara is only looking for attention. As a young child, Sara lacked the opportunity to become attached to and bond with her mother because her mother left her at the age of four months.
This experience, together with the lack of a caring and loving environment at home, has affected her psychological growth and development. Sara is thus vulnerable to psychological disorder if no action will be taken soon. The nursing care provided to Sara should thus be holistic by addressing her physical, social, and psychological well-being. Moreover, it should involve her guardians so as to ensure that it is a continuous and life-long process.
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