Introduction
Peter, a 6-year-old male child, suffers from chronic airway disease that manifests with recurrent cough, wheezing, sputum production, chest tightness, dyspnea, and reduced exercise tolerance. He looks pale and fatigued. The patient had an asthma attack three months earlier and was started on therapeutic intervention by his family doctor. Additionally, Peter has Down’s syndrome, diagnosed intrauterine, but his mother refused to terminate the pregnancy for religious reasons. He also has various congenital disorders, such as mental retardation, a congenital heart defect, and weakened musculoskeletal abilities. Peter’s asthmatic symptoms seem to exacerbate in cold weather, particularly at night and early morning. The patient’s parents are concerned and worried that their child might have a serious underlying condition, especially when they observe the abrupt development of symptoms in cold weather after exercise. They are anxious, depressed, and fearful that their son’s condition might worsen. On the other side, family members also feel exhausted and distressed from caring for Peter. Peter has been treated, and his condition seems to improve. He is ready for discharge.
Peter’s problems are associated with asthma and his congenital disorders. He experiences respiratory problems, including chest tightness, persistent cough, and sputum production. Additionally, Peter is experiencing difficulty breathing associated with asthma. He has low exercise tolerance and gets fatigued easily after mild physical activity. Apart from that, he has a heart congenital heart condition that potentially decreases his quality of life. He was born with a weak musculoskeletal system and mental retardation. On the other hand, his family members are also undergoing psychological problems associated with taking care of him. His parents are depressed and anxious as they constantly worry about his condition’s severity. His family members are also distressed and express exhaustion about taking care of him.
Taking care of Peter requires a family-centered approach whereby family members are involved in the patient’s care plan. A family-centered approach involves working with family members in caregiving to promote their ability to care for and protect their children. A nurse should engage Peter’s family members in decision-making and empower them to adjust to the prevailing changes in his health. A family-centered approach ensures that parents are prepared to care for their child after discharge from the hospital (Harper et al., 2015). The principal aim of Peter’s care plan is to improve his quality of life by improving his health and preventing any health risks associated with his pre-existing conditions. Peter’s care plan will begin with a nursing diagnosis to identify his healthcare needs. Making a nursing diagnosis will entail identifying subjective and objective data that support the diagnosis. The prioritization of diagnosis will follow this with rationales, then goals and desired clinical outcomes will be set. The care plan will then detail the family-centered interventions that suit the patient.
Family-centered approach and its application in the care plan
A family-centered approach is collaborating with families through service systems to enhance their capability to look after and safeguard their children. The approach emphasizes meeting a child’s safety and health needs by involving their parents, families, and friends. It also entails strengthening family members’ capacities to care for their children to obtain optimal outcomes (Kuo et al., 2012). Generally, a family comprises two or more individuals who communicate and depend on one another to meet their social, financial, and emotional needs. Families provide physical needs, including shelter, food, and water, as well as economic needs. They nurture, love, and prepare their children to become productive members of society. Therefore, families have a fundamental role in the care plan of their children. Involving families in decision-making is essential since they have better relationships and understanding of their children. Family-centered practice defines health care from the experiences of families.
Notably, the family-centered care approach is a form of relationship-based health care whereby the child and his family remain at the center of the care plan. Nurses attempt to create a relationship with the child’s family members to ensure the provision of personalized care that meets the child’s specific needs depending on issues during nurse/child/family member conversations (Committee on Hospital Care and Institute for Patient-and Family-Centered Care 2012). Additionally, family-centered care is based on the ability to express dignity and respect for the child and his family, share information with family members, and involve the family in the planning and provision of care (Pekcici et al., 2021). It involves forming partnerships with the child’s family, negotiating, and respecting their decisions.
Providing family-centered care involves working with families and being sensitive and responsive to various kinds of families. A nurse should provide unique services depending on the needs of families. One should be flexible and be able to introduce social services and networks for families. The family-centered approach also involves supporting the child and parents (Harper et al., 2015). One should establish a good relationship with families while providing secure and loving interaction. A respectful relationship with parents is optimal in family-centered practice.
Family-centered care is remarkably effective in providing quality care and improving patient outcomes. It promotes health care and improves family satisfaction with the service delivery system. A nurse recognizes the familial role and encourages cultural literacy by practicing family-centered care. Most importantly, family-centered care can be applied in in-patient scenarios, ambulatory settings, and home care. In an in-patient setting, interdisciplinary actions involve communicating with the child’s parents and discussing their child’s care plan (Arango, 2011). It entails forming partnerships and collaborations to facilitate health education during ward rounds and rotations. Notably, family-centered practice can be applied in home-based care whereby parents are supported without judgment to care for their sick child.
Nursing diagnosis and prioritization
Ineffective airway clearance related to asthma as evidenced by mucus production, chest tightness, and recurrent cough
Peter is asthmatic and frequently has symptoms of ineffective airway clearance, evidenced by mucus production and persistent cough. Subjective data include increased mucus production, wheezing, chest tightness, and recurrent coughs. There is no objective data from the case study, but they would include elevated breathing rate and abnormally raised pulse. This nursing diagnosis is prioritized because it affects health perception and health management patterns of functional health patterns. Ineffective airway clearance will affect the patient’s general well-being and daily life. Consequently, Peter’s caregivers’ (his family) perception of health and health promotion is affected.
Deficient knowledge related to the chronicity of asthma as evidenced by expression of worry when the patient’s symptoms exacerbate during certain conditions
Peters’ family expresses a lack of adequate information about asthma when they always suspect an underlying condition when his symptoms tend to worsen with weather changes and after exercise. His parents only know that he is asthmatic, but they are not well informed about asthma triggers. The subjective data supporting the lack of information is the parent’s expressions of fear that the client might have an underlying condition when they observe his symptoms worsening during cold and after physical activity. Lack of information is an important nursing diagnosis as it affects the health perception and health promotion functional health pattern. Deficient knowledge might limit the capacity of family members to care for their children; thus, it requires prioritization. It is the nurse’s role to educate Peter’s parents and ensure they are well-informed about asthma, what to expect during certain weather conditions, and how to manage symptoms.
Decreased exercise tolerance related to chronic airway inflammatory disease as evidenced by fatigue.
The defining subjective data is fatigue, worsening symptoms after exercise, and generally decreased endurance to exercise, as stated by Peter’s parents. Reduced exercise tolerance is prioritized because it affects the activity-exercise functional health pattern. Low exercise endurance limits the patient from engaging in leisure activities and physical acts, which are important for a child’s development and well-being.
Interrupted family processes related to chronically ill children as evidenced by parental feelings of fear and depression
The primary subjective data supporting the nursing diagnosis of an interrupted family process is parental fear and depression. Additionally, family members express that they are exhausted and stressed about taking care of the sick child. Interrupted family processes can affect family relationships, especially between the child and his parents, consequently decreasing the parent’s ability to care for their child. This nursing diagnosis affects health management, coping, stress tolerance, and functional health patterns. Stressed parents will not be able to optimally provide care to their sick child, which will affect the child’s general well-being. The child has Down’s syndrome and suffers from several other congenital diseases which require close parental and nursing care.
Risk of falls related to the weak musculoskeletal system
The principal subjective data for the risk of falls is the patient’s weakened musculoskeletal abilities. His ability to perform voluntary activities requiring musculoskeletal power is reduced. Risks of falls interfere with activity and exercise functional health patterns. Activity and exercise pattern encompasses a client’s ability to engage in physical activity and maintain good health. Impaired musculoskeletal abilities also affect the health perception and management pattern because the patient’s overall wellbeingt is threatened by thefall riskls. This, therefore, forms the rationale for the prioritization of this nursing diagnosis.
Nursing interventions with rationales
Ineffective airway clearance related to asthma as evidenced by mucus production, chest tightness, and recurrent cough
a). Educate his parents on how to evaluate the effectiveness of cough.
Coughing is the body’s natural mode of clearing airways and eliminating foreign objects, airway secretions, and irritants. Generally, asthma causes the breathing airways to produce a lot of secretions which might accumulate and affect airway clearance. Therefore, effective cough enhances airway clearance by eliminating excessive mucus. A controlled or effective cough happens when one coughs from deep inside the lungs (Lima et al., 2013). A controlled cough possesses the sufficient force to loosen and remove airway secretions without causing airways to narrow and collapse. Additionally, an effective cough preserves oxygen, which is often inadequate during asthmatic attacks.
A nurse attending to Peter should approach his parents with respect and consider their concerns in taking care of the patient. He/she should explain the importance of effective cough to the patient’s family in an elaborate manner and ensure that they understand before. He should explain effective coughing techniques systematically and listen to his parents when they ask questions (Kuo et al., 2012). The nurse offers support to the child and parent as he demonstrates how to assess the effectiveness of cough without judgment.
b). Encourage the client to increase their daily fluid intake.
Fluids such as water prevent the drying of the mucosal and facilitate ciliary movement to eliminate secretions. Nurses have a role in educating the client’s family on the amount of fluids that the patient should take (Chaves et al., 2016). The nurse should be sensitive to parents’ concerns and handle them with respect and dignity.
Deficient knowledge related to the chronicity of asthma as evidenced by parent’s expression of worry when the patient’s symptoms exacerbate during certain conditions
a). Assess parents’ knowledge of the triggers of asthma and its management
Being able to pinpoint asthma triggers will enable the parents to better understand how to control them and, consequently, minimize their fear of taking care of their child. The nurse should be respectful when assessing parents’ knowledge (Arango, 2011). He/she should maintain respect regardless of the extent of the parent’s knowledge deficiency.
b). Examine home-management practices of an acute asthma
The chronicity of asthma necessitates home-management practices to prevent the progression of the disease. A nurse should share information regarding home management practices, such as the use of inhalers and hydration, to ensure the participation of family members in care provision.
Decreased exercise tolerance related to chronic airway inflammatory disease as evidenced by fatigue.
a). Pace the patient’s daily activities
Breaking up the daily activities of the client into smaller tasks which allows them to take breaks and rest in between, helps avoid fatigue. It also enables one to breathe properly. Notably, a nurse should involve Peter’s parents in planning his activities since they understand their child better (Lima et al., 2013). Additionally, he/she should explain to the parents the importance of diving Peter’s activities in his health condition. The nurse should encourage Peter’s parents to schedule and allow rest periods in a calm, relaxed environment.
b). Encourage less strenuous exercises such as quiet playing, watching television, and reading.
Less strenuous activities help prevent alterations in the respiratory status of the patient. Activities such as quiet play and reading in a calm environment help preserve energy associated with excessive exercise. A nurse should involve Peter’s parents in planning the exercise plan that will work well for him. He/she should allow the parents to identify an exercise that is most favorable to Peter and those that will allow them to take care of him.
Interrupted family processes related to the chronically ill child as evidenced by parental feelings of fear and depression
a). Assess the family’s feelings concerning the child and his condition
A nurse should hold open discussions with Peter’s family members to help identify family-related stress and assist them in coping. He/she should assist the child and family in adjusting to the changes associated with the child’s health. The nurse should enhance the normalization process by acknowledging the normalcy of parents’ feelings, as well as their strengths and weakness. To promote normalization, the nurse, in collaboration with the family, should prepare the child for anticipated changes in his health and involve the child in decision-making as much as possible (Davidson et al., 2012). A nurse should allow Peter’s family and his friends to participate in the care regimen whenever possible. For instance, parents can give Peter his medication while his friends receive their supplements.
b). Validate parents’ feelings
A nurse should help Peter’s family members to explore their feelings surrounding guilt, irritation, fear, exhaustion, and disappointment. Validating their feelings and assuring them that their feelings are normal facilitates stress reduction and positive coping mechanisms (Kuhlthau et al., 2011; Davidson et al., 2012). Additionally, validating the normalcy of the family’s emotions will enable them to accept the child’s condition and improve their readiness to meet the child’s normal developmental needs.
Risk of falls related to the weak musculoskeletal system
Assess a patient’s risk of falls using a fall risk assessment tool such as the Hopkins Fall Risk Assessment Tool
Assessing the risk of falls will enable the nurse to discover whether the patient has a low, moderate, or high risk of falling and, in turn, provide individualized care for the patient (Montero‐Odasso et al., 2012). The nurse should collaborate with the patient when deciding the appropriate strategies to prevent falls and promote the musculoskeletal strength of the child. Supplements such as calcium, vitamin B, and proteins are recommended to increase the strength of bones and joints.
Conclusion
Family-centered care approach is fundamental in child care planning. It is a collaboration or partnership between the child’s family and the healthcare worker. Peter’s care plan starts with making nursing diagnoses such as ineffective airway clearance, low exercise tolerance, deficient knowledge, interrupted family processes, and risks of falls associated with a weak musculoskeletal system. These diagnoses are followed with individualized nursing interventions which are family-centered. Peter’s family is involved in every aspect of care, particularly in decision-making.
References
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