Nursing Writer's Choice Paper

Subject or discipline: Nursing Title: Writer's choice Paper instructions

Analyze two pediatric case studies involving kidney and vascular conditions, including patient assessment, diagnosis, nursing priorities, expected outcomes, and interventions, supported by evidence-based research and references.

Paper For Above instruction

Introduction

Pediatric nursing encompasses a broad spectrum of conditions requiring comprehensive assessment, diagnosis, and intervention strategies tailored to children's unique physiological and psychological needs. The presented case studies of Maria Gonzales and Dag Barstow exemplify the complexities faced by pediatric nurses when managing acute and chronic conditions such as nephrogenic diabetes insipidus and Henoch-Schönlein purpura. This paper provides an in-depth analysis of each scenario, emphasizing critical assessment findings, priority nursing diagnoses, anticipated outcomes, and evidence-based interventions. Such analysis underscores the vital role of pediatric nurses in optimizing health outcomes through vigilant assessment, timely interventions, and family-centered care.

Case Study 1: Maria Gonzales – Nephrogenic Diabetes Insipidus

Maria Gonzales, a 4-year-old girl with known polycystic kidney disease, presents with signs suggestive of dehydration and possible diabetes insipidus. Her history reveals extreme polyuria, polydipsia, and recent weight loss. Vital signs indicate dehydration: hypotension (88/50 mm Hg), tachycardia (110 bpm), tachypnea (30 breaths per minute), and hypernatremia (sodium 166 mEq/L). Physical examination shows poor skin turgor, dry mucous membranes, and pallor. Urinalysis demonstrates a low specific gravity of 1.002 g/mL, which points toward dilute urine typical in diabetes insipidus. The pediatrician suspects nephrogenic diabetes insipidus due to the kidney's inability to respond to ADH, confirmed via water deprivation testing and laboratory evaluation (Frokjaer et al., 2017).

Assessment and Diagnosis

Assessment reveals signs of dehydration, electrolyte imbalance, and ongoing polyuria. The primary concern focuses on maintaining fluid and electrolyte balance, preventing hypovolemia, and addressing underlying renal dysfunction. Based on findings, the primary nursing diagnoses include Fluid Volume Deficit related to excessive urine output, Risk for Electrolyte Imbalance related to dehydration, and Knowledge Deficit regarding disease management.

Expected Nursing Outcomes

Goals include restoring and maintaining hydration, correcting electrolyte disturbances, and educating the family about disease management. The child will demonstrate improved hydration status with stable vital signs, balanced electrolytes, and reduced urine output within the hospital stay (Hockenberry & Wilson, 2019).

Nursing Interventions

Nursing interventions focus on precise fluid management—administering prescribed hypotonic fluids, monitoring intake and output meticulously, and regular laboratory assessment of electrolytes. Education of the family about disease process, signs of dehydration, and medication adherence is crucial (Davidson & Malvino, 2018). Ensuring safety during water deprivation tests and preparing for ongoing management involves collaboration with multidisciplinary teams to optimize outcomes.

Case Study 2: Dag Barstow – Henoch-Schönlein Purpura

Dag, a 2-year-old with palpable purpura, edema, and gastrointestinal symptoms, exemplifies a classic presentation of Henoch-Schönlein purpura (HSP), a small vessel vasculitis predominantly affecting children. His clinical signs include nonpitting edema, palpable purpura on lower extremities, abdominal cramping, mucosal involvement, and positive stool occult blood. Laboratory findings show hematuria, proteinuria, and elevated serum IgA levels, confirming the diagnosis (Pillebout et al., 2018).

Assessment and Diagnosis

Assessment highlights the potential for systemic involvement, especially renal complications. The primary nursing diagnoses cover Risk for Impaired Kidney Function, Acute Pain related to abdominal cramping, and Risk for Fluid Imbalance due to edema and gastrointestinal losses.

Expected Nursing Outcomes

Outcomes aim for pain relief, stabilization of renal function, reduced edema, and prevention of complications. The child will exhibit decreased abdominal pain, normalized urine findings, and improved hydration status during hospitalization (Scolpino et al., 2017).

Nursing Interventions

Interventions include administering corticosteroids as prescribed to modulate inflammation, providing supportive care for edema, and closely monitoring urine output and renal function tests. Pain management strategies, nutritional support, and family education about disease course and warning signs of renal failure are necessary (Heinlen et al., 2019). Collaboration with pediatric specialists ensures comprehensive care addressing all aspects of the disease.

Discussion

The management of pediatric patients with complex conditions relies on meticulous assessment, accurate diagnosis, and tailored interventions. In Maria's case, fluid management and electrolyte correction are pivotal, with family education integral. For Dag, addressing systemic vasculitis involves treating inflammation, preventing renal impairment, and supporting the child's comfort. Both cases exemplify the importance of a holistic, evidence-based approach in pediatric nursing to achieve optimal health outcomes.

Conclusion

Effective pediatric nursing care involves understanding the pathophysiology of specific diseases, implementing targeted interventions, and engaging families as active participants. The scenarios of Maria Gonzales and Dag Barstow demonstrate the critical role of nurses in early recognition, management, and education to improve long-term health prospects for pediatric patients with serious conditions.

References

  • Davidson, M. M., & Malvino, M. (2018). Pediatric Nursing: Scope and Standards of Practice. American Nurses Association.
  • Frokjaer, J. B., et al. (2017). Nephrogenic Diabetes Insipidus: Pathophysiology and Management. Pediatric Nephrology, 32(3), 361-370.
  • Hockenberry, M., & Wilson, D. (2019). Wong's Nursing Care of Infants and Children (11th ed.). Elsevier.
  • Heinlen, L., et al. (2019). Management of Henoch-Schönlein Purpura in Children. Journal of Pediatric Healthcare, 33(5), 593-599.
  • Pillebout, E., et al. (2018). Henoch-Schönlein Purpura in Children. The Lancet, 392(10152), 795-807.
  • Scolpino, N., et al. (2017). Pediatric Vasculitis: Clinical Manifestations and Management. Pediatric Clinics of North America, 64(4), 769-785.

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