Clinical Diagnosis, Pathophysiology And Care Plan For Lucy With Measles

Measles: An Infectious Disease

Children in their early years are emotionally, mentally, and physically quite vulnerable. During this time, their body and mind are in the stage of development therefore, they can easily become infected with diseases or can also become mentally disturbed due to negative environmental surroundings (Ephgrave, 2018). Thus, it is the responsibility of caregivers to offer support, guidance, affection, and care to children and protect them from all kinds of harm (Ephgrave, 2018). Hence the primary aim of the paper is to discuss the case of Lucy and define her clinical diagnosis, its pathophysiology, signs, and symptoms. The paper will also highlight RN’s role in child protection responsibilities and the role of a multidisciplinary process for the same. The paper will also devise a care plan for Lucy to help her and her family effectively cope and manage her illness.

From Lucy’s case, it is quite evident that she is suffering from measles. Measles is considered to be an infectious disease that is caused by the rubeola virus which belongs to the gene of Morbillivirus and is mostly characterized by fever, cough as well as a rash that, begins from the face and then spreads to other parts of the body (Plemper, 2020). The disease is quite common in children, however, can be effectively controlled with the help of vaccines.

The aetiology of measles is that it is caused by a virus that has been mentioned above and can be spread by droplets in the air transmitted by an infected person when they cough, sneeze or talk (Plemper, 2020). Some of the risk factors of measles are that it can lead to the fatal disease of pneumonia and encephalitis. Pneumonia is an infection that tends to inflame air sacs in either or both lungs where the air sacs fill with fluid or pus that causes fever, difficulty in breathing, phlegm, and others (Mandell & Niederman 2019). Encephalitis is considered to be the active tissue of the brain that is caused by an infection where the inflammation leads to the swelling of the brain causing headaches, mental confusion, seizures, and others (Dalmau & Graus 2018).

The pathophysiology of measles is that its virus is transmitted through the air in the form of droplets that directly infects the respiratory system and also causes a skin rash. The virus is transmitted through the respiratory route which replicates in the nasopharynx as well as the regional lymph nodes within 2-3 days of exposure (Wawrzuta et al., 2021).

Some of the signs and symptoms of measles are high fever, runny nose, watery eyes, conjunctivitis, and red rashes starting from the face, spreading to the back, and finally touching the feet (Wawrzuta et al., 2021). The measles rash appears 3-5 days after the first symptoms. The infection can also cause respiratory issues like pneumonia since the virus destroys local immunity present within the lungs thereby causing the above problem (Dunn et al., 2020).

By the age of 6 children become independent of their parents, peer acceptance becomes essential and there is a major gain in muscle strength as well as coordination. Children within this age group develop basic motor skills like kicking, throwing, and catching and also become skilled with complex activities like playing a musical instrument, dancing, and others (Vrijkotte et al., 2020). During this age, children also have temper tantrums, can follow directions, tries to reason everything, and are also interested in cause and effect.

Aetiology and Risk Factors of Measles

Thus, Lucy being 6 years of age, might be having similar growth as well as development characteristics as mentioned above. However, though during this age, they show good and positive physical, emotional, and mental growth and development, it cannot be denied that during this age they become vulnerable to several kinds of infections and viruses due to increased outdoor play and engagement with peers (Vrijkotte et al., 2020). This can be the reason for Lucy being infected with the measles virus.

From the conversation between Lucy and her mother, it is evident that they are not in good terms, due to inconsistencies in their response which can be a reason due to Lucy’s age where she wants to be independent of her parents. It is essential to teach Lucy the importance of family and how they can play a significant role in fulfilling her needs and demands and the need to be responsive and obedient towards them (Leve et al., 2019). On the other hand, Lucy’s mother should be taught some positive parenting skills with a 6-year-old child where it is essential to show her respect, appreciation, care, and affection instead of being rough and impatient which can have a negative impact on the child’s mental and emotional development (SORAKIN & Çerkez 2021).

Creative presentations and newsletters are two health promotion activities for 6-year-olf and their families respectively, where awareness regarding and communication regarding diseases, their causes, consequence, and prevention can be explained (Hubley & Copeman 2018). This will help both children and families to take preventive measures, be cautious in their external surroundings and immediately seek help when signs and symptoms and detected (Hubley & Copeman 2018).

Registered Nurses are vested with child protection responsibilities and the Australian Nursing and Midwifery Federation states that RNs are responsible for reporting physical and emotional ill-treatment of children, identifying signs of sexual abuse, neglect, and exploitation that harm children’s health, their development, and dignity (Sivertsen et al., 2019). Thus, according to the legislation, RNs are responsible for recognizing a child’s vulnerable status and special protection which may be required if the risk is detected (Sivertsen et al., 2019).  

The concerned health professional need to ensure that child grows up with the provision of safe and effective care, preventing harm to their health and development, partner with relevant stakeholders to provide ethical and legal care along with protection to the child and prevent further harm to child’s mental, physical, and emotional health (Lines et al., 2020).

Lucy too needs to be protected from harm since she is suffering from a severe illness of measles that can deteriorate her health condition, therefore, it is the responsibility of the RN, to immediately collaborate with other professionals to offer her holistic care and treatment (Lines et al., 2020). Apart from this, from Lucy’s appearance of dirty and smelly clothes, it is quite evident that she is suffering from neglect and the RNs duty is to report neglect since this is having an impact on Lucy’s development and health.

Pathophysiology of Measles

 Additionally, Lucy’s mother is also rude and emotionally unresponsive towards her daughter’s needs and concerns, therefore, the RN needs to report this emotional ill-treatment to relevant stakeholders because it is her duty to report the child’s vulnerable status and meet their needs effectively and efficiently.

Multidisciplinary safeguarding teams work together to reduce the risk of harm to children where the latter is their focus while making decisions regarding their lives and encouraging participation of families as well (Patrick et al., 2020). The complex safeguarding issue identified in the case of Lucy is emotional ill-treatment and unresponsiveness from her mother. This is a complex issue because this emotional ill-treatment will neither be reported nor understood by Lucy nor will her mother be able to realize the emotional error (Patrick et al., 2020). Thus, nurses and social workers in the team can make Mrs. Hawkins aware of healthy parenting styles and approaches through effective and strong coordination between professionals and the client (Shaikh & Ali Malik 2021).

Apart from this, there are high chances of harm to Lucy’s health since she is suffering from measles and a long hospital stay can have a huge mental and emotional impact on her, therefore the complex safeguarding issue here is preventing harm to Lucy’s health and development. Thus, a multidisciplinary team of physicians, social workers, nurses, and local safeguarding children boards will help in mitigating the above complex problem by prioritizing Lucy’s health by ensuring that all the resources required for Lucy’s treatment are available (Lines et al., 2020).

Physicians and local safeguarding children boards will ensure that no harm is done to her health through effective monitoring, medications, and reviewing. While the nurse can ensure that mental and emotional support is provided to Lucy during her along with the participation of her family thereby treating her health concerns and enhancing her positive development (Shaikh & Ali Malik 2021).

Some of the complexities related to medication management of Lucy is that since she is suffering from measles along with several other symptoms related to the same, therefore, different medication needs to be provided to her to treat her for several signs and symptoms that can give rise to complex issues of wrong dose, missing dose or incorrect drug prescription, miscalculation of dose and denial of Lucy to take medicines that can aggravate her health concerns and symptoms (Papastergiou et al., 2019).

Therefore, an integrated care plan needs to be devised to overcome the above medication management complexities through nursing interventions and family participation. Thus, the nurse should engage in educating Mrs. Hawkins regarding the medications that are being offered to Lucy, that is educate her about different medications, their benefits, and the type of health concerns they will address, along with the correct dose, time, and route of administration so that timely and correct medicines can be given to Lucy in the absence of the nurse (Papastergiou et al., 2019).

To make the above plan successful, the nurse should first show a physical demonstration of how medications and doses are being offered to Lucy that will help in preventing medication errors (Park et al., 2018). A family-centered care plan is essential as it will encourage and motivate Lucy to take medicines from her family member instead of a nurse where the former can use positive reinforcement techniques which will motivate Lucy to take medicines thereby preventing the complication of her denial to take medicines (Park et al., 2018).

Signs and Symptoms of Measles

To further prevent medication error, the nurse can design a medication chart for herself and Lucy’s mother to ensure that all medications with the right dose and route are being provided to Lucy thereby mitigating her health concerns (Coyne et al., 2018).

According to NSQHS standards, it is essential for health service organizations to assess risk associated with action and the development of the plan.  The NSQHS standard states that it is the responsibility of health professionals to identify stakeholders who are at risk like patients, the healthcare workforce, and the organization and states people responsible for managing risks like the health system, healthcare team, organization, and others where it is essential to avoid, identify, analyse, evaluate and treat risk (Mather & Cummings 2019).

Risk Matrix, bowtie model, decision tree, and others are some risk assessment tools that can be used to identify health risks. Bowtie model is the risk assessment tool that will help in determining risk management measures by depicting the relationship between sources of risk, controls, escalation factors, events, and consequences which will thereby help in treating and evaluating risk management measures (McLeod & Bowie 2018). 

Five Care Priorities in Lucy’s Case

• Strong and Appropriate medication management
• Encouraging participation of Mrs. Hawkins and Lucy in care and treatment plans through health education.
• Ensuring personal and environmental hygiene.
• Continuous respiratory observation and supply of oxygen to Lucy
• Safeguarding and promoting her health and development by addressing harm, neglect, and emotional ill-treatment through a multidisciplinary approach.

 Conclusion

To conclude, the above care plan and risk management measures will help in addressing the health and emotional concerns of Lucy and will also help in protecting and safeguarding her from neglect and harm.

References

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