Addressing Vitamin D Deficiency in Migrant Children

Elias, a four-year-old Somali migrant, and his brother Benji are experiencing irritability, malaise, delayed motor development, and inadequacy of vitamin D. These issues are likely caused by their mother's vitamin D deficiency, low milk intake, and exposure to sunlight. As a nurse, the priority is to implement interventions that promote proper nutrition, hygiene, and education for the family. Food supplements rich in vitamin D can help compensate for the deficient supply of milk and nutrients. Educating the family on proper nutrients and exposing both children to sunlight can also boost their immunity and development. Additionally, proper hygiene practices can reduce the risk of bacterial infections. By working with Elias' mother and implementing a care plan that includes patient involvement and education, the goal is to promote positive changes in Elias' condition and support his growth and development.

Running head: CHILD AND ADOLESCENT NURSING
1
Child and Adolescent Nursing
Institution’s Name
Date

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Introduction
In the nursing profession, various ways exist of assessing a patient, and in this case, a
child who is purportedly sick. This essay, in particular, explains a case study of a young child
that has developmental complications and suffering from Vitamin D deficiency. Additionally, it
tries to figure out by use of scientific evidence, the influence of a new environment on children
well-being. The essay will base its evidence from scholarly works in the determination of causes
and health status of the patient. Additionally, the essay analyzes the assessment of irritability,
specific cause of motor development in the patient and whether there is any influence on the
health status of the child as a result of exposure to a new environment. Also, after determination
of the problem, what are some of the interventions and recommendations or steps that a nurse
ought to make as far as this case study is concerned? Thus, below is a full elaboration,
intervention, and solution of the situation of the patient as far as the case study is concerned.
Description of the case study and what it implies
Elias, the child in the case study, is four years old but still breastfeed together with his
four months sibling. In addition to that, Elias is a refugee from Somalia and has been in Australia
for six months. This raises the question of adaptability to the new environment and the state of
health, especially, emotional well-being that comes in a child trying to adapt to a new
environment (Giger, 2016). Rash infection is also important to assess in such a situation. The
patient, despite being four years of age is not able to walk, which is a delay in motor
development. Thus investigate whether adaptability to the new environment is causing such a
problem or is it nutritional deficient which is also causing a deficiency in vitamin D (Oermann,
& Gaberson, 2016). Moreover, Elias and his brother possess crusty yellow sores that are evident

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around their noses and mouths. This is a condition characteristic of bacterial infection, and thus,
there is need to carry out laboratory examination to ascertain the presence of bacteria. Moreover,
assessment of the diet that both the mother and child takes is of paramount importance to assess
whether they eat short of what is expected of a mother breastfeeding two children or that of the
two children, Elias and Benji. Lastly, Elias is being investigated for Malaise, which is a stress
condition and in children, it has the potential to cause pain, alteration in body temperature and
pulse rate and alteration of blood pressure.
Nursing Assessment and Priorities
In nursing and medical field in general, there are certain codes of conduct or simply
ethics that each professional must adhere to in assessing a patient or patients. As far as the case is
concerned, it is important to respect the patients involved especially during the assessment and
treatment period. Moreover, it is crucial to give them the necessary information so that they can
either consent or decline suggestions that a nurse put forward to them (Hockenberry, Wilson, &
Rodgers, 2016). Lastly, this case, in particular, needs the partnership of the mother and nurse for
the assessment to be successful, thus, upholding this aspect is critical in assessing Elias, or Benji.
As the family comes from another country, determination of whether they need an interpreter is
of paramount importance (Lewis et al., 2016). The information put forward to them must be in
the language familiar for them to get a clear understanding of what is taking place and in effect,
accept or reject.
There are various ways that a nurse can make an assessment as far as the case study is
concerned. However, and especially because the assessment involves examination of bacterial
infection, there must be proper protective mechanism or measures put in place to prevent the

CHILD AND ADOLESCENT NURSING 4
likelihood of transmission of infection (Oermann, & Gaberson, 2016). Thus, personal protective
equipment (PPE) is useful for this assessment. Firstly, as a nurse, it is crucial to put on PPE
because there is a possibility of contact of fluid from the patients. Secondly, taking note in the
process of removing gloves is important to avoid contamination of the skin and clothing. Lastly,
discard gloves before leaving the place of examining the patient.
Another Assessment is pain examination in the child. Determination of pain is important
for establishing whether the child has malaises. There are various methods of assessing pain in
children and adolescents. In assessing pain, it follows six main stages or process referred to as
QUESTT. In its full explanation, it denotes questioning the child denoted by letter Q, followed
by using a pain rating scale for rating the pain (James, Nelson, & Ashwill, 2014). The next step
is evaluating the behavior and also physiological changes which represent the E part of the word.
As a nurse, it is also important to secure the involvement of parents which is the S part of the
word formula. After conducting all this in assessing the child pain, the next step ought to be
taking account of the cause of pain representing the second last T-word (Harrison et al., 2013).
Lastly, evaluate results after taking action which is the last step of assessing pain by the word
formula and represent the last T in the word.
In elaborating the process, the first part of pain assessment, that is questioning the child
involves using their languages. In addition to that, consider other aspects, for instance, children
not able to communicate have the potential of their pain being under estimated. On the second
assessment of pain, which is using a scale to estimate or measure pain, the scale can be in the
form of faces, behavioral or physiological and numerical (Wilson, & Hockenberry, 2014).
Behavioral scale involves the use of face, legs, activity, cry or consolability, which denotes
FLACC scale. The other step mentioned above is evaluating the behavior and changes in the

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physiology of the patient. It involves behavioral changes that related to age, while physiological
changes, that is, altered sleep pattern, change in skin color and the tone. The other assessment of
pain is taking action or evaluating the results (Kozlowski et al., 2014). In this step, it is important
to administer analgesia or uses other comfort actions. Additionally, taking the assumption that
the analgesia is working is not right, but instead, it is recommended to take action if the
effectiveness of analgesia proves otherwise. Lastly is documentation of findings, by choosing an
appropriate tool and on the observation chart. Some of the scales used for measuring pain include
but are not limited to NRS, FLACC-R, FACES-R, and VAS.
On the other hand, Elias appears to be having malaises which are a condition
characterized by distress and can cause pain, alteration in temperature and pulse rate. Also, there
is the need for assessing blood pressure. In case of measuring temperature, the best tool to use
for this age group is the electronic or chemical thermometer with a dot which is applied in the
axilla (Eccleston et al., 2014). Also, an infrared tympanic thermometer is also of use in this case.
In using the thermometer, it is important to leave it in position to allow time to gain an accurate
reading as prescribed by the manufacturer (Lauwers, 2015). Additionally, for the sake of pulse
rate, a stethoscope is applicable for children, but it is worth to note the effect that crying or eating
can have on the readings. Lastly, to measure blood pressure, use lower legs or upper arm taking
note on the right size of the cuff as it is essential for correct readings.
As part of the assessing the reasons behind the crusty yellow sours in children, and since
this is an indication of bacterial infection, a swab from the nose and the mouth is essential for
laboratory examination. Additionally, the nurse may request for urinalysis to be carried out to
further ascertain the presence of bacteria. However, bacteria are highly infectious; therefore, care
ought to be taken in assessing the two boys, Elias and Benji to avoid transmission. In addition to

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that, it is important to isolate them from other patients to avoid possible transmission for the
same (Boon, & Pentney, 2015). One of the most common indications of bacterial infection is
rash, thus, taking note of the same is important in assessing bacterial infection.
Risk factor and nursing problem
Several risk factors are evident in the case study that has the potential to either cause or
have already caused the ill condition of the child. Firstly, is the change of environment or new
environment for that matter? There is various documentation that stipulates the effects that a new
locale can have in the growth and development of a child. Thus, the fact that the family is in a
new country is a risk factor to the health status of both Elias and Benji. In addition to that, the
two children breastfeed their mother in tandem. This requires that the mother and the children
take food supplement rich in vitamin D (Boon, & Pentney, 2015). There is no such evidence, and
thus a risk factor and a nursing problem as well predisposing the children to vitamin D
deficiency. On the other hand, Elias is diagnosed with vitamin D deficiency; therefore, this is a
nursing problem that is likely causing his slow motor development (Huggins, 2015). Non-white
ethnicity has a higher risk of suffering from vitamin D deficiency. Elias family comes from
Somalia, and this can be a risk factor for developing such a condition. It is also true that
deficiency of vitamin D is also a nursing problem that may be causing distress in children and
thus, malaises (Ahmann, & Dokken, 2012). Low intake of milk has the potential to cause low
immunity to the two children as the strength of their immune system is largely dependent on the
milk intake that passes immunity to the children. This a risk factor for various infection and
establishment of diseases in children. Lastly, the fact Elias and Benji are below five years is
another risk factor as their immunity is not yet developed.

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Nursing Interventions
As a nurse, this case scenario calls for interventions in some ways. To start with delayed
motor development, the option for this in this case study is for Elias and Benji to take food
supplements rich in vitamin D to compensate for the deficient supply of milk and in effect,
nutrients they get from their mother. Additionally, the mother needs to take food supplements
rich in vitamin D and other nutrients to not only improves her Vitamin D content in the milk, but
also improves nutrients in milk that will boost the immunity of the child (Carneiro, Meghir, &
Parey, 2013). Educating the family on the proper nutrients to give to the child is important to
make sure it improves their immunity and fasten their growth and development. There is the
need for the family to expose both children to the sunlight to get Vitamin D. Proper hygiene is
essential to avoid bacterial infection (Payne, & Isaacs, 2017). The doctor can also prescribe
antibiotics for the treatment of bacteria upon confirmation. The family needs to be advised on
these aspects. For the case of bacterial infection, the family needs to be referred for treatment
should there be any presence of bacterial infection causing sores in the mouth and nose of Elias
and Benji. This intervention will, in turn, reduce malaises that are as a result of the side effects of
the deficiency in milk and the new environment.
Extended Care Plan
One of the best ways for nurses to successfully implement a care program is to include
the patients in its implementation. This is beneficial in many ways, to start with ethics, it makes
it possible to respect and allow the patient to give consent to whatever undertakings that the
nurse intends to carry out on him or her. Firstly, is the diet that they need to take, both Elias and
his mother. As a foreigner, they may disdain some foods as result of their cultural background.

CHILD AND ADOLESCENT NURSING 8
Thus, allowing choosing what to take is essential. In addition to that, Elias mother needs
to be taught how to monitor Elias on whether there are any significant changes in his condition.
The mother ought to keep record periodically to share with the nurse to determine whether
positive changes are taking place or not (Trawick-Smith, 2013). Lastly, is education on the
family on how to make the child adapt to the new environment.
Conclusion
The case study tries to explain nurse’s intervention, extended care plan and assessment of
irritability, malaise, delayed motor development and inadequacy of vitamin D. In addition to
that, the patient under case study, that is, Elias, is a migrant, four years of age. He has some signs
of bacterial infection characterized by his mouth conditions. As a nurse, it is crucial to apply the
code of conduct before and during the assessment, use protective measures to avoid transmission
of infections and the right tools for assessing the patient. Additionally, and in this case, in
particular, it is crucial to educate the mother so that she is aware of the role she has to play in the
recovery process. The environment has been shown to be one of the factors that can affect
growth and development of the child. Another thing is the deficiency of nutrients. Lastly, the
short term and long term program of curing Elias must be done in partnership as this is the only
way to successfully carry out a proper healing program on Elias and even his sibling Benji.
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