Evidence-Based Clinical Assessment Report in Paediatrics Module

This report presents an evidence-based clinical assessment of a 9-year-old boy, Rohan, diagnosed with type 1 diabetes. It meticulously analyzes his care needs, including managing his diabetes through proper medication, diet, and insulin administration, considering his vegetarian family's dietary restrictions. The report also addresses the care needs of Rohan's mother, who suffers from nephrotic syndrome and depression. It prioritizes the treatment of type 1 diabetes, proper nutrition, and the mother's health. The report then explores strategies for developing trusting relationships using family-centered care and communication theories, supported by relevant literature. Finally, it outlines a plan of care focused on diabetes management, diet, and physical activity, evaluating the effectiveness of interventions and highlighting the importance of family involvement for improved outcomes. The report underscores the need for regular monitoring, appropriate diet, and family support to enhance the child's well-being. The assignment is available on Desklib, a platform providing study resources for students.

Evidence based clinical
assessment report in paediatrics

Table of Contents
INTRODUCTION...........................................................................................................................1
Part 1 Description and Analysis ......................................................................................................1
Analysing the Care needs............................................................................................................1
Priorities on the Issues and Needs...............................................................................................2
Part 2 Application and synthesis.....................................................................................................3
Strategies for developing trusting relationships..........................................................................3
Relevant literature and Plan of Care...........................................................................................5
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................8

INTRODUCTION
Type 1 diabetes mellitus is considered as a type of diabetes mellitus in which the
pancreas produces a little or no amount of insulin, which further results in higher blood sugar
levels (Thomas and et.al, 2010). Rohan was diagnosed with type 1 diabetes. The report includes
the care needs and priorities for he and his family. Also it involves the strategies which can help
in interacting and developing a trusting relation with them for proper evaluation of the factors
and treatment.
Part 1 Description and Analysis
Analysing the Care needs
Care needs for Rohan
Management of Type 1 diabetes
As Rohan was earlier diagnosed with chronic illness, type 1 diabetes mellitus which is
considered as a condition when the pancreas produces very little or no amount of insulin. He has
high levels of blood sugar as well. This can further lead to more problems for Rohan as it can
cause excessive urination problem, nausea, blurred vision etc. So, it needs to be prevented by
taking proper medication and appropriate diet.
Proper Diet Plan
As he was diagnosed with Type 1 diabetes, his parents must have taken care of him
having proper and balanced diet. According to the diet plan, he had to take a non vegetarian diet
which could help him in improving his conditions. But, his family is a pure vegetarian family, so
they should focus on giving him some alternatives for that such as they can provide him foods
with carbohydrates and fibres but they should be given in moderate levels only. Therefore, the
second care need for Rohan is a proper and balanced diet plan that is based on a vegetarian diet
so that he can follow it properly.
Proper administration of insulin
As Rohan is a 9 year child, he must not be capable of getting the insulin done by himself.
His father goes very early for work and his mother is suffering from nephrotic syndrome and
depression, from the time they have immigrated to Australia. His teacher has also had a talk with
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his mother but she has no concern as she herself is mentally not well. So, the care need is
regarding proper administration of insulin to Rohan.
Care needs for family
Treatment of mental and physical sickness of Rohan’s Mother
Since the time, they have immigrated to Australia, her issue of depression has started.
Along with that, she also is suffering from nephrotic syndrome. It is a kidney problem that makes
the body to excrete proteins in higher amounts in the form of urine (Prytuła and et.al., 2010) .
She must undergo some treatment as cholesterol reducing medications, blood pressure
medications as these drugs helps in reducing the BP and thus minimizing the amount of proteins
released in the urine. Rohan's father leavers very early for work, Hence, her mother would need
care and support regarding going for these treatments. It will help Rohan also in getting a proper
care and treatment.
Priorities on the Issues and Needs
Priorities for Rohan
On the basis of the case scenario, three basic priorities are discussed as under:
Treatment of Type 1 diabetes
This problem occurs when the beta cells, that are the cells in the pancreas are being
damaged by the immune system. These cells are responsible for making insulin in the pancreas
(American Diabetes Association, 2014). He used to take insulin by his own as his mother is not
well and his father used to leave early in the morning for work. He should be given proper
treatment of diabetes by a nurse. His blood sugar levels should be monitored on a regular basis.
Provision of proper diet
The diet he has to take for the treatment of type 1 diabetes, includes meat and the non
vegetarian products but his family is not able to feed him with it as they are vegetarian. So, they
should focus on providing him the required diet so that it will help him in improving his
condition. Also, Rohan is required to take foods having high carbohydrate content.
Treatment of illness of her mother
His mother is suffering from nephrotic syndrome as well as she is in depression. This
makes her incapable of caring for Rohan during his illness. Hence, it is the third priority to treat
Rohan’s mother. She should maintain her blood pressure levels so as to delay from any kidney
damage. She needs to be provided corticosteroids and other medications which will help her in
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overcoming from the syndrome. For coping with the depression, she also needs to include some
changes in her lifestyle activities such as exercises, actions and meditations which will help her
in recovering from the issue (Yeung, Rawlinson and Craig, 2011). After solving her issues, she
can be able to concentrate on wellness of Rohan and in providing him a better treatment.
Part 2 Application and synthesis
Strategies for developing trusting relationships
Some strategies that can help me in developing a trusting relationship with Rohan and
his family are discussed as under :
Family centred care theory
For developing a trusting relationship with Rohan and his family, I can make use of this
approach as it can help in interacting with them so that I may be able to know the faults and can
focus on them. Rohan was diagnosed with type 1 diabetes and his mother was suffering from
depression and nephrotic syndrome. As this theory deals with meeting the needs of patient along
with the family, so I can also discuss the issues of Rohan as well as his mother with them and
reach to some conclusion which will help him overcoming the problem.
Communication theory
For developing a trusting relationship with Rohan and his family, I can make use of
communication theory as well. Communication is a very essential tool between any two bodies
for discussing the ideas as well as the issues. As Rohan used to take insulin by his own, I can
interact with him and teach him the risks he can go through by taking insulin by himself. He is
not mature enough to do this. I can communicate with her mother as well and can have a talk
with her as her illness can impact very bad for Rohan. I will also suggest her that if her health
would be better, she can take proper care of Rohan and provide her appropriate treatment so that
his condition can be improved. These concerns can help me in developing a trusting relationship
with them so that I will be able to focus where the treatment is required and provide them so.
Relevant literature and Plan of Care
According to Yeung, Rawlinson and Craig, (2011), the family centred care approach acts
as an effective tool in developing the trust factors between the two bodies. As per Prytuła and
et.al, (2010) , this approach is being used to encompass various ideas about service delivery to
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the child along with the families. Amy (2017) says it acts as an overall approach of the planning,
delivering and analysis of the health care. But Riddell and Milliken (2011) says, communication
theory can produce more effective results than the other approaches. It is because communication
is considered as a very important tool for the two parties to interact and discuss their ideas along
with the issues. By means of it, one can discuss their views and issues with the other and then
can reach to an outcome.
Plan of care
Priority- treatment of type 1 diabetes mellitus
From all the three priorities, the most important one which can help in analysing a plan
of care for Rohan is treatment of type 1 diabetes. His blood sugar levels should be checked on
a regular basis. For maintaining it, he can include some exercises and actions in his routine.
Using the insulin pump or taking required injections can also help, but it should be done with the
help of a nurse or practitioner. He used to take by himself but he is not mature enough to do so,
with the help of nurse, he should take proper medications. Her mother should ensure that as they
are vegetarian, they should provide him some alternates of the said diet such as foods with sugar
alcohols, fibres etc. but they should be given in moderate levels only. So, she should focus on
providing him the appropriate diet. His father used to leave early in the morning and returns late,
but he should focus on regular medical check-ups of Rohan to evaluate his condition.
Interventions
Proper Diet : As he is suffering from type 1 diabetes, his diet includes non vegetarian foods as
meat etc., which he is not able to get as he and his family is vegetarian. So, they should focus on
providing him the appropriate diet so that he can be able to cope with the situation. They should
focus on providing him carbohydrates and fibres in distributed amounts because its higher intake
can lead to more problems. A healthy and balanced diet can act as an important part for the
treatment (Amy, 2017). He have to balance the type as well as timings of his diet, so as to
prevent any further complications of type 1 diabetes.
Regular Physical Activities : Rohan should undergo various physical activities on a regular basis.
It will help him in maintaining a healthy body weight. These activities will provide a sort of
relief for Rohan from the poor symptoms of type 1 diabetes. Doing exercises and more activities
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will help in the proper maintenance of the insulin in the body (Chimen and et.al, 2012). He can
involve activities in his daily routine as walking, playing, riding bicycle etc. These will help in
staying fit and healthy, thus maintaining the level of proportion of insulin in the body. It will also
maintain the blood sugar level in his body.
Evaluation of the effectiveness of the care
I provided him proper injections on a regular basis which helped a lot in improving the
condition. I suggested her mother to provide him food containing distributed amount of
carbohydrates and fibres as they were vegetarian and Rohan was not having proper diet. This
also helped in providing him some relief from the symptoms. When I had a talk with her mother,
she was having no concern with the illness of Rohan as she was mentally as well as physically
sick herself. So, I suggested her to some medications which helped her in getting out of the
depression and nephrotic syndrome. Then, she was able to concentrate on his health and in
providing him the appropriate treatment . Regular activities and exercise in the routine helped
Rohan much in improved conditions as these activities help in maintaining the proper proportion
of insulin in the body.
CONCLUSION
From the essay, it can be concluded that Rohan was diagnosed with type 1 diabetes and
he was not able to get the appropriate diet because of his mother's illness. It included the care
needs along with the priorities that Rohan and his family need for evaluating the condition of
him. Taking proper medications and including some regular activities helps in maintaining the
exact proportion of insulin level in the body, thus improving improving the condition of Rohan.
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REFERENCES
Books and Journals
American Diabetes Association, 2014. Diagnosis and classification of diabetes
mellitus. Diabetes care. 37(Supplement 1). pp.S81-S90.
Chimen, M. and et.al., 2012. What are the health benefits of physical activity in type 1 diabetes
mellitus? A literature review. Diabetologia. 55(3). pp.542-551.
Kalyva, E. and et.al., 2011. Health‐related quality of life (HRQoL) of children with type 1
diabetes mellitus (T1DM): self and parental perceptions. Pediatric diabetes. 12(1). pp.34-
40.
Maahs, D. M. And et.al., 2010. Epidemiology of type 1 diabetes. Endocrinology and metabolism
clinics of North America. 39(3). pp.481-497.
Polanco, N. and et.al., 2010. Spontaneous remission of nephrotic syndrome in idiopathic
membranous nephropathy. Journal of the American Society of Nephrology. 21(4).
pp.697-704.
Prytuła, A. and et.al., 2010. Rituximab in refractory nephrotic syndrome. Pediatric Nephrology.
25(3). pp.461-468.
Riddell, M. C. and Milliken, J., 2011. Preventing exercise-induced hypoglycemia in type 1
diabetes using real-time continuous glucose monitoring and a new carbohydrate intake
algorithm: an observational field study. Diabetes technology & therapeutics, 13(8),
pp.819-825.
Rood, I. M. And et.al., 2010. Comparison of three methods for isolation of urinary microvesicles
to identify biomarkers of nephrotic syndrome. Kidney international. 78(8). pp.810-816.
Thomas, M. C. And et.al., 2011. The association between dietary sodium intake, ESRD, and all-
cause mortality in patients with type 1 diabetes. Diabetes care. 34(4). pp.861-866.
Yeung, W. C. G., Rawlinson, W. D. and Craig, M. E., 2011. Enterovirus infection and type 1
diabetes mellitus: systematic review and meta-analysis of observational molecular
studies. Bmj. 342. p.d35.
Online
Amy., H. Meal Planning for Children with Type 1 diabetes. 2017. [Online]. Available through:
<https://www.endocrineweb.com/guides/type-1-children/meal-planning-children-type-1-
diabetes >. [Accessed on 7th September 2017].
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