Community Hospital: Nursing Management of Mikey's Submersion Injury

This case study centers on Mikey, an 18-month-old male admitted to a community hospital after a submersion injury. The assignment explores various aspects of his care, including effective communication and collaboration among healthcare professionals, pain assessment and management str...Read More

Student’s name;
Institutional affiliation;

Introducing the case study.
This assignment describes a case scenario of an 18 months male child called Mikey, who is admitted in a
community hospital after falling in the water in a swimming pool. Mikey developed signs of shock
followed by comma and now a diagnosis of submersion injury. Mikey is for acute nursing care and
management.
Question 1
Effective communication and collaboration are encouraged when a team of healthcare professionals meet
to discuss long term interventions for an acutely ill patient. Adler, Rodman & Du Pré, (2016), said that
exchanging information leads to interaction and connectedness between human beings involved in the
conversation. Face to face interaction focuses on advancing the physical and emotional well-being of the
patient (Davis Boykins, 2014).
Collaboration between the team members can work out if the team ensure that they trust each other,
respect each other, for these are the pillars of a capable team. A team with a common goal to achieve
should avoid common barriers to interprofessional communication. Such obstacles may include which
may include personal values and expectations, personality differences, hierarchy, disruptive behaviour,
historical and interprofessional rivalries. As they discuss, they should aim in a thriving, and this can work
out by building a collaborative, thriving work environment. Everyone should remember the compelling
mission that brought them together; that is, Mikey's condition. A typical mission will inspire the team
members to want to be that part of the team that came up with a solution to for Mikey's situation. They
can establish specific team goals and encourage all to work aiming to achieve the goals by re-evaluating
the goals and redirecting whenever necessary. The particular team goals lead to working with
transparency, thus decreasing confusion, finger-pointing and the disintegration of team cohesion. They
can consider working with their strengths rather than working around their weaknesses; this will help in
each of the members being set up for success.
Question 2
Mikey’s parents are uncomfortable due to their son’s pain. To make them comfortable, I will consider
telling them how nurses asses for pain. In as much as neonatal pain assessment is critical due to the effect
the illness has on developing the nervous system, it is difficult to assess (Hockenberry & Wilson, 2018).
The difficulty in assessment is because the most reliable indicator of pain, self-report, is not possible.
Nurses, therefore, base their neonatal pain evaluation on physiological changes and behavioural
observations with validated instruments. (Hatfield & Ely, 2015). Typical infant's behaviours tend to vary

in different situations (Hockenberry, & Wilson, 2018). Vocalizations, facial expressions, body
movements and general relaxation state are the four are the typical infants' characteristics. Facial
expression is the most consistent and commonly used characteristic to assess pain in infants
(Hockenberry, & Wilson, 2018). Mike is a child with communication and cognitive impairment as he is in
comma, a critically ill infant who is under ventilators hence has communication barriers. Assessing pain
in such kind of patients with communication barriers is usually challenging (Crosta et al. 2014). Nurses,
therefore, use non-communicating children’s pain checklist (NCCPC), a measurement tool that is
designed explicitly to children with cognitive impairments such as Mikey. According to Massaro et al.
(2014), NCCPC has been used during the postoperative period and has shown effectiveness in the
measurement of pain in clinical settings. With this pain assessment tool, assessment is on the vocal,
social, facial expressions, child's activity, body and limbs, and physiologic. All the variables are given a
rating of a 0 to 3, with five being the most severe. Sedation in children is safe. Combination of sedatives
with pain medication helps children remain comfortable during procedures that are painful to perform
(Hockenberry, & Wilson, 2018).
Question 3
To prevent the child from potential long-term physiologic, psychosocial and behavioural consequences,
nurses manage pain with pain medications or implementing non-pharmacologic interventions. The
doctors can prescribe morphine and in which its final dosage that can be administered to Mikey is 10.89
mg of morphine at a go in every 4 hours. The volume of the medication will be (10.89/0.5) *1ml, and this
will give 21.78 ml of morphine at a go. It should be administered slowly over 5 minutes.
Question 4
Morphine is a phenanthrene opioid receptor agonist. It is an analgesic drug that interacts with the Miu or
delta receptors at the CNS, interrupting pain sensory perception (Devereaux et al. 2018). Morphine's
potential side effects once administered, may include nausea, vomiting and constipation in the
gastrointestinal tract. Morphine can also lead to lightheadedness, dizziness, drowsiness, sweating and dry
mouth. Allergic reactions presenting as rashes may appear though rarely.
Question 5
Submersion injury occurs when a person is submerged in any liquid. Once the infant is overwhelmed, he
may hold breath initially and attempts to breathe. As the infant attempts to breathe, he ends either

aspirating the water or with laryngospasm without aspiration. The prognosis or outcome of submersion
injury can either be death, morbidity or no morbidity (Thomas et al., 2017; Semple-Hess & Campwala,
2014). In as much as submersion injuries are highly prevalent, they are preventable once the risk factors
are recognized. The risk factors include epileptic child, a child with underlying cardiac dysrhythmias,
hyperventilation, hypoglycemia, and hypothermia. As a nurse, I will implement the following
interventions to support Mikey's mother, who is now like having a child with special needs. Establishment
of an individualized family service plan (us. Department.) According to Woodman (2014), parents with
children with disabilities experience more stress compared to those with typically developing children
Question 6
Mikey's sibling in the third stage of development. She is in the phallic stage as she is four years old
(Hockenberry & Wilson, 2018). Since her brother got admitted, her mother's attention has shifted to the
sick child, and it is stressful to cope up. She has started a new behaviour of wetting her bed.
Question 7
Children that are below two years old require proper evaluation when it comes to evaluating their specific
neurologic status (Hockenberry & Wilson, 2018). Such children are unable to respond to directions
designed to elicit specific neurologic responses. Most information about infants and small children is
gained by observing their spontaneous and evoked reflex responses. Assessing brain death and
dysfunction can be done by evaluating the child's family history offers clues regarding possible genetic
disorders with neurologic manifestations. The second one is evaluating health history, such as the history
of some medical history. The last part is the physical evaluation of the infants where you will assess the
level of alertness, respiration, muscle activity and many more (Hockenberry & Wilson, 2018)
When the family has a child, who is admitted everyone in the family is affected, including his/her
siblings. The attention of the mother goes more to the sick child. Adjustment is therefore required to
ensure that the needs of the siblings are met and help the siblings feel included as well. The Bowen family
systems theory views the family as an emotional unit. The family uses systems thinking to describe the
complex interactions in the group. often the family members feel more distant and disconnected although
this a more feeling than fact(Titelman, 2014)
Question 8
Ineffective tissue perfusion related to impaired transport of oxygen across alveolar as evidenced by
extremity weakness or paralysis, altered mental status and changes in motor response (Gil Wayne, 2017).
The goal is to ensure that the patient shows no further worsening of deficits. Interventions may include

checking the mental status by performing a neurological exam. Implementing interventions helps in
reviewing trend in the level of consciousness and the possibility for increased intracranial pressure. It is
also helpful in deciding the extent of the central nervous system damage (Gil Wayne, 2017).

References.
Adler, R. B., Rodman, G. R., & Du Pré, A. (2016). Understanding human communication (Vol. 10).
Oxford University Press
Crosta QR, Ward TM, Walker AJ, et al. A review of pain measures for hospitalized children
with cognitive impairment. J Spec Pediatr Nurs. 2014;19(2):109–118
Davis Boykins, A. (2014). Core communication competencies in patient-centred care. ABNF
Journal, 25(2
Devereaux, A. L., Mercer, S. L., & Cunningham, C. W. (2018). Dark classics in chemical neuroscience:
morphine. ACS chemical neuroscience, 9(10), 2395-2407.
Gil Wayne, R. (2017). Constipation – Nursing Diagnosis & Care Plan. [online] Nurseslabs. Available at:
https://nurseslabs.com/constipation/ [Accessed 19 Mar. 2017].
Hatfield LA, Ely EA. Measurement of acute pain in infants: a review of behavioural and
physiological variables. Biol Res Nurs. 2015;17(1):100–111.
Hockenberry, M. J., & Wilson, D. (2018). Wong's nursing care of infants and children-E-book. Elsevier
Health Sciences.
Massaro M, Ronfani L, Ferrara G, et al. A comparison of three scales for measuring pain in
children with cognitive impairment. Acta Paediatr. 2014;103(11):e495–e500
Semple-Hess, J., & Campwala, R. (2014). Pediatric submersion injuries: emergency care and
resuscitation. Pediatr Emerg Med Pract, 11(6), 1-21.
Thomas, A., Sanseau, E., Uspal, N., Burns, R., Auerbach, M., Caglar, D., ... & Reid, J. (2017). Pediatric
Emergency Medicine Simulation Curriculum: submersion injury with hypothermia and
ventricular fibrillation. MedEdPORTAL: the journal of teaching and learning resources, 13.
Titelman, P. (2014). Emotional cutoff: Bowen family systems theory perspectives. Routledge