CNA342: Clinical Scenario Assignment - Pediatric Care Report

This report presents a clinical scenario assignment focusing on an eight-year-old patient, Jamir, diagnosed with asthma. The assignment analyzes the patient's care needs, considering physical, psychosocial, and cultural factors. It identifies key issues such as exercise-induced bronchospasms, family dynamics, and cultural considerations. The report details strategies for therapeutic engagement, emphasizing communication, family-centered care, and cultural safety. A comprehensive care plan is outlined, including nursing goals, interventions, and rationales to improve asthma management, address psychosocial needs, and promote family support. The strategies include communication theories, family-oriented psychotherapy, and cultural sensitivity to enhance the therapeutic alliance and achieve holistic patient care.

Running head: CLINICAL SCENARIO ASSIGNMENT
Clinical scenario assignment
Name of the student:
Name of the university:
Author note:

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CLINICAL SCENARIO ASSIGNMENT
Table of Contents
Part I:...............................................................................................................................................2
Part II:..............................................................................................................................................3
Strategies for therapeutic engagement:........................................................................................4
Care plan:.....................................................................................................................................6
References:......................................................................................................................................9

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Part I:
The case scenario selected for the assignment focuses on Jamir, an eight year old
ethnically diverse patient living in the rural suburban neighbourhood of Australia. The case was
reported by a teacher who came to the clinic to share her concerns about the deteriorating asthma
that Jamir had been suffering from ever since his diagnosis of asthma 12 months ago. The
teacher has mentioned that the patient has had three asthma attacks within the last two months
and all of which had been occurring during the physical exercise education classes. The teacher
has also mentioned that she had spoken to Jamir’s mother regarding the asthma complications
that he experiencing, signs of his deteriorating condition and his absenteeism and affected
educational progress due to the deterioration. The teacher mentioned that they immigrated to
Australia from Afghanistan two years ago and ever since his mother has developed depression
and it being a family of five with only his father being an earning member, his father has to work
long hours to sustain the family. The teacher explained that even though Jamir’s mother has been
notified about the deteriorating condition, nothing changed for Jamir.
As per the information provided by the case study, there are various care needs that are
present for the patient. First and foremost, it has to be acknowledged that exercise induced
bronchospasms are prevalent in the patient groups with lack of properly medically managed
asthma. Hence, one of the most important physical health need of the patient is proper
management of asthma. The fact that he had been feeling considerably low and non-participative
in class and had been absent for long period of times from the school, it indicates at deteriorating
health due to asthma. Along with that he had been falling behind in the studies due to his
deteriorating health he had been suffering from lack of proper growth and development is also
affected due to the his deteriorating health. It was discovered from the case study that he

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belonged to a culturally and ethnically diverse immigrant family with four children and parents
and only one earning member. Hence, his nutritional requirements must also be restricted due to
the fiscal constraint on the family and hence proper nutrition and development is also a very
important need (Murray et al. 2017). It seemed that Jamir only knew how to use the salbutamol
puffer and he did not have enough understanding of the asthma self-management either, hence it
is also a very important need. Considering the psychosocial needs of the patient, it has to be
mentioned that this culturally diverse family as living in a fiscal constraint with the father
working long hours to sustain the family and the mother being depressed for two years. Hence,
the familial bonding and residential environment of the family must be compromised due to
these complicated factors, hence proper familial support and parenting is also a considerable
need for Jamir. Although, from the array of needs of the patient, proper medical management of
asthma, affected growth and development of the child, and lack to familial or parental support
are three most pressing needs that need to be addressed immediately (Keeney et al. 2014).
Part II:
It has to be mentioned in this context that asthma is a chronic lung disorder which is
associated with many health related restrictions and lifestyle modifications. The physical
exercise is one of these restrictions that an asthma patient has to undergo in order to be able to
avoid the risk of asthma attack or exacerbations. As discussed by Jayasinghe, Kopsaftis and
Carson (2015), vigorous exercise or physical activity is associated with exercise induced
bronchospasms in the asthma patients, and hence, students with asthma should not be allowed to
take part in regular vigorous physical activity to avoid risk of exacerbations. The information
provided on the patient includes Jamir using salbutamol in school only when he experiences
asthma attacks and yet his health had been deteriorating and he had been absent from the school

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for increasing number of days on a stretch which indicates that his health had been deteriorating
further and without adequate interventions taken to address the issues that the patient is
experiencing, it might lead to considerable adverse events and his studies are also going to get
affected further (Weiler et al., 2016). Along with that, living in the care of a depressed mother
and a work absorbed father with three younger sibling has a significant impact on the psyche and
sense for safety of a child. Hence, there is need for proper therapeutic engagement with patient
and his family to address the overlapping care needs.
Strategies for therapeutic engagement:
Hence, the first strategy for the patient will be to address the communication issues in
order to develop the therapeutic relationship. Exploring this issue further, Jamir belonged to the
ethnic Islamic background which is associated with many restrictions and cultural constraints
associated with communicating with parents. The relationship between the children and their
parents in this culture is respectful yet very formal with the affection guarded by conventional
and traditional strictness (Yeh et al., 2016). Hence, the children feel awkward and afraid to
communicate their needs and problems, and for Jamir the depression of his mother and extreme
occupational stress of his father, his communication skills become limited. The strategy will
need to involve different communication theories namely relational communication theory and
interpersonal communication theory where, his personal ties and relationship will be evaluated
and encouraged with the parents so that he feels comfortable in sharing his woes and health
issues (Kurtz, Draper and Silverman 2016). Along with that, the nurse will have to include
strategies to enhance the interpersonal communication with the family and develop a therapeutic
alliance with Jamir.

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Family centred care can be defined as the care approach that allows the parents of the
child be the centre of the decision making for care planning and implementation with
collaboration of the health care staff (Mohanty et al., 2018). In this case, Jamir’s health issues are
not limited to just his physical health needs but also the emotional and mental health ne4eds
which is associated with the parents and family. Here the nurse will have to suggest family
oriented psychotherapies to enhance familial bond and suggest psychotherapeutic interventions
for both Jamir and his parents that will also help his father deal with work stress and his mother
to overcome depression. Along with that, the nurse will also have to focus on involving both
parents in care planning and implementation procedure, to help them feel useful, connected with
their child and in control. These will help the parents and the family build trust and comfort with
the child and his family and will allow the nurse to engage in a therapeutic relationship and help
address the care needs of Jamir and help him overcome his health concerns effectively and
holistically (Coyne, 2015).
The third strategy will undoubtedly have to focus on the need for cultural safety for the
therapeutic engagement and subsequent care planning. It has to be mentioned in this context that
Jamir belongs to an ethnic Islamic background which is associated with many traditional healing
concepts and ideologies which is needed to be acknowledged in the care planning. And
developing a therapeutic alliance with a patient belonging to CALD background, the need for a
culturally safe and appropriate approach will be essential (Cené et al., 2016). Language and non-
verbal communication is a very important aspect of the therapeutic engagement with Jamir and
his parents, hence there will be need to incorporate a language interpreter for Jamir and his
family to understand and participate optimally in the process. Lastly, respecting the cultural
identity and the honouring the choices and preferences are a very important aspect of caring for

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as culturally diverse child, hence the nurse will also require to respect his and his family’s
cultural identity and ethnicity along with taking the assistance of cultural liaison officer and
CALD expert to put across my thoughts and concerns better to the family and help them
understand me more effectively and help in strengthening the therapeutic engagement (Arnold
and Boggs, 2015).
Care plan:
The most important care need for Jamir is better management of his asthma exacerbations
and frequent bronchospasm attacks that were mostly exercise induced which indicated at the fact
that his asthma not being properly medically managed.
Nursing goal Nursing intervention Rationale Evaluation of
outcome
Jamir will be
receiving proper
treatment regimen to
control his asthma
better
Carrying out adequate
extensive assessment of
respiratory rate, depth, and
rhythm along with
adventitious breathing
sounds.
Administering short acting
beta 2 andrenergic agonists
such as albuterol and
A thorough
assessment will help
understand the extent
of bronchial
constriction and detect
any infection to
provide adequate
intervention (Teach et
al. 2015).
The bronchodilators
will relieve the
The exact
extent of
asthma was
determined
which helped
in further care
planning.
The
administration
of medication
diligently over

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corticosteroids such as
budesonide as prescribed
by physician
bronchoconstriction
by dilating the
bronchial tubes and
corticosteroids will
reduce any
inflammation in the
airways and will help
relieve the shortness
of breath (Puranik et
al. 2017).
a period of
time helped in
relieving the
frequency and
severity of
bronchospasms
Jamir will understand
the self-management
techniques
effectively
Teaching Jamir how to use
spacer inhalers with help
from parents prior to
discharge.
Taking the aid of teach
back method with
collaboration from cultural
liaison officer
Knowing how to use
inhalers on their won
will avoid the risk of
respiratory emergency
(Teach et al. 2015)
Teach back method
will ensure the patient
has understood the
entire patient
education session
(Peter et al. 2015)
Jamir
positively
understand
how to use
spacer inhalers
properly and
can use it on
his own in
emergencies
His parents will Arranging counselling and Demonstrative and Jamir’s parents

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understand asthma
exacerbation triggers
and how to manage
and/or prevent them
educational interactive
session explaining asthma
attack triggers, how to
prevent and manage them
by the use of a workshop.
Giving informative
brochures in simple and
easy to understand English
interactive sessions
will enhance the
understanding of the
parents (Kurtz, Draper
and Silverman 2016).
Having a brochure for
future reference will
help the family adhere
to the instructions
more effectively
understand
triggers for
asthma attacks
and how to
prevent as well
as mange them

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References:
Arnold, E.C. and Boggs, K.U., 2015. Interpersonal Relationships-E-Book: Professional
Communication Skills for Nurses. Elsevier Health Sciences.
Cené, C.W., Johnson, B.H., Wells, N., Baker, B., Davis, R. and Turchi, R., 2016. A Narrative
Review of Patient and Family Engagement: The “Foundation” of the Medical Home. Medical
care, 54(7), p.697.
Coyne, I., 2015. Families and health‐care professionals' perspectives and expectations of family‐
centred care: hidden expectations and unclear roles. Health expectations, 18(5), pp.796-808.
Jayasinghe, H., Kopsaftis, Z. and Carson, K., 2015. Asthma bronchiale and exercise-induced
bronchoconstriction. Respiration, 89(6), pp.505-512.
Keeney, G.E., Gray, M.P., Morrison, A.K., Levas, M.N., Kessler, E.A., Hill, G.D., Gorelick,
M.H. and Jackson, J.L., 2014. Dexamethasone for acute asthma exacerbations in children: a
meta-analysis. Pediatrics, pp.peds-2013.
Kurtz, S., Draper, J. and Silverman, J., 2016. Skills for communicating with patients. CRC Press.
Mohanty, S., Wells, N., Antonelli, R. and Turchi, R.M., 2018. Incorporating Patient-and Family-
Centered Care Into Practice: The PA Medical Home Initiative. Pediatrics, p.e20172453.
Murray, C.S., Foden, P., Sumner, H., Shepley, E., Custovic, A. and Simpson, A., 2017.
Preventing severe asthma exacerbations in children. A randomized trial of mite-impermeable
bedcovers. American journal of respiratory and critical care medicine, 196(2), pp.150-158.

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Peter, D., Robinson, P., Jordan, M., Lawrence, S., Casey, K. and Salas-Lopez, D., 2015.
Reducing readmissions using teach-back: enhancing patient and family education. Journal of
Nursing Administration, 45(1), pp.35-42.
Puranik, S., Forno, E., Bush, A. and Celedón, J.C., 2017. Predicting severe asthma exacerbations
in children. American journal of respiratory and critical care medicine, 195(7), pp.854-859.
Teach, S.J., Gill, M.A., Togias, A., Sorkness, C.A., Arbes Jr, S.J., Calatroni, A., Wildfire, J.J.,
Gergen, P.J., Cohen, R.T., Pongracic, J.A. and Kercsmar, C.M., 2015. Preseasonal treatment
with either omalizumab or an inhaled corticosteroid boost to prevent fall asthma
exacerbations. Journal of Allergy and Clinical Immunology, 136(6), pp.1476-1485.
Weiler, J.M., Brannan, J.D., Randolph, C.C., Hallstrand, T.S., Parsons, J., Silvers, W., Storms,
W., Zeiger, J., Bernstein, D.I., Blessing-Moore, J. and Greenhawt, M., 2016. Exercise-induced
bronchoconstriction update—2016. Journal of Allergy and Clinical Immunology, 138(5),
pp.1292-1295.
Yeh, H.Y., Ma, W.F., Huang, J.L., Hsueh, K.C. and Chiang, L.C., 2016. Evaluating the
effectiveness of a family empowerment program on family function and pulmonary function of
children with asthma: a randomized control trial. International journal of nursing studies, 60,
pp.133-144.