Pediatric Nursing: Comprehensive Analysis of a Trauma Case Study

This report presents a comprehensive analysis of a pediatric nursing case study involving a 2-year-old boy, Jerome, who sustained severe injuries in a car accident. The report is divided into two parts, the first detailing the incident, emergency medical care, and subsequent complications, including intraventricular hemorrhage, and respiratory failure. The second part analyzes the problems, interventions, and the role of nurses in trauma care. It emphasizes the importance of therapeutic communication with the patient and parents, ethical and legal considerations, and the application of Henderson’s nursing meta-paradigm. The report highlights the need for immediate intervention, physiotherapy, and parental support to improve the patient's condition and mitigate the impact of the traumatic event on the family. The case underscores the critical role of pediatric nurses in providing holistic care, ensuring ethical practices, and promoting positive outcomes for young trauma patients.

PEDIATIC NURSING

Table of Contents
Introduction......................................................................................................................................2
Analysis...........................................................................................................................................2
Part 1............................................................................................................................................2
Part 2: The case study analysis....................................................................................................8
Conclusion.....................................................................................................................................12
Reference List................................................................................................................................13
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Introduction
Pediatric nursing is developed to provide nursing assistance to pediatric clients and their families
with the best use of nursing meta-paradigm. The NFDN-2005 nursing foundations provide care
assistance to the process of growth and development of the nursing care for the paediatrics. This
study will describe the effectiveness of pediatric nursing care to nullify the traumatic problems of
nursing. The study will be developed into two parts. The first part will initiate a case study that
will be developed chronologically based on the traumatic problems of the pediatric patients. The
second part analyzes the reasons and solution of the problems through pediatric nursing,
therapeutic communication and teaching and learning process. The legal and ethical issues will
also be described based on the nursing process and meta-paradigm. The concluding part will
summarize the whole discussion and will focus on the effectiveness of pediatric nursing for
pediatric trauma care.
Analysis
Part 1
The case scenario of the pediatric care is capable to unfold the detail of the injury that has led the
patient to the traumatic situation. An emergency care treatment is always required for the trauma
injury patient to mitigate the initial risk factors associated with traumatic nursing (Plog et al.,
2015). The case is as follows:
The incident
Jerome is a 2 years old boy who was sitting on the lap of his mother at the backseat of the car.
While sitting at a stoplight, the car was suddenly hit by another car which was chased by the city
police. With the sudden shock of the accident the mother needed to put her hands out of fear to
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save herself and the baby boy was thrown down on the floor under the passenger side dashboard.
The car was damaged badly and the parents went unconscious stuck by the windscreen. The baby
boy was found crying at the scene and was unable to move his lower extremities.
Emergency medical care
The baby boy was sent to the local pediatric hospital where he had undergone some initial
treatment. It was found after a chain treatment process that his right ankle was totally dislocated.
The caregivers quickly sent him for the CT scan and were found an intraventricular hemorrhage
in his skull fracture. However, the chest position was normal. The intraventricular hemorrhage
signifies a little paralysed mental order and a little malfunction in the narcotic elements
(Bolisetty et al., 2014).
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Picture; chest CT scan report
Source: http://www.ucdenver.edu/academics/colleges/medicalschool/departments/surgery/
education/GrandRounds/Documents/GRpdfs/2007-2008/10-1-07%20Keith.pdf
Emergent exploratory laparotomy
The emergent laparotomy report suggests that the emergency blood report of the patient. The
report has shown that the patient had
 Hct level in the blood -24.7
 the platelets level was 208
 the Pt was 19.1
 INR was 1.58 and
 PTT was 35
Moreover, the report also stated that the baby boy was having additional fluid resuscitation and
he needs a place of his left chest tube. A longitudinal aortotomy and a circumferential of intima
were noticed in his body that has led the level of his mental disorder to traumatic transection of
terminal ileum due to the de-vascularized bowel.
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Picture: Longitudinal aortotomy
Source: http://www.ucdenver.edu/academics/colleges/medicalschool/departments/surgery/
education/GrandRounds/Documents/GRpdfs/2007-2008/10-1-07%20Keith.pdf
Emergent trauma observation
The patient was then sent to the pediatric intensive care unit. He was almost in the comatose
situation. He has genuinely required an immediate increase in the oxygen level to improved his
brain function. Moreover, an adequate development of circulatory volume was required to
optimize the cognitive development (Cook et al., 2017). A great increase in the ICP level was
required for adequate development of his paralysed situation. Mannitol, dexamethasone and
narcotic treatment went failure for the development of the cognitive health of Jerome. No further
improvement of his brain health was noticed. The traumatic situation of Jerome was
continuously deteriorating so as a constant decline in his brain function. The platelet level was
deteriorated to the level of 109 from 208 and the level of INR was declined to 1.17 from 1.58. A
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profound respiratory failure was found in Jerome which results in hypoxemia and again moved
to Frequency Oscillatory Ventilation (HFOV). Moreover, the respiratory bias gas flow was
declined to 20ml/minute where the normal level is 30 to 60ml/minute. Hence, the medical
reports of Jerome have shown that there are 58% of the aneurisms, 10% of the aortic rupture
15% of the intimal tear with occlusion and 17% of the intimal acute injury.
The respiratory frequency was lowering even in the ventilation and the pressure of amplitude
was declining due to buck flow. The symptoms of barotrauma were further developed in Jerome
which was found in the observation after 21 days. After 30 days of the observation, the
barotrauma was developed to volutrauma. The symptoms found in the volutrauma are alveolar
over-distension that is distributed to the compliant lung. The volutaruma resulted in atlectruama
due to the parenchymal injuries. The parenchymal injuries resulted in the constant collapse of the
distal airways. Thus, the change in the traumatic situation signifies the deterioration of the
traumatic process of Jerome.
The trap under the dashboard promoted the severity of the traumatic injury. Jerome was found
crying in that situation that had also affected his mental health. The little delay in the rescue
operation promoted his traumatic situation which was ascending its stage as per the severity
standard. Jerome presently requires not only medication and chain of medical tests. Instead, he
also requires effective nursing care and self-motivated approach from the caregivers to promote
his betterment.
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Picture; respiratory frequency situation of Jerome during trauma
Source: http://www.ucdenver.edu/academics/colleges/medicalschool/departments/surgery/
education/GrandRounds/Documents/GRpdfs/2007-2008/10-1-07%20Keith.pdf
Part 2: The case study analysis
Problem description
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Accidents generally carry the largest responsibilities to the pediatric trauma. Around 25000
pediatric traumatic cases are the resultant of the car accident in Canada ("Home - Trauma
Association of Canada", 2018). As mentioned in the case study the patient is under severe trauma
due to the road accident while travelling with his parents. He had knee fracture and
intraventricular hemorrhage that led him to the narcotic malfunction. The narcotic malfunction
results in a constant decline in his brain health (Benedict et al., 2013). The initial test reports
signified that his platelet, Ptt, pt and INR level was normal. However, the situation declined after
10days of the observation. He was suffering from several acute levels of trauma (Lynch, DeHart,
Belknap & Green, 2013). The change in traumatic level signifies the constant deterioration of
the mental and physical health. Moreover, it results in a comatose situation that may signify the
early brain death.
Intervention and implementation
The intervention process for the pediatric trauma is a time-consuming process. The intervention
process must be aligned with the current situation, the severity of the situation and required time
for a definite care (Gaudine & Beaton, 2016). The nursing care staffs must communicate the
patients and their family properly to record the pediatric trauma score end injury severity scores.
The comatose situation can be developed by the physiotherapy and mental assistance (Wesson et
al., 2013). As mentioned in the case study, the patient, the patient genuinely requires integral
care and physiotherapy in order to mitigate the risks of brain death.
Role of nurse
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The role of the nurses for the situational development of the pediatric trauma care is to set the
tone for ethical care (Anbanad, Singh & Kapoor, 2013). The patients must be soft-spoken
to the pediatric patients. The caregivers of the pediatric hospital must communicate
Jerome in a soft and quiet manner. He requires a constant mental support and satisfaction
for the development of the care process. The attitudes must be composed that can nullify
the level of anxiety to the pediatric patients (Anbanad, Singh & Kapoor, 2013). This
could be helpful for Jerome develop the cognitive function by reducing the level of
anxiety (Schauer & Elbert, 2015). Pediatric surgeries must be conducted after evaluating
the EM evaluation. The report of the EM evaluation must be communicated according to
the ATLS protocol (Gaudine & Beaton, 2016). The nursing caregivers should be aware of
the trauma alert notification of Jerome. This would enable them to convey a rapid
mobilization of pediatric trauma care (Anand et al., 2013). Furthermore, the nursing
personnel must communicate with the parents of the patients’ family. However, Jerome's
father must be informed all the care process and required elements of effective care
(Gaudine & Beaton, 2016). Thus, a comfort and formidable communication with the
patients and his family can provide an effective outcome. Apart from that, in case of any
comatose situation, a gentle application of physiotherapy could be beneficial to increase
the blood circulation in the nerve cells (McDonald, Code & Togher, 2016). Hence, proper
dietary advice should be advised to increase the platelet level. Papaya, apple and guava
must be provided in the diet chart of the traumatic patient (McDonald, Code & Togher,
2016). Low-fat foods and fruits are capable to increase the level of the platelet. Apart
from the diet and medicine, communication and physiotherapy, gentle behaviour and
parental assistance are also required for Jerome.
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Picture: ATLS protocol
Source: http://bulletin.facs.org/2018/06/atls-10th-edition-offers-new-insights-into-
managing-trauma-patients/
Therapeutic communication with client and client parents
The parents of the child must be informed about the detail care process. They must be assured
with quality care for their child (Gaudine & Beaton, 2016). Thus, a communication with
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Jerome’s parents must be developed for the effective outcome of the process. The information
towards the parents can also be beneficial to make them stress-free (Ball, Murrells, Rafferty,
Morrow & Griffiths, 2014). Jerome's father must be assured that of the proper treatment process
of Jerome that is helping him to get rid of from his traumatic and comatose situation. The ethical
perspective of informing the child’s parents considers the ethical process o the nursing care
(Gaudine & Beaton, 2016). The constant flow of information is effective for the quality care
improvement of the pediatric trauma.
The effect of illness on the client’s family
The traumatic situation of the child affects strongly the mental health of the child’s family. This
may result in severe cognitive impairment or permanent mental illusion (Freud, 2013). The as
mentioned in the case study, Jerome;’s mother was shot dead after the accident with immediate
reaction. However, Jerome’s father went into a traumatic situation on hearing the deteriorating
condition of her son. Thus, the immediate effect of the pediatric trauma can lead the parents of
the child to severe cognitive decline (Villemagne, 2013) . However, it is the ethical duty of the
nursing staffs to take initiative to mitigate the sudden mental tremor of the parents of the
patients. Proper communication must be kept in order to heal the aftershock of the patient’s
family.
Legal and ethical process
The legal and ethical perspective of the pediatric trauma care defines an autonomous care to the
patients. The caregivers must be efficient enough to provide care through an autonomous will.
An every time observation is essentially required for trauma care (Villemagne, 2013). Thus, the
nursing caregivers of the pediatric hospital must provide non-maleficence and beneficence care
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to the Jerome for his quick recovery (Villemagne, 2013). The autonomy enables the patients
individual freedom, non-maleficence and beneficence uphold the obligation of not to harm and
protecting the right of the patients. Moreover, justice must be practised as per the Canada
Health Act (1984) in the ethical care Jerome. Thus, the effective maintenance of the nursing care
principles can promote the trauma recovery process of the trauma patients (Varcarolis, 2016).
Nursing process and meta-paradigm: Henderson’s theory
The discussion of nursing meta-paradigm defines the articulation of relationship among four care
principles; person, environment, health and nursing. The nursing meta-paradigm can be
conceptualised through Virginia Henderson’s theory.
 Person: The person defines the personal preferences to achieve independence in the good
mental health. This includes biological, psychological, sociological and spiritual
requirements. The biological, psychological, sociological and spiritual requirement of the
traumatic patient must be satisfied to promote the process for betterment ("Home", 2018).
Jerome also requires a personalised care for an ethical outcome
 Health: The health defines the quick recovery from the critical situation of the patients
("Home", 2018). Thus, the nursing care staffs must be eloquent enough to promote the
betterment of Jerome from his traumatic situation.
 Environment: The environment defines a situation having an effective interactive
situation. The nursing caregivers must possess good communication with the patients and
his family for the situational betterment ("Home", 2018). Jerome requires an ethical
environment that can mitigate his traumatic situation.
 Nursing: The nursing defines effective assistance to the traumatic patience for his quick
recovery. The assistance includes every time care, proper diet, proper communication and
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proper treatment process ("Home", 2018). Jerome should get an ethical nursing treatment
for the betterment from his situational crisis.
Picture: Nursing meta-paradigm
Source: https://www.slideshare.net/NIRMALRAJ46/conceptual-framework-64901181
Conclusion
The study has emphasised on the pediatric trauma and traumatic care. A case study has been
developed that has defined a car accident faced by 2 years old boy Jerome and his parents.
Jerome was admitted to pediatric hospital and his mother was sport dead. Jerome had severe
ankle fracture and intraventricular hemorrhage that leads him to severe stages of trauma.
Effective care treatment and various nursing care perspectives have been discussed for his
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betterment care. The proper maintenance of all the care process can provide an effective
outcome.
Reference List
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countries. Anaesthesia, Pain & Intensive Care, 17(1) link:
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Ball, J. E., Murrells, T., Rafferty, A. M., Morrow, E., & Griffiths, P. (2014). ‘Care left
undone’during nursing shifts: associations with workload and perceived quality of
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(2017). Complex trauma in children and adolescents. Psychiatric annals, 35(5), 390-398.
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http://www.ncdsv.org/images/BJA_WomensPathwaysToJail_3-2013.pdf
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