Abstract
A good proportion of young children between the ages of ten months to eleven years have been hospitalized with gastrointestinal complications. These complications more than often, result from acts of swallowing foreign objects, which are usually bits of the toys these children play with. According to the United State’s Consumer Product Safety Commission [CPSC] (2007), most of the toys children play with today, have magnet bits with them, and the number of such toys is increasing in the market. This increase has led to the rise in the number of serious injuries in children resulting from the ingestion of magnets. Ingestion of more than two magnets by children leads to serious complications like intestinal perforations since these magnets attract each other through the linings of the different loops in the intestines. These attractions often puncture intestinal wall linings. Danny, a twenty-two-month-old baby, happens to have swallowed seven small, tablet-shaped-magnets. These magnets, unfortunately, separated into two groups within his intestines, and have been attracting each other through his intestinal wall. The attraction caused two perforations of his bowel, which was repaired by surgery. Unluckily, he is back in the ward suffering several complications relating to the damage the magnets caused in his intestines. This paper demonstrates the nursing assessment of Danny, the tests undertaken by the medical staff, and the nursing management plan.
Pediatrics Case Study
The medical implication brought about by the ingestion of magnets is not a new phenomenon among young children. From the periods between 2003 and 2006, nearly twenty percent of all foreign ingestion cases reported were of magnet ingestion. Of this twenty percent, nineteen of them required gastrointestinal surgery and one of them resulted in the death of the victim (Midgett, Inkster, Rauchschwalbe, Gillice, & Gilchrist, 2006, p 1297). This paper demonstrates the nursing assessment, medical tests, and the nursing management plan given to Danny, a twenty-month-old baby who happened to have swallowed seven magnets.
Introduction
This paper is about Danny, a twenty-month-old baby who has perforations in his bowel. These perforations were caused by the act of swallowing seven small tablet-shaped magnets as the child was playing with his toys. Apart from the pain, Danny also suffers from general anesthesia.
In explaining Danny’s case, this paper is divided into four major parts, that is; a discussion of the initial complaint, which talks about the ingestion of the magnet and the bowel perforations together with the surgical repairs. The next section discusses the assessment of Danny by the nurse and the medical tests that the staff will undertake. The third section outlines the Management plan and the fourth part evaluates the effectiveness of the care given to Danny and his family during the whole process. This paper has been written from the time Danny arrived in the emergency department, up to the point he started improving from his condition. The assessment starts from the time the child arrived in the emergency department and the care plan only appertains to the ward.
Discussion of Initial Complaint
Danny was brought to the emergency department of the hospital by his mother and was immediately admitted due to the seriousness of his condition. He was admitted with sharp abdominal pain, severe in the upper abdomen. Danny had been in excellent health and only after waking up several times complaining of stomach pains did his mother get concerned. In addition to the pains, he had several episodes of vomiting and signs of dehydration indicated by red notches and bluish tinges to his hands and feet. He also experienced high fever, chills, and nausea.
On scrutiny and inquiry from the mother, she confesses that Danny had swallowed some button-like pieces of magnets which fell off from his toys. An x-ray of the upper abdomen showed the existence of foreign immobile objects obstructing the mouth of his large intestines. These foreign objects were found to be seven small tablet-shaped magnets. The laparoscopy carried out found out that these magnets were stuck together pinching the bowel tissues. The act of pinching the bowel tissues had resulted in bowel perforation and it is what caused the sharp abdominal pains.
Ingestion of magnets and bowel perforations are life-threatening conditions normally categorized as medical emergencies that need surgical repair and peritoneal lavage. These complications if not corrected early can lead to unexpected deaths. Other foreign bodies when swallowed by a person will be automatically expelled from the body through the normal body functions. Ingested magnets on the hand are not so and specifically where they have separated into two groups and started attracting one another. They become difficult to remove from the intestines (Walker, 2008, p. 2). As they continue attracting one another, they ultimately cause problems by preventing blood flow in the intestines, resulting in perforations in the bowels. The majority of parents and pediatricians assume that ingested magnets will be passed on, which is never the case.
Magnets in the bowels lead to further serious complications like volvulus, sepsis, ulceration, bowel resection, peritonitis, and bowel necrosis (Weintrub, 2007, 45). These complications can only result if the magnets are not removed early as possible. The perforations can only be corrected by surgery, which is done to repair the holes either through the removal of a small part of the intestine or by joining the torn tissues. This removal can also be done through temporary ileostomy or colostomy. Alternatively, the surgical removal can be through exploratory laparotomy or closing the perforations through medical evacuation (Hockenberry, Wilson, Rentfro, & McCampbell, 2006, p 23).
The complications that accompany perforation treatment include bleeding, contraction of infections like sepsis, which can lead to the death of the victim, and intra-abdominal abscess. Early treatment of ingestion of magnets and bowel proliferation is of prime importance since it helps prevent further complications, which could lead to the death of the victims.
Discussion of Assessment
Danny was brought to the emergency department by his mother who was extremely concerned about his high fever, abdominal pains, and concurrent vomiting. Danny will be picked up from the recovery by a nurse accompanied by his mother. This accompaniment is necessary because Danny is a toddler and most of the things he is going through it his mother who can explain them better. It is also a good ethical medical practice for one of the parents to be available during the tests, and in this case, it is the mother who is accessible. The presence of the mother will also help to reduce stress in case the child is distressed in the room. Another reason for this accompaniment is that some tests require the consent of an elderly adult specifically a parent or a relative.
On return to the ward, the nurse will run several tests and assessments on Danny like maintaining airway breathing circulation. The tests that will be carried out on Danny include radiology tests, specifically an x-ray of his abdomen. Apart from the x-ray test, the nurse will run a stool test to ascertain what is wrong with the child’s gastrointestinal system. Still in the ward, the nurse will check his temperature readings, pulse rate, respiration rate, and SpO2 (Rosdahl & Kowalski, 2008, p. 1246). Tests will also be done on him to ascertain the level of pain he is experiencing.
Nursing Care Plan
Identification and description of the patient
The patient is known as Danny: he is twenty months old and has a four-year-old sister by the name of Charlotte. He is mostly under the care of his mother who looks after them since his father works offshore on an oil rig, and is mostly away from the family. The child had ingested a total of seven-minute tablet-fashioned pieces of magnets which might have dropped from his playing toys. These seven magnets separated and formed two groups that kept on attracting one another in his bowels. This later caused perforations in his bowels which were corrected by surgery. The correction left him with a central abdominal wound which has subcutaneous sutures. This wound is always covered with a clear dressing and experiences minimal leakages. The assessment gave the following readings of Danny’s situation; his temperature was 37.4oc, his pulse rate was one hundred and six, his respiration rate was twenty-four and his SpO2 was ninety-eight percent in room air.
Family Situation
Danny is mostly under the care of his mother since his father works away. An assessment of this situation suggests that the mother needs help in bringing up the two kids more so when one of them is unwell. Teamwork between the two parents is necessary to help Danny recover faster and also to help Charlotte the older sister in the same. Family-centered care is highly advised for Danny being a child in his early year of life. He needs constant attention, and care from both his parents. This management plan involves training the parents on how to handle him effectively and ensure he recovers faster.
Medication
Danny has been experiencing abdominal pain regularly portrayed through his acts of squirming, moans, and occasional whimpers. He has a continuous morphine infusion to relieve him from the intense pain. Morphine is a narcotic pain reliever used to treat moderate to severe forms of pain (Twycross, Dowden, & Bruce, 2009, p. 16). This drug operates by dulling the pain perception area of the brain and is used in short-acting and extended-release formulations to deal with pain. The side effects of this drug include experiences of shallow breathing and a slow heartbeat, seizure attacks, cold and clammy skin, and confusion (Browne, Flanigan, McComiskey, & Pieper, 2004, p. 578). The contraindications of the use of this drug include hypersensitivity to morphine sulfate. This hypersensitivity or allergy makes it dangerous to use when the patient is in a convulsive state since it has a stimulating effect on the spinal cord. This drug is also contraindicated in respiratory depression, heart failure, bronchial asthma, cardiac arrhythmias, brain tumor, and delirium tremens among others (Cote, 2001, p. 56).
Other antibiotics which could be effective in reducing pain in Danny’s case include Acetaminophen, which is also known as Tylenol, a nonaspirin pain reliever easier on children’s stomachs (Beevi, 2009, p. 51). This medication is safer for children and is strongly recommended by doctors since it has fewer side effects and contraindication which are feelings of nausea and vomiting in case of an allergy. Due to the risk of the wound being contaminated, the dressing should be replaced daily and the wound washed with antiseptic. His breathing should also be monitored frequently until it comes back to normal. This drug forms the dose that Danny will be on again until his pain ceases and the abdominal wound heals completely. Danny will be on continual use of antibiotics since his immune system is not that well developed to fight the disease-causing pathogens that can enter his abdominal wounds. The use of antibiotics boosts his immune systems and helps to fight the germs and this facilitates the healing process. In dealing with general anesthesia, a preoperative assessment is recommended before he is taken to the anesthetic room.
Evaluation
The care that has been prescribed for Danny and his family is in line with the current best practice as required of any nursing plan program. The evaluation is also in line with the requirements of the American board of pediatrics.
Summary and Conclusion
This paper describes the nursing care plan for Danny who suffers from perforated bowels caused by swallowing seven magnets. This plan has explained in detail the causes, and consequences of this condition if left untreated. It also outlines the drugs that can be used to relieve, since this complication can only be corrected through surgery as it was done in the child’s case. Further to this, it also emphasizes family-centered care for this twenty-month-old child, since it is what is best for him. In addition, it provides a management plan to deal with his general anesthesia. Lastly, it evaluates the program by the generally acceptable nursing practices and finds it fit and applicable.
References
Beevi, A. (2009). Textbook of pediatric nursing. Noida: Elsevier.
Browne, N. T., Flanigan, L. M., McComiskey, C. A., & Pieper, P. (2007). Nursing care of the pediatric surgical patient (2nd ed.). Sudbury, MA: Jones and Bartlett.
Consumer Product Safety Commision. (2007). Small magnets are injuring children; CPSC releases stronger warning to parents. Web.
Cote, C. J. (2001). A practice of anesthesia for infants and children. Ann Arbor, MI. Saunders.
Hockenberry, M. J., Wilson, D., Rentfro, A. R., & McCampbell, L. W. (2006). Wong’s nursing care of infants and children (8th ed.). Philadelphia, PA: Elsevier Science Health Science div.
Midgett, J., Inkster, S., Rauchschwalbe, R., Gillice, M., & Gilchrist, J. (2006). Gastrointestinal injuries from magnetic ingestion in children – United States, 2003-2006. Morbidity & Mortality Weekly Report, 55(48), 1296-1300.
Rosdahl, C. B., & Kowalski, M. T. (2008). Textbook of basic nursing (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Twycross, A., Dowden, S., & Bruce, E. (2009). Managing pain in children: A clinical guide. Oxford: Blackwell.
Walker, W. A. (2008). Walker’s pediatric gastrointestinal disease: Physiology, diagnosis, management, volume 2. Hamilton, ON: PMPH-USA.
Weintrub, P. S. (2007). Ingestion of magnets: Trouble when opposite attract. Journal Watch Pediatrics and Adolescent Medicine. Web.