3. A 5-year-old male child with intermittent fevers for 3 weeks and a current temperature of 39 degrees Celsius, tachypnea with a respiratory rate of 70/minute, severe chest in-drawing, and abnormal lung sounds (crepitations and wheezes) on lung examination. Blood smear for malaria parasites is negative; no FBP results or chest x-ray were done because this was a clinical diagnosis.
a) Which type of protein energy malnutrition is the child suffering from? (2 marks)
b) Give reason(s) for your answer in 3(b). (2 marks)
c) Yesterday the child developed acute watery diarrhea; which type of fluid should be given to this child? (1 mark)
4. Blandina is a four-year-old girl admitted to the pediatric ward where you are working. Her mother says that since the day before yesterday, Blandina vomits everything and has reduced oral intake. For the past few hours, the child has been increasingly drowsy, and for the last half an hour, she has been unconscious. Her mother looks very anxious, and her major concern is the condition of her child because today Blandina has convulsions. In your assessment, the child is well-nourished, unconscious, and not dehydrated. The axillary temperature is 40.2°C, pulse rate 120 beats/minute, and malaria rapid diagnostic test (MRDT) is positive. Blandina was then diagnosed to have severe malaria.
a) From the above information, mention clinical features supporting that Blandina has severe malaria. (3 marks)
b) Based on the information above, write a nursing care plan for Blandina from any four nursing diagnoses. Each nursing diagnosis should have two nursing interventions. (22 marks)
Answer (1)
a) The child is likely suffering from Kwashiorkor.
b) Kwashiorkor is characterized by protein deficiency in the presence of adequate calorie intake, and it often presents with symptoms such as edema, enlarged liver, and in some cases, changes in skin and hair color. Given that the child has severe illness signs and chronic fever without a clear diagnosis from the exam results, it supports the likelihood of a malnutrition-related immunocompromise which Kwashiorkor can lead to.
c) For acute watery diarrhea, the child should be given Oral Rehydration Solution (ORS) to prevent dehydration.
a) Clinical features that support Blandina has severe malaria include:
High fever (40.2°C).
Vomiting everything and reduced oral intake.
Recent onset of increased drowsiness, leading to unconsciousness.
Convulsions.
Positive malaria rapid diagnostic test (MRDT).
b) Nursing care plan for Blandina can include:
Nursing Diagnosis: Risk of impaired consciousness related to high fever and malaria infection.
Intervention 1: Monitor Blandina's level of consciousness regularly.
Intervention 2: Administer anti-malarial medication as prescribed to treat the underlying infection.
Nursing Diagnosis: Risk for dehydration related to vomiting and reduced intake.
Intervention 1: Monitor fluid intake and output.
Intervention 2: Administer intravenous fluids as prescribed to maintain hydration.
Nursing Diagnosis: Risk for injury related to convulsions.
Intervention 1: Ensure the bed is at a safe height with side rails up to prevent falls and injuries.
Intervention 2: Have seizure precautions in place, including ready access to emergency medication.
Nursing Diagnosis: Anxiety in the mother related to the child's sudden illness and symptoms.
Intervention 1: Provide emotional support to the mother, informing her of Blandina’s current medical status and care plan.
Intervention 2: Educate the mother on signs to watch for and explain the ongoing treatments to encourage participation in care.
