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Part B: Scholarly Written Paper

Ralph Pangan
N01050021
Complex Issues And Patient Safety
NURS 252
March 14, 2016
Humber College

The case scenario I have been presented with for the concept map is about a 4 year

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old male with no past medical history, who is admitted into the emergency room with a
barking cough and non productive sputum. The background of the child is he has started
junior kindergarten just 2 months ago. He is crying and restless, and his vital signs were
39.4 , 122 bpm, 32 resp, BP 122/80, O2 sat 94% on room air. The patients mom is
anxious and states He cant be admitted to hospital; I cant stay here because I need to
be at work this evening. Cant you just give us an antibiotic? With this scenario, I had to
formulate two priorities/diagnoses, one being a pathophysiological problem and the other
to be a psychosocial problem. The diagnosis that I have made for the pathophysiological
priority was restlessness due to illness, and the psychosocial priority is fear/anxiety
related to unfamiliar environment. Out of the two priorities, the pathophysiological
problem is more crucial than the other, which is why I have chosen to start my path here,
febrile or fever is my chosen clinical manifestation for my pathway as there are negative
complications that can arise from this problem which can further decline the patients
health, I have selected the following nursing interventions listed on my concept for the
clinical manifestation as they are the most effective treatments in curing fever.
I have selected my pathophysiological diagnosis as the highest priority pathway
because the patient within the case scenario needed medical attention as he is physically
ill. ...the hierarchy is not a matter of valuing what is important but, rather, whether one
is physiologically "deprived" of something, which, when sufficiently lacking, gives rise
to the need. (Gao and Taormina, pg. 155, 2013) Based on Maslows hierarchy of needs,
the physiological state of a person is much more of a necessity and comes before the
psychological/psychosocial state; hence, why I have chosen the pathophysiological
diagnosis as a priority. Also, the case scenario that I have been given presents little to no

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psychosocial problems that can out weight the importance of the pathophysiological
problems that the patient is faced with. In other words, my patient needs medical
attention rather than psychological help. In addition, the physiological factors that are at
hand could be an influence as to why the child is experiencing such psychosocial
problems in the first place. The child is crying and restless because he has a fever, a
barking cough and is hypoxemic. If these physiological problems are fixed, then the
psychosocial problems of the patient will also be resolved.
Secondly, I have selected hyperthermia or fever as the highest priority of all clinical
manifestation or complication because there are complications that can arise from this
problem that can endanger the childs health even more and is the most relatable to the
diagnosis. There are three complications that are most likely to happen when one has a
fever. One of them is severe hydration, which is crucial in this case especially with a
toddler as childrens bodies lose fluids very quickly compared to older children and
adults. Another complication is hallucinations. This is more apparent in adults rather than
kids, but it is completely harmless. Lastly, another complication of fever is febrile
seizures. It can also be harmless unless the patients surroundings is not safe. Fever is
usually related to a rapidly self-limiting viral infection and may be associated with
important discomfort. (Bertille et al., 2015) With such important discomfort, comes
restlessness. Fever can cause great inconvenience for a child and will prevent a child
from obtaining much needed rest. Ultimately, fever is my highest priority in my case
study as a clinical manifestation because it can lead my patient into severe hydration
which poses as a serious health problem and also it is very bothersome to the child which
can result in restlessness.

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Finally, I chose these priority interventions based on my selected highest priority and
related clinical complication as they are fast and effective in relieving my patient from
experiencing fever. When a person has fever, they can either feel hot or cold. The first
and initial thing to do to solve this problem is to remove unnecessary and excessive
clothes for a patient whos feeling hot or provide a warm blanket to a patient who is
feeling cold. The next nursing intervention would be to administer anti-pyretics as
ordered by the physician to help treat hyperthermia and have the childs body return to its
normal temperature. Next, I chose the third nursing intervention would be to maintain
hydration by either fluid intake by mouth or maintaining the prescribed IV fluids also as
ordered by the physician. Dehydration is a serious problem for older adults and for
children with low body weight. Maintaining optimum fluid volume status is an important
nursing intervention. (Potter, pg. 494, 2014) Dehydration is a main concern when it
comes to fever and this is why I placed this intervention in third place. Another nursing
intervention is to monitor patients vitals. This intervention is key as it can indicate the
nurse if the patient is responding well to the treatment and/or if there is a problem with
the patient. My last intervention for management of fever in this case study would be to
promote rest. Rest is a vital component in treating illnesses as it helps the body to fight
off any infection and provides comfort.
As a nurse, it is important to acknowledge what problem is at hand and what
treatments should be carried out that meets clients needs. This assignment has allowed
me to explore beyond physiological factors that needs to be dealt with and to also pay
attention to the psychosocial problems that are also in play. It is not often that nurses
overlook the psychosocial problems that a client could be experiencing when in the

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hospital, especially in the emergency room where a client needs immediate medical
attention. Overall, psychosocial factors, in certain times and situations, can become
equally and more important than physiological factors. To sum it all up, the highest
priority pathway that I have chosen for my case study was pathophysiological as humans
needs to meet the physiologic level first then psychosocial later, next on the list is febrile
and fever as the highest priority since this clinical manifestation is closely related to
restlessness and can lead the patients health to worse state, and I chose these nursing
interventions based on my chosen highest priority and related clinical manifestation
because they are very effective and quick in treating the patients fever.

References

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Bertille, N., Pons, G., Charrier, E. F., & Chalumeau, M. (2015, November 23).
Symptomatic Management of Fever in Children: A National Survey of Healthcare
Professionals' Practices in France. Retrieved March 14, 2016, from
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0143230
Potter, Patricia, Anne Perry, Janet Ross-Kerr, Marilynn Wood, Barbara Astle, Wendy
Duggleby. Canadian Fundamentals of Nursing, 5th Edition. Mosby Canada, 2014.
VitalBook file.
Taormina, R. J., & Gao, J. H. (2013, Summer). Maslow and the motivation
hierarchy: measuring satisfaction of the needs. American Journal of
Psychology, 126(2), 155+. Retrieved from
http://go.galegroup.com.eztest.ocls.ca/ps/i.do?id=GALE%7CA3378146
1&sid=summon&v=2.1&u=humber&it=r&p=AONE&sw=w&asid=ca7 cc1b
35c6420f0c91925e60c38f993