Blunt Abdominal Trauma in Children: The Case Study

Introduction

Trauma in children which is also referred to as pediatric trauma can be defined as a traumatic injury that occurs in an infant, child or adolescent. In the pediatric population, trauma has been evidenced as one of the main factors contributing to morbidity and mortality (Hussain, 2016). In children, Intra-abdominal arterial lesions are not very common, and they have only been found to occur in only 2.4percent of cases concerning blunt abdominal trauma. It has been reported that only 0.11% of these situations affect the abdominal aorta. Between 1966 and 2012, only twenty-one cases involving abdominal aorta trauma was documented (Jesus-Silva et al., 2014). Most of these cases involved car accidents. The research paper is about a case of a five-year-old child who encountered blunt abdominal trauma whose aortic bifurcation ruptured.

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A young family had been blessed with a child and they were very happy about it. The child was very active and sometimes it would be a problem monitoring the child as the family members had to be engaged on other things in the family compound when at home.The child who is five years old and female gender fell when climbing a laundry sink and suffered a slam on the anterior abdominal wall. The child became unconscious both mother and father were very terrified .They thought their only baby would die as a result.The unconscious patient was rushed to the emergency room by her family. She had bruises on the anterosuperior iliac spine. After the physical examination, it was established that her airways were open and had hypotension. There was no evidence of trauma on the head or chest and did not have external bleeding. The blood pressure of the patient improved after stabilization and orotracheal intubation were performed (Jesus-Silva et al., 2014). It was however observed that there was an abdominal wall distension and had no femoral pulses.

A midline incision was used to carry out exploratory laparotomy. It was established that the victim had two lacerations which were devoid of enteral fluid leakage. One of these lacerations was in mesentery while the other was observed along the mesenteric border of a section of the small bowel (Jesus-Silva et al., 2014). There was also an identification of an expanding retroperitoneal hematoma. Since there was expansive hematoma to the pelvis, the isolation of iliac arteries was not possible. Since the victim had a hemorrhagic shock, the pediatric nurse did not administer intravenous heparin. When hematoma was examined, it was determined there was an entire rupture of the aortic bifurcation. The rupture was repaired after vascular, structures and local heparinization were isolated (Jesus-Silva et al., 2014). A transverse arteriotomy and iliac artery thrombectomy were used in the treatment of the left femoral pulse. There was saturation of small intestine and mesentery lesion with absorbable sutures. This was completed after evaluation of homeostasis and closure of retroperitoneum. The abdominal wall was then closed, and no complications were experienced. The team that was handling the child felt that it was a critical situation and the child needed specialized treatment with close monitoring by a team of specialized doctors. The pediatric nurse was responsible for the coordination of this case with other doctors who may be called in to assist in this case.

The patient was taken to the ICU for keen observation.All this long the family which included both father and mother had been waiting outside in the hospital's casualty waiting bay. They were worried about the situation of their only child and they felt responsible for not taking good care of him. They were also anxious of the child's critical condition and no one had informed them of the progress the doctors and the teams of specialist involved were making. At the end of the days shift for the pediatric Nurse, it was noted that she went home without proper handing over of the days' reports to the colleague who was to relieve her for the night shift. It became a challenge for the secondary care team of consultant specialists in the ICU who depended on the pediatric nurse for proper information flow regarding the admitted patient in a critical care situation. It was also clear that she did not explain to the family what was happening to their child after admission to ICU.

The family remained at the waiting bay shocked and not understanding what was happening to the child. They suffered extreme anxiety and became violent to the hospital staff. The ugly situation was dealt with and everything returned to normal. The night shift Pediatric nurse was able to find her a different colleague nurse who was present when the patient was brought in and helped her provide the necessary information to the specialists in the intensive care unit. Using her experience as a pediatric nurse, she was able to communicate with the parents of the child and calmed them down. She explained to them the procedures and what was happening to their lovely child and what was expected at the end (Jesus-Silva et al., 2014). After eight days of admission in the possible, the patient was recovering and released to go home. Additionally, the patient also came back for a check-up which shows that quality care was provided despite the problem which arose with the day shift nurse not providing the relevant information to the night shift nurse.Additionally failing to inform the family about what was going on with the child and what the parents were to expect.In this case the coordination of information with the medical team faced some problems as a result of the day shift pediatric nurse not following the laid down procedures on how to handle such cases in the facility. It was expected the family was traumatized by the situation of their child and they needed someone from the medical team to assure them that all was well. They hated to see their child in that situation.

Case Study Analysis

Children who are severely injured services of a facility that is adequately staffed with experienced practitioners in the management of injuries. It is important to note the emotional, anatomical and physiological differences in the treatment of traumatic conditions for adults and children. The rate of child's support can be enhanced if threatening conditions are recognized early and addressed (McFadyen et al., 2012). There is a specific sequence followed in the initial assessment of a child and the management of the trauma. These include primary survey and resuscitation. Then there is a secondary survey which requires a specialized team. Healthcare practitioners must work together in a well-coordinated communication process so that there is proper flow of information between the primary assessment team and the secondary assessment team. The conditions that are life-threatening are addressed as soon as they are determined. Constant reassessment is required for any deterioration in health to be identified. The team involved in the pediatric trauma care is discussed below.

Pediatric Trauma Teams

In the treatment of the child, different expertise is required. The people involved in the treatment of the child include:

Pediatric Surgeons: They worked to manage the child's injuries. It entailed taking the child to the operating room to undergo surgery.

Specialist pediatric doctor: In this case, specialist doctors were involved. After the child's surgery was complete, she was transferred to the intensive care. This required the services of an intensive care doctor.

Major trauma nurse coordinator: The major trauma nurse coordinator works to ensure that the entire pathway of the child treatment is of high quality. They ensure to collaborate with other healthcare professionals in the provision of care.

Clinical nurse specialist: They worked alongside the major trauma nurse coordinator. They ensured that they provide the family with necessary updates and support. They met the child after the discharge for the follow-up clinic.

Clinical psychologist: They worked to reduce distress the family was experiencing in addition to enhancing the patient's wellbeing.

Clinical psychiatrist: The clinical psychiatrist worked to ensure that the patient was assessed, treated and then all mental issues were managed.

Acute pediatric therapies team: They offered specialist intervention to the patient and the family since support was essential after the traumatic injury. They worked in collaboration with nurses and doctors to enhance recovery. Additionally, they worked for a safe, timely and supported discharged.

Play Team: They worked to offer specialist preparation and distraction so that the patient can be given patient-centered care before, during and after treatment.

Problem Analysis

In this case, the patient was taken to the hospital by her family since they resided near the hospital. The child was hypotensive which could be a safeguard measure against the lower retroperitoneal hematoma expansion (Jesus-Silva et al., 2014). There was no pre-hospital care for the injured child which means that the risks are greater. Pediatric nurse played a critical role in the recognition and reduction of the secondary injury process in traumatic injuries presented in the case. However, she made a mistake of not writing a report for use by her night shift colleague which made it difficult for coordination of treatment and observation for the night shift team. (Bimal et al., 2009). Lack of the days reports complicated the roles of the night shift pediatric nurse who had to seek the help of one of her colleagues whom she was informed was present when the child was received as an emergency case. A pediatric nurse is supposed to write proper reports for their days' activities and explain cases that were handled for unobstructed flow of information (McFadyen, 2012).

Solution

After the initial assessment of the patient, and the establishment of a baseline, the planning of care can commence. In the planning for care, it is important to consider some factors such as the child's care needs, and the family's needs in addition to unit organizational issues. (Tume, 2007). In this case, the daytime pediatric nurse was involved in planning for the child's care. This includes planning for initial assessment or examination, and provision of care. Since the child was brought by family members. It was the duty of the daytime Pediatric nurse to include all these information in a report to hand over to the night shift Pediatric nurse which she did not do. Talking to the family of critical care patient helps the family calm down and deal with anxiety. It also helps the parents of the admitted child to stop blaming themselves for what happened to their child (McFadyen, 2012).

Delivery of Nursing Care

This step entails the nursing management of the patient with serious traumatic injuries. The focus is on essential factors that promote child stability, avoidance of hypotension and hypoxia (Bimal et al., 2009). First, abdominal ultrasound was conducted and it established there was a retroperitoneal hematoma. This was followed by an exploratory laparotomy was conducted with the utilization of a midline incision. This led to the identification of two lacerations and an expanding retroperitoneal hematoma (Jesus-Silva et al., 2014). To reduce hypotension, orotracheal intubation and stabilization were conducted and it was observed that blood pressure improved. The pediatric nurse also ensured appropriate scheduling of surgical procedures and transfer into the intensive care.

General Nursing Management

For the critically-ill children, there are various issues that need to be addressed to enhance optimal other organ functioning and to prevent complications related to extended immobility and medical therapies. The...