The case study was done to the patient by name Andrea Delgado, who is fourteen years old. She was admitted to PICU hospital as she was suffering from 1-b glycogen storage disease. The disease was associated with lactic acidosis, hypoglycemia, and emesis. According to her mother observation, the patient has been experiencing reduced oral intake for the last month. This was because of discomfort and abnormal bloating. At the age of eight-month, the patient was diagnosed with GSD. After her eight-month diagnosed, she has also been admitted four times in hospitals related to the disease with hypoglycemia (low level of blood glucose) and emesis (vomiting). She also has special diet ay home. Thus she does not eat dairy products, glucose, and fructose. Her mother refers to the patient that she received neutropenia because the patient has complex chronical medical experience history that requires vital monitoring. Complex medical histories patients’ normally require frequent interventions and assessments for the neurological and respiratory supportive health care.
Since 2005, the patient has been suffering from hypoglycemia, which is glycogen storage disease of type 1B, gastritis, and emesis. Despite frequent illness of the patient, she was grade seven in the school. Her frequent absenteeism in school due to her illness has led her performance drop, but patient mother believes that her daughter will catch up with others when the patient recovers and pass her final exam. She is studying psychology in Peru with the disease, and she uses Spanish as a primary language. The patient normally preferred battleship board game and personal phone. The patient lives with her father, mother and their siblings. The patient’s strengths are seen as she like playing and working independently. She is also creative and curious on every this she does. She always asks for assistance when she needs it. She has hobbies and passions and always follows routines and rules well of the institution or place. The patient can express her ideas, wants and needs orally without the problem. She also uses expression and inflection when speaking. She like listening to music, stories and other activities. She can also answer what, when who, where questions in the conversations.
The patient is always engaged and very active in socialization. She consistently enjoys craft and art projects to be completed at the bedside, or she travels to the playroom to work on those projects. She is approachable and also looks for the appointment when she arrived in the room. She strives with the transition because her diagnosis which affects her mental status. Changing room and units possess seen as the challenge to the transitions to the new environment with the new staff. However, she occasionally suffers from severe headaches, and she experiences headache precaution. At this moment it’s significant to minimize sensory stimulation in diming the light, encouraging limited disruptions and limit noises. When the patient is not experiencing headache precaution, she also doesn’t experience sensory sensitivity. The mood of the patient fluctuates daily. The mood of the patient always fluctuates by interactions and symptom with the staff of the health care. I have seen her responding in interaction with intense verbal and calm response. In the interaction, she is interested in the topic that interests her and also those that touch her medical plan for care. The patient always exercises intensive attention on the conversation about future goals or working to complete daily activities.
However, the patient can speak her recent medical status and verbalize plans regarding her care directly. She is fully knowledgeable about her plan of care and medical history, and also seek involvement regular. She was included in the professionals meeting to assist in determining the proper way of treatment. As stated initially, the patient has been on the medical support system according to her past admission record from different hospitals. During hospitality, the patient got family support from his parent and her brothers and sisters. As her condition was worsening while she was at home, she acknowledged she decided to travel to Miami hospital to get best health care possible. She copes fast with hospital setting that assisted her to recover fast from her critical condition. In my interaction with the patient about her health condition, she did show any fear or anxiety about her health condition. She just demonstrates the time taken on impatient by the medical staff. However when the patient anxiety and fear, she becomes quiet and make improper comments.
The family member is not always available during in and out of hospitalization of the patient throughout her ill life. However, the stress of the family was discovered in the meeting with professionals in the Miami hospital, where the professionals questioned the ability of the patient to make her personal decision because of her mental status diagnosis. They proposed for surgery that would heal her. The patient was encouraged by this proposal, and she decided to bring herself to Miami children hospital to get medical assistance. She hopes to get treated despite the surgery implication and hopefully believe she will be better. Kid life is immanent in the hospital care staff in giving the patient skills on the development for the patient independence on the evident discharge. The specialist on the unit child life has been working with Delgado since the start of this case study. He has been working on the following areas: communication skills, hygiene, daily routines and how to handle emotions. Specialist work to assist the patient develops correct boundary at the moment of interaction with family members, guests, and hospital care staffs. As the patient stays in the health center, there is continuous therapeutic intervention on her life. This encourages the patient to have the list of the past experiences and memories to be written down to promote healthcare organization. Also, the patient should set goals and objective to achieve in future after getting out of the hospital. The specialist will work base on the previous activities and experience of the patient to reinforce advance cognitive thoughts and know how to redirect thoughts inpatient mind and also keep to the daily routines and involve in social interaction correctly. To facilitate this, the specialist accompanies typically the patients to the hospital playroom to promote creative expression of the challenging feeling or thoughts and artwork. The patient always enjoys to create artwork for her care room, and she also promoted territoriality in the hospital setting. She benefits from the consistency and structure in the plan of hospital care. In giving the hand-off other kid life specialist, I would emphasize the significance of the daily routine, promotion of the health organization and communicate the needs for consistency.
After investigation and interaction with the patient, child life intern believe that patient will benefit from child life services two to three per week to give the following intervention:
- Give emotional support for the family.
- To continue psychosocial support to help the patients coping with fear, stress, and anxiety during the hospitalization.
- Give the patients with therapeutic actions with the opportunities to enhance self-esteem, body image and express feeling independent.
- Help patients to establish the communication strategy to effective communication with hospital staff and encourage herself decision regarding the strategic plan to care patient.
The child life intern at first met this patient during investigation week with the specialist of child life on neurology unit. The mannerisms and communication style are affected by child life intern investigated by child life specialist. Specialist established intern to the patient. Patient oral surprise in providing to know spending time and intern with her. Hospital staff always continue to follow patients at the moment of hospitalization.
May 02, 2017
Child life services are introduced to the patient and members of the family (patient father, mother and relatives). Patient experience developmental delay in speech. The patient felt sad due to her deferent appear from others and had experience repeated admissions in the hospital due to his illness. Specialist of the child life facilitates diagnostic symptoms or teaching or extended hospitalizations and the reason for their visit. Patient orally and verbalize comprehending regarding repeated admission, and she feels sad because she appears different than others and also repeated hospitalization. Encouragement of active role in the treatment or care and emotional support for the patient and family.
May 03, 2017
The patient was sleeping at the time the specialist visited, the parent of the patient (father and mother), sibling and relative were present at the bedside. Mother orally explain patient status in the change in prognosis. At that moment the patient was actively vomiting. The specialist encourages active patient role in treatment, education reinforcement, encourage parental advocacy and give emotional support for the family. The child care specialists will visit again patient the following day. She is increasing adjustment and coping, rise involvement or compliance and will reassess as the medical condition of the patient changes.
May 04, 2017
Nurse in charge of the patient informs the child life and child life specialist intern that the patient is going PICC hospital under sedation. Relative of the patient wave and smile to the specialist intern in the family break room
May 05, 2017
Specialist intern gives bedside therapeutic activity to the patient. They are actively associated with the patient and her mother in emotion mask. Because of the slow rise in temperament, child life intern started the activity of silly mask match game, so that the patient can get the opportunity to identify the emotion. Specialist encourages the patient to show or point to the current mood. She shows that the current mood at the hospital is happy because she pointed at visual aid emoji funny face. However, her mother explains her daughter condition to the specialist. At this moment child life intern established pain management and coping skills by illustrating squeezing the stress ball, playing music, playing handheld games, conversation, positive self-talk, and journaling. Specialist encourages the patient to develop the mask that allows the patient to have self-expression which represents emotion.
At the time of patient care or treatment activity, the child life intern also used google translator to socialize with the mother and the patient. The intern gives psychosocial support her which let her know that she is pretty and unique. After five day admission in the hospital, the patient was active associate with child life intern, and she was laughing and smiling at the time of decoration. She was coping and adjusting effectively in that duration of hospitalization. After those five days, the patient was taken back home under new medication units that were prescribed by GI.
May 6, 2017
The health of the patient is improving gradually, and she was feeling better. The patient is taken back home under new medication that was prescribed by GI. As the move out of the hospital, patient and her mother smile and waved hand to child life specialist and child life intern. They were encouraged not to worry as the patient is transferred to the new unit.