This essay will discuss the assessment of the scenario regarding Toby, focusing on the holistic care that he needs. Toby is 4 years old, currently attending full time primary education, but he has been admitted to hospital due to having gastroenteritis. The aspects of gastroenteritis that Toby has includes off, a decreased urine output, he is frequently passing stools which is causing him to have stomach pains and his body is not tolerating any fluids leading the doctors to believe that he is dehydrated.

One of Toby’s parents Claire is staying with him on the ward whilst his other parent Julie is at home taking care of his sister. Main body of EssayGastroenteritis is when the stomach, gastrointestinal tract or the bowels become inflamed. Common conditions that gastroenteritis causes often include of food poisoning, diarrhoea and stomach bugs. (National Institute of Health and Care Excellence 2017) When an individual has Gastroenteritis, it affects the absorption in the gastrointestinal tract. (Mcalinden & Price 2017) It is mostly caused by eating food or drinking fluid which contains a form of bacteria, virus or parasite.

As well as these causes, gastroenteritis can be caught from touching other people or surfaces which present the bacteria or virus causing the infection. Viral and bacterial infections can cause individuals to get gastroenteritis. (NICE 2017)The presentation of gastroenteritis can occur in a variety of ways. Abdominal cramps are a common symptom especially if your stomach is inflamed, inflammation of the bowel and gastrointestinal tract can cause pain and discomfort in those areas. The infection can cause vomiting and diarrhoea which can last for up to seven days, but it is not uncommon for it to last for up to two weeks. Other symptoms of gastroenteritis such as temperatures, tiredness and muscle aches usually last for no more than three days. (NICE 2017)Gastroenteritis can spread easily so there are certain precautions which need to take place to stop the spread of infection. Washing your hands with soapy, warm water should be done regularly especially before entering and leaving a ward, isolation room and or before and after having contact with an individual who has the infection. If gastroenteritis is present, not attending school or work for forty-eight hours is important otherwise the infection will spread. Daily items that may normally be shared such as towels should not be shared while an individual has the infection. In serious cases of gastroenteritis an individual may have to be isolated, depending on how bad the infection is. (NICE 2017) Most gastroenteritis symptoms are not red flag symptoms but there are a few that are. Tachycardia is a red flag symptom which may present with severe gastroenteritis. If an individual presents, with sunken eyes, a sunken fontanel, any disorientation or confusion then using the alert, voice, pain and unresponsiveness tool can help to indicate that the child may be deteriorating. (NICE 2017)Assessment of DehydrationToby is not tolerating any fluids which has led to affect his urine output. The urine output is decreased which is a sign of clinical dehydration, a child of Toby’s age should have a urine output of one milligram to one kilogram of urine per hour. (NICE 2017) A decreased urine output can also affect stools. The Bristol Stool chart shows that different types of stool appearance determine the health of the individual and if the child has diarrhoea or food poisoning. As Toby is dehydrated the stools will pass through his gastrointestinal tract easily and quickly as they will not be absorbing any fluid. Toby’s stools are likely to be soft with a mushy’ consistency or they may be watery. The frequency of urine output and the frequency and consistency of Toby’s stools must be documented. (The Royal Marsden NHS Foundation 2016)Toby is dehydrated but his signs of dehydration do not indicate that he is at risk of clinical shock. Decreased urine output is not shown on the National Institute for Clinical Excellence’s table for assessing dehydration in children under five years in the column that shows signs of clinical shock. If Toby’s level of consciousness decreased and he was showing signs of tachycardia or tachypnoea alongside having cold extremities, then he would become at risk of clinical shock. (NICE 2017)The appropriate action that Toby will need for his dehydration is to receive his fluids through an intravenous cannulation. Cannulation is the appropriate treatment that Toby needs as he is not tolerating any fluid through the oral route. Rehydrating Toby regularly through the use of fluids and re-hydration drinks through the intravenous cannulation route. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life’ (International Association for the study of Pain 1979) Pain is never the same for each individual, it is a subjective feeling which can be dependent on morals, beliefs and by an individual’s own perceptions. life’ (International Association for the study of Pain 1979) There are multiple types of pain which can be felt by individuals. They can include of Acute pain, Chronic pain, Somatic pain, Visceral pain and Neuropathic pain. (Royal College Of Nursing 2009) Gastroenteritis is an illness which will cause Toby to feel acute pain and discomfort. Toby is likely to be experiencing acute pain as the pain will have a beginning point, end point and it will not last for long. (NEED TO REFERENCE, USED UNI POWERPOINT) The need for paracetamol will be necessary, it will have to be given intravenously as Toby is not tolerating oral fluids. Other medications such as ibuprofen and codeine are not appropriate for Gastroenteritis, ibuprofen will irritate the stomach and therefore irritate the gastroenteritis and potentially worsen or prolong the infection. (need reference here) Codeine is not suitable for a child of Toby’s age, children should only be given codeine if they are over the age of twelve due to the fact it has been correlated with causing respiratory problems. (National Health Service 2018) According to Piaget’s theory of The Stages of Development Toby’s age falls under the Preoperational stage from the ages of two to the age of seven. Between these ages Piaget stated that children of this age should have a strong intuition, imagination, be able to syntax properly so that they can express how they are feeling, the concept of things and form proper sentences. (Saul McLeod 2018) Although children should be able to do this between the ages of two and seven, they often still find complex thoughts difficult to understand and process. At Toby’s age of four it is likely that he will assume that everybody else feels the same way that he does as he will only see his own point of view. Due to his age, the stage of development he is in Toby will view pain in a different way to an eight-year-old. During this stage children may see pain as a punishment because they can’t understand the difference between the cause and effect for pain. The lack of understanding can often lead to children blaming healthcare professionals for the pain that they are in, this could occur because they feel guilty and believe they are being punished so they blame somebody else. Although this is not always the case some children of Toby’s age often have two separate understandings of health and illness and individual understanding is different for each child. (Myant & Williams 2005) When assessing pain there are different pain measuring tools that can be used to get an indication as to how much pain the child is in. The tool that is used should be appropriate in relation to the age of the child and the stage of development they are in. At the age of four the pain rating scale that is likely to work best for Toby is the Wong and Baker Faces Pain Scale, it is simple, the faces can be used to represent their pain which is a development that children of this age should be able to do and the faces shown can help to differentiate to Toby that not everybody feels the same as each face is showing a different level of emotion. (Twycross & Dowden 2009) During treatment for Toby he will need reassurance that the pain is not a punishment and it will not be a permanent feeling. Toby may not understand this as he will focus on the physical sensation of pain and blame others for his pain. (Twycross & Williams 2014) To help with pain providing Toby with a distraction toy or technique will help the pain assessment and Toby when he is dealing with the pain. To ensure that the distraction from the pain is successful the distraction needs to be interesting, stimulate hearing, touch, movement and vision to enhance the distraction. The toy must be age appropriate and meet Toby’s energy level so that it is not boring or overwhelming. (Twycross & Williams 2014) A distraction in the form of a toy that would be beneficial to Toby could be a light up fan toy as this will distract his attention through the use of visual and auditory simulation. Further to this the utilisation of an iPad with educational games that require thought and attention could distract Toby through the cannulation process. Support for Toby’s family is equally as important as his care and there are many aspects which need to be considered when the family need to be supported. In the scenario regarding Toby his family are separated due to his Mum Julie and sister being at home as the risk of Gastroenteritis spreading to her is too high, Claire is staying with Toby in the hospital. Family centred care is one of the correct approaches that should be taken to support the family unit. Ensuring that Toby’s family are always at the centre of his care through ways such as involving the family when care is being delivered and there should always be an option for family members to get involved with the child’s care where possible. Involving family in the care is a key tool to help find out any unique needs or difficulties that need to be addressed during the care. (Coyne et al.,2013) Toby may prefer his mum to carry out his care particularly his basic hygiene needs, keeping his family involved will reduce the amount of distress he may be experiencing. (Coyne 2015). Casey’s partnership model of 1988 believed that care is better for the child when it is carried out by a family member. (Casey 1998) Toby’s parents should be allowed to make informed decisions about the care and treatment that they wish to have for their child. These decisions should be made alongside health care professionals and it is important to take into consideration their preferences. (NICE 2017) In relation to this when a decision is reached about what treatment Toby needs it should be discussed with the family to allow them to understand why this treatment has been chosen, what the treatment will entail, and it should be a chance for the family to ask any questions or express their views on the situation. (NICE 2017) Family centred care involves viewing the family individually to any other family and treating that family as a whole unit. Family centred care is a good way to value family individuality and although family centred care is important it is not always easy to apply which can be due to a number of reasons. (Coyne et al., 2013) Some parents may be scared to participate in their child’s care, so they will not want to participate and help the health care professionals caring for their child. Other parents might be unable to be involved in the care because of physical, medical needs or they may not be able to be with the child at the time that a certain type of care occurs. (Coyne 2015) When a child goes in to hospital it does not just affect the child, it impacts on the whole family unit. Hospitalisation of the child can cause a variety of emotions to occur such as stress, anxiety and lots of worry about their child. Stress and anxiety may occur because they are scared of the unknown, what is going to happen to their child and how their child is feeling. In the first instance the family may not be able to do much for the child, so they might feel helpless leading them to feel stressed. Toby and his mum Claire who is staying with him in hospital may feel homesick due to the unfamiliar and unhomely surroundings that they are in without the rest of their family. Not being able to see their family every day can become difficult for the entire family, especially for Toby and his sister. Toby’s sister may struggle as she has less time with her family because they are spending time with her brother in hospital. Hospitalisation does not just affect the family’s emotions, it can cause financial implications. In this scenario regarding Toby only one of his parents is working whilst the other one stays with him in hospital. This means that the family are only receiving one income, potentially effecting the amount of money they can spend on food, household bills and travel money to come and visit Toby in hospital. ( need reference)A care plan needs to be in place for both the benefit of the child and the family. In the scenario regarding Toby a care plan will be needed to ensure that his care is effective, efficient and so that his family can work alongside the health care professionals to make sure Toby’s recovery is free from complication. A care plan can also help the family to see what care they can be involved in and what treatment their child is going to be undergoing. The care plan should be ongoing throughout Toby’s treatment. There are a number of things that will be involved in the care plan for Toby. As Gastroenteritis is the problem being experienced it is very important that hand hygiene is completed properly, hands must always be washed before entering the room, after touching the patient and before leaving the room. This is vital to stop the spread of infection. Toby’s treatment will be re-hydration through the use of intravenous fluids which will need to be on his care plan and the reasons why this is being done. Regular paracetamol will be needed to manage the pain, the dosage and times of the day that it is needed should be on the care plan. Monitoring Toby’s condition including of his urine and stool output needs to be monitored. Finally, any care that his family will be undertaking such as his personal hygiene needs should be included in the care plan. ( need reference)Professional values are an important aspect of the holistic care that Toby will be receiving. As Toby is a young child, he is more vulnerable than an adult and therefore he has special rights alongside all of his basic human rights he needs to survive and develop. (UNICEF 2018) Dignity is one of the main principles of human rights and is very important when caring for a child in hospital, to honour respect to the child and their family. Gastroenteritis can be a messy infection to have so ensuring that Toby is kept clean after any life (International Association for the study of Pain 1979) Diarrhoea or vomiting incidents is vital alongside ensuring that curtains are drawn when it is necessary and making sure that he is not lonely. Toby’s sister and mum Julie are at home whilst Claire stays with him in the hospital this could become lonely for him as he has less company around and no sibling to play with him so alleviating loneliness for Toby will respect his dignity. (National Dignity Council) Communication with Toby and his mum Claire must be done in a non-aggressive tone, ensuring that their personal space is respected, and when there is something that needs to be explained speech should not be fast, this can cause communication problems and confusion. Once information has been relayed to the family there should always be time for questions to be asked and for opinions and worries to be expressed. A range of communication should be used and being able to adapt to the communication needs of the family will enhance the quality and success of the communication. (Nursing and Midwifery Council 2018) At the age of four Toby might not be able to understand to the full extent about what has been explained so using a method such as role play on a soft toy can broaden his understanding. When explaining to Toby about the procedure around entering a cannula showing it on a soft toy whilst you explain each step will help Toby to understand and also getting him to try and do it will make it clearer and perhaps reduce any fears and anxieties that he might have about the procedure. It is an age appropriate communication technique which should be used when communication needs to be adapted. (NMC 2018) Toby is not able to consent for any medical treatment that he receives due to being under the age of sixteen, his mum Claire will be the one who consents on his behalf during his stay in hospital. The consent that is given can be in a verbal or non-verbal way, consent will always need to be given before any procedure occurs. (RCN 2009) To conclude In conclusionthere are many aspects of care that need to be considered when treating a child who has gastroenteritis and to ensure that there is support in place for each family unit. There are many aspects of care that need to be considered when caring for a child with gastroenteritis. Ranging from personal care, communication, supporting the family unit, protecting the child’s human rights and keeping their dignity. Toby’s care needs to be consistently holistic to ensure that his condition does not deteriorate, and he is able to recover successfully.