Blunt Abdominal Trauma in an Infant: 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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The Case Study

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 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 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 patient was taken to the ICU for keen observation. On the first day after the operation, the patient was extubated, and for the next three days, she was held under observation. The patient had stable blood pressure, and there was an observation of the bilateral pedal and posterior tibial pulses. Six and seven days after the operation, the patient had two febrile peaks. The interpretation was that it was marginal to resorption of the hematoma and it was adequately addressed (Jesus-Silva et al., 2014). There was no observed sign of abdominal compartment syndrome. The discharge of the patient was after eight days of admission. It was observed that the patient had a normal and uneventful feeding behavior. The patient then returned for outpatient services after 15 days, and she did not have any signs of infections or disease. For the documentation of aortic bifurcation, aortoiliac ultrasound was carried out. At present, the patient has no symptoms of any illness and performs normal activities.

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.

Case Study Analysis

Pediatric trauma as the traumatic injury experienced by an infant, child or adolescence, and has been reported as the leading cause of children's disability and some unfortunate deaths. It is reported that one out of six children requires emergency care and approximately 10,000 children succumb to injuries (McFadyen et al., 2012). 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. 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 work in collaboration and the primary survey is carried out in a few minutes. The conditions that are life-threatening are addressed as soon as they are determined. Constant reassessment is required for any deterioration in health is identified.

In this case, the patient was taken to the hospital by her family since they resided near the hospital. The medical team that officers rescue services would have delayed further complicating the situation. The child was hypotensive which could be a safeguard measure against the lower retroperitoneal hematoma expansion (Jesus-Silva et al., 2014). In this case, there was no pre-hospital care which means that the risks are greater. The surgical options utilized entails simple stitches and application of autologous vein and polytetrafluoroethylene patches.

The Role of the Pediatric Nurse

Pediatric nurses play a critical role in recognition and reduction of the secondary injury process in traumatic injuries such as the one presented in the case. These roles have significant impacts on the patient outcomes. The role of the nurse involves the identification of problems, assessment, planning, delivery of care and evaluation (Tume, 2007). The discussion of the nurse's role in the case study will follow these essential areas in nursing practice.

Nursing Assessment

It is essential for the nurse to make an assessment of the patient as a critical step in planning care delivery. It is important to understand that each patient is different and there is the possibility of different injury at a varying stage of maturity. The establishment of a baseline helps with information necessary to inform the planning and delivery of care (Bimal et al., 2009). In this case, the pediatric nurse made a physical assessment and established that the child had open airways, hypotension, and tachycardia. However, there were no trauma to the chest or the head and no external bleeding. The assessment of the airways involves the determination of the ability of air movement into the lungs unobstructed (McFadyen, 2012). A systematic head-to-toe assessment was conducted especially since the child would be admitted to intensive care.

Planning Pediatric Nursing Care

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 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, the nurse ensured there was contact communication concerning how the child was responding to treatment.

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 the child stability, avoidance of hypotension and hypoxia (Bimal et al., 2009). The pediatric nurse in this case first ensures the child could gain stability from the blunt abdominal trauma. 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. These include:

Establishment of Early Enteral Feeding: This is one of the essential general nursing interventions and should be established within 24 hours or less (Tume, 2007). In this case, the nurse had to ensure even small trophic amounts were given to the child which has been evidenced to uphold the integrity of the gut membrane and reduce the possibility of bacterial translocation. Early enteral feeding ensured that the client has some calories who is this case is catabolic.

Pressure Area Care: It is essential for the nurse to ensure effective pressure care which entails appropriate attention to hygiene. It is important for a child with blunt abdominal trauma have a high likelihood of developing pressure areas due to immobility. Therapeutic cooling, muscle relaxants, and log-rolling were given which helped reduced skill perfusion.

Support, Education, and Families

One of the aspects of a pediatric nurse is providing support and appropriate education. It is normal for the patient's family and the nurse to develop a strong relationship due to the prolonged stay. Blunt abdominal trauma is an accidental and the associated unpredictability places family members in an extreme state of shock, grief, disbelief and sometimes guilt. Research has shown that the parents of such patients have many needs. However, priority is given to ensuring the child is stable, accurate diagnosis is given in addition to receiving qual...