Management of the High Dependency child Essay
Management of the High Dependency child
High dependency care (HDC) is an important transitional continuum care, for children who no longer required intensive care service, but still need close observations and also for the children who are too sick on the general ward, but not sick enough to go to intensive care (Dixon et al, 2009). The aim of this essay is to analyse the evidence which supports the care and treatment given to Hanifa, who has been transferred from intensive care unit (ICU) and required HDC, due to severing cardiac arrhythmia, which responded partially first-line therapy, which is one of the disorders constituting requirement of HDC (DoH, 2001) see appendix III. Before going on to explore the HDC given to Hanifa in detail, the definition of high dependency care will be mention, background history of Hanifa, her family and the nature of her condition will be briefly discussed. The ABCD (A-airway, B-breathing, C-circulation and D-disability) structure approach will be used to carry out a primary and secondary assessment of Hanifa, to identify and treat any immediately life-threatening emergencies (ALSG, 2011). Furthermore, as a part of the essay is reflection first person is unavoidable to use when reflecting and evaluating the holistic care provided to Hanifa and her family. The names of the hospital, ward, staff or patient will not be mention or will be changed to maintain confidentiality as recommended by NMC (2008).
The Department of Health (2001) defines HDC as “care provided to a child who may require closer observation and monitoring than is usually available on ordinary children’s ward. High dependency is largely defined by the nature of the condition or cares received and dependent on disease, intervention or condition”. Paediatric Intensive Care (PIC) states in the framework for the future report, that a critically ill child may need a number of different levels of high dependency or intensive care during a single period of treatment in hospital. High Dependency Care (often described as Level 1), different levels of Intensive Care (Level 2, 3 and 4) (DoH, 1997) dependent on their condition and level of the life support needed (see Appendix II)
Hanifa was born 36 weeks of gestation in good condition, antenatal diagnosed with Supraventricular Tachycardia (SVT) and Microcephaly (small head), and jittery movement noted postnatal. Mother was taken Flecainide (anti-arrhythmia drug) in pregnancy, as Flecainide crosses the placenta and can be used to control fetal supraventricular arrhythmia (BNF, 2011). SVT occurred at 17hours of life heart rate 220-280bpm transferred to intensive care unit (ICU). She had 20 episodes SVT in 1st 24 hours of life, 10 of which required electrical cardioversion as adenosine and vagal stimulation was unsuccessful, rest were self-corrected while was in the ICU. No known cardiac disease in the family, Hanifa has 1 year older brother who is fit and healthy (Hanifa’s medical notes).
HDC is sometimes provided as a step down from intensive care, where high dependency beds are provided on the same site and some beds are dedicated to intensive care (DoH, 1997). Like the case of Hanifa where her SVT was stable but needed closer observations in case reoccur. This essay will only concentrate aspect of HDC required for management of Hanifa’s