NUR322 - Nursing - The Child Client - Joshua Jai Plumb - Miranda Plumb - Case Study Assignment Help

Joshua Jai Plumb - Miranda Plumb - Case Study Assignment Help

Assignment Task: NUR322 Joshua Jai Plumb was born on 27 July 2003 and died on 16 December 2010 at the age of seven. He died unexpectedly in the Ipswich General Hospital and his death was reported to the coroner as the cause of death was unknown.1 The circumstances leading to his death were investigated as his death could also have been a health care related death. Section 10AA of the Coroners Act 2003 defines a health care related death as-  10AA Health care related death defined (1) A person’s death is a health care related death if, after the commencement, the person dies at any time after receiving health care that—  (a) either—  (i) caused or is likely to have caused the death; or (ii) contributed to or is likely to have contributed to the death; and  (b) immediately before receiving the health care, an independent person would not have reasonably expected that the health care would cause or contribute to the person’s death.  (2) A person’s death is also a health care related death if, after the commencement, the person dies at any time after health care was sought for the person and the health care, or a particular type of health care, failed to be provided to the person and— (a) the failure either—  (i) caused or is likely to have caused the death; or (ii) contributed or is likely to have contributed to the death; and  (b) when health care was sought, an independent person would not have reasonably expected that there would be a failure to provide health care, or the particular type of health care, that would cause or contribute to the person’s death.  (3) For this section—  (a) health care contributes to a person’s death if the person would not have died at the time of the person’s death if the health care had not been provided; and  (b) a failure to provide health care contributes to a person’s Findings of the Inquest into the death of Joshua Jai Plumb 1 death if the person would not have died at the time of the person’s death if the health care had been provided.  (4) For this section, a reference to an independent person is a reference to an independent person appropriately qualified in the relevant area or areas of health care who has had regard to all relevant matters including, for example, the following—  (a) the deceased person’s state of health as it was thought to  be when the health care started or was sought;  Example of a person’s state of health an underlying disease, condition or injury and its natural progression  (b) the clinically accepted range of risk associated with the health care;  (c) the circumstances in which the health care was provided  or sought.  Example for paragraph (c) It would be reasonably expected that a moribund elderly patient with other natural diseases would die following surgery for a ruptured aortic aneurysm.  (5) In this section commencement means the commencement of this section. health care means—  (a) any health procedure; or  (b) any care, treatment, advice, service or goods provided for or purportedly for the benefit of human health.’  At the time of his death Joshua lived with his mother Miranda Plumb (Miranda) and his younger brother who was born in 2008. His mother was told after Joshua’s birth he had aspirated meconium. He was diagnosed with epilepsy and spastic quadriplegia. He experienced seizures from the time he was 48 hours old and required specialist care commencing at the Royal Women’s Hospital. Dr Malcolm Miller was Joshua’s treating paediatrician throughout his life. Joshua was often hospitalised due to breathing difficulties. Joshua was admitted to Ipswich Hospital 122 times in seven years, 26 times during 2010.2  Miranda cared for Joshua as a single parent after an initial period of support during the first year when Miranda and Joshua lived with Miranda’s mother. Miranda was a highly dedicated, loving and competent mother. She learned the many skills required to care for Joshua who was entirely dependent on her for all his needs; physically, emotionally and medically. Despite Joshua often being unwell and requiring frequent hospitalisation, his mother described him as being a happy, bubbly boy. He could not speak or walk or crawl but moved on his back when kicking his legs. He had no head control and could not sit up. He had a medical procedure to reduce problem reflux which stopped his ability to vomit and reduced, but did not eliminate, the risk of aspiration. His mother pushed him in a wheel chair. Joshua attended Ispwich Special School from 2008.  His mother was acutely attuned to his needs and understood when he was crying loudly in pain or when he was ‘whingeing’, expressing a need for company or comfort. She administered medication as required into his feeding tube sited in his abdomen. In the 18 month period prior to his death a diagnosis of ulcerative colitis was made and another medication was added to his regime of care. However, this diagnosis was subsequently reconsidered and the medication was ceased shortly before his final hospital admission.  Miranda observed Joshua would experience seizures when he had a virus, causing him to lose consciousness and twitch. His breathing would become depressed. Joshua had not experienced a grand mal (tonic clonic seizure) from the time he was aged about three years of age.  Distinct from his epilepsy, Joshua also experienced spasms which increased in severity over the last year of his life. He would become very stiff and his limbs would be extended or clenched in rigid positions. These spasms were often associated with distress or constipation. His mother thought they were triggered by the pain of constipation. He would sometimes thrash about when experiencing a spasm, kicking repetitively and sustaining bruising to his knees and shins. He could move while in bed but in her experience he would cry out quite a lot if he was in distress.  In April 2009 his mother Miranda lodged a complaint with Ipswich Hospital as she felt hospital staff was not listening to her concerns for Joshua, particularly as he was frequently requiring admission. This led to a management plan to facilitate Joshua’s access to necessary care. Guidelines were formulated to inform Emergency Department staff and paediatric staff of Joshua’s and his mother’s needs. They are significant and are therefore reproduced as follows-  1 Low threshold for admission 2 Paediatric Registrar to conduct physical assessment 3 Ask Ms Plumb ‘What would you like us to do for Joshua right now?’ 4 If admission is not arranged, Ms Plumb will likely re-present because Joshua’s condition is unstable and fluctuations occur between ED and home. Ms Plumb only presents for good reasons, and sometimes this may be because her ability to cope with Joshua during periods of declining  Findings of the Inquest into the death of Joshua Jai Plumb 3 health status is compromised. During these times, she needs our support to improve his current condition 5 We have advised Ms Plumb to make the following statements as relevant;  ‘What I need you to do for Joshua right now is.... If I take him home, it is likely I’ll have to come back because he has been sick for some time. He is uncomfortable/in pain but he cannot tell you. The doctors here usually admit him when he is like this.’ 6 Please respect Ms Plumb’s decision about her son’s needs.

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