Tetralogy of Fallot - Ruth Nursing Case Study Assessment Answer

TASK:

Ruth is a 7-month-old baby who was born with Tetralogy of Fallot, a serious heart defect that can be corrected with surgery. Ruth had her first surgery - a shunt between the aorta and pulmonary artery to provide adequate blood flow to her lungs-when she was 2 months old. The complete repair of her heart will be performed when she is strong enough and her condition is stable enough to tolerate the stress of a more complicated operation. Her local physician and the paediatric cardiovascular surgeon at the medical centre estimate that Ruth will not be ready for surgery for several months, perhaps a year.
Despite the earlier surgery, Ruth's heart functions inefficiently. As a result, her lungs frequently fill with fluid and she turns blue and becomes extremely short of breath. When this happens, her parents must rush her from their farm to the nearest hospital in a small town about 15 minutes away. In the Accident and Emergency Ward (A & E) she is usually given oxygen and medicines to help her breathe more easily and remove the extra fluid from her lungs. Ruth’s parents, Sam and Maddi Phillips, have had to rush her to the A & E ward approximately once a week since she was born.

Sam is 18 years old; Maddi is 17 years old. Neither has finished high school. They live with Sam’s father on his farm. In addition to helping his father on the farm, Sam works from midnight to 6 am. at a local grocery store, in order to make a little extra money. He is chronically sleep-deprived and exhausted. Maddi is also chronically tired, as Ruth's care makes demands on her day and night. Both parents are terribly frightened by Ruth's crises and fear they may not make it to the A & E ward in time. They have become very close to the health workers and depend on them for psychological as well as medical support.
One night Ruth arrives to A & E in more distress than usual. The staff are working as fast as they can to give the drugs needed to save her life. One of the nurses caring for Ruth is inexperienced; she rarely works in A & E and has never worked with critically ill children. In the stress of the crisis, she grabs the adult rather than the paediatric vial of morphine (the narcotic given to help ease Ruth's breathing) and inadvertently gives Ruth an adult dose rather than the paediatric dose. As a result, Ruth receives ten times the recommended dosage. Because morphine is a powerful respiratory suppressant, Ruth suffers a respiratory arrest and stops breathing completely. The staff are present when Ruth experiences her respiratory arrest and immediately begin resuscitation. Within a few minutes they discover the cause of the arrest and promptly give Ruth a narcotic antagonist - a drug to reverse the effects of the morphine. The narcotic antagonist works quickly, and in less than a minute Ruth is breathing again. Meanwhile, the oxygen and medicines have had a positive effect, and her breathing, heart function, and general condition are much improved.
The A & E registrar, Dr. Koh, approaches Maddi and Sam. Maddi begins to cry and through her tears she sobs, "This is just what we were scared would happen. She's getting worse, isn't she? That's why she stopped breathing, isn't it? I don't know what we would do if we couldn't count on you." Dr. Koh had intended to tell Sam and Maddi the true cause of Ruth’s respiratory arrest, but now she hesitates. Dr. Koh knows these parents well; she has personally resuscitated Ruth several times and has seen firsthand the parents' stress and the difficulty they usually experience coping with the all-too-frequent crises her illness generates. Dr Koh wonders if it might be better not to tell Sam and Maddi about the medication error, as they may lose faith in the hospital. She is worried that the next time Ruth has an episode, they may decide to take her to another hospital half an hour further away. Any delay in resuscitating Ruth could cause death or irreversible brain damage.

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