The Death of an African Child - Nursing Assignment Help

Assignment Task

The Death of an African Child
On a typical morning in Sub-Saharan Africa a young mother arrived at the hospital around 9 a.m. carrying her three-month-old daughter who had been sick for some days. The previous evening the child had a high fever and was very lethargic. Unable to pay the small fee for the minibus, the young mother had to walk several kilometers to the hospital carrying her child. The child had been experiencing severe headache and fever for the past 5 days. On the 3rd day of the illness, the mother had taken her child to a traditional healer but the herbal medicine had failed to relieve the pain and fever. On the 4th day, the concerned mother tried some tablets (pain killers) she bought from a local vendor. Unfortunately, many of the tablets sold by local vendors do not have labels indicating the name of the drug or the expiration date. Sadly many of the medications are of very low quality or fake.
After taking the child’s medical history and performing a physical examination, the clinician in the outpatient department suspected severe malaria with a differential diagnosis of meningitis (Links to an external site.). He admitted the child to the pediatric ward and ordered some routine laboratory tests consisting of a lumbar puncture (Links to an external site.) for cerebral spinal fluid (CSF) (Links to an external site.) analysis, blood smear (Links to an external site.) for malaria (Links to an external site.) parasites, and a blood sample for a complete blood count (CBC) (Links to an external site.) including a  HYPERLINK "https://medlineplus.gov/ency/article/003645.htm" \t "_blank" hemoglobin (Links to an external site.) (Hb) determination. Since the presentation of complicated malaria and meningitis are similar, the clinician initiated treatment that would cover the two possible diagnoses.
The child arrived on the ward at 10:45 a.m. and the routine admission procedures were performed. The nurse on duty collected the blood samples and the clinician on the ward did the lumbar puncture that yielded clear CSF indicating no macroscopic evidence of meningitis. Nonetheless, the initial treatment from the outpatient department was maintained. The blood and CSF samples stayed in the specimen tray in the admissions room until around 3 pm when they were taken to the laboratory for analysis. Due to the high workload, in the small, inadequately equipped laboratory, the samples were not processed until the following morning. Worse still the sample for the CBC was returned because the chief laboratory technician said that the sample was clotted. Additionally, the patient’s clinical data was missing from the order form. The technician commented, "For quite some time I have been emphasizing the importance of completely filling in the order form. Since it seems that the people in the clinical units are not listening to us, we try to reinforce the practice by sending the forms back to the nurse so that it should serve as a reminder to our plea. Unfortunately, in the short term, it’s the patient who is the victim".  After convincing the mother that the patient needed further tests the nurse managed to draw another blood sample.
Two days passed without results from the laboratory. Nobody bothered to ask for the results since the patient’s condition did not deteriorate. That evening at 11 pm, the child began convulsing. This surprised the mother since the child appeared fine earlier that day. She rushed to the night nurse who alerted the clinician on call. Since the clinician was busy with another emergency admission at that time he informally [verbally] ordered slow intravenous anticonvulsant (diazepam (Links to an external site.)). After 60 minutes he came to the child’s bed and asked for the chart to review his medications. He noted that the patient was being treated for meningitis and complicated malaria, but he could not see the results of all the samples that were taken on the day of admission. An attempt to get the patient’s results from the lab was made immediately but no one answered the phone in the laboratory. He later went to the laboratory himself to check for the results. Flipping through all the recently documented results in the laboratory logbook, he managed to find the results for the malaria, which were negative. However, no CSF results could be found. Worse still the sample itself could not be traced. It would be necessary to repeat the lumbar puncture. Unfortunately no spare lumbar puncture kits were available and the central sterilization department was closed for the day. He communicated to the mother that the patient would continue with the current medication and everything concerning the CSF results would be sorted out the following morning.
The next morning, the clinician was still unable to obtain the results of the CSF. Since the results for this patient were not available the only alternative was to take another CSF sample, although this procedure is a painful one that no patient would want to experience more than once. The doctor told the child’s mother that he needed to do another lumbar puncture on her daughter because the previous CSF sample was somehow misplaced. She did not take this news well. Regardless, the doctor continued. Two minutes after finishing the procedure the patient convulsed again. The mother started weeping while blaming the doctor who had just done the lumbar puncture. This time the doctor personally carried the specimen to the laboratory.
By the afternoon the results were known. The child had tuberculous meningitis (Links to an external site.)1. The plan was to modify treatment to cover for the isolated organism. However, the condition of the child kept on deteriorating until on the second day after the confirmed diagnosis, when the child passed away. “The hospital has killed my little girl”, could be heard in the mother’s cries of mourning.
What were the key steps in the management of the patient, including prior to her hospitalization?
What problems occurred during her management?
Could affordable digital technologies have improved her management? If so, what and how?

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