pediatric nursing diagnoses
- 0Mar 21, '08 by carribluei have to develop three nursing diagnoses for the following scenario and literally have been thrown into the fire with a do to learn it approach from my instructor.. we have not even had peds yet!!!
the scenario is this
Pediatric Physical Assessment Case Study #1CC: Bonnie L. is a 6-year-old female who presents to the nursing clinic with a 5 day HX of generalized weakness, fatigue, and pains in her arms and legs. Bonnie and her mother deny a history of fall or other injury. Bonnie is shy and hesitant to get up on the exam table. She wants to sit on her motherís lap.Focus Assessment of the Musculoskeletal System
I must develop an actual, wellness and risk diagnoses complete with goal and outcome...
Can anyone offer guidance or direct me to a good resource? I have been working on this for what feels like hours and I am so discouraged
- 1Mar 21, '08 by leslie :-Dpain?
risk for self care deficit?
risk for alt family process?
(sorry, i don't have a list handy...but these dxs could be appropriate, regardless of pt's age...except alt fam process)
don't let the peds part scare you.
- 3Mar 21, '08 by Daytonitehi, carriblue, and welcome to allnurses!
ok, i get that you haven't had peds yet, but did you read the title of this assignment very carefully, it says:
pediatric physical assessment case study #1
focus assessment of the musculoskeletal system
have you had lecture(s) on the nursing process and care planning? assessment is the first (and major) step of the nursing process. there are no such things as "pediatric nursing diagnoses". the nursing diagnoses at their most simple classification are either (1) actual problems, or (2) potential problems. gordon, as in gordon's functional patterns, classified the nanda diagnoses into 11 classifications, none of them pediatric. the choice to use any nursing diagnosis is based upon the symptoms that serve as evidence supporting the existance of that problem (nursing diagnosis). any diagnosis can be used for a pediatric, adult or geriatric patient as long as the person has the essential symptoms.
what you have to do to complete this assignment is to work the steps of the nursing process in the sequence they occur.
- assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
- determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
- planning (write measurable goals/outcomes and nursing interventions)
- implementation (initiate the care plan)
- evaluation (determine if goals/outcomes have been met)
- http://allnurses.com/forums/f205/hea...ms-145091.html - health assessment resources, techniques, and forms (in nursing student assistance forum)
- 5-day history of generalized weakness
- pains in her arms and legs
- no history of fall or other injury
- shy and hesitant to get up on the exam table
- wants to sit on her motherís lap
you need the symptom list going into step #2 of the nursing process. the first three symptoms are evidence for at least one actual nursing diagnosis (pain) and a potential one (see discussion above). there is a list of all the wellness diagnoses on post #84 of this thread:
- http://allnurses.com/forums/f205/des...ns-170689.html - desperately need help with careplans (in nursing student assistance forum)
goals/outcomes (they are basically the same thing) are intimately associated with the nursing interventions. they are linked to the symptoms the patient has. goals/outcomes are the results you expect to occur when the nursing interventions you order for the symptoms are performed. i believe their is a subtle difference between goals and outcomes. goals are the predicted results of collaborative nursing actions; outcomes are the predicted results of our independent nursing actions.
you can read about how to write a care plan which is basically what you are being asked to do here on this thread:
Last edit by Daytonite on Mar 21, '08
- http://allnurses.com/forums/f50/help...ns-286986.html - assistance - help with care plans (in the general nursing discussion forum)
- 0Mar 21, '08 by carriblueLeslie and Daytonite,
Thank you both for your help! :bowingpurI have read your postings and searched the links... all I can say is wow! This is a great site, resource and learning tool. I am grateful there are people out there who are willing got take the time to help out people such as myself.
Activity Intolerance r/t acute pain AEB pts report of pain of 6 out of 10 in arms and legsGoal:
reduction of painOutcome:
Will report reduction in pain level, on a scale of 1-10, of a 2 or less by April 1,2008
DiagnosisRiskReadiness for enhanced sleepGoal:
11-12 hrs sleep/dayOutcome
Will sleep, 11-12 hours total, each day for 1 consecutive week by April 1, 2008
Risk for delayed growth and development r/t activity intoleranceGoal:
activity levels considered normal by ptOutcome:
Will report levels of activity, consistent with those prior to illness, unassisted, for 3 consecutive days by April 1, 2008
- 1Mar 22, '08 by DaytoniteQuote from carriblue"pts report of pain of 6 out of 10 in arms and legs" is a symptom of pain, not activity intolerance. do you have a nursing diagnosis reference? every nursing diagnosis has a set of signs and symptoms that nanda calls defining characteristics. you cannot assign a nursing diagnosis to a patient unless they had one or more of the defining characteristics. it would be more appropriate to use acute pain r/t unknown musculoskeletal disorder aeb patient report of pain in arms and legs of 6 on a scale of 10.activity intolerance r/t acute pain aeb pts report of pain of 6 out of 10 in arms and legs
Quote from carribluei'm not crazy about you using this. activity tolerance is not a risk factor for this diagnosis. there is a nursing diagnosis for this: risk for activity intolerance. use that instead.risk diagnosis: risk for delayed growth and development r/t activity intolerance
- 0Mar 22, '08 by carriblueper your earlier suggestion regarding being creative with this assignment, we were told that we do not need to know what is wrong with the pt (medical diagnosis) to determine what we as nurses need to do.... "what would you do as a nurse."
Quote from daytoniteno, all i have is a nanda list of diagnoses with nothing else attached... no r/t or defining characteristics.. nothing... one reason this is so hard. is there a particular reference you would recommend over others?"pts report of pain of 6 out of 10 in arms and legs" is a symptom of pain, not activity intolerance. do you have a nursing diagnosis reference? every nursing diagnosis has a set of signs and symptoms that nanda calls defining characteristics. you cannot assign a nursing diagnosis to a patient unless they had one or more of the defining characteristics. it would be more appropriate to use acute pain r/t unknown musculoskeletal disorder aeb patient report of pain in arms and legs of 6 on a scale of 10.
i see why i cannot use the pt report of pain for activity intolerance .. i was just thinking that the pain caused the activity intolerance. well, now i know i had it backwards. if nothing else this is an incredible learning experience and i no longer feel llike beating my head against a wall.
is unknown musculoskeletal disorder really a related factor? wow, i had no idea.
Quote from daytoniteok. thanks i will...i'm not crazy about you using this. activity tolerance is not a risk factor for this diagnosis. there is a nursing diagnosis for this: risk for activity intolerance. use that instead.
risk for activity intolerance r/t pt report of fatigue
? but if you can't tolerate activity wont that delay your muscular development and coordination? or is this not relevant in writing these diagnoses
i see that once again i approached my goal and outcome statement from point of the related factor. boy, i hope one day i can get these right.
goal: activity tolerance
outcome:will report levels of activity, consistent with those prior to illness, unassisted, for 3 consecutive days by april 1, 2008
thanks again daytonite
- 1Mar 22, '08 by DaytoniteQuote from carribluethat is correct! go back to the nursing process and review what goes on in each of the steps. we address and treat the patient's response to their disease, situations and what is happening to them. the doctor's treat the disease.we were told that we do not need to know what is wrong with the pt (medical diagnosis) to determine what we as nurses need to do.... "what would you do as a nurse."
Quote from carribluenanda, the north american nursing diagnosis association, publishes the nursing diagnosis taxonomy. the taxonomy currently contains 188 nursing diagnoses for which nanda has developed for eachno, all i have is a nanda list of diagnoses with nothing else attached... no r/t or defining characteristics.. nothing... one reason this is so hard. is there a particular reference you would recommend over others?
- a definition (actually, this is a more descriptive statement of the nursing problem)
- defining characteristics (actually, these are merely the signs and symptoms that support the problem)
- related factors (the etiology, or underlying cause, of the problem) - often you need to understand the pathophysiology of the disease process going on to choose the correct related factor connected with a physiological nursing diagnosis
- risk factors - these are etiologies that are only listed with the anticipated, or potential, (have yet to occur) nursing problems. these are the nursing diagnoses that begin with the words "risk for" and are used when the patient is vulnerable to possibly developing a problem.
Quote from carribluethe related factors that nanda lists for acute pain are "injury agents (biological, chemical, physical, psychological)". it just seemed logical to me that an unknown musculoskeletal disorder would be a biological injury agent, or illness. i didn't want to say illness because that hasn't been established.is unknown musculoskeletal disorder really a related factor?
Quote from carribluei'm pretty confident in saying no. normally, i would tell you to research this before making this claim. however, nanda has already done it and lists the risk factors for this diagnosis (quite a long list, too) in the taxonomy. not tolerating activity just isn't on the risk factor list of the risk for delayed development nursing diagnosis (page 70, nanda-i nursing diagnoses: definitions & classification 2007-2008).? but if you can't tolerate activity wont that delay your muscular development and coordination? or is this not relevant in writing these diagnoses
Quote from carriblueyou can do that. your goal might be to remove, neutralize or do away with the element(s) causing the risk or potential danger. that's ok. that's well within the spirit of these types of nursing problems. for example, if a patient's activity intolerance is related to deconditioning (this is an actual risk factor of the diagnosis of risk for activity intolerance), a goal of the patient can be to "increase physical conditioning by the end of two weeks as measured by. . ." this goal targets the related factor. other targets can be to prevent specific symptoms. goals can also reflect the expected results of the nursing interventions that are going to be performed as well.i see that once again i approached my goal and outcome statement from point of the related factor.
when you get a chance to sit and think on all this information you will realize that there is rationality to it all. it takes a little bit of time for it all to sink in and the light bulbs to turn on. but once you get it, you'll be explaining it to others.Last edit by Daytonite on Mar 22, '08