hi, 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)
it seems obvious to me that your instructor wants you to focus your efforts on the musculoskeletal system. you can find information on a musculoskeletal and pediatric assessment on this thread of allnurses (part of your assessment activity):
the scenario has given you some symptoms and developmental stage behavior information which you do not want to ignore:
- 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 mother's lap
if i were you i would do some reading and exploration of fatigue and weakness in children to see what you come up with. muscle weakness can be due to heart problems, myalgias, malnutrition, muscular atrophy, polio or a brain or spinal tumor. a congenital condition that has weakness and fatigue as a symptom is hypertrophic polyneuritis. these are also symptoms of diabetes and hypothyroidism. since these are not a normal finding in a child, it may yield you your at risk diagnosis. to use a "risk for" diagnosis you must have a specific problem in mind. so, for example, let's say you think this kid is in danger of having polio (really, not likely) and you are worried about her developing pneumonia because of progressive paralysis of the lung tissue. you would diagnose risk for infection
and develop nursing interventions to monitor for the signs and symptoms of pneumonia as well as do some preventative measures. long-term goal: no pneumonia.
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:
pick one. i think you can safely get away with making up supporting symptoms, but ask your instructor if you want to be sure. also ask how creative you are allowed to get with this assignment. what kind of data can you add to spice it up?
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
you can read about how to write a care plan which is basically what you are being asked to do here on this thread:
hope this has helped you. good luck with your assignment.