just because the child is being discharged doesn't mean that her medical problem of pneumonia is resolved. what can this family do to prevent re-hospitalization? financial concerns, community resources for medications, well-child visits.. etc.
this child needs to get well. i am sure that some of the things you mention (finances, medications, day care) contribute to the child's recovery. i would assess what happened after the other 5 or 6 hospitalizations that resulted in the child being readmitted. obviously, either the medical plan of care wasn't working or it wasn't followed as ordered. that needs to be clarified. the parents need to be clear on what the discharge instructions are and the nurse needs to make an evaluation that the discharge strategies are adequate to be carried out or new ones need to be put into place. make sure the parents know what has to be done and are willing and able
to do it. maybe the parents don't have the money to buy the medication. maybe the child refuses to take her medication from the daycare providers. those are not interrupted family processes
. but there are ways to assist the parents in fixing them. focus on the child
and assist in getting her medical care accomplished. ineffective health maintenance
is a good suggestion. deficient knowledge, specify
is another. can you assume that the family is struggling with finances after husband has been laid off?
can we as scientific thinkers ever assume anything? next time remember to delve into this so you have this information. the child's whole daily routine is completely different than what she is used to
. how is that significant to her not getting better? if it is significant, what caused the change? how can that change be assisted by the nurse in any way that will be helpful to all concerned?
diagnosing should always be done using the nursing process. a care plan and it's solutions to a patients problems is only as good as the assessment data that goes into it. the collection of data is ongoing and never ends. i post this all the time for care planning:
- 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)
- a physical assessment of the patient
- assessment of the patient's ability and any assistance they need to accomplish their adls (activities of daily living) with the disease
- data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians
- knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. if this information is not known, then you need to research and find it.
- 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). it helps to have a book with nursing diagnosis reference information in it. there are a number of ways to acquire this information.
- your instructors might have given it to you.
- you can purchase it directly from nanda. nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international. cost is $24.95 http://www.nanda.org/html/nursing_diagnosis.html
- many authors of care plan and nursing diagnosis books include the nanda nursing diagnosis information. this information will usually be found immediately below the title of a nursing diagnosis.
- the nanda taxonomy and a medical disease cross reference is in the appendix of both taber's cyclopedic medical dictionary and mosby's medical, nursing, & allied health dictionary
- there are also two websites that have information for about 75 of the most commonly used nursing diagnoses that you can access for free:
- planning (write measurable goals/outcomes and nursing interventions)
- goals/outcomes are the predicted results of the nursing interventions you will be ordering and performing. they have the following overall effect on the problem:
- improve the problem or remedy/cure it
- stabilize it
- support its deterioration
- interventions are of four types
- assess/monitor/evaluate/observe (to evaluate the patient's condition)
- note: be clear that this is assessment as an intervention and not assessment done as part of the initial data collection during step 1.
- care/perform/provide/assist (performing actual patient care)
- teach/educate/instruct/supervise (educating patient or caregiver)
- manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)
- implementation (initiate the care plan)
- evaluation (determine if goals/outcomes have been met)