Care plan due tomorrow need help on nursing Dx!

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I have a child of 5 years who is healthy. He plays very rough with the family puppy who is 6 months and 35 pounds. His mother sometimes smokes while he is in the car, and he hasnt been to the doctor since his birth.

I was thinking...

Risk for injury r/t developemental age. (not sure what interventions I would do for this.)

Impaired parenting r/t stress AEB use of cigarettes in presence of child.

Ineffective health maintainence r/t blah blah blah...

Anyways we have to pick the top priority which would be risk for injury correct?

If so could someone offer me some interventions I could use for this?

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Specializes in med/surg, telemetry, IV therapy, mgmt.

when you are doing a pediatric care plan the first thing you need to do is compare the child to his normal growth milestones. find out what is normal behavior for a 5-year old and how he compares to it. there are pediatric weblinks listed on this thread where you can find that information on several websites: https://allnurses.com/nursing-student-assistance/medical-disease-information-258109.html - medical disease information/treatment/procedures/test reference websites

and don't forget about erickson's development stage because that will tell you a lot about his behavior as well.

as for your diagnoses. . .

risk for injury r/t developemental age. (not sure what interventions i would do for this.)

  • "risk for" diagnoses are never sequenced as first diagnoses because it they are anticipated problems. anticipated problems haven't happened yet, so they are considered of less importance than actual nursing problems.
  • your related factor is wrong. developmental age is not a cause for injury. in this case i was thinking that you meant that the way the child interacted with the dog would eventually result in injury. say that. risk for injury r/t rough interaction with family dog.
  • interventions for "risk for" diagnoses are limited to:
    • strategies to prevent the problem from happening in the first place
    • monitoring for the specific signs and symptoms of this problem
    • reporting any symptoms that do occur to the doctor or other concerned professional

    [*]you will have to go to dog training sites to get your interventions for this one!

impaired parenting r/t stress aeb use of cigarettes in presence of child.

  • this care plan is about the child. the child cannot have the problem of impaired parenting. that is something that the parent has and this care plan is not about the parent. think about what the effects of cigarette smoke are on the child and that is the problem you are trying to convey here. does he have any cough or allergies yet? he is at risk for developing them. read up on second hand smoke and children and see what you come up with. the most likely diagnosis to use would probably be risk for injury r/t second hand smoke.

ineffective health maintainence r/t blah blah blah...

  • because this is an actual problem, this would be your first diagnosis in the listing. it is often used when noncompliance becomes an issue, but we don't want to use the word noncompliance.
  • the definition of this diagnosis is inability to identify, manage, and/or seek out help to maintain health (page 57, nanda international nursing diagnoses: definitions and classifications 2009-2011). the related factors will be the causes of why they patient didn't seek out health maintenance of any sort. the taxonomy lists a number of reasons:
    • cognitive impairment
    • complicated grieving
    • deficient communication skills
    • diminished fine motor skills
    • diminished gross motor skills
    • inability to make appropriate judgments
    • ineffective family coping
    • ineffective individual coping
    • insufficient resources (e.g., equipment, finances)
    • lack of fine motor skills
    • lack of gross motor skills
    • perceptual impairment
    • spiritual distress
    • unachieved developmental tasks

    [*]in other words, what kept the mother from taking this child to the doctor for 5 years? that will be your related factor for this diagnosis. your aeb is that he has had no professional health care for 5 years.

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