care plan help!

[2bsunshinenurse3]

I'm having trouble comong up with a nursing diagnosis for an 8-year old child with a cast on his left arm. We have to have 3 total, and I'm down to my last one and just can't seem to figure out the best diagnosis to choose. I have ineffective tissue perfusion, and risk for impaired skin integrity. Any ideas of a 3rd? I thought of self-care deficit or activity intolerance but I don't know about my interventions, and I need 2 for whatever diagnosis I choose.

I would LOVE some help!!! Thanks = )

[JeepDudeRN]

What about some knowledge deficit? There is ALOT of teaching for him and his family about what he can do, what he cant do, what he can take for pain, some non pharmacologic things for pain... Then theres acute pain...Im sure there could be something for social because he wont be able to play like he was before the cast... Is he having anxiety? Is he scared?

Is there anything else wrong with him? You just have to think it through. But I hope this helps.

[Daytonite, BSN, RN]

A care plan is about your identification of the patient's nursing problems and your strategies to solve those problems. To identify the problems you must do an assessment of the patient and their situation and abnormal data falls out (symptoms). These symptoms (NANDA calls them defining characteristics) are the basis of any nursing diagnoses that you end up using. Nursing diagnoses are not based upon the person's medical problems although their medical problem and condition can help you identify their nursing problem(s).

The only information you've supplied is that this is an 8-year old child with a cast on his left arm. Is he left-handed? How is this going to affect his ability to hold a fork and spoon so he can eat? Button his shirts? Tie his shoes? Take a bath? Wipe his butt when he goes to the bathroom? This is very basic nursing care and teaching related to self-care. Is this a broken bone? Was there trauma involved? Is he having any pain? What are the complications of a fracture and a cast? (compartment syndrome, palsy, paresthesias, ischemia, pressure necrosis, nonunion of the bone, misalignment of the bone, wound infection, fat embolism, neurovascular impairment). Who helps care for this boy? Do they need assistance with understanding the medical regime that is necessary to get this boy healed and back to health? These are all things that should have been identified during assessment activities and the answers point to potential nursing diagnoses.