Care Plan Help, Tricky One about Agenesis of Corpus Callosum

[Stargazn03]

hi everyone! i am in my 3rd semester of my program and am doing my pediatric rotation. i have to write 2 priority nursing diagnoses for my patient and i am having a tough time with my second diagnosis.

here is a little background:

my patient is 13 months old, has been in the hospital for 5 weeks, admitted for respiratory distress. patient has a tracheostomy and a feeding tube as well. this patient has agenesis of the corpus callosum (acc) which by definition is: an abnormality of brain structure, present at birth, that is characterized by partial or complete absence of the corpus callosum. the corpus callosum is a bundle of nerve fibers that connects the two hemispheres (halves) of the brain and allows information to pass back and forth between both sides.

patients meds are: acetic acid to clean trach site, budesonide inhalation suspension for prevention of asthma, lactobacillus rhamnosus-probiotic to stop growth of harmful bacteria in intestines, prevacid for acid reflux/heartburn, multivitamin with iron, oxycarbazpeine (anticonvulsant), vitamin k, and ursodiol.

patients abnormal labs are:

chloride 114 (norm 98-106)

bun 20 (norm 5-15)

cr 0.8 (norm 0.3-.06)

bili 1.1 (norm 0.2-0.9)

alb 2.6 (norm 3.8-5.1)

height: 25.98in

weight: 8.08kg (17.8lbs)

at 13 months the patients growth and development should be: walking with increasing confidence, climbs stairs, etc., turns book pages, drinks from a cup by holding it with two hands, explores objects by banging, shaking, throwing, dropping, should be responding to simple verbal requests such as "no", tries to imitate words, etc.

my patient however, layed in bed the majority of the day and showed no signs of any of the above. patient was not walking, no speech, but could follow sounds with his eyes and could squeeze my hands, and sleeps majority of day.

assessment data:

rr: 22

wob: labored (intermittently)

o2 stats: 100% on 3 l/min, 24% concentration

crackles in lung sounds, all lobes

temp: 35.9 celsius

absent cough

apical pulse: 138 regular rhythm

flacc score of 1 (given a 1 for activity; squirming, shifting back and forth, tense [restlessness])

suctioned 4x during shift, 1 deep suction

humidified air

patient gets tube feedings 45 ml/hr for 17 hours (peptamen junior)

soooo.... i know that's a lot of info. here is the first nursing diagnosis i came up with:

ineffective airway clearance r/t presence of secretions in the bronchi and presence of artificial airway (tracheostomy) aeb crackles in all lobes, intermittently labored breathing, and absent cough.

and for the life of me, i can't come up with another one!! i was thinking about delayed growth and development r/t the effects of physical disability secondary to acc or impaired physical mobility but sometimes i come to a block in the road when it comes to making a realistic outcome and realistic interventions that i, as the nurse, can help with (i can't just assess something or monitor something, i have to actually do something for the interventions).

could i even do something with imbalance nutrition: less than body requirements?

i've been stumped for hours now! any help would be greatly appreciated, it's definitely a tricky one with an admitting diagnosis of respiratory distress and this person also has agenesis of the corpus callosum.

thanks!!!!

[lovescoffee]

You could use "risk for infection" or "failure to thrive". If you use "imbalanced nutrition" I'd suggest making sure the kcal requirements of the pt are higher vs what they are receiving. I despise care plans! GOOD LUCK!!!

[FlyingScot, RN]

What are some of the physiologic consequences of a basically immobile patient who lies in bed all day?

[EricJRN, MSN, RN]

In addition to the effects of being immobile, technology-dependent kiddos are at risk for complications related to the very devices that sustain them.

Also carefully consider the patient's meds and see if that's a direction that you want to go in. What are vitamin K and ursodiol used for?

You've done well to include some assessment data, but the above assessment findings seem very focused. I might think more broadly - things like skin, head and neck, abdomen and extremities.

There should be at least a couple of independent nursing actions for the most common nursing diagnoses that affect children with neurodevelopmental delay.

[adsn 8806]

If i have a patient who was admitted for a CVA, but the scan showed no sign of a stroke... how do i come up with a nursing diagnosis. I figured accute confusion but i dont know what the related to factor would be

[nurseprnRN, BSN, RN]

is this kiddo going to go home with parents? i'd be thinking mobility/equipment issues, caregiver strain, impaired parenting/relationships between parents, knowledge deficit on care, anticipatory and actual grieving ....

[nurseprnRN, BSN, RN]

if you have a patient with any medical diagnosis, how do you come up with any nursing diagnosis? you assess the patient. nursing diagnosis is not the automatic result of a checklist of medical diagnosis, although a checklist could help you focus your assessment.

so...what's going on with that not-a-cva patient?

1/10/12 edit. no idea at all how this post ended up here.

[Vershonda]

Risk for impair skin integrity related to immobility. As we learned in fundamentals, a patient that is immobile is at risk for skin breakdown because they are unable to move on their own.

What about bowel functions related to immobility.

I was also taught to think simple in coming up with Nursing Diagnosis. We make it much harder that what it really is...

Hope this helps and Good Luck

[FlyingScot, RN]

I'm thinking the OP isn't coming back.

[LadyinScrubs, ASN, RN]

if i have a patient who was admitted for a cva, but the scan showed no sign of a stroke... how do i come up with a nursing diagnosis. i figured accute confusion but i dont know what the related to factor would be

1. what is the age of the pt? elderly? if so, the elderly are at risk for conflusion and/or delirium r/t many factors. dehydration, poor kidney clearance of drugs, electrolyte problems, lack of o2 perfusion, etc. is there a uti--what do the labs show? again what do the labs and other dx tests show?

2. is the pt a child. again, risk for serious problems caused by hydration or lack thereof.

3. the pt is confjused. when did this confusion start. slow onset or abrupt. if abrubt consider what cold cause an abrupt onset of confusion.

4. was there a fall?

i had a similar problem with my my very elderly, bedbound, frail family member. after starting a new med, she exhibited some confustion that moved quickly to --> acute delerium--> complete break with reality all quickly within 2 days after new med--> and then pseudoparkinson like s/s. i stopped her new med admin on 3rd day but she sitll progressed to break with reality.

off to ed and she was seen by many. last specialist they brought in stated that although the cat scan showed no stroke, it was possible. if so,she would never return to her previous level of health. they wanted to admit her to a psych facility and control her s/s with strong psychtropic meds. i wanted to wait to see if the problem was side effect from decreased kidney clearance (only one very elderly working kidney) plus i could give her 1-on-1 care better and keep her safer than than the facility.

the delerium also caused decreased food/fluid intake r/t seeing spiders in her food and liquids. she was given 1 1/4 l of ns and she settled down. next day she was much better. she finally cleared the med; she is just fine now. i have vowed to remind the md to start new meds low and increase slowly.

[Sehille4774]

grntea said:is this kiddo going to go home with parents? i'd be thinking mobility/equipment issues, caregiver strain, impaired parenting/relationships between parents, knowledge deficit on care, anticipatory and actual grieving ..

i was thinking amen. realistically...these are some of the most major issues facing this patient..(seen it for my self!) when mom and dad take him home do they have a good enough understanding of his respiratory status that they know when he needs help? and if he needs help..would they know what to try and how to do it?

are they getting enough support that they are not burnt out and actually have the sleep/energy to make good decisions...take care of themselves and meet his healthcare needs.

lots of kids end up in the hospital because parents of trach kids either don't know how to manage their secretions properly...or get so tired that they let the kid go and it turns into uri or pneumonia.

is their a good plan in place for this family.

grieving...another good one. contributes to caregiver strain too.

ok....so one thing i noticed is that you say he was admitted 5 weeks ago for respiratory distress. respiratory distress tends to be an acute condition, that is not the disease itself, but caused by something else...such as bacterial infection, pneumonia, thick secretions, inflammation of the airway from allergies or asthma....all i was wondering is if rd was his diagnosis..then what was it that caused it and has led him to be in the hospital for 5 weeks? that info would be helpful to give you better info. seems like his other needs such as nutrition are being met.

i agree with immobility.

and ineffective airway clearance tends to go hand in hand with impaired gas exchange...if they have one they usually have the other. r/t copious mucus secretions preventing adequate exchange of co2 and o2 in the alveoli, as evidenced by spo2

great detailed information btw. developmental delay would be of course important to this baby...is he just delayed or has he progressed as far as he will? this age is when it is most critical to work with them if they are going to progress...so though the acute care nurse has little to do with this (and he already should be receiving those services such as early intervention in the home to deal with it...you can assess if you want, find out if they do indeed have a plan at home..and if not refer them to social services...and tailoring your care while he his hospitalized to his developmental level to promote healing and comfort: ie: try to keep the same nurses on his case, um, involve the parents in the care, cluster care for rest, try to get on a schedule cause babies like their routine..i think its relevant. maybe not in my top five tho compared to those others listed.

anyway just some random thoughts. i didnt actually look anything up here (thats your job )

[Sehille4774]

Wow. I really need to look at the dates these are posted >.<. so how did you do on your paper.>