Care Plan Outcome / Interventions Help

[MsKayleigh]

I'm working on a nursing care plan for my pediatric clinicals at a sort of long-term care facility for children with disabilities. I am struggling a bit with establishing a realistic, measurable outcome and appropriate interventions for my client.

Some background:

5-year-old female with a progressive neurodegenerative disorder (and nobody seems to agree on which one) and myoclonic seizures.

Some of the diagnoses scattered throughout her chart include static encephalopathy with resultant spastic quadriplegic cerebral palsy, West Syndrome, degenerative brain disorder, seizure disorder, and developmental delay.

Assessment:

Client is wheelchair bound, completely dependent for all cares, and wears orthoses for a few hours each day. She has a gastrostomy for tube feedings, secondary to decreased alertness and limited responses and communication. She is non-verbal, and her communication is facial expression. (There's a lot more I could add here, but for the sake of keeping things brief, I will stop here; let me know if there is more pertinent information I should be including!)

Care Plan:

The priority diagnosis I am working with is Impaired Physical Mobility r/t neuromuscular weakness and spasticity aeb dependence for all cares, confinement to wheelchair, and use of orthoses. Where I'm struggling is with a realistic outcome as well as appropriate interventions. I've looked through my textbooks, but most of the interventions are inappropriate for my client (mostly geared toward those who still have some mobility and increasing mobility).

My instructor has told us that our outcome should be measurable in the long-term; it's unrealistic to expect outcomes within a shift or even a week. However, with my client staying seemingly stable (as her chart reads), I'm really not sure what sort of outcome I can develop, aside from maintaining where she's at currently.

Thoughts or experiences? Any input would be greatly appreciated! Thanks in advance!

[Qtip]

For ease of writing a care plan, I think I would go with self care deficit.

[kk2021]

Yeeea, this one is tricky! I agree with the other poster about doing a self-care deficit for the sake of ease, but if your instructor is a stickler for priority dx that might not work. I'm drawing a blank on an outcome, but here's a few possible interventions (in no particular order):

-assist with range-of-motion exercises (if this is even possible, and if PT isn't already doing this)

-turn q2hrs to prevent formation of pressure ulcers

-assess for skin breakdown that can result from impaired mobility

-assess neurologic system (LOC, language, cranial nerves, etc)

-assist patient with ADLs

-educate family (if they are present during her stay) on importance of position changes and S/S of skin breakdown

Hope this helps a little..good luck!

[Esme12, ASN, BSN, RN]

sometimes the goal is to try maintain the status quo.

nursing resources - care plans

[color=#1122cc]nursing care of clients with neurologic disorders

www.nvcc.edu/home/nsharma/neurologicdisorders.ppt

http://www.enurse-careplan.com/2010/08/nursing-care-plan-ncp-muscular.html

[nurseprnRN, BSN, RN]

i'm looking in my nanda-i 2012-2014 (which you all should have, available at your favorite online bookseller or from nanda-i directly), under domain 11, safety/protection-- you could consider several "risk for.." nursing diagnoses-- aspiration,infection, injury, impaired skin integrity, impaired tissue integrity... and a number of others.

don't forget the family-- they are part of the "patient" too, according to the american nurses association scope and standards of practice.

i'm looking in domain 7, role relationships, and seeing things like caregiver role strain / risk for caregiver role strain, impaired parenting/risk for impaired parenting, and risk for impaired attachment, dysfunctional or interrupted family processes.

as always, you don't pick what sounds like an appealing nursing diagnosis and then try to fit your patient into it. you select your nursing diagnosis based on your assessment, which includes personal physical and verbal interaction with the patient/family and whatever you can glean from the medical record. then you see if some of those possible nursing diagnoses have defining characteristics which are congruent with your assessment data, and find out what you can do to help.

[MsKayleigh]

Thank you all so very much!! I found all of your answers helpful and useful. The outcome of maintaining status quo was what I opted for; I have always had outcomes that were progressing towards something, so doing maintenance was a bit foreign to me.

I actually needed two diagnoses, but one had to be an "actual" diagnosis. The risk I went with was for impaired skin integrity.

Again, thank you all very much!