Help with care plan-Sickle Cell Disease

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Hello!

I am working on my care plan and I am having some difficulties on my Nanda workups.

It's my first peds rotation and on my first care plan the teacher said I needed more critical interventions specific to patient and I got a really low grade =(

My intervention were monitor vitals q4, assess for pain, provide periods for rest,

provide patient teaching, monitor oxygen saturation.. and others.

I really want to do better and redeem myself with this next care plan.

Any help would be greatly appreciated!

My patient is a 11 yr old male, admitted with sickle cell crisis, fever, and back pain.

He is on a general diet with fluids encouraged.

Activity: One person assist, risk for falls.

Continuous pulse ox.

His current medications are:

Rocephin IVPB 2mg/50 mL

Docusate 50mg/ 1 cap

Folic acid 1mg/1tab

Hydroxyurea 500mg/ 1 cap

Ketorolac 16 mg/0.53 mL IV push

Dilaudid PCA 60mcg, lockout interval 10 mins, loading dose 0 mcg

During date of care vitals signs were:

BP- 92/54 HR- 102 RR- 22 O2Sat- 99% T- 37.4 Celcius

Pain level 2 on a number scale of 0-10

Patient pointed to pain on lower back area.

Lung sounds clear on all lobes, no past medical history besides

sickle cell disease.

Patient was asleep for the most part of the day.

When patient was awake he was alert and orientedx3

Mother, grandparents, and brother were present

Mother did not seem anxious, was calmed but did ask questions when

vital signs were taken. Father was present on the second day and

had knowledge about medication

and already knew what the medications were what they were for.

I need at least 5 Nandas for my care plan but only 3 need to be worked up.

I was thinking for my #1 Nanda I would use Acute pain

#2 Ineffective tissue perfusion

#3 has to be a psychosocial one- parental anixiety...???? I used this one for my last

care plan.

Any help will be appreciated thank you!!

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when you flip through your nanda 2012-2014, what pops out at you? i strongly suggest that if you don't have one, you get one (at your favorite online bookseller) , and you will be amazed at what you learn.

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I have a Nanda book and a care plan book too but I think I will definitely look into getting a new version! We had a group activity during class where we compared interventions from different books and we were able to see the difference between having one source versus eight. It would benefit me to expand my sources. Thank you for responding =)

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

What is the child's response to illness according to Erickson's development? What is the assessment of the child? What does the patient say? Care plans start with the assessment of the patient NOT the medical diagnosis. Where is the pain? What is being done about pain? what is the level of knowledge of the patient? Did the child sleep all day for depression? Is the child coping? How would you adjust your interventions for an 11 yo

[TABLE]

[TR]

[TD]Stage

[/TD]

[TD]Basic Conflict

[/TD]

[TD]Important Events

[/TD]

[TD]Outcome

[/TD]

[/TR]

[TR]

[TD]Infancy (birth to 18 months)

[/TD]

[TD]Trust vs. Mistrust

[/TD]

[TD]Feeding

[/TD]

[TD]Children develop a sense of trust when caregivers provide reliability, care, and affection. A lack of this will lead to mistrust.

[/TD]

[/TR]

[TR]

[TD]Early Childhood (2 to 3 years)

[/TD]

[TD]Autonomy vs. Shame and Doubt

[/TD]

[TD]Toilet Training

[/TD]

[TD]Children need to develop a sense of personal control over physical skills and a sense of independence. Success leads to feelings of autonomy, failure results in feelings of shame and doubt.

[/TD]

[/TR]

[TR]

[TD]Preschool (3 to 5 years)

[/TD]

[TD]Initiative vs. Guilt

[/TD]

[TD]Exploration

[/TD]

[TD]Children need to begin asserting control and power over the environment. Success in this stage leads to a sense of purpose. Children who try to exert too much power experience disapproval, resulting in a sense of guilt.

[/TD]

[/TR]

[TR]

[TD]School Age (6 to 11 years)

[/TD]

[TD]Industry vs. Inferiority

[/TD]

[TD]School

[/TD]

[TD]Children need to cope with new social and academic demands. Success leads to a sense of competence, while failure results in feelings of inferiority.

[/TD]

[/TR]

[TR]

[TD]Adolescence (12 to 18 years)

[/TD]

[TD]Identity vs. Role Confusion

[/TD]

[TD]Social Relationships

[/TD]

[TD]Teens need to develop a sense of self and personal identity. Success leads to an ability to stay true to yourself, while failure leads to role confusion and a weak sense of self.

[/TD]

[/TR]

[TR]

[TD]Young Adulthood (19 to 40 years)

[/TD]

[TD]Intimacy vs. Isolation

[/TD]

[TD]Relationships

[/TD]

[TD]Young adults need to form intimate, loving relationships with other people. Success leads to strong relationships, while failure results in loneliness and isolation.

[/TD]

[/TR]

[TR]

[TD]Middle Adulthood (40 to 65 years)

[/TD]

[TD]Generativity vs. Stagnation

[/TD]

[TD]Work and Parenthood

[/TD]

[TD]Adults need to create or nurture things that will outlast them, often by having children or creating a positive change that benefits other people. Success leads to feelings of usefulness and accomplishment, while failure results in shallow involvement in the world.

[/TD]

[/TR]

[TR]

[TD]Maturity(65 to death)

[/TD]

[TD]Ego Integrity vs. Despair

[/TD]

[TD]Reflection on Life

[/TD]

[TD]Older adults need to look back on life and feel a sense of fulfillment. Success at this stage leads to feelings of wisdom, while failure results in regret, bitterness, and despair.

[/TD]

[/TR]

[/TABLE]

http://psychology.about.com/library/bl_psychosocial_summary.htm

http://psychology.about.com/library/bl_psychosocial_summary.htm

www.schoolhealthservicesny.com/.../Sickle Cell IHCP.doc

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Remember ABC? Do you think ineffective tissue perfusion should be number 1?

opiate pain med yes? LBM? Quality? Bowel Sounds?

Labs? Peripheral pulses?

I dont see any evidence for parental anxiety in your data base. She is asking questions so maybe knowledge deficit?

How does his IV site look?

I see he is a fall risk....so Risk for falls is a good one and a favorite of hospitals worldwide......

Also consider Constipation or risk for constipation......just a few initial thoughts....

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Thank you for the help! I have some problems with my prioritizing so this helps me greatly =)

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thank you for the information and the links, a major part of my care plan includes erickson's stage of development. "care plans start with the assessment of the patient not the medical diagnosis" that information will help me a lot when making my interventions! i often find that i do write my interventions based on diagnosis and i need to focus my interventions on the patient. for some reason i was not able to completely grasp what i was doing wrong with my interventions so this will definitely change how i write my interventions. thank you so much for the help! =)

Up Vote Up Vote ×

Thank you for the information and the links, a major part of my care plan includes Erickson's stage of development. "Care plans start with the assessment of the patient NOT the medical diagnosis" That information will help me a lot when making my interventions! I often find that I do write my interventions based on diagnosis and I need to focus my interventions on the patient. For some reason I was not able to completely grasp what I was doing wrong with my interventions so this will definitely change how I write my interventions. Thank you so much for the help! =)

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