Help with care plan!!

[jbedwards]

Ok, I had a patient on my very first Peds clinical who was a 19 y/o male that was admitted with neutropenia, fever, and sore throat following a transfusion of RBC & platelets the day before. This has been a FUN care plan so far, but what I have come up with is: risk for infection r/t chronic disease, risk for deficient fluid volume (pt is receiving chemo, transfusion, & IV fluid), acute pain r/t disease process, and social isolation r/t altered state of health. Do these sound ok? I have been able to come up with interventions, rationale, and response to the first three diagnosis, but am drawing a blank on the social isolation! We have to come up with a general goal, then a specific goal. I don't know if I am just having an off day or what, but I cannot come up with anything! Please help! Thanks so much in advance!!

[SoldierNurse22, BSN, RN]

Those sound perfect. We had patients who were often times experiencing all of those issues all at once.

You could also accurately state that they are at risk for infection r/t neutropenia, risk for infection r/t immunosuppressive therapy, acute pain r/t medication side effects, and social isolation r/t risk for infection.

Unfortunately, for patients who are neutropenic especially due to oncologic reasons, there isn't a whole lot you can do to expand their social experience in a face to face setting. There is a good reason for isolation during this period.

However, you can encourage them to stay connected via other modes. We'd always encourage them to call relatives, Skype, message on Facebook, write letters, write emails, blog--whatever helped them feel more connected to people they cared about. On nights, we'd invite them to the nurse's station and we'd all play Uno together at the desk. If they were severely neutropenic, the RNs would sit outside their room in the hallway and we'd pull their bedside table into the doorway with the patient sitting just inside their room.

[jbedwards]

However, you can encourage them to stay connected via other modes. We'd always encourage them to call relatives, Skype, message on Facebook, write letters, write emails, blog--whatever helped them feel more connected to people they cared about.

I didn't even THINK of using social media as an intervention!! Thank you!!

[SoldierNurse22, BSN, RN]

No problem! It's especially effective for younger patients, though even our older folks loved their FB.

We had a couple of patients who befriended each other, too, while walking the halls at night. When they were neutropenic, they couldn't always go into each others' rooms, but they'd stand at their doors and talk, try to encourage each other and socialize through our stylish masks. That's not really something you can engineer--sometimes the stars just align for those patients. But social media is a good alternative--especially something interactive like Skype if your hospital wireless can sustain it--when patients are feeling lonely.

[Esme12, ASN, BSN, RN]

Great advice!

[jbedwards]

I have to agree. Best advice ever. This one I will remember forever. Thank you.