Help w/pediatric care plan

KelRN215, BSN, RN · Jul 25, 2013

What do you have so far? What is your assessment of the patient and his/her parents?

You're not going to find anyone on here who's going to just give you answers without you telling us what you think first.

delleh · Jul 25, 2013

I'm not looking for answers as much as guidance from someone with experience. My care plan is finished except for the acute pain portion, which is what I'm having trouble with. The patient is sedated and on pain meds. Pain is subjective and in an infant I would use the FLACC scale, but how? Is there something else used when the patient is sedated? I've looked and can't find anything. Would it be risk for pain instead?

**NICU Guy, BSN, RN** · Jul 25, 2013

There are many other choices for a care plan on a patient that had major cranial reconstruction other than pain that are higher on the priority list.

KelRN215, BSN, RN · Jul 25, 2013

I'm not looking for answers as much as guidance from someone with experience. My care plan is finished except for the acute pain portion, which is what I'm having trouble with. The patient is sedated and on pain meds. Pain is subjective and in an infant I would use the FLACC scale, but how? Is there something else used when the patient is sedated? I've looked and can't find anything. Would it be risk for pain instead?

I am a former inpatient pediatric neuro/neurosurgery nurse and have cared for MANY infants with craniosynostosis over the years. I'm going to have to agree with Don1984- in an infant with this type of surgery- especially one who is currently sedated- there are more important things to worry about than pain.

Why is this child sedated? Most of the kids I've cared for with this surgery came straight to the floor (no ICU unless surgery was a frontal-orbital advancement), awake and usually having started feeding in the PACU.

delleh · Jul 25, 2013

I can appreciate your experience, as I obviously have very little. This was the only time I've been to the PICU and the only time I've seen craniosynostis. It was frontal-orbital advancement, but I was under the impression that all craniosynostosis patients went to the PICU. I am aware that there are other higher priority interventions. So you don't asses pain in the sedated patient? Thanks for your input...rude tone and all :) It would be fantastic to work with you someday!

smatrang001 · Jul 25, 2013

Physical findings: sweating, increased HR, BP, pallor, etc.

**NICU Guy, BSN, RN** · Jul 25, 2013

My comment wasn't intended to be rude. I am just trying to help you get a better grade. Pain is usually the default diagnosis that students use when they start writing care plans. My belief is that your instructor will be looking for higher priority nursing diagnosis. They don't have you write care plans just for practice. They want to see if you were their nurse what would be the most critical things that you would need to look for. This infant had a major surgery and a lot of life threatening complications could occur in the first few days post-op. Helping with pain is a lower priority if the infant is at risk for an infection or a brain bleed. Always think of what might kill my patient first, then down the list of least likely. What could be the worst complications that could possibly happen to an infant with this surgery?

delleh · Jul 25, 2013

My comment wasn't intended to be rude. I am just trying to help you get a better grade. Pain is usually the default diagnosis that students use when they start writing care plans. My belief is that your instructor will be looking for higher priority nursing diagnosis. They don't have you write care plans just for practice. They want to see if you were their nurse what would be the most critical things that you would need to look for. This infant had a major surgery and a lot of life threatening complications could occur in the first few days post-op. Helping with pain is a lower priority if the infant is at risk for an infection or a brain bleed. Always think of what might kill my patient first, then down the list of least likely. What could be the worst complications that could possibly happen to an infant with this surgery?

I didn't take your response as rude. It was very much appreciated. You are absolutely correct in believing that my instructor will be looking for my nursing diagnoses to be prioritized. And in providing care, I recognize that there are higher priorities than pain. The thing is, I'm required to have three nursing diagnoses that aren't "risk for". I know this child has pain, it just seems like I'm missing something in how to assess it. I'm going to try and find a different route. Unfortunately my instructor is out for a week on vacation. Thanks again to you and everyone who gave me a reply. I do value your experience and the time you took to reply :)

NicuGal, MSN, RN · Jul 25, 2013

Does FLACC have a sedation portion? We use NPASS and have a sedation portion to it. I have to disagree with the PP, pain is important to address as it can affect so many other systems.

Esme12, ASN, BSN, RN · Jul 25, 2013

We all love to help with homework.....we answer many care plan situations and we need to know what semester you are currently in....what do YOU think first....so we can best help you discover what you are not seeing or where you are going awry. We will help but we do NOT give answers. We want to make you the best nurse you can be and that is helping you discover the answer yourself.

Care plans are all about the assessment.....of the patient. I know you have to start somewhere but it is so difficult to "get the picture" from a bunch of typed words. Care plans when you are in school are teaching you what you need to do to actually look for, what you need to do to intervene and improve for the patient to be well and return to their previous level of life or to make them the best you you can be. It is trying to teach you how to think like a nurse.

Think of the care plan as a recipe to caring for your patient. your plan of how you are going to care for them. how you are going to care for them. what you want to happen as a result of your caring for them. What would you like to see for them in the future, even if that goal is that you don't want them to become worse, maintain the same, or even to have a peaceful pain free death.

Every single nursing diagnosis has its own set of symptoms, or defining characteristics. they are listed in the NANDA taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. You need to have access to these books when you are working on care plans. You need to use the nursing diagnoses that NANDA has defined and given related factors and defining characteristics for. These books have what you need to get this information to help you in writing care plans so you diagnose your patients correctly.

Don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. These will become their symptoms, or what NANDA calls defining characteristics.

Let the patient/patient assessment drive your diagnosis. Do not try to fit the patient to the diagnosis you found first. You need to know the pathophysiology of your disease process. You need to assess your patient, collect data then find a diagnosis. Let the patient data drive the diagnosis.

So tell me about this patient.....how sedated are they? Not all cranial surgeries go to the PICU at all facilities. That will be one thing you will learn that care is not universal....there are standards however.....the actual policy care will vary greatly facility to facility and even greater state to state.

Since care plans are ALL about the PATIENT ASSESSMENT....what is your assessment? How sedated is this child....are the intubated (on a vent)? What monitoring devices do they have? What are the other physiological signs of pain? What are this patients vitals? What car plan book do you have?

Tell us more a bout the patient and about you so we may help.

KelRN215 would be your BEST SOURCE for this patient a she is the MOST SKILLED in this specialty....I defer to her expertise in this arena.

A good nurse knows she doesn't have all the answers....a GREAT nurse knows where to go to find them.

delleh · Jul 25, 2013

Does FLACC have a sedation portion? We use NPASS and have a sedation portion to it. I have to disagree with the PP, pain is important to address as it can affect so many other systems.

Thanks so much for your response! This was just the the type of guidance I was hoping for. My patient is a bit out of the recommended age for N-PASS, but it is the one I chose to use because of the sedation portion. I have a kazillion nursing books so it seems like I would be able to find more on pain assessment, but I had to turn to trusty old google. My care plan is finished and I do appreciate the help. :)