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Discussion

Need help with developmental care plan

Hello,

So I'm struggling with a developmental care plan for a patient I had today. He is 2 months old and has cri du chat syndrome. He has microcephaly with a head circumference of 34 cm with a 2.23% on the growth chart. He's also only 8lb 11oz (0.22%) and height of 21 inches (0.88%) on growth charts. I did the nursing diagnosis of delayed growth and development but for the goal has me stumped I was going to do the child will demonstrate weight and growth-stabilization or progress toward age-appropriate size but I feel like this is incorrect or unattainable. Any advice?

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    • Experts

    you are over shooting your goal.....what are the normal developmental milestones for a 2 month old. Have they met any of them? what would be a developmental goal for a two month old....think simple.

    Think weight if the baby is having feeding issues.....are they tracking objects or turning theuir head toward noises?

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    • Author

    I only had a chance to see him this morning to do vital signs on him before he was taken to the operating room for a supraglottoplasty. He was asleep the whole time while the mom held him. The only other thing I can think of is he had an abnormal hearing test bilaterally and not one sound woke him up, his vocalization was impaired with the cat like cry, he didn't smile or respond to his mothers voice?

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    The wait gain goal is appropriate if they are classified as failure to thrive or if they have feeding difficulties.

    As a pediatric home care/private duty nurse the goal for an underweight d/t feeding issues is often ' receive adequate nutrition & hydration to promote positive weight gain without s/sx malnutrition, dehydration, or reflux..,,

    A positive weight gain does not mean hit the 10th or 50th percentile but if a child is 3% they stay at the 3-5% range and not drop off the chart or gain too quickly. It is relative to the underlying diagnosis. Some conditions/syndromes lend to a smaller stature which is ok if it is WNL for the child.

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    • Experts
    I only had a chance to see him this morning to do vital signs on him before he was taken to the operating room for a supraglottoplasty. He was asleep the whole time while the mom held him. The only other thing I can think of is he had an abnormal hearing test bilaterally and not one sound woke him up, his vocalization was impaired with the cat like cry, he didn't smile or respond to his mothers voice?
    your care plan has to be developmental? what considerations would need to be considered for this patient with this procedure? How will abnormal hearing affect this baby development and binding with family? what can be utilized to increase bonding?
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    The child is probably not going to make a big jump onto the growth curve and be in the 50% any time soon but weight gain is an absolute and measurable goal. Is the child tube fed? If so there are a lot of interventions and goals that could be based on that.

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    Remember that your baby's mother is your patient too. Look in your NANDA-I 2012-2014 (which every student should have, $29 at Amazon, free 2-day delivery)) under:

    Health promotion

    Nutrition, G&D (good points made above)

    Perception/cognition (communication)

    Role/relatonships (family relationships, caregiver roles)

    Coping and stress tolerance (coping responses, neurobehavioral)

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    • Author

    Thanks for all of your replies, I talked this over and my instructor approved of the goal that the patient will maintain current weight and growth. As for interventions she suggested appropriate toys and activities as well as parental support etc.

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