Need help with developmental stage nursing dx

EricJRN, MSN, RN · Oct 19, 2013

Have you had a chance to assess the patient yet? That's really where nursing diagnosis/care planning should start. Just as a general rule, you don't have an AEB on a risk-for diagnosis.

Esme12, ASN, BSN, RN · Oct 19, 2013

Where should this baby be for a two month old baby? What developmental milestones shod the baby have net already? what is the assessment of the baby now?

A two month old should by now have reached

http://www.cdc.gov/ncbddd/actearly/milestones/milestones-2mo.htmlCheck the milestones your child has reached by the end of 2 months. Take this with you and talk with your child’s doctor at every visit about the milestones your child has reached and what to expect next.
[h=3]What most babies do at this age:[/h][h=3]Social and Emotional[/h]
Begins to smile at people
Can briefly calm himself (may bring hands to mouth and suck on hand)
Tries to look at parent
[h=3]Language/Communication[/h]
Coos, makes gurgling sounds
Turns head toward sounds
[h=3]Cognitive (learning, thinking, problem-solving)[/h]
Pays attention to faces
Begins to follow things with eyes and recognize people at a distance
Begins to act bored (cries, fussy) if activity doesn’t change
[h=3]Movement/Physical Development[/h]
Can hold head up and begins to push up when lying on tummy
Makes smoother movements with arms and legs

Now what does this baby do or not do?

Esme12, ASN, BSN, RN · Oct 19, 2013

Have you had a chance to assess the patient yet? That's really where nursing diagnosis/care planning should start. Just as a general rule, you don't have an AEB on a risk-for diagnosis.

Well technically that is not true....they don't have a "related to"......How do I write a diagnostic statement for risk, actual and health promotion diagnoses? | NANDA International Knowledgebase

RISK DIAGNOSIS
For risk diagnoses, there are no related factors (etiological factors), since we are identifying a vulnerability in a patient for a potential problem; the problem is not yet present. Therefore we identify the risk factors that predispose the individual to a potential problem.
The correct statement for a NANDA-I nursing diagnosis would be: Risk for _____________ as evidenced by __________________________ (Risk Factors).
Risk Diagnosis Example: Risk for infection as evidenced by inadequate vaccination and immunosuppression (risk factors).

nurseprnRN, BSN, RN · Oct 19, 2013

Risk diagnoses do not have evidence, because nothing has happened yet. The existence of the risk factor is the evidence you need to make the nursing diagnosis. There is a "Risk for delayed development" nursing diagnosis, page 485, with all possible approved risk factors, in your NANDA-I 2012-2014, which you should have even if the faculty didn't remember to put it on the bookstore list. $29 at Amazon.com, free 2- day delivery for students.

There is also, on page 484, "Delayed growth and development", which has defining characteristics (which you identify in your personal assessment of the baby's condition and behavior) and the causative (related to) factors, many of which I would bet your baby has. Check them out.

Also, I'm no premie expert but I do know this: A baby born at 12 weeks before due date is not expected to be like a normal two-month old two months after his birth. He's assessed like a 36-weeker, i.e., one month premature. He's behind.

Esme12, ASN, BSN, RN · Oct 19, 2013

I took that right of the NANDA site.....How do I write a diagnostic statement for risk, actual and health promotion diagnoses? | NANDA International Knowledgebase

[COLOR=#8f2343]RISK DIAGNOSIS
For risk diagnoses, there are no related factors (etiological factors), since we are identifying a vulnerability in a patient for a potential problem; the problem is not yet present. Therefore we identify the risk factors that predispose the individual to a potential problem.
The correct statement for a NANDA-I nursing diagnosis would be: Risk for _____________ as evidenced by __________________________ (Risk Factors).
Risk Diagnosis Example: Risk for infection as evidenced by inadequate vaccination and immunosuppression (risk factors).
[COLOR=#8f2343]HEALTH PROMOTION DIAGNOSIS
Because health promotion diagnoses do not require a related factor, there is no “related to” in the writing of this diagnosis. Instead, the defining characteristic(s) are provided as evidence of the desire on the part of the patient to improve his/her current health state.
Health Promotion Diagnosis Example: Readiness for enhanced self-care as evidenced by expressed desire to enhance self-care.

KelRN215, BSN, RN · Oct 20, 2013

My pt was a 2 m/o in the NICU barely weighed 2.5 kg he was born at 28 weeks. I am having trouble with a developmental nursing diagnosis. I have so far risk for delayed development r/t prematurity AEB?? Not sure if I am even on the right track any help will be beneficial. Thanks!

2.5 kg is a fine size for an infant that is gestationally 36 weeks of age. This baby hasn't even reached his due date yet.

You don't assess preemies based on their chronological age but based on their gestational age. Think about it. At 3 months old, this baby will be 40 weeks gestation so he will be a newborn. A full term 3 month old should have a social smile, should be able to lift his head and should be beginning to roll. You don't expect any of this from a 3 month old ex 28 weeker.

What is your assessment of this baby beyond his weight? Is he feeding PO? Is he NG fed? Is he on TPN?

Esme12, ASN, BSN, RN · Oct 20, 2013

I am so not NICU......I know they are "assessed" at their gestational age. When does that stop? I am curious....are they considered developmentally delayed when for a "3 month old" they should be doing this.....but for their gestational age they are fine.

When do they "catch up" so to speak.

For a care plan in school would you consider that they are behind their "chronological age" but near their gestational age as developmentally delayed?

nurseprnRN, BSN, RN · Oct 21, 2013

I am so not NICU......I know they are "assessed" at their gestational age. When does that stop? I am curious....are they considered developmentally delayed when for a "3 month old" they should be doing this.....but for their gestational age they are fine.
When do they "catch up" so to speak.
For a care plan in school would you consider that they are behind their "chronological age" but near their gestational age as developmentally delayed?

A baby is not considered developmentally delayed if her behavior is appropriate for her gestational age. KelRN215 explains that better than I do-- the normal 40-weeker can do all sorts of things at 3 months post birth that a 28-weeker cannot do at 3 months post birth, because she's really only at 40 weeks gestation by then.

I don't know about "catching up." So many premies are permanently disabled in some ways that they never "catch up" to their normal schoolmates, but a lot of them are developmentally normal at some point.

Esme12, ASN, BSN, RN · Oct 21, 2013

Clearly some are permanently disabled and never "catch up".

I KNOW they are assessed at their gestational age.... but what would be considered "delayed" at this juncture. I mean if the baby isn't at gestational age yet.....not bottle feeding would be "normal" and breathing on their own advanced since they shouldn't be born yet.

I'm curious.

JustBeachyNurse, LPN · Oct 21, 2013

Age correction for gestational age generally stops at around 36 months. Many catch up at this point.

Others are age-adjusted until 60 months/5 years (but I've only seen this a few times and the children all had significant medical complexities from neonatal brain bleeds, CP, cardio-pulmonary congenital abnormalities, failure to thrive etc. )

JustBeachyNurse, LPN · Oct 21, 2013

In my experience, for care plans and nursing assessments in private duty pediatrics and often early intervention, developmental milestones are based upon age corrected. So a 6 month old ex-28 week preemie would be a 6 month chronological adjusted to 3 month gestational and assessed against 3 month old developmental and growth milestones.