Need help with NANDA dx

[grensa]

I am trying to come up with a nursing dx for the following:

• 4 yr old
  
• post MVA with grade 5 liver lac and humerus fx
  
• going to be discharged and placed on bed rest for 2mos
  
• I would like to structure my dx around the challenge of keeping a 4yo on bedrest with only minimal activity and bathroom priviledges allowed.
  
• activity intolerance and impaired physical mobility won't work because they deal with regaining mobility, that is not an option right now, and the dx of risk for impaired liver function does not deal with trauma.
  
• I have already formulated a care plan for the parents of caregiver role strain but i am totally stumped on the child
  

**Any guidance on this would be greatly appreciated

[dmw2489]

umm what about risk for impaired skin integrity, if it was an open fracture risk for infection, not sure what types of meds he is on specifically pain control but if so depending on which med - risk for constipation, risk for deficient fluid volume can be a great dx because there can be multiple risk factors from your pt for example... if he is vomiting from the med that can be a factor, possibly imbalanced nutrition- especially if diet is not adequate for wound healing, how about pain!?!?!? acute pain r/t trauma!!!! he must be in pain the poor little guy, knowledge deficit, risk for disuse syndrome may work for this case r/t the humerus fx.

I dont know about you pt, there wasnt to much information... but look at EVERYTHING, i promise you can come up with so much more... how were his labs... look at anything that is related to liver, i havent studied GI yet in school so im not sure if they would do a billi level on him with this dx, but it would proably be good to see, also WBC and inflammation markers, how was his chem 7 and cbc anything abnormal? did they test stool for occult blood? did they do any LFT's?... what meds is he on? how do those meds metabolize? do any effect the liver? what are the side effects? did you assess him? -did he have pain? did he have equal, bilateral radial pulses, cap refill less than 3 seconds on both hands, did he have any numbness or tingling in the affected arm, how was the color in the affected arm? was the arm warm or cool? swelling/edema any where? look at all these and see what is abnormal and that can help you, you need the evidence to back up your nursing dx.... i gave just a few possible things but it will really be dependent on the info you have for him