Need Help With Nursing Diagnosis for Strep Throat!!!

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Hello, my name is Jennifer. I am new to allnurses.com, and I am in dire need of some assistance on my pediatric patient with strep throat! I had one clincial day with this patient, and the patient was going to be discharged that day. I was going to go with ineffective gas exchange, impaired swallowing, risk for infection( he was on an infectious disease floor) and knowledge deficit. However, my patient had normal vital signs, no complaint of pain, and no lab test except a positive strep test. He was only on one medication,ampicillian. This seriously limits the data that I can add to my ND. My instructor said to start looking at things like family structure and being in the hospital. I was going to add interrupted family processes but most of my data (lack of communication amongst family members, lack of support system, lack of parental attachment behaviors, father making decisions, mother absence) could be due to their culture. They are hispanic. I would appreciate any help!!

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Specializes in Critical Care, Emergency Care.

Was the child anxious about being there? Maybe anxiety r/t new environment?

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Specializes in Critical Care, Emergency Care.

More objective and subjective data will help with an appropriate dx

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Hello, my name is Jennifer. I am new to allnurses.com, and I am in dire need of some assistance on my pediatric patient with strep throat! I had one clincial day with this patient, and the patient was going to be discharged that day. I was going to go with ineffective gas exchange, impaired swallowing, risk for infection( he was on an infectious disease floor) and knowledge deficit. However, my patient had normal vital signs, no complaint of pain, and no lab test except a positive strep test. He was only on one medication,ampicillin. This seriously limits the data that I can add to my ND. My instructor said to start looking at things like family structure and being in the hospital. I was going to add interrupted family processes but most of my data (lack of communication amongst family members, lack of support system, lack of parental attachment behaviors, father making decisions, mother absence) could be due to their culture. They are hispanic. I would appreciate any help!!
HI! Welcome to AN!

First...how does strep throat impair gas exchange.....what evidence do you have for that?

Your nursing diagnosis..... for impaired swallowing, and knowledge deficit....are good. What complications can arise form a strep infection? Strep throat: Complications - MayoClinic.com .......can it lead to other (more dangerous) illnesses? What knowledge deficit to avoid that is necessary in the proper treatment of strep throat? like completing the antibiotics although the patient seems better. A child hospitalized with strep throat is kind of unusual....what was the presenting factor that determined the patient required admission? Severe dehydration? What else is altered due to a difficulty in swallowing? Nutrition? Hydration? Is the child febrile still?

How does hospitalization affect this child age group? How do they cope? Think of Erickson's growth and development.

I was going to add interrupted family processes but most of my data (lack of communication amongst family members, lack of support system, lack of parental attachment behaviors, father making decisions, mother absence) could be due to their culture
Just because it may be their culture....how will that effect this child's recovery...treatment. How will you modify care for this patients culture....Just because it's this patients culture doesn't mean it doesn't need to be addressed or included in the plan of care.

Do you see where I'm going with this? What semester are you?

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Check the post I just put in "facial edema" thread...Don't want to copy and paste it all over again. In your case, you'll want to look at several of the things I threw out there, but you can find more in your NANDA-I. Which you WILL get. You WILL thank us later. :)

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Specializes in Pedi.

What was going on with this kid that he had to be admitted to the hospital for strep throat? There's gotta be something there which could lead to a nursing diagnosis.

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Thank you all so much for your help! Honestly, we only had one day to be on this floor with our patients and by the time I had gotten there he was pretty much ready for discharge. I have never had a pediatric patient before, or been required to do a concept map on someone with so little data. I looked in his chart for any background information, reason for admittance but there was nothing! He did have IV fluids 0.9 NS, and the IV antibiotic but I did not find any reason for admitting him to the hospital. It was my instructors guidance that led me to impaired gas exchange, and possibly due to the amount of swelling in the throat. They had my patient NPO at one time, I think they were going to possibly drain any fluid collection there was, however; there was no fluid collection. I am in my last semester and will graduate in May. Also, my patient is Hispanic but speaks English very well. It was the father who did not speak it very well. So I am going to include in my care plan Impaired Verbal Communication, but is it ok to focus on the father for this diagnosis? I really want to do well, and I am already well into reality shock of nursing! I want to be as prepared as I can and so I thank you all for helping me!

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Also, I am rationalizing the Impaired Gas Exchange myself. I think my instructor may have led me to this diagnosis due to the inflammation in the throat, with this inflammation the patient's breathing could be impaired and thus lead to a decrease in the exchange of oxygen and carbon dioxide.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Thank you all so much for your help! Honestly, we only had one day to be on this floor with our patients and by the time I had gotten there he was pretty much ready for discharge. I have never had a pediatric patient before, or been required to do a concept map on someone with so little data. I looked in his chart for any background information, reason for admittance but there was nothing! He did have IV fluids 0.9 NS, and the IV antibiotic but I did not find any reason for admitting him to the hospital. It was my instructors guidance that led me to impaired gas exchange, and possibly due to the amount of swelling in the throat. They had my patient NPO at one time, I think they were going to possibly drain any fluid collection there was, however; there was no fluid collection. I am in my last semester and will graduate in May. Also, my patient is Hispanic but speaks English very well. It was the father who did not speak it very well. So I am going to include in my care plan Impaired Verbal Communication, but is it ok to focus on the father for this diagnosis? I really want to do well, and I am already well into reality shock of nursing! I want to be as prepared as I can and so I thank you all for helping me!
No H&P? No ED record? No nursing admit record? Nothing in the MD progress notes?

I don't see impaired gas exchange at all....NANDA I definition: Excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane

Defining Characteristics

Abnormal arterial blood gases; abnormal arterial pH; abnormal breathing (e.g., rate, rhythm, depth); abnormal skin color (e.g., pale, dusky); confusion; cyanosis; decreased carbon dioxide; diaphoresis; dyspnea; headache upon awakening; hypercapnia; hypoxemia; hypoxia; irritability; nasal flaring; restlessness, somnolence; tachycardia; visual disturbances

Related Factors (r/t)

Ventilation-perfusion imbalance; alveolar-capillary membrane changes

Strep throat causes none of those.

Impaired swallowing? Yes.

Impaired oral mucous membranes? Yes.

Ineffective Airway clearance....(Inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway)? Yes.

impaired gas exchange? No.

And yes, especially in peds, the inclusion of the parent IS important.

Here are some sheets to help you organize/structure your information before or after graduation.....affectionately called brain sheets

doc.gif mtpmedsurg.doc

doc.gif 1 patient float.doc‎

doc.gif 5 pt. shift.doc‎

doc.gif finalgraduateshiftreport.doc‎

doc.gif horshiftsheet.doc‎

doc.gif report sheet.doc‎

doc.gif day sheet 2 doc.doc

‎critical thinking flow sheet for nursing students

student clinical report sheet for one patient

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I really want to be as smart as you someday lol! And this patient had no significant medical history. In the H&P, there was only what he presented with (dyspnea, c/o pain in throat, unable to eat solids). Nurses notes were the same, just re-establishing what the patient presented with. I was astonished at the lack of information, history and medical that I had to use for this paper. I am now going with Impaired Oral Mucous Membranes, Imbalanced Nutrition, Impaired Verbal Communication, and Knowledge Deficit regarding medication completion. We are only allowed to do four, however I am aware there are more that could be used. This has certainly been a challenge, and I have never struggled so much with a care plan....not even when I did my first one. I thank you for bringing to light the impaired gas exchange issue, i tried to fit the patient into the diagnosis because its what my instructor had said. I see now that my patient does not fit into that diagnosis and the ones I have decided to go with fit the patient, not the other way around!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I really want to be as smart as you someday lol! And this patient had no significant medical history. In the H&P, there was only what he presented with (dyspnea, c/o pain in throat, unable to eat solids). Nurses notes were the same, just re-establishing what the patient presented with. I was astonished at the lack of information, history and medical that I had to use for this paper. I am now going with Impaired Oral Mucous Membranes, Imbalanced Nutrition, Impaired Verbal Communication, and Knowledge Deficit regarding medication completion. We are only allowed to do four, however I am aware there are more that could be used. This has certainly been a challenge, and I have never struggled so much with a care plan....not even when I did my first one. I thank you for bringing to light the impaired gas exchange issue, i tried to fit the patient into the diagnosis because its what my instructor had said. I see now that my patient does not fit into that diagnosis and the ones I have decided to go with fit the patient, not the other way around!
If your instructor asks you about the impaired gas exchange be prepared to present you reasoning. That is another part of nursing....standing up for what you believe is right.
I see now that my patient does not fit into that diagnosis and the ones I have decided to go with fit the patient, not the other way around
This makes me feel good that you heard what I said and then followed through by trying to fit it yourself and after evaluation...you decided it didn't fit. You are now thinking like a nurse!

You should always use assess what your patient needs then decide what diagnosis fits.....not find a diagnosis and try to fit the patient into the diagnosis.

I might think about impaired swallowing for that can lead to dehydration and aspiration and after aspiration into the lung.....they can have impaired gas exchange.

Yeah....don't be astonished at the lack of information...with drive through admissions that are in and out in 24 to 36 hours most of the documentation is done post admission.

I've been a nurse a LONG time!!!!!!!!!!!!!!!!!!!! I didn't come by this over night. Yes we had to do care plans too....they use different terminology but the reasoning is the same. YOu are well on your way to being a good nurse by the reasoning you just used.

((HUGS))

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I tried to fit the patient into the diagnosis because its what my instructor had said. I see now that my patient does not fit into that diagnosis and the ones I have decided to go with fit the patient, not the other way around!

:: cue the band :: Hooray! :rckn:

Remember this- it doesn't apply just to this patient and this instructor, it's for every patient you ever have from here forward.

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