Nursing Interventions - Disruptive family processes

Nursing Students Student Assist

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For the diagnosis of disruptive family processes.

I'm stuck- finishing up on my care plan and looking for help with some nursing interventions.

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Related to ....

AEB......

Can you give a little more info? Do you have and are you allowed to use a nursing care plan book?

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My nursing diagnosis is...

Interrupted family processes r/t situational transitioning(daycare+preschool)and modification in family finances aeb changes in availability for emotional support and change in pattern/rituals.

Here's some background info.

I was caring for a 4 year old patient admitted for Left upper lobe pneumonia. This problem was resolved by hospital day 4 which was the same day she was under my care and discharged. Other nursing diagnoses were not applicable during my care. Sooo I went a different direction. The child has been hospitalized 6 times prior to this hospitalization all for pneumonia and asthma related symptoms. Dad works 3rd shift and was recently laid off. Mom works during the weekend and both are currently starting back to school. The patient has been increasingly aggressive and sometimes combative according to the mother. The patient also stated to me that " she gets sad when she has to be in the hospital"

My current outcomes are:

1. Family Functioning

2. Family Coping

I am struggling with the interventions.. All I have so far is Family Process Maintenance.

Any ideas please let me know.. THANKS!

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I think you must do your care plans a little different than we do. Are you using NIC interventions such as:

Support System Enhancement

or writing out interventions such as:

(The nurse will) Refer the family to appropriate resources (counseling, financial assistance) for assistance

or do you write both?

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I think you need to add something about the childs illness in the nursing diagnosis as this is part of the family problem, such as R/T illness of family member.....

under the AEB something like: child family member with history of asthma and frequent hospitalization for exacerbation of symptoms and pneumonia

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Specializes in med/surg, telemetry, IV therapy, mgmt.

This little girl had pneumonia. She's had 6 previous hospitalizations for it including some asthma. Hello! Red flags. This is not normal. Something is going on with this kid's respiratory system. The pneumonia is not clearing up for some reason. Before I would worry about a dysfunctional family I want to do what I can to get this kid well. Something is not being done correctly once she is discharged. Discharge instructions should include things like following up on taking medication, continuing to deep breathe and cough and following up with the pediatrician. Pneumonia takes times to resolve. The discharge teaching needs to take the family's situation into account. This child sounds like a respiratory wreck waiting to happen. The diagnosis you are proposing wants to fix the family dynamics and that is not the issue as far as I can see.

The diagnosis you want to use is Interrupted Family Processes R/T situational transitioning(daycare+preschool)and modification in family finances AEB changes in availability for emotional support and change in pattern/rituals. I had to go to my NANDA guide to check this one out since I am not a psych nurse. I don't recommend that anyone use any of these psychosocial diagnoses if (1) you do not know how to assess what the diagnosis is about and (2) you do not know interventions or where to start looking for them for the problem you are diagnosing. I don't know what this problem is or the interventions for it!

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So heres more to the story..

All of the nursing diagnoses r/t pneumonia and or asthma, were resolved by hospital day 4, which was the day I was assigned to the patient. I had the child 2 hours before discharge. I was responsible for a daily assesment, Dcing the IV, and bath cares before discharge. I was also there for discharge instructions. I was thinking along those lines.. What can this family do to prevent re-hospitalization. Financial concerns, community resources for medications, well-child visits.. etc.

Father had been laid off his job, Child had gone into a daycare setting, Mother no longer the primary care giver during the day.

Thanks for your response.

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I also looked in Ackley under discharge planning.

Deficient Knowlege, Impaired Home Maintenance, and Ineffective Health Maintenance were the three diagnoses listed.

Impaired home maintenance r/t (isufficient family planning and finances, and unfamiliarity with neighborhood resources) aeb...

Could this work? Can you assume that the family is struggling with finances after husband has been laid off? The child's whole daily routine is completely different than what she is used to..

I'm wondering if I should just start completely over?! :banghead:

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Remember you can't assume anything. The AEB is objective and subjective data.

I think a diagnosis related to her asthma/pneumonia would be appropriate (more important on Maslow's Hierarchy) if you plan on starting over.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

just because the child is being discharged doesn't mean that her medical problem of pneumonia is resolved. what can this family do to prevent re-hospitalization? financial concerns, community resources for medications, well-child visits.. etc. this child needs to get well. i am sure that some of the things you mention (finances, medications, day care) contribute to the child's recovery. i would assess what happened after the other 5 or 6 hospitalizations that resulted in the child being readmitted. obviously, either the medical plan of care wasn't working or it wasn't followed as ordered. that needs to be clarified. the parents need to be clear on what the discharge instructions are and the nurse needs to make an evaluation that the discharge strategies are adequate to be carried out or new ones need to be put into place. make sure the parents know what has to be done and are willing and able to do it. maybe the parents don't have the money to buy the medication. maybe the child refuses to take her medication from the daycare providers. those are not interrupted family processes. but there are ways to assist the parents in fixing them. focus on the child and assist in getting her medical care accomplished. ineffective health maintenance is a good suggestion. deficient knowledge, specify is another. can you assume that the family is struggling with finances after husband has been laid off? can we as scientific thinkers ever assume anything? next time remember to delve into this so you have this information. the child's whole daily routine is completely different than what she is used to. how is that significant to her not getting better? if it is significant, what caused the change? how can that change be assisted by the nurse in any way that will be helpful to all concerned?

diagnosing should always be done using the nursing process. a care plan and it's solutions to a patients problems is only as good as the assessment data that goes into it. the collection of data is ongoing and never ends. i post this all the time for care planning:

  1. assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
    • a physical assessment of the patient
    • assessment of the patient's ability and any assistance they need to accomplish their adls (activities of daily living) with the disease
    • data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians
    • knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. if this information is not known, then you need to research and find it.

[*]determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use). it helps to have a book with nursing diagnosis reference information in it. there are a number of ways to acquire this information.

[*]planning (write measurable goals/outcomes and nursing interventions)

  • goals/outcomes are the predicted results of the nursing interventions you will be ordering and performing. they have the following overall effect on the problem:
    • improve the problem or remedy/cure it
    • stabilize it
    • support its deterioration

    [*]interventions are of four types

    • assess/monitor/evaluate/observe (to evaluate the patient's condition)
      • note: be clear that this is assessment as an intervention and not assessment done as part of the initial data collection during step 1.

      [*]care/perform/provide/assist (performing actual patient care)

      [*]teach/educate/instruct/supervise (educating patient or caregiver)

      [*]manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)

[*]implementation (initiate the care plan)

[*]evaluation (determine if goals/outcomes have been met)

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