Peds otitis media care plan

Daytonite, BSN, RN · Sep 10, 2009

a care plan is about determining the patient's nursing problems as you find them at the moment in time you are caring for them--like a snapshot. each nursing diagnosis (nursing problem) is based on abnormal data (evidence) you have observed or find in the record. we use the nursing process to help us organize all of this care planning (problem solving) activity. i demonstrate how this is done all the time in care plan posts and you can also see examples of it on this thread: https://allnurses.com/general-nursing-student/help-care-plans-286986.html - help with care plans. you actually have a lot of evidence for nursing problems.

step #1 - assessment. assessment consists of:

a health history (review of systems) - a 3 year and 11 month old male admitted with otitis media and strep throat that is a bit developmentally delayed.
performing a physical exam - where is your exam information? did you look in his ear? did he have any redness, drainage? what did his mom tell you about his ear problem? did you look in his throat? you also said he didn't eat well. do you suppose that might have something to do with his sore throat? he also had guarding behavior (guarding what?), irritability and moaning.
assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming) - what was he able to do for himself? since this is peds and he is almost 4 years old there are 3 and 4 year old milestones that he should have been assessed for. were they assessed? what can and can't he do? that will tell you if he is developmentally delayed. what stage of erickson do you think he is in? did his behavior reflect it? your instructor is probably going to look for this information somewhere on the care plan. are malformed words and sentences normal for someone his age who is learning our language?
reviewing the pathophysiology, signs and symptoms and complications of their medical condition - there are specific signs and symptoms of otitis media and strep throat and he should have had some of them and is being treated medically for some of them. you need to read about these conditions to learn the pathophysiologies of them because you need them for the related factors of your diagnostic statements. you also need to be aware of the complications that can occur from these conditions, such as meningitis.
reviewing the signs, symptoms and side effects of the medications/treatments that have been ordered and that the patient is taking - the rocephin and motrin

step #2 - determine the problems - first list your abnormal data which is really the evidence of the nursing problems:

he didn't eat well during my shift
guarding behavior
irritability
moaning
malformed words and sentences
difficulty in understanding patient's speech

from those come the diagnoses:

imbalanced nutrition: less than body requirements r/t difficulty swallowing aeb poor food intake during shift (i'd be more specific about how little this intake was)
- as an alternative i would consider impaired swallowing r/t inflamed throat, but look at the defining characteristics for this diagnosis very carefully to see if any of them might apply to this patient
[*]acute pain r/t inflamed ear and throat aeb guarding of ear, irritability and moaning
[*]impaired verbal communication r/t developmental age aeb malformed words and sentences and difficulty in understanding patient's speech

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pain r/t ear infection and strep throat aeb guarding behavior, irritability, and moaning

this is an incorrect nanda diagnosis. the correct diagnosis is acute pain.
the related factor cannot be medical diagnoses. both "ear infection" and "strep throat" are medical diagnoses. the cause of the pain is the underlying inflammation process that goes along with infections which includes these 4 things: redness, heat, swelling and pain.
you need to be specific about your evidence. what is he guarding? his ear--and he doesn't want it touched!

my psychosocial dx is going to be impaired verbal communication r/t developmental delay aeb malformed words and sentences and difficulty in understanding patient's speech..just popped this off the top of my head, will probably get some fine tuning..suggestions welcome!

is it really a developmental delay? do you have the proof? your instructor is going to want it. my niece didn't speak a word until she was 4. another niece said "gotfor" for the longest time when she really meant "forgot" which was interesting. kids experiment and do odd things with words as they learn to master language up to the age of 5.
you pop nothing off the top of your head. this is all logical and rational thinking based on scientific principles that you go to books and look up if you have to.

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that lying in bed all day watching cartoons made me think he was kind of bored. there's a diagnosis for that. deficient diversional activity r/t lack of diversional activities aeb patient boredom.

Stearnsy · Sep 12, 2009

imbalanced nutrition: less than body requirements r/t difficulty swallowing aeb poor food intake during shift (i'd be more specific about how little this intake was)
as an alternative i would consider impaired swallowing r/t inflamed throat, but look at the defining characteristics for this diagnosis very carefully to see if any of them might apply to this patient
[*]acute pain r/t inflamed ear and throat aeb guarding of ear, irritability and moaning
[*]impaired verbal communication r/t developmental age aeb malformed words and sentences and difficulty in understanding patient's speech

i used imbalanced nutrition: less than body requirements r/t physical factors (pain), environmental factors (hospital as foreign environment), and psychological factors (boredom) aeb meal consumption not exceeding 20% of each meal.

i know this particular diagnosis is more like a run-on sentence, but however many times i read it, it makes sense. is there a limit to the amount of etiologies you list that i am not aware of? the rationale for this diagnosis in my care plan book (gulanick & myers, ed.6) went into physical, environmental, and psychological/intrapsychic factors so i used what i felt applied. in the assesment data portion of this diagnosis' page in my care plan i made sure to include many subjective statements i got from mom about eating habits at home and how they have been altered since admission to our facility.

i fixed my pain diagnosis to acute pain and removed the medical diagnosis as an etiology. i have read on this very forum in the past about the pes (problem - etiology - s/sx) methodology that a nursing diagnosis is to be modeled after. i just....forgot. thanks for pointing that out.

for my psychosocial i ended up using deficient diversional activity r/t lack of diversional activities and confinement to hospital room aeb pt. boredom

also,

you pop nothing off the top of your head. this is all logical and rational thinking based on scientific principles that you go to books and look up if you have to.

by this i meant i had not put any prior thought into what i might use as a psychosocial diagnosis and that i conjured that particular diagnosis up as i was typing.

thanks!

ts

Daytonite, BSN, RN · Sep 12, 2009

i used imbalanced nutrition: less than body requirements r/t physical factors (pain), environmental factors (hospital as foreign environment), and psychological factors (boredom) aeb meal consumption not exceeding 20% of each meal.
i know this particular diagnosis is more like a run-on sentence, but however many times i read it, it makes sense. is there a limit to the amount of etiologies you list that i am not aware of? the rationale for this diagnosis in my care plan book (gulanick & myers, ed.6) went into physical, environmental, and psychological/intrapsychic factors so i used what i felt applied. in the assesment data portion of this diagnosis' page in my care plan i made sure to include many subjective statements i got from mom about eating habits at home and how they have been altered since admission to our facility.

no it doesn't make sense. forgive me, but it sounds like you copied it right out of your gulanick & myers, ed.6. first of all, the etiologies aren't specific enough. second, boredom doesn't cause someone not to eat--it's usually the opposite. third, if you took care of this patient you should specify the exact type of pain involved. my copy of gulanick & myers is buried at the moment and i just had surgery and can't move very well over here to dig it out, but i know these diagnoses and the taxonomy fairly well. the etiology is supposed to explain why the problem (not eating enough) is happening. when a nurse who happens along and reads your diagnostic statement they should get a good idea of what is going on without having seen or examined this patient. this kid has a sore throat. strep throat hurts like the dickens. you don't want to swallow--period--end of story. that's your "physical factors (pain)". gulanick & myers was just giving you a guideline when it said "physical factors (pain)". you need to customize this to the patient. it's because of the sore throat that he won't eat. it's that simple and your instructor is going to look for that, not that you copied the wording out of a book. they want to see that you put some thinking into this. anyone can copy words from a book, but you are going to be paid to think.

Stearnsy · Sep 12, 2009

Hey, if I wasn't ready for your criticisms I wouldn't have asked for help..I'm a big boy. No need to forgive you, instead I should be giving kudos....

I have already turned my care plan in but I would rather understand this than say "screw it, I already handed it in."

Should I even bother including the foreign environment as an etiology? The more and more I read this and try to correctly word it, the more I feel like I am trying to "fudge" it in. Should I have just left that out and said,

"Imbalanced nutrition: less than body requirements R/T painful throat inflammation AEB patient's unwillingness to eat" ? Sounds cleaner and more straight to the point....

A nurse reading this would say,

what is this problem? patient is not consuming an adequate caloric intake.

why is this problem happening? the patient is suffering from a painful, inflamed throat.

How is this known to be true? the patient isn't eating.

Right?

He wasn't completely incapable of eating, as he ate literally like 5 fruit loops for breakfast. He ate, but barely anything. How else can I word the S/Sx portion of that diagnosis to be more accurate?

"...AEB patient not consuming an adequate amount of calories"

"...AEB patient not eating more than [certain %] of each meal"

?

Daytonite, BSN, RN · Sep 12, 2009

Inflammation, other than it's component of swelling, isn't important to why the patient isn't eating, is it?

Be scientific and measurable when describing the symptoms because your goal statements also have to be measurable and reflect back on the original symptoms (goals must show improvement or stabilization).

Stearnsy · Sep 12, 2009

So replace "painful throat inflammation" with "difficulty swallowing" as you said in your initial post and it would be an appropriately constructed nursing dx?

imbalanced nutrition: less than body requirements r/t difficulty swallowing aeb patient's unwillingness to eat

I think I might still be being too vague..but how do I paint the picture of strep throat in one line without explicitly saying strep throat, which is a medical dx?

SolaireSolstice, BSN, RN · Sep 12, 2009

We were taught that we could use medical diagnosis as the Secondary to. So you could have

imbalanced nutrition: less than body requirements r/t difficulty swallowing secondary to strep throat aeb patient's unwillingness to eat

Daytonite, BSN, RN · Sep 13, 2009

how do i paint the picture of strep throat in one line without explicitly saying strep throat, which is a medical dx?

we can't use medical diagnoses except in one particular semantic way (which i will demonstrate for you).

imbalanced nutrition: less than body requirements r/t sore throat secondary to strep throat infection aeb _____
imbalanced nutrition: less than body requirements r/t difficulty swallowing secondary to strep throat infection aeb _____

make your evidence more specific than "unwillingness to eat" if the patient is eating anything. remember, when it comes time for evaluation (step #5 of the nursing process) there will be another assessment of the child's ability to eat and it will be measured against the initial assessment done in step #1 to determine if the goals you established in step #3 were met. this is all a logical, rational process that must make sense.

linda5508 · Sep 15, 2009

I hate strep throat, it can be quite troublesome

Stearnsy · Sep 16, 2009

SolaireSolstice & DayTonite, it seems that "secondary to" was the missing link! I am grateful for your help and apologize for the double post...my original thread I realized was not in the "assistance" forums. I think I am going to redo this entire careplan so my clinical instructor doesn't think I am an idiot! I will report back--thanks again.

TS