Peads Gastro Care plan

Daytonite, BSN, RN · Apr 5, 2007

michelle. . .is this a case study of a non-existent patient? were you given, or do you know a medical diagnosis? when you are putting together case studies of imaginary patients, you start by looking up the medical diagnosis and getting a list of the signs and symptoms related to that diagnosis. when the subject is a real patient you get a list of signs and symptoms from the patient's clinical records and from the assessment data you collected yourself. those signs and symptoms become many of the problems you will address with nursing interventions. you also want to check out what tests the doctor is going to order to diagnosis and treat this condition as well as the medications and other treatments that he is going to order. all of these will also have some impact on the nursing care you will give. some instructors also want students to give information on the pathophysiology of the disease process the subject or patient is experiencing. this information has to be found in a book of pathophysiology and sometimes can be found among the articles on the emedicine website (http://www.emedicine.com/)

here is a site where you can search for medical diagnoses and get a listing for a medical diagnosis that will include the signs and symptoms, diagnostic tests, and medical treatments that will be ordered. you will need to add the nursing part of it.

family practice notebook (use the search box at the top left to search for specific diagnoses) http://www.fpnotebook.com/index.htm

at these two sites are examples of student case studies of some actual patients they took care of that you can link into and look at to see how they were completed. there is a lot of variety in the way the students completed them:

if you still need more help, please ask.

Michelle123 · Apr 6, 2007

Thanks so much I am so bad and thick when it comes to care plans. We have done one assignment on them and that was last year. I feel that we really should have spent a bit more work on them.

It is a made up case study, Jamie, who is 18 months presented to the ED with vomiting, diarrhea, dehydrated, etc He was diagnosed with gastroenteritis and was ordered an NG tube, and that is about all we know.

So I have broken up the care plan in to columns; Need (ie diarrhea), Rationale, nursing intervention, Rationale and outcome. He wasn't ordered any medication as such only a gastrolyte solution through the NG tube. I have incorporated that into the diarrhea and vomting needs.

bethem · Apr 6, 2007

Thanks so much I am so bad and thick when it comes to care plans. We have done one assignment on them and that was last year. I feel that we really should have spent a bit more work on them.
It is a made up case study, Jamie, who is 18 months presented to the ED with vomiting, diarrhea, dehydrated, etc He was diagnosed with gastroenteritis and was ordered an NG tube, and that is about all we know.
So I have broken up the care plan in to columns; Need (ie diarrhea), Rationale, nursing intervention, Rationale and outcome. He wasn't ordered any medication as such only a gastrolyte solution through the NG tube. I have incorporated that into the diarrhea and vomting needs.

Good on you! You won't have to do them in third year. Or, you know, EVER AGAIN.... good old Newy Uni. Do you have to have a Nursing Diagnosis instead of/as well as the column you've titled 'need'?

Where do you go to prac this year?

Michelle123 · Apr 6, 2007

Yeah that is the nursing diagnosis column. My template has "need" from when I had a certain lecturer last year...

How is everything??? How did you go with the consortium? They have disbanded this year! How is life outside of uni?

Oh, I have my orientation for the Royal on Tuesday!!

Michelle123 · Apr 6, 2007

And I went to manning base ED and Kara for placement this semester.

Daytonite, BSN, RN · Apr 6, 2007

thanks for posting more information. i'm assuming you don't use nursing diagnosis, which is ok. you can still work with symptoms from assessment.

the first thing you need to do is look up information on dehydration, gastroenteritis and the care of n/g tubes because you need that to help with this case study. interestingly, when i search family practice notebook's site for gastroenteritis a link for acute diarrhea, one of this patient's problems, came up and the page had some references to children! you will find the pathophysiology, etiology, evaluation and lab studies that doctors will order for the evaluation of gastroenteritis at that page (links are listed below). if this patient is being given a gastrolyte solution through an n/g tube then he can't be vomiting at present. so, the tube is there to hydrate him.

here are the symptoms of gastroenteritis:

fever
chills
diarrhea (could have flecks or streaks of blood if bacterial in origin or appear mucusy)
spasmodic contraction of anal sphincter with involuntary straining to empty bowel (tenesmus)
abdominal pain or cramps
nausea
poor feeding
diaper rash
tachypnea

dehydration can be mild, moderate or severe. the signs and symptoms for it are:

mild dehydration: oliguria
decreased oral intake
dry lips
dry mouth
decreased tears or crying without tears
moderate dehydration: worsening signs are sunken eyes
absent tears
dry mucous membranes
weak rapid pulse
poor skin turgor with tenting
capillary refill greater than 2 seconds
listlessness
irritability
very dark urine
urine output of less than 1 to 2 cc/kg/hour
elevated bun
arterial ph below normal indicating acidosis
severe dehydration: the patient presents as limp and cold or in a coma
acrocyanosis
thready pulse
grunting
deep rapid respirations
decreased blood pressure
skin retraction greater than 2 seconds
capillary refill greater than 4 seconds
oliguria or anuria
urine specific gravity greater than 1.035
very highly elevated bun
arterial ph below 7.10

treatment: oral fluids, antibiotics if the gastroenteritis is bacterial in nature (antibiotics will not work with viral gastroenteritis), medications (antidiarrheals, lactobacillus)

now, what you need to do is address the symptoms that are listed above. to convert it all to the format your instructor is looking for, you will take a symptom (your form is calling it a need) and i think the column next to it for rationale is probably for the pathophysiology of, or why, that particular symptom is occurring in this illness. your next column for nursing intervention will be what you, the nurse, can do to help treat that particular symptom. some nursing programs are very funny about not wanting the students to include any interventions that involve what are called collaborative interventions. these are things you do for the patient that depend on the order of a physician or interventions that must be performed by another licensed healthcare worker such as a physical therapist. only you will know what your instructors are allowing you to do in regard to that. the rationales for the nursing interventions will be found in nursing textbooks and nursing journals. this is often a frustrating part of these papers because many college programs want the students to reference these rationales. and, the outcomes, of course, are pretty much the anticipated prediction of what you want to see happen after the nursing interventions are performed.

i've included some links to nursing diagnosis pages on care plan constructor sites that are appropriate to the symptoms listed above that will have nursing interventions on them that you should be able to use. you'll have to pick through them to see which ones will be appropriate. in some cases, they will include rationales. if you have access to a care plan book that would also be immensely helpful. you should also look at references on acid-base balance as these kids can get into respiratory or metabolic acidosis if the diarrhea goes on for very long or they get really dehydrated from the big loss of electrolytes. if you need weblinks for these i have some.

hope this information helps get you started. this is a big project and everything has to link together in it. good luck! if you still need more help, please ask.

http://www.fpnotebook.com/gi16.htm - acute diarrhea. at the left side of the page are more links. scroll down to the section of pediatrics and you will see links to the treatment of diarrhea in children. check them out as you will need much of this information for your case study.

http://www.fpnotebook.com/ped9.htm - pediatric dehydration

http://www.fpnotebook.com/gi177.htm - pediatric diarrhea fluid replacement

http://www.fpnotebook.com/gi178.htm - management of mild diarrhea in age less than 2 years

http://www.fpnotebook.com/gi179.htm - management of moderate diarrhea in age less than 2 years

http://www.fpnotebook.com/ped10.htm - pediatric dehydration management

http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=16 - diarrhea

[color=#3366ff]http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/careplan_023.php - diarrhea

http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=21 - deficient fluid volume (dehydration)

[color=#3366ff]http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/careplan_030.php - deficient fluid volume (dehydration)

[color=#3366ff]http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/careplan_039.php - hyperthermia (fever)

[color=#3366ff]http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/careplan_048.php - nausea

[color=#3366ff]http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/careplan_051.php - impaired oral membrane