pediatric nursing diagnoses

Published

i have to develop three nursing diagnoses for the following scenario and literally have been thrown into the fire with a do to learn it approach from my instructor.. we have not even had peds yet!!!

the scenario is this

Pediatric Physical Assessment Case Study #1

Focus Assessment of the Musculoskeletal System

CC: Bonnie L. is a 6-year-old female who presents to the nursing clinic with a 5 day HX of generalized weakness, fatigue, and pains in her arms and legs. Bonnie and her mother deny a history of fall or other injury. Bonnie is shy and hesitant to get up on the exam table. She wants to sit on her mother's lap.

I must develop an actual, wellness and risk diagnoses complete with goal and outcome...

Can anyone offer guidance or direct me to a good resource? I have been working on this for what feels like hours and I am so discouraged :cry:

Up Vote Up Vote ×

pain?

act intolerance?

imp mobility?

knowledge deficit?

risk for self care deficit?

risk for alt family process?

(sorry, i don't have a list handy...but these dxs could be appropriate, regardless of pt's age...except alt fam process)

don't let the peds part scare you.

leslie

Up Vote Up Vote ×
Specializes in med/surg, telemetry, IV therapy, mgmt.

hi, carriblue, and welcome to allnurses! :welcome:

ok, i get that you haven't had peds yet, but did you read the title of this assignment very carefully, it says:

pediatric physical assessment case study #1

focus assessment of the musculoskeletal system

have you had lecture(s) on the nursing process and care planning? assessment is the first (and major) step of the nursing process. there are no such things as "pediatric nursing diagnoses". the nursing diagnoses at their most simple classification are either (1) actual problems, or (2) potential problems. gordon, as in gordon's functional patterns, classified the nanda diagnoses into 11 classifications, none of them pediatric. the choice to use any nursing diagnosis is based upon the symptoms that serve as evidence supporting the existance of that problem (nursing diagnosis). any diagnosis can be used for a pediatric, adult or geriatric patient as long as the person has the essential symptoms.

what you have to do to complete this assignment is to work the steps of the nursing process in the sequence they occur.

  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)
  2. 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)
  3. planning (write measurable goals/outcomes and nursing interventions)
  4. implementation (initiate the care plan)
  5. evaluation (determine if goals/outcomes have been met)

it seems obvious to me that your instructor wants you to focus your efforts on the musculoskeletal system. you can find information on a musculoskeletal and pediatric assessment on this thread of allnurses (part of your assessment activity):

the scenario has given you some symptoms and developmental stage behavior information which you do not want to ignore:

  • 5-day history of generalized weakness
  • fatigue
  • pains in her arms and legs
  • no history of fall or other injury
  • shy and hesitant to get up on the exam table
  • wants to sit on her mother's lap

if i were you i would do some reading and exploration of fatigue and weakness in children to see what you come up with. muscle weakness can be due to heart problems, myalgias, malnutrition, muscular atrophy, polio or a brain or spinal tumor. a congenital condition that has weakness and fatigue as a symptom is hypertrophic polyneuritis. these are also symptoms of diabetes and hypothyroidism. since these are not a normal finding in a child, it may yield you your at risk diagnosis. to use a "risk for" diagnosis you must have a specific problem in mind. so, for example, let's say you think this kid is in danger of having polio (really, not likely) and you are worried about her developing pneumonia because of progressive paralysis of the lung tissue. you would diagnose risk for infection and develop nursing interventions to monitor for the signs and symptoms of pneumonia as well as do some preventative measures. long-term goal: no pneumonia.

you need the symptom list going into step #2 of the nursing process. the first three symptoms are evidence for at least one actual nursing diagnosis (pain) and a potential one (see discussion above). there is a list of all the wellness diagnoses on post #84 of this thread:

pick one. i think you can safely get away with making up supporting symptoms, but ask your instructor if you want to be sure. also ask how creative you are allowed to get with this assignment. what kind of data can you add to spice it up?

goals/outcomes (they are basically the same thing) are intimately associated with the nursing interventions. they are linked to the symptoms the patient has. goals/outcomes are the results you expect to occur when the nursing interventions you order for the symptoms are performed. i believe their is a subtle difference between goals and outcomes. goals are the predicted results of collaborative nursing actions; outcomes are the predicted results of our independent nursing actions.

you can read about how to write a care plan which is basically what you are being asked to do here on this thread:

hope this has helped you. good luck with your assignment.

Up Vote Up Vote ×

Leslie and Daytonite,

Thank you both for your help! :bowingpurI have read your postings and searched the links... all I can say is wow! This is a great site, resource and learning tool. I am grateful there are people out there who are willing got take the time to help out people such as myself.

Actual

diagnosis:

Activity Intolerance r/t acute pain AEB pts report of pain of 6 out of 10 in arms and legs

Goal:

reduction of pain

Outcome:

Will report reduction in pain level, on a scale of 1-10, of a 2 or less by April 1,2008

Wellness

Diagnosis

Readiness for enhanced sleep

Goal:

11-12 hrs sleep/day

Outcome

Will sleep, 11-12 hours total, each day for 1 consecutive week by April 1, 2008

Risk

diagnosis:

Risk for delayed growth and development r/t activity intolerance

Goal:

activity levels considered normal by pt

Outcome:

Will report levels of activity, consistent with those prior to illness, unassisted, for 3 consecutive days by April 1, 2008

Up Vote Up Vote ×
Specializes in med/surg, telemetry, IV therapy, mgmt.
activity intolerance r/t acute pain aeb pts report of pain of 6 out of 10 in arms and legs

"pts report of pain of 6 out of 10 in arms and legs" is a symptom of pain, not activity intolerance. do you have a nursing diagnosis reference? every nursing diagnosis has a set of signs and symptoms that nanda calls defining characteristics. you cannot assign a nursing diagnosis to a patient unless they had one or more of the defining characteristics. it would be more appropriate to use acute pain r/t unknown musculoskeletal disorder aeb patient report of pain in arms and legs of 6 on a scale of 10.

risk diagnosis: risk for delayed growth and development r/t activity intolerance

i'm not crazy about you using this. activity tolerance is not a risk factor for this diagnosis. there is a nursing diagnosis for this: risk for activity intolerance. use that instead.

Up Vote Up Vote ×

per your earlier suggestion regarding being creative with this assignment, we were told that we do not need to know what is wrong with the pt (medical diagnosis) to determine what we as nurses need to do.... "what would you do as a nurse."

"pts report of pain of 6 out of 10 in arms and legs" is a symptom of pain, not activity intolerance. do you have a nursing diagnosis reference? every nursing diagnosis has a set of signs and symptoms that nanda calls defining characteristics. you cannot assign a nursing diagnosis to a patient unless they had one or more of the defining characteristics. it would be more appropriate to use acute pain r/t unknown musculoskeletal disorder aeb patient report of pain in arms and legs of 6 on a scale of 10.

no, all i have is a nanda list of diagnoses with nothing else attached... no r/t or defining characteristics.. nothing... one reason this is so hard. is there a particular reference you would recommend over others?

i see why i cannot use the pt report of pain for activity intolerance .. i was just thinking that the pain caused the activity intolerance. well, now i know i had it backwards. if nothing else this is an incredible learning experience and i no longer feel llike beating my head against a wall:banghead:.

is unknown musculoskeletal disorder really a related factor? wow, i had no idea.

i'm not crazy about you using this. activity tolerance is not a risk factor for this diagnosis. there is a nursing diagnosis for this: risk for activity intolerance. use that instead.

ok. thanks i will...

risk for activity intolerance r/t pt report of fatigue

? but if you can't tolerate activity wont that delay your muscular development and coordination? or is this not relevant in writing these diagnoses

i see that once again i approached my goal and outcome statement from point of the related factor. boy, i hope one day i can get these right.

goal: activity tolerance

outcome:will report levels of activity, consistent with those prior to illness, unassisted, for 3 consecutive days by april 1, 2008

thanks again daytonite

Up Vote Up Vote ×
Specializes in med/surg, telemetry, IV therapy, mgmt.
we were told that we do not need to know what is wrong with the pt (medical diagnosis) to determine what we as nurses need to do.... "what would you do as a nurse."
that is correct! go back to the nursing process and review what goes on in each of the steps. we address and treat the patient's response to their disease, situations and what is happening to them. the doctor's treat the disease.

no, all i have is a nanda list of diagnoses with nothing else attached... no r/t or defining characteristics.. nothing... one reason this is so hard. is there a particular reference you would recommend over others?

nanda, the north american nursing diagnosis association, publishes the nursing diagnosis taxonomy. the taxonomy currently contains 188 nursing diagnoses for which nanda has developed for each

  • a definition (actually, this is a more descriptive statement of the nursing problem)
  • defining characteristics (actually, these are merely the signs and symptoms that support the problem)
  • related factors (the etiology, or underlying cause, of the problem) - often you need to understand the pathophysiology of the disease process going on to choose the correct related factor connected with a physiological nursing diagnosis
  • risk factors - these are etiologies that are only listed with the anticipated, or potential, (have yet to occur) nursing problems. these are the nursing diagnoses that begin with the words "risk for" and are used when the patient is vulnerable to possibly developing a problem.

what you need to do is get a copy of it. where is the taxonomy? it can be purchased from nanda. it is published in nanda-i nursing diagnoses: definitions & classification 2007-2008. most of the taxonomy information only takes up one page, two at the most, for each diagnosis. this is the reference i use the most because it is compact and only about 340 pages long with just the information listed above. it has no other nursing information (no interventions, no goals). you can only purchase this book from nanda and the cost is about $25. however, many authors of care plan and nursing diagnosis books have already paid nanda a royalty in order to print the taxonomy information in their books. they usually print this information right below the title of a nursing diagnosis. it doesn't take up much space. in addition you are getting nursing interventions and rationales for a variety of medical diseases in the care plan books along with goals and other extra goodies. there are also two websites that have information for about 75 of the most commonly used nursing diagnoses that you can access for free:

is unknown musculoskeletal disorder really a related factor?

the related factors that nanda lists for acute pain are "injury agents (biological, chemical, physical, psychological)". it just seemed logical to me that an unknown musculoskeletal disorder would be a biological injury agent, or illness. i didn't want to say illness because that hasn't been established.

? but if you can't tolerate activity wont that delay your muscular development and coordination? or is this not relevant in writing these diagnoses

i'm pretty confident in saying no. normally, i would tell you to research this before making this claim. however, nanda has already done it and lists the risk factors for this diagnosis (quite a long list, too) in the taxonomy. not tolerating activity just isn't on the risk factor list of the risk for delayed development nursing diagnosis (page 70, nanda-i nursing diagnoses: definitions & classification 2007-2008).

i see that once again i approached my goal and outcome statement from point of the related factor.

you can do that. your goal might be to remove, neutralize or do away with the element(s) causing the risk or potential danger. that's ok. that's well within the spirit of these types of nursing problems. for example, if a patient's activity intolerance is related to deconditioning (this is an actual risk factor of the diagnosis of risk for activity intolerance), a goal of the patient can be to "increase physical conditioning by the end of two weeks as measured by. . ." this goal targets the related factor. other targets can be to prevent specific symptoms. goals can also reflect the expected results of the nursing interventions that are going to be performed as well.

when you get a chance to sit and think on all this information you will realize that there is rationality to it all. it takes a little bit of time for it all to sink in and the light bulbs to turn on. but once you get it, you'll be explaining it to others.

Up Vote Up Vote ×

I have the Nursing Diagnosis book by Ackley. It's very useful! As a nursing student just completing my first semester I totally understand that Nursing Diagnoses are hard to get a handle on.

Up Vote Up Vote ×
+ Join the Discussion