Peds care plan help

care planning is problem solving. it is based on using the nursing process as a problem solving tool in accomplishing this. we use assessment as our fact finding activity. we need facts (evidence) to support the problems that we diagnose. think of yourself as a kind of detective. without finding the evidence to support the nursing problems, you can't diagnose them. intuitively, you know they exist (pain, impaired nutrition), but you can't quite figure out how to get to them. let me show you how using the nursing process.

the nursing process consists of 5 steps: assessment, problem identification (nursing diagnosis), planning, implementation, and evaluation.

step 1 assessment - the collection of data. assessment consists of:

• a health history (review of systems) - cerebral palsy, hx of ger, failure to thrive, weight was 75th percentile at birth
  
• performing a physical exam - development and cognitive level is that of a 3-4 month old, weight is well below the 3rd percentile now, cries when strangers approach her crib - what else? did you measure her responses against those of what a normal 3-4 month old child should do? she's in erickson's trust vs. mistrust stage. how does she fit in with it, or not? is crying when someone approaches her normal for that stage? she has a g-tube. . .how does the site look. . .does it need care? does she try to pull at it? describe her pain. where is her pain? how can you assess its intensity? how will you know when she is in pain to even medicate her? how will you communicate with her--communication is a psychosocial issue.
  
  • http://www.med.umich.edu/yourchild/topics/devmile.htm - developmental milestones
    
    • http://www.medem.com/medlib/article/zzzqt68uydc - what a baby should be doing at 3 months of age
      
    • http://www.medem.com/medlib/article/zzzu126uydc - what a baby should be doing by 12 months of age
      

  [*]assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming) this is a 14 month old child. . .who takes care of her adls because a 14 month old can't walk, cook or wash clothes. she is dependent on an adult for all care: bathing, dressing, eating, toileting and mobility.

  [*]reviewing the pathophysiology, signs and symptoms and complications of their medical condition - look up cerebral palsy, failure to thrive and ger(d) so you know what these conditions are. learn about their signs and symptoms and think back to whether or not your little patient actually had any of those symptoms. this is how you learn to improve your assessment techniques for future patient contacts. you also need to know the pathophysiology of these conditions in order to choose nursing diagnoses and understand what etiologies (related factors) you will need to go with them when you compose your diagnostic statements. the big burning question in my mind is how did this kid get into a failure to thrive situation in the first place? what's the history on that and what is the parental involvement with it because the parents are the ones responsible for feeding this baby?

  • cerebral palsy
    
    • http://www.merck.com/mmpe/sec19/ch283/ch283b.html - cerebral palsy (cp) syndromes
      
    • http://kidshealth.org/parent/medical/brain/cerebral_palsy.html
      
      

    [*]failure to thrive - you really need to read more about this condition that has been diagnosed in this child.

    • http://www.merck.com/mmpe/sec19/ch286/ch286a.html - failure to thrive - includes psychosocial info/abuse info
      
    • http://kidshealth.org/parent/growth/growth/failure_thrive.html - failure to thrive - information on feeding and growth
      

    [*]gerd

    • http://www.merck.com/mmpe/sec02/ch012/ch012g.html - gastroesophageal reflux disease (gerd)
      
    • http://kidshealth.org/parent/system/surgical/gerd_reflux.html
      

  [*]reviewing the signs, symptoms and side effects of the medications/treatments that have been ordered

step #2 determination of the patient's problem(s)/nursing diagnosis - to make a diagnosis we must have done assessment in order to obtain as much data as possible. we need signs and symptoms. all diagnoses are based upon a collection of signs and symptoms. this is why your diagnostic statement consists of a problem (the nursing diagnosis), its etiology (the cause of the problem) and the evidence of the problem (signs and symptoms). it is all very logical. what makes it a tad frustrating when we are new at doing this is we can't use medical diagnoses and must re-word them into generic medical terminology. nanda calls it nursing language. if you use nanda taxonomy to write your nursing diagnoses you don't have to think as hard. the taxonomy actually has a lot of the related factors and signs and symptoms for all the nursing diagnoses already listed out. the difference between medical diagnoses and nursing diagnoses is that medical diagnoses are much more precise. there is no room for error in the diagnosing of something like pneumonia. nursing diagnoses, however, are more lax. while there is no doubt that deficient fluid volume is about dehydration, the patient doesn't have to have all the defining characteristics and there is a lot of leeway as to someone having deficient fluid volume or not. what i am saying is that there are a lot of shades of gray. it is because with nursing diagnoses we are dealing with patient's responses to medical conditions or their environment. a lot of the signs and symptoms are behavioral so they fluctuate.

ok, so the data that you did post is what needs to be paired with nursing diagnoses

• development and cognitive level is that of a 3-4 month old
  
• weight is well below the 3rd percentile
  
• cries when strangers approach her crib - i believe this is a normal trust vs, mistrust response
  

i have a copy of a taxonomy. i would not say the imbalanced nutrition: less than body requirements is a problem now because the gastric tube is in place. unless you have lab evidence of nutrition problems, the patient's feeding needs are now being met.

• delayed growth and development r/t nutritional deficit aeb development and cognitive level is that of a 3-4 month old and weight is well below the 3rd percentile
  
• i cannot diagnose acute pain because there are no symptoms for it.
  
• risk for impaired verbal communication r/t impaired ability to articulate secondary to cerebral palsy
  

step #3 planning (write measurable goals/outcomes and nursing interventions) - for each nursing diagnosis addressing each symptom that supports the diagnosis. you can also, in some cases, address the cause of the diagnosis.

regarding your proposed diagnoses. . .

• observe her physical responses
  
  
  • behavioral: changing body position, moaning, sighing, grimacing, withdrawal, crying, restlessness, muscle twitching, irritability, immobility
    
    
  • sympathetic response: pallor, elevated b/p, dilated pupils, skeletal muscle tension, dyspnea, tachycardia, diaphoresis
    
    
  • parasympathetic response: pallor, decreased b/p, bradycardia, nausea and vomiting, weakness, dizziness, loss of consciousness
    
    

• http://www.mdanderson.org/pdf/pted_painscale_faces.pdf
  - wong-baker faces pain rating scale
  
  

this is why i gave you weblinks for developmental tasks for a 3-month old. you need to look at what the expected developmental tasks are for a normal 14 month old child. the closest i could find online was for a 12 month old. what is your patient lacking? those are her developmental lags and symptoms for the delayed growth and development diagnosis. now, your interventions will be to look at what she can do. look at the websites. what are they saying you need to do with children to encourage them to move forward in their growth and development? read the websites about what kind of play and activities to engage in with them. those are your nics (interventions). what are the expected nocs with this? there is also a noc for child development: 4 months which is about where the developmental age of your patient is. these are the nocs listed (page 195, nursing outcomes classification (noc), third edition, by sue moorhead, marion johnson and meridean):

• holds head erect and raises body on hands while in prone position
  
• controls head well
  
• rolls over from prone to supine
  
• holds own hands
  
• grasps rattle
  
• reaches for objects
  
• bats at objects
  
• babbles and coos
  
• recognizes parents voices
  
• recognizes parents touch
  
• looks at and becomes excited by mobile
  
• smiles, laughs and squeals
  
• sleeps for at least 6 hours
  
• comforts self (e.g., falls asleep by self without breast or bottle)
  

the nocs for a diagnosis like risk for impaired verbal communication r/t impaired ability to articulate secondary to cerebral palsy which is an anticipated problem is to prevent the problem from happening. interventions are

• strategies to prevent the problem from happening in the first place
  
• monitoring for the specific signs and symptoms of this problem
  
• reporting any symptoms that do occur to the doctor or other concerned professional
  

you can find more on developmental milestones and interaction with babies on the pediatric websites posted on this sticky thread: https://allnurses.com/nursing-student-assistance/medical-disease-information-258109.html - medical disease information/treatment/procedures/test reference websites