trauma in peds

[425april, ASN, RN]

I had a 15 yr old in PICU yesterday with a left subdural hematoma, and other complications that have him with GCS of 5, 2 on the vent, and can wiggle his toes on left side. I need to do a care plan on him, and I am a 3rd semester student. I think they plan to trache him in a few days .His I&Os are good, so his kidneys are perfusing. No problems cardiac. My first priority is airway, however for the second I am a little confused. He is slightly alkalotic, metabolically and now has strep. pnemon. Should my second DX be related to the alkalosis or the strep. They are related , and I feel that the infection is due to the increased secretions in the lung field, plus he had a pneumothorax that resolved enough to remove the chest tube. any advice?

[Daytonite, BSN, RN]

clarify for me. . .are you a medical student or a nursing student? i can understand both being so interested in the medical diagnoses, but we nurses are more interested in the patient's responses to them. what that means is that before you even start thinking about nursing diagnoses you have to start determining what this little guys responses, or symptoms, are to his current conditions. you started to list some of it, but i know you missed a lot more (i worked on a neuro unit for 2 years). hint: it isn't subdural hematoma, strep pneumonia or pneumothorax. another hint: follow the nursing process.

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 based upon the abnormal assessment data)
   
4. implementation (initiate the care plan)
   
5. evaluation (determine if goals/outcomes have been met)

yet another hint: use a nanda nursing diagnosis reference or a care plan book that includes the nanda reference information to find the "related to" information (related factors, etiologies) for each nursing diagnosis you end up choosing.

"i feel that the infection is due to the increased secretions in the lung field". the increased secretions are a result of the debris from the cells fighting off the invading bacteria and a response to irritation from the various biological chemicals that have flooded into the area to fight the infection. (https://allnurses.com/forums/f205/pulmonary-tuberculosis-pneumonia-pathophysio-273191.html)

see the information on

• https://allnurses.com/forums/f50/help-care-plans-286986.html - assistance - help with care plans
  

[425april, ASN, RN]

I am a nursing student, 3rd semester. this was a clinical rotation. I had trouble putting all the lab info, and ABG results together. THere was just so much, it is hard to think through. Thanks for the great sheets on critical thinking. That will help me find my way.