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Jasmine Nicholson Nurse 421 Grand Rounds. OBJECTIVES. To present a plan of care for a previous patient through introduction, physical assessment and history, nursing problems with plan of care, with research.
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OBJECTIVES To present a plan of care for a previous patient through introduction, physical assessment and history, nursing problems with plan of care, with research.
Welcome to the Hospital lets provide holistic careJJ 4 and2/3yoMedical Diagnoses: Neck Abscess(Surgery)POD1
Health History No health history on file Born healthy Youngest sibling out of 5 No prior hospitalizations No psychosocial history on file No visits from social work
Culture • Young parents with multiple children • Living in a large family with many siblings • First time hospitalizations
On The Visit • Chief reason for admission Abscess on neck • Primary medical diagnoses Infection as evidence by abscess in need of incision and drainage
On The Visit • Patho-physiology What is an abscess? An abscess results from pus gathering in a tissue of the body that has formed a cavity due to an infection. How does it start/form? A series of immune responses beginning with the migration of white blood cells to the infection and the separation of a fluid-filled cavity from the surrounding, healthy tissue.
On The Visit • Patho-physiology Why? Immune system compensates creating the pus that forms the abscess What is the pus? Mixture of dead cells and the chemical mediators of immune response, fills the area around the site, which is separated from healthy tissue by the formation of an abscess wall.
On The Visit • Treatment plan Antibiotic Clindamycin to treat infection and surgery to remove the puss (incision and drainage) • There is no secondary diagnosis
Measurements on Growing • Developmental Stage • What ‘s expected psychosocialy? • In using the psychosocial developmental theory by Erickson this child should be in the initiative vs guilt stage. In this stage it is important for the child to have exploration and play in order to gain accomplishment • Were expectations met? • YES
Measurements on Growing • Developmental Stage • How were expectations met? • Through observation • How did this effect care? • Did not try to limit the amount of time of child time. • We adjusted our schedules. • Praise for simple task completed so that he would that he was being “a good boy.”
Measurements on Growing • Developmental Stage • What ‘s expected cognitively? • In using the cognitive developmental theory by Piaget this child should be in intuitive part of the preoperational stage. There is a shift from totally egocentric thought to somewhat understanding others view points. Able to think and talk about what is going on inside their head without having to stop to act out their thinking • Were expectations met? • YES
Measurements on Growing • Developmental Stage • How were expectations met? • Through observation • How did this effect care? • Communication was adjusted. More active listening. • Encouraged trial and error before teaching.
Measurements on Growing • Other Developmental Manifestations • Personal • Takes frustration out on parents • Understands do’s and dont’s • Speech • Knows simple songs • Uses sentences of 5 words or more
Measurements on Growing • Other Developmental Manifestations • Fine Motor • Copies Drawings • Plays video games reliably • Gross Motor • Catches ball reliably • Skips on one foot
Measurements on Growing • Abnormal Physical Assessment • Cardiovascular • IV in right antecubital in infusing with 10mL/hr of Clidamycin • Blood pressure increased to 119/65 when norms are 70-106/42-63 because of anxiety and fear of unknown • Skin • Bandage of incision site with 4x4 gauze and hypafix dressing • Fluid Balance • Output > Input because of infection (insensible fluid loss)
Providing Total Care • General Nursing Care Interventions • Assessing site of incision when saturated • change dressing and use aseptic technique • Infection • Administering continuous infusion of Clindamycin • Comfort • Checking vital signs q 4 hrs including pain and bowel sounds
Providing Total Care • Holistic Care Interventions • “Pain” due to previous NPO status • Encourage small light foods first • Comfort • Position on non-affected side • Communication • Behavior • Understanding regressed behavior
Providing Total Care • Collaborative Care Interventions • Comfort • Child life, Parents
Providing Total Care • Alternative Care Interventions • Comfort • Dog Therapy
Providing Total Care • INCLUDES…. • General Nursing Care Interventions • Holistic Care Interventions • Collaborative Care Interventions • Alternative Care Interventions
Fear -> ComfortKnowledge Deficit of Parents-> Fear Comfort Knowledge Deficit of Parents-> ComfortKnowledge Deficit of Parents-> Fear -> ComfortImpaired Skin Integrity/Infection-> Comfort Impaired Skin Integrity/Infection-> Fear Impaired Skin Integrity> Fear -> Comfort Impaired Skin Integrity/Infection -> Further Infection
Teaching and Discharge Planning • Teaching • Parameters surrounding hospital stay • Assessing Child • Discharge Planning • Clindamycin information because of newly diagnosed med, may need pamphlet • Signs of Infection, may need pamphlet
Research NURSING SUPPORT FOR PARENTS OF HOSPITALIZED CHILDREN Sanjari, M. (2009). Nursing Support for Parents of Hospitalized Children. Issues In Comprehensive Pediatric Nursing, 32(3), 120-130. Background: Having a child in hospital is a stressful experience for most parents. Support from nurses can assist parents to maintain their parenting role and promote quality pediatric nursing care. Aims and objectives: The aim of the study is to describe the quality of nurse-parent support in Iranian parents of hospitalized children in pediatric sites.
Research NURSING SUPPORT FOR PARENTS OF HOSPITALIZED CHILDREN Sanjari, M. (2009). Nursing Support for Parents of Hospitalized Children. Issues In Comprehensive Pediatric Nursing, 32(3), 120-130. Methods: This was a descriptive study using a convenience sample. 230 parents (183 mothers and 47 fathers) with hospitalized children took part in this survey. There was 250 the others opted out. They were notified of what was going on and wanted to sign. Eliminated if they could not speak Farsi.
Research NURSING SUPPORT FOR PARENTS OF HOSPITALIZED CHILDREN Sanjari, M. (2009). Nursing Support for Parents of Hospitalized Children. Issues In Comprehensive Pediatric Nursing, 32(3), 120-130. Tool: The NPST is a 21-item questionnaire that was developed by Miles, Brunssen, & Carlson to assess the type of nursing support that parents received during the hospitalization of their child. The tool is classified into groups : Information Giving and Communication Support (nine items); Emotional Support (three items); Appraisal Support (four items) and Instrumental Support (five items). Scores range from 1 to 5 with higher scores showing a greater amount of support provided by the nursing staff.
Research NURSING SUPPORT FOR PARENTS OF HOSPITALIZED CHILDREN Sanjari, M. (2009). Nursing Support for Parents of Hospitalized Children. Issues In Comprehensive Pediatric Nursing, 32(3), 120-130. Discussion/Result: Based on the results, it can be said that the parents in this study received a high level of support (4.1 ± 0.7) from the nurses.
Research How does this relate to my patient? Nurses have an important role in assisting parents to define their role in the relationship between them and their critically ill child. A child is in the care of the parent, once the parent is reached, care of the child may be easier. Interrelatedness of Knowledge Deficit of Parents in treatment regimen.
Summary Presented a plan of care for a previous patient through introduction, physical assessment and history, nursing problems with plan of care, with research.
REFERENCE • Caramenico , G. (n.d.). Retrieved from http://www.wisegeek.com/what-is-the- pathophysiology-of-an-abscess.htm • Google media images • Hockenberry, M. J., & Wilson, D. (2011). Wong's essentials of pediatric nursing (9th ed.). St. Louis, MO: MosbyElsevier. • Sanjari, M. (2009). Nursing Support for Parents of Hospitalized Children. Issues In Comprehensive Pediatric Nursing, 32(3), 120-130.
