Beruflich Dokumente
Kultur Dokumente
Grand Rounds
Margaret Clough, Student Nurse
Objectives
To apply physical assessment data to the care
of a pediatric client and family in the acute care
setting
Utilize critical thinking and independent
judgments
Understand a holistic plan of care for a pediatric
patient with Bowel Obstruction
Review applicable research to the patient
Patient Introduction
1o month old
Female
Presented with
emesis,
personality change
intolerance to feedings
decreased activity
Dehydration
mild acidosis
hyperkalemia
Bowel Obstruction
Pathophysiology
When the passage of
nutrients and secretions
is impeded by a
constricted or occluded
lumen, or when these is
impaired motility.
Characterized by:
abdominal pain, nausea,
vomiting, abdominal
distention, and change in
stool patterns
Patient Introduction
Post op day 9
and 10
Primary
Medical Dx:
Bowel
Obstruction
Secondary
Medical Dx:
Congenital
diaphragmati
c hernia
Cultural
Considerations
Single mom
Low
socioeconomic
status
Frequent
Hospitalizations
Assessment
Single parent
Several female
influences
Patient tolerated PO
feedings post-op day
10
Fed herself with
bottle
Regular BMs
Appropriate I&O
VS w/in normal limits
Alert and Oriented
Sucking, swallowing,
giggling
Abdomen soft and
non-distended
Incision on abdomen
clean, symmetrical,
and dressing intact
Positive family
bonding, several
visitors
Developmental age
appropriate
Development
Eriksons :
Trust Vs.
Mistrust
Understand
behavioral
cues
Piagets
Cognitive
Development
Sensorimotor
Phase
Nursing Diagnoses
1. Readiness for Enhanced Nutrition
2. Interrupted family processes
3. Risk for Infection
4. Risk for imbalanced nutrition: less than
body requirements related to risk for
altered body composition
5. Risk for Acute Pain related to extensive
exploratory laparoscopic surgery
Readiness for
Enhanced Nutrition
Supporting Data:
Successful bowel movement
absence of vomiting after PO intake
expresses willingness to enhance nutrition
by reaching for bottle
Labs:
TPN panel, metabolic panel, glucose check
Readiness For
Enhanced Nutrition
Nursing Interventions:
Educate mother on proper nutrition for
patient
monitor bowel movements and bowel
sounds
assess tolerance of PO intake
determine patterns of hunger
Wean from TPN
Readiness For
Enhanced Nutrition
Expected Outcome: Patient engages
in feeding herself with a bottle and
tolerates PO feeding.
Evaluation: The patient was able to
appropriately reach for the bottle and
tolerate PO feeding on the day of
discharge as evidence by the absence
of emesis. Last bowel movement was
recorded 9/29.
Nursing Interventions:
maintain potassium <3.89
mEq/kg/day
Maintain calcium <1.94
mEq/kg/day
consult a dietician regarding TPN
order
assess for the signs and
symptoms of electrolyte
imbalance
monitor triglycerides
assess hyper/hypoglycemia,
Interrupted Family
Processes
Supporting Data:
Interrupted Family
Processes
Nursing Interventions:
Assess caregiver-care
recipient relationship
teach stress-reducing
techniques
assess familial
communication patterns
provide illness
information,
management strategies
Interrupted Family
Processes
Expected Outcome: Before discharge, the caregiver will
express satisfaction with caregiving role, demonstrate
confidence in post discharge care, recognize available
resources, and demonstrate flexibility and understanding
towards health issues.
Evaluation: The patients primary caregiver demonstrated
satisfaction after feeding the patient on the day of discharge
by smiling and interacting with the patient positively. She
expressed excitement to get home, as well as, appropriate
understanding of signs and symptoms that would indicate
return to the hospital. The caregiver addressed day care as
an available resource in the community. She discussed
helpful sources within her family as her mother,
grandmother, and brother.
activity
Personality
fatigue
comfort level
Interrupte
d Family
Processes
Readiness
for
enhanced
nutrition
Risk For
Infection
Bowel
Obstruction
secondary to
intraperitoneal
adhesions and
intestinal
malrotation
Risk for
imbalance
d nutrition
Risk for
acute pain
Discharge Planning
Parent Teaching
How to clean incision
How to maintain appropriate I/O
s/s of emergent complications
(including hyperglycemia)
3 week check back
Research
Predictors of parent post-traumatic stress symptoms after child
hospitalization on general pediatric wards: A prospective cohort
study
Objective: The aim of this study was to identify predictors of parental
post-traumatic stress symptoms following child hospitalization
Conclusions:
one quarter of parents of children hospitalized on pediatric (non-intensive
care) wards experienced significant post-traumatic stress symptoms
after their childs discharge.
Parents hospital-related anxiety, uncertainty and use of negative
coping strategies are potentially modifiable factors
Ruther research is urgently needed to test the effectiveness of different
methods to provide psychological, emotional and instrumental support for
parents, focusing on increasing parent coping resources and reducing
distress during hospitalization.
Research
Comments?
Thank you!
References
Franck, L. S., Wray, J., Gay, C., Dearmun, A. K., Lee, K., & Cooper,
B. A. (2015). Predictors of parent post-traumatic stress symptoms
after child hospitalization on general pediatric wards: A
prospective cohort study. International Journal Of Nursing Studies,
5210-21. doi:10.1016/j.ijnurstu.2014.06.011
Gulanick, Meg; Myers, Judith L. (2013-02-05). Nursing Care Plans:
Nursing Diagnosis and Intervention (Kindle Location 1329).
Elsevier Health Sciences. Kindle Edition.
Mosby (2012-11-29). Mosby's Dictionary of Medicine, Nursing &
Health Professions (Kindle Locations 61798-61805, 78160).
Elsevier Health Sciences. Kindle Edition.
Wong, D. L., Hockenberry, M. J., & Wilson, D. (2011). Wong's
nursing care of infants and children. St. Louis, Mo: Mosby/Elsevier.