Pediatric Nursing Rounds

NURS 420 -Nursing Care Infants and Children

Purpose of Assignment
To provide the student an opportunity to integrate knowledge from the sciences,
developmental theory and physical assessment data to the care of a pediatric client and
family in the acute care setting. The student will utilize critical thinking and independent
judgments in presenting a holistic plan of care in a formal oral presentation.
Student Approach to Assignment
This assignment, completed during my pediatrics clinical, reflected my ability to analyze
and present the plan of care for a patient at Childrens Hospital Kings Daughters. This
assignment consisted of a twenty minute oral presentation that was provided to the class.
This assignment highlighted my ability to gather essential information to plan and
implement holistic care while strengthening my presentation skills. The patient that I
cared for was a twenty year old hispanic female who was diagnosed with acute
lymphoblastic leukemia. In the presentation I discussed the care plan provided and
explored the effects of chronic illness on the adolescent patient.
Reason for Inclusion of the Assignment in the Portfolio
This assignment was included in my portfolio because it required me to explore my
ability to comprise an effective plan of care while demonstrating my ability to provide an
organized and informative presentation. Furthermore, this assignment contributed to my
knowledge in tailoring my care to the pediatric client and being able to recognize
different developmental skills.
v Critical Thinking
Revises actions and goals based on evidence rather than conjecture.
This patient was taking an experimental therapy named blinatumomab.
Nursing management for this drug included a daily handwriting sample and
daily finger nose test. Since neurotoxicity was the biggest side effect with this
drug, it was imperative that the nurse obtained this data every four hours.
When we conducted the test, the patient demonstrated confusion with spelling
her name and had difficulties with the nose-finger test. The nurse immediately
contacted the physician, following protocol of the experimental therapy. This
intervention was beneficial because the physician was able to lower the dose
of the therapy drug, essentially reducing the side effect of the drug.
v Nursing Practice
Performs therapeutic interventions that incorporate principles of quality
management and proper safety techniques based on assessment findings.
Acute pain was a priority in the plan of care for this patient. The patient
consistently complained of pain and at times showed facial grimaces; when
asked her pain level on a scale of one to ten, she stated eight. To reduce the
pain, the patient was given morphine. She was also given Tylenol for her

headaches. The nurse and I also provided proper safety techniques as we

explained safety precautions about the PCA to the visitors. We informed them
that only the patient can use it. The nurse and I continually reassessed the
patient for respiratory depression, a common side effect of opioids.
Furthermore, the nurse and I made sure that the experimental therapy drug
was monitored according to the plan of care provided by the trial handbook.
This provided the patient with safe and effective care.
Establishes and/or utilizes outcome measures to evaluate the effectiveness of
care.
The patient demonstrated anxiety related to her situational crisis of
cancer, threat of death, and consistent hospitalization. This was evident
by depression, decreased use of social support, and her desire for
isolation. In addition to administering Zoloft and Ativan for her
depression, the nurse and I also used therapeutic communication by
providing empathy and providing care tailored to her developmental
level. We identified the outcome measure of patient exhibiting less
fear and were able to assess the effectiveness of care by continuously
assessing. We evaluated her by asking her questions that reflected her
affect and noted improvement. This demonstrated the effectiveness of
the medication and care provided.
v Communication
Adapts communication methods to patients with special needs.
The patient was very tired and fatigued and consistently complained of
a headache. We made sure that we spoke gently when we
communicated with her. Additionally, the patient had parents that
spoke Spanish so we made sure we provided a translator when
appropriate; this allowed them to comprehend the information and
gave them the opportunity to ask questions.
v Teaching
Provides relevant and sensitive health education information and counseling to
patient, and families, in a variety of situations and settings
The nurse and I made sure to educate the patient on infection control
and identifying signs and symptoms that requires medical attention.
We educated the patient on this since she was at risk for infection due
to immunosuppression. Furthermore, the use of interdisciplinary care
was reflected as the nutritionist worked with the patient to identify
adequate food for her treatment plan.

v Research
Shares research finding with colleagues
This assignment demonstrated the importance of an adolescent
psychosocial health related to cancer treatment. I learned that in the
adolescent patient, it is imperative that nurses provide support, comfort
and understanding so that the psychosocial component of the
individual is not affected. This research finding was applicable for this
patient and is essential to include in evidence based practice; I
included this information in the presentation to help my claamates
understand the importance of psycosocial health in an adolecent
patient.

v Leadership
Assumes a leadership role within ones scope of practice as a designer, manager
and coordinator of healthcare to meet the special needs of vulnerable populations
in a variety of practice settings.
The patient was very nauseous and kept complaining about the food
that she was being given. I advocated for the patient by calling the
cafeteria to change her orders. After they changed her order, I made
sure that the patient enjoyed every meal provided.
v Professionalism
Differentiates between general, institutional, and specialty" specific standards of
practice to guide nursing care.
According to the CHKD policy, nurses should be assessing fall risk
continuously and providing reassessments for those at an increased
risk. The nurse continuously assessed the patient for falls and made
sure that the floors were clear of objects that might contribute to falls.
This prevented any falls or accidents.
CHKD policy also states that if the patient has a pulse ox reading that
is not in the therapeutic range, the nurse has to make sure that the
physician is informed following a comprehensive respiratory
assessment. The use of this policy was seen as the nurse notified the
physician of a low pulse ox reading and providing an assessment
following her finding.
It is essential that pediatric nurses properly assess the childs
developmental level. This is important as it provides a baseline for
what interventions will be needed to promote optimal growth and
health. Upon assessment of our patient, me and the nurse agreed that
the patient seemed depressed and did not meet her developmental
level.
When the nurse wants an order based on a health complaint of a
patient, the nurse must receive an order from the physician to give the

medication based on the complaint. For example, the patient had

dilaudid but still had pain. Therefore, the nurse called the physician to
inform him and he put in an order for morphine.
v Culture
Considers the impact of research outcome and, the effects of health and social
policies, on persons from diverse backgrounds.
The research used for this project emphasized the need to acknowledge
the psychosocial effects that cancer has on adolescents. The patient
was a Hispanic female from Mexico. The nurse and I had to
incorporate different resources such as child life, counselors, and nonpharmacological interventions to promote developmental stimulation
and ensure that the child did not feel isolated. The use of these
resources positively impacted the psychosocial aspect of cancer