Jasmine Nicholson Nurse 421 Grand Rounds

Jasmine NicholsonNurse 421Grand 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.

Welcome to the Hospital lets provide holistic careJJ 4 and2/3yoMedical Diagnoses: Neck Abscess(Surgery)POD1

Health History

No health history on fileBorn healthyYoungest sibling out of 5No prior hospitalizationsNo 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

• Chief reason for admission Abscess on neck• Primary medical diagnosesInfection as evidence by abscess inneed of incision and drainage

On The Visit

• Patho-physiologyWhat 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-physiologyWhy? Immune system compensates creating the pus that

forms the abscessWhat 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

On The Visit

Measurements

on GrowingDevelopmental 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 accomplishmentWere expectations met?YES

Measurements

on GrowingDevelopmental Stage How were expectations met? Through observationHow 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 GrowingDevelopmental 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 GrowingDevelopmental Stage How were expectations met? Through observationHow did this effect care?Communication was adjusted. More active listening.Encouraged trial and error before teaching.

Measurements

on GrowingOther Developmental Manifestations PersonalTakes frustration out on parentsUnderstands do’s and dont’sSpeechKnows simple songsUses sentences of 5 words or more

Measurements

on GrowingOther Developmental Manifestations Fine Motor Copies DrawingsPlays video games reliablyGross MotorCatches ball reliablySkips on one foot

Measurements

on GrowingAbnormal Physical Assessment CardiovascularIV in right antecubital in infusing with 10mL/hr of ClidamycinBlood pressure increased to 119/65 when norms are 70-106/42-63 because of anxiety and fear of unknown SkinBandage of incision site with 4x4 gauze and hypafix dressing Fluid BalanceOutput > Input because of infection (insensible fluid loss)

Providing TotalCare

Providing Total CareGeneral Nursing Care InterventionsAssessing site of incision when saturatedchange dressing and use aseptic technique

InfectionAdministering continuous infusion of Clindamycin

ComfortChecking vital signs q 4 hrs including pain and bowel sounds

Providing Total Care

Holistic Care Interventions“Pain” due to previous NPO statusEncourage small light foods first ComfortPosition on non-affected sideCommunication BehaviorUnderstanding regressed behavior


Collaborative Care Interventions

ComfortChild life, Parents


Alternative Care Interventions

ComfortDog Therapy

Providing Total CareINCLUDES….

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

TeachingParameters surrounding hospital stayAssessing Child

Discharge PlanningClindamycin information because of newly diagnosed med, may need pamphlet Signs of Infection, may need pamphlet

ResearchNURSING SUPPORT FOR PARENTS OF HOSPITALIZED

CHILDREN

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.

Sanjari, M. (2009). Nursing Support for Parents of Hospitalized Children. Issues In Comprehensive Pediatric Nursing, 32(3), 120-130.


CHILDREN

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.



CHILDREN

Tool: The NPST is a 21-item questionnaire that was developed by Miles, Brunssen, & Carlson to assess the type of nursing support thatparents 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.



CHILDREN

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.


ResearchHow does this relate to my patient?

Nurses have an important role in assisting parents todefine 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.

Jasmine Nicholson Nurse 421 Grand Rounds

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