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Pediatric Concept Map : Failure to Thrive

Krysta Quiner

10/12/2020

Failure To Thrive (FTT)

History of present illness

Failure to thrive does not have a universal definition, however it can be identified as “inadequate growth resulting from an inability to obtain or use calories required for growth” (Hockenberry, Wilson, & Rodgers, 2019). There are three parameters that are followed when diagnosing failure to thrive; the first is a drop of more than 2 percentiles from the original baseline for the child, the second is for the child to be persistently below the third to fifth percentile, and the third is for the child to be less than the 80th percentile for their median weight to height measurement.

History of present illness

This baby came in with a multitude of symptoms; respiratory failure, metabolic acidosis, dehydration, fever, leukocytosis, emesis, and diarrhea. A sepsis workup was done, but found to be negative. Due to the long term fever, diarrhea, and emesis, this infant fell below his correct percentile and was diagnosed with Failure to Thrive (FTT).

Subtopic 1

Past Medical History

Past Medical History

  • This infant was born at 37 1/7 weeks gestation via C-Section.
  • He was 3847 grams.
  • His APGARs were 8/9.
  • At birth, his bilirubin was high and was therefore placed under phototherapy for 24 hours.
  • He was positive for sickle cell trait.
  • Due to him being only 7 weeks old, his only two immunizations include Hep B, and Vitamin K.

Sickle Cell Trait

RBCs are usually round, but sickle cells are more elongated. This causes the cells to die more quickly and can cause a shortage of RBCs, or anemia. As well as the shape can cause the smaller blood vessels to become clogged much easier. This leads to many long-term issues.

Subtopic 2

Nutritional History

  • The patient was not eating well and had a long bout of diarrhea and emesis. This caused the patient's weight to decrease well below what it should be. This led to the Failure to Thrive diagnosis.
  • He was taking in 30ml every 3 hours and that was increased to 45ml every 3 hours as he was able to tolerate it and had no diarrhea/emesis for 24 hours.
  • The patient is now on TPN and has been for two days. This will make up for the lost calories that are not being taken in through oral feedings.

Nutritional History

Nutritional requirements

Infants require 100 cals/kg

Subtopic 3

Physical Exam Measurements

Physical Exam Measurements

  • Temp: 98.3 (axillary)
  • Pulse: 162
  • Resp: 42
  • BP: 98/78 (L calf)
  • SpO2: 100 (RA)
  • Musculoskeletal: tone increased on all 4 extremities (hypertonia)
  • Integumentary: scattered bruising from PIV attempts
  • Nutrition: infant diet, 45ml q3hr oral feedings with TPN running at 16ml/hr.
  • GI, cardiac, respiratory, and GU were all WDL for this infant.

Supporting Labs

  • Sepsis workup: negative
  • B-cell phenotype: abnormal
  • C. diff: negative
  • Resp. sputum culture: negative
  • Chest X-Ray: new atelectasis or pneumonitis in L base
  • ECHO: small PFO with left to right shunting
  • Glucose (70-100): 85 (on 10/1) to 118 (on 10/7) --> TPN started on 10/7
  • TPN can increase glucose
  • Anion Gap (6-22): 12 (on 10/1) to 8 (on 10/7)
  • Tells us if someone is experiencing acidosis
  • Albumin (2.8-4.7): 2.5 (on 10/1) to 3.1 (on 10/7)
  • indicator for nutrition status

Supporting Labs, etc.

Priority Nursing Diagnosis

Priority Nursing Diagnosis

Imbalanced nutrition: less than body requirements r/t insufficient dietary intake a/m/b frequent diarrhea and emesis.

Goal

Goal and Outcomes

Patient will tolerate an increase in oral feedings this shift.

Outcomes

  • Patient will have no emesis/diarrhea throughout the shift
  • Patient will tolerate and increase to 45ml of oral feedings every 3 hours

Title

Developmental Stage: Trust vs. Mistrust

Developmental Stage and Nursing Interventions

Nursing Interventions:

  • Before starting cares, use the 3 P's to allow the infant to warm up to you (peek-a-boo, piggies, patty-cake)
  • Involve the parents in as many cares as possible as the infant is used to them and trusts them, as well as this helps the parents feel more in control of their child's care.
  • Start with the least invasive cares, such as listening to heart and lungs, before doing the more invasive cares as the child is less likely to cry and skew lung/heart sounds.
  • Educate the parents on keeping track of the number of wet diapers the infant has as well as the color, consistency and amount of stool the infant has.

Evaluation of Goal

Evaluation of Goal

This goal was met and the evidence is that the patient did not have any emesis/diarrhea throughout the shift which in turn indicated the infant tolerated an increase from 30ml to 45ml every 3 hours.

Therapeutic Communication

Therapeutic Communication

  • Use the 3 P's to allow the infant to warm up to you
  • Do the least invasive cares that you can before considering the invasive cares
  • Cluster cares to allow the infant adequate sleep throughout the day and night
  • Much of the therapeutic communication will be directed towards the parents. Due to this being their first baby, it is important to explain what you are doing and what is going on with their baby. As well as respect their space.

References

References

Hockenberry, M., Wilson, D., & Rodgers, C. C. (2019).

Wong’s nursing care of infants and children (11th ed.). St. Louis, MO: Elsevier Health Sciences.

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