Pediatric Concept Map

Past Medical History

• Full Code
• Allergies: soy, eggs, milk
• Health hx: born at 36 weeks 4 days, drug exposure in utero (cocaine, THC), umbilical hernia (followed by peds surgery), oropharyngeal dysphagia (current with speech therapy), eczema

Pediatric Concept Map - NURS 292

Grace Kelemen

Physical Assessment/Labs

• Diet: General 6m-12m
• Nutritional Supplements: Similac Alimentum Formula
• HEENT: thick, white nasal drainage, congestion
• Resp: adventitious lung sounds - coarse, wheezing. Tachypnea. Non-productive cough. Room air.
• Cardio: WNL
• Neuro: WNL
• GI: umbilical hernia
• GU: WNL
• MSK: WNL
• Skin: eczema

Discharge Plan

• Weight: 11.2 kg
• Height: 29 in

Vitals:

• T: 97.5 F
• P: 122
• R: 40
• Po2: 100%
• B/P: n/a

Labs:

• Respiratory Panel: RSV positive, the rest were negative

• UTD on all Immunizations

• Home with foster mom: who will continue to monitor and treat pts symptoms as ordered by provider until resolved
• Follow up appt with PCP
• Medical equipment needed: nebulizer machine (care management to send script prior to discharge)

Medications

• Albuterol (proventil, ventolin) 3mL nebulizer treatment every 4 hrs
• Prednisolone Sodium Phosphate (Orapred) 3mg/mL : 0.5mg/kg/day x 11.2kg = 0.92mL oral 2x daily
• Acetaminophen (Tylenol) 160mg/5 mL : 15mg/kg x 11.2kg =169.6mg every 4 hrs PRN for discomfort with fever greater than 100.4 F
• Ibuprofen (Advil, Motrin) 100mg/5mL : 10mg/kg x 11.2kg = 112mg every 6 hours PRN for discomfort with fever greater than 100.4 F

Education prior to Discharge

Chief Complaint:

• Print out of all discharge education given to foster parent
• Home nebulizer machine: how to use it, hygiene/cleaning it
• Medication to continue at home, dosing, side effects, etc
• Congestion: can turn on hot water in shower and sit in the bathroom with the door closed with the infant on your lap for 10 minutes. The hot steam will help loosen mucous secretions and then bulb suctioning will help promote ease of breathing.
• Hand washing & seclusion from other children and family until symptoms resolved- to prevent spread of infection
• Signs/symptoms of respiratory distress - bring child back to ED immediately
• Importance of good nutrition, increased fluids, and promoting rest to conserve energy to continue at home to help fight infection and promote healing

• A 10 month old African American female was brought to the ED by her foster mother c/o difficulty breathing the last few days.

• Symptoms: runny nose, congestion, cough (inducing vomiting at times), fever, decreased urinary output, decreased oral intake (food and fluids).

• Dx: Respiratory Syncytial Virus (RSV) : is a common respiratory virus that infects the nose, throat, lungs, breathing passages. RSV spreads through contact with respiratory droplets (coughing, sneezing, kissing) from an infected person or touching surfaces contaminated with the virus and then touching your eyes, nose, mouth.

Current Treatment

Potential Nursing Diagnosis #2

• Droplet Isolation
• Continuous Pulse oximetry
• Strict I/O
• Saline nasal drops & Wall suction with nasal aspirator PRN
• Oxygen PRN
• Vitals every 4 hours
• Medication to help manage symptoms

At risk for hyperthermia related to dehydration as evidenced by irritability, tachypnea, and warm skin.

Goal: pt will maintain core body temperature less than 100.4 F for the rest of the shift.

1. Monitor pts temperature every 4 hrs

Rationale: to determine if additional interventions are needed

2. Administer antipyretics (Tylenol) for temperature 100.4 F or higher

Rationale: to reduce fever and ease discomfort

3. Encourage oral fluid intake every hour

Rationale: to replace fluids lost from sweating due to fever

4. Apply cool wet wash cloths/ ice to forehead, armpits, back of neck etc

Rationale: to help reduce fever, and ease discomfort

5. Remove excess clothing and blankets

Rationale: infants are unable to regulate their body temperature

Evaluation: goal met. Pt did not develop a fever during the shift.

Growth and Development

Nursing Diagnosis #1

Potential Nursing Diagnosis #1

• Gross motor: pull self up from a seated position, cruising around while holding onto furniture
• Fine motor: feeds self finger foods
• Socialization: waves bye-bye, imitates facial expressions
• Play: pat-a-cake, peek-a-boo
• Psychosocial: Erikson's: Trust vs Mistrust
• Cognitive: Piaget's: Sensorimotor Stage
• Environmental: Lives with foster mom, only child in the home.
• Maslows: Safety needs - due to illness/hospitalization
• Emotional Needs: feelings of security and love

Ineffective airway clearance related to excessive mucous production as evidenced by adventitious breath sounds, ineffective cough, and nasal drainage.

Goal: pt will maintain a patent airway as evidenced by oxygen saturation levels above 90% for the rest of the shift

1. Elevate HOB 30 degrees or hold child in an upright position when sleeping

Rationale: this position promotes better lung expansion and improved air exchange

2. Encourage fluid intake (water, pedialyte) sips every 10 minutes during the day.

Rationale: helps loosen and move thickened sections

3. Administer saline nasal drops (2-3 drops per nostril) then suction with bulb syringe or nasal aspirator before feeding, sleeping and PRN.

Rationale: nasal drops - help loosen secretions. Suction - to relieve nasal congestion and ease breathing

4. Encourage activity or repositioning on each side

Rationale: prevents accumulation of pooling of secretions and body movement helps mobilize secretions

5. Monitor oxygen saturation with continuous pulse oximeter

Rationale: to obtain an accurate assessment of pts oxygen level to determine effectiveness of therapies

Evaluation: goal met. pt maintained a continuous pulse oximeter reading of above 90% for the entire shift.

At risk for fluid volume deficit related to decreased oral fluid intake as evidenced by decreased urinary output, vomiting, and fever.

Goal: pt will maintain adequate fluid intake with out vomiting and stay fever free during the shift.

1. Monitor strict I/O: weighing diapers, recording PO intake, daily wt etc.

Rationale: a key indicator of a pts fluid status is an accurate measurement of fluid I/O.

2. Encourage fluid intake (water, pedialyte) sips every 10 minutes during the day

Rationale: promotes hydration and to replace fluids losses.

3. Remove excess clothing or blankets from child especially at night

Rationale: infants are unable to regulate temperature, leading to sweating which decreases fluid volume

4. Administer Tylenol for discomfort related to fever above 100.4 F

Rationale: for pain relief and to help decrease fever

5. Hydrate with IV fluids

Rationale: If pt is unable to keep oral fluids down or not taking in enough, IV fluids can be used for hydration

Evaluation: partially met. pt did vomit after morning feeding due to coughing to hard, but did stay fever free.