Clinical Case Study 7: Failure to Thrive
Evonna Barnes
Kristine Corona
Scenario:
Comprehensive
Patient
Scenario
Lisa has brought in her daughter, Mai, to the emergency room following her 6 month well baby check up. The pediatrician called in ahead of time to discuss her concerns regarding the child's weight. Mai was born at 39 weeks gestation and weighed 3.09 kg (6.8 lbs). She was 3.6 kg (7.9 lbs) 3 months ago. She is currently 4.34 kg (9.5 lbs). Lisa states that she did not smoke or drink throughout her pregnancy and that she did not have any problems during delivery. She does state that she is frustrated during feedings. She states that Mai does not latch very well and when she does it hurts too much to continue to feed her. She has since switched to formula.
Demographics
- Mai
- Female
- Born October 20th 2021
- Resides with mother, Lisa, a food service worker
Cultural background
- Asian
- English is primary language
- No religious affiliation
Psychosocial factors
- Lisa is primary care provider(stressful environment)
- Lisa works as a waitress (low socioeconomic status)
Demographics
Health History
- Vaginal delivery after 39 weeks gestation
- No known allergy
- Immunization up to date
- Bottle fed 4 oz every 5 hrs.
- "She never wants to eat, she's just wants to cry all the time” per mother
Health
History & Health Assessment
Health assessment
- HR - 160, RR - 30
- Head circumference - 14 in
- Height - 24 in
- Weight - 4.34 kg
- Hair and skin are dry, nails are brittle
- Pale conjunctiva
- Poor muscle tone
- Abdominal distention
- Flat affect, irritable, lethargic
- Delayed gross motor skills
- Unable to sit on a tripod at 6 months.
- Have difficulty rolling from supine to prone and back, presence of head lag
Cultural and Psychosocial Factors -- delete slide
Cultural
and
Psychosocial
Factors
Cultural
- Asian
- English is primary language
- No religious affiliation
Pyschosocial
- Lisa is primary care provider(stressful environment)
- Lisa works as a waitress (low socioeconomic status)
Erickson's Stage and Impact
Growth
and
Development
Pathophysiology
Pathophysiology
Failure to thrive (FTT) can be due to organic or inorganic causes. The underlying issue of both causes is the lack of necessary calories needed for growth and development. This could be from inadequate calorie intake, excess loss of calories, or increased caloric demand. Inorganic causes are more common and are due to reasons outside from getting enough calories such as poor feeding skills, parental neglect, impaired parent-child interaction, or lack of proper feeding knowledge
Labs and Diagnostic Tests
- CBC - to test anemia
- Iron panel - to test iron deficiency
- Metabolic panel - to assess electrolyte and hydration status, liver and kidney function
- Erythrocyte sedimentation rate (ESR) - useful to identify underlying inflammation
- Prealbumin - assess overall nutrition status
- TSH & Free T4
- Urinalysis - to assess kidney function
- Chest X-ray
- ECG/echocardiogram
- Endoscopy
- Enteral tube feeding
Labs & Diagnostic tests
Diagnostic Tests and Procedures
delete slide
Diagnostic
Test/Procedures
Chest X-ray
ECG/echocardiogram
Endoscopy
Enteral tube feeding
Clinical Manifestations
- Less than 5th percentile on growth chart
- Malnourished appearance
- No fear of strangers
- Minimal smiling
- Decreased activity level
- Withdrawal behavior
- Developmental delays
- Feeding disorder
- Wide-eyed gaze
- Stiff or flaccid body
Treatment
- Reverse the cause of the growth failure by correcting nutritional deficiencies and achieve ideal weight for height
- Nutrition management
- Nasogastric tube until patient is able to eat on his own again
Diagnosis:
Ineffective infant feeding dynamics as evidenced by food intake less than daily allowance
Nursing Diagnosis 1
Intervention:
1. Maintain adequate nutrition and fluid intake
- Schedule meals every 2-3 hours
- Document intake and outake
2. Assist mothers to identify infant engagement and disengagement cues during breastfeeding or formula feeding
- Provide a relaxing environment during feeding time and teach how to encourage the child to eat
3. Demonstrate proper positioning of infant during feeding
- Use return demonstration, illustration
Risk of delayed child development
Nursing Diagnosis 2
Intervention:
1. Educate on the importance of responding to infants needs in a consistent and timely manner
- Responding to the infant's basic needs (feeding, changing diapers, holding) will create a sense of trust in the infant
2. Provide age-appropriate patterns of development to parent and promote activities and interaction appropriate to the client
- At 6 months, infant should be able to grasp a rattle, and release object in one hand to take another
- Appropriate toys to give: unbreakable mirror, rattle, singing elmo, light stimulating toys
3. Collaborate with other health professionals such as PT. OT, nutritionist, and family therapist
- To catch up on the desired nutrition status and developmental capabilities