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1. outcome met. pt was able to verbalize an acceptable pain level of 1 out of 10

2. outcome me. we were able to distract him by having him watch movies as well as play on his ipad

3. outcome met. pt verbalized when his pain was not controlled and got above a 1

1. outcome met. pt was urinating frequently and more than 30mls/hr.

2. outcome met. patient maintained well hydration and did not show any signs of dehydration.

3. outcome not met. Pt has not yet been discharged from the hospital.

1. outcome met. mom verbalized that she will make sure he finishes all home abx and understood the importance of it.

2. outcome met. mom was able to tell me signs and symptoms of infection and that she will take him into his PCP if he presents with any symptoms.

3. outcome not met because pt has not been discharged.

Nursing Diagnoses

Medications

Vitals

  • Acetaminophen 320 mg=10 mL PO Q6

This medication is being given to help control his pain after surgery

  • Zosyn 2,720mg= 54.5 mL IVPB Q6

This is an ABX that is being given to help fight any infection he has and to help prevent an infection from growing

CONTINUOUS INFUSIONS:

  • D5% NaCl 0.45% + KCl 20 mEq/L at 70 mL/hr

This is to keep him hydrated

Knowledge deficit related to lack exposure AEB the development of preventable complications (i.e. ruptured appendix), questions about post-op care & infection, and home antibiotics.

  • Temp: 37 C
  • BP: 117/79
  • RR: 24
  • HR: 87
  • Oxygen sat: 100 on room air
  • Pain: 3 out of 10

Acute pain related to recent surgery for ruptured appendix as evidence by reporting pain of 3/10 and reporting pain/abdominal discomfort when abdomen is palpated.

LABS

Desired Outcomes

Desired outcomes

1. Patient will verbalize an acceptable pain number at the beginning of my shift.

2.Patient will use non-pharmacological interventions strategies for pain relief on my shift.

3. Patient will verbalize pain before it reaches 2/10 on the pain scale for the remainder length of stay in the hospital.

Interventions

1. Patient and family will verbalize the importance of taking all prescribed home antibiotics on my shift.

2. Patient and family will verbalize signs and symptoms of infection on my shift.

3. Patient and family will verbalize proper care of incision site to help prevent infection by discharge.

1. Nurse will ask the patient to identify a pain level that will allow the patient to perform necessary or desired activities easily.

Rationale: The relationship between pain level and functional goals should be a major focus in the development of individualized pain management plans (McCaffery, Herr & Pasero, 2011)

2. Nurse will teach patient ways to manage acute pain using non-pharmacological interventions.

Rationale: Complementary therapies such as relaxation, distraction, hypontics, art therapies, and imagery may play an important role in holistic pain management (Bouza, 2009)

3. Nurse will assess acceptable pain intensity level using a valid and reliable self-reporting pain tool, such as 0-10 numerical pain rating scale.

Rationale: The first step in pain assessment is to determine if the patient can provide a self report. Ask the patient to rate pain intensity using a valid and reliable self report pain tool. (Breivik et al, 2008).

Assessment

Interventions

1. Nurse will inform the parents about how important it is for the child to finish all prescribed home antibiotics.

Rationale: Restriction and proper use of antibiotics are important for reducing and preventing harmful adverse effects to the patients and preventing antibiotic resistance. (VanRossem, Schreinemacher, VanGeloven, & Bemelman, 2016)

2. Nurse will go over signs and symptoms of infection with the family

Rationale: If you have any symptoms of an infection, such as redness, pain at the surgery site, drainage, fever, call your doctor immediately (CDC, n.d.)

3. Nurse will teach the patient about the importance of not soaking in a bath or hot tub

Rationale: Longer showering or bathing (>10 min) unnecessarily increases the risk of skin infection (Ubbink, Brölmann, Go, Vermeulen, 2015)

Neurologic: alert oriented x4. age appropriate interactions

Musculoskeletory: normal tone. normal ROM, no edema present.

Cardiac: regular and strong heartbeat. Normal S1 and S2. no murmurs. Cap refill less than 3. pedal and radial pulses are 2+ bilaterally

Respiratory: clear bilaterally. no wheezes or crackles. symmetric rise/fall of chest. no signs of increase WOB.

Integumentary: warm, dry, well perfused skin. no bruising or cyanosis present. appy site was covered with steri-strips and dressing is clean dry and intact with no signs of infection.

GI: Abdomen is soft and tender to the touch. normoactive bowel sounds. no guarding or rebound tenderness present.

  • CBC: WBC 10.8 with 72.8% Neutrophils (These were the only charted labs in the H&P. No other labs were drawn on his admission).

This was ordered to check to see if the patient has any infection. Because of his Dx of ruptured appendix, the Drs were looking for elevated WBCs, especially neutrophils

  • UA: Negative for leukocytes, nitrates, WBCs, and bacteria.

This was ordered to check if the pt had a UTI.

Risk for fluid volume deficit related to fluid volume loss and inadequate fluid volume intake AEB vomiting/diarrhea for 6 days, NPO pre-op and post-op, and lack of interest to oral rehydrate after taken off NPO restrictions.

Desired Outcomes

1. Patient will maintain a urine output of at least 0.5 ml/kg/hr on my shift.

2. Patient will maintain good hydration on my shift.

3. Patient and family members will be able to identify signs of dehydration by discharge.

Interventions

1. Nurse will monitor I & O every 4 hours.

Rationale: A urine output of less than 0.5 ml/kg/hr is insufficient for normal renal function and indicates hypovolemia (Scales & Pilsworth, 2008).

2. Nurse will provide oral hydration fluids every 2 hours.

Rationale: Oral fluid therapy is recommended by the American Academy of Pediatrics and the WHO and should be used for children with mild to moderate dehydration (Cellucci, 2017)

3. Nurse will teach the patient and family key signs of dehydration

Rationale: Signs of dehydration include, few to no tears, sunken eyes, urinates less frequently, fussy, and plays less than normal (Signs of dehydration in infants & children, 2015).

Pathophysiology

Patient Demographics

Appendicitis

Evaluations

An appendix is a finger-shaped pouch that projects from your colon and does not have a specific purpose. The cause of acute appendicitis is almost always as a result from an obstruction in the lumen of the appendix (London et al., 2017). It can be caused by a hard fecal mass, parasitic infestations, stenosis, hyperplasia of lymphoid tissue, or a tumor. Ischemia, cellular death, and ulcerations can occur because of increased pressure from the build up of mucus secretions (London et al., 2017). Appendicitis causes pain in the lower right quadrant, but typically begins around the bellybutton. As the inflammation worsens, the pain tends to increase and become more severe. The appendix can rupture resulting in fecal and bacterial contamination of the peritoneum which can cause an infection and if not treated result in small bowl obstruction, electrolyte imbalance, septicemia, and hypovolemic shock (London et al., 2017).

  • W.W.
  • 9 y/o male
  • Caucasian
  • Wt 27 kg
  • NKA
  • Primary DX:
  • Ruptured Appendix

Health history

  • ADHD
  • Asthma
  • Seasonal allergies

Peds Concept Map

Janelle Randall

Northern Arizona University

411L

References

Patient W.W.

  • Bouza, H. (2009). The impact of pain in theimmature brain. J Matern Fetal Neonatal Med 11:1-11
  • Breivik, H. (2008). Assessment of pain. Br J Anaesth. 101 (1):17-24
  • CDC. (n.d.) Frequently asked questions about surgical site infections
  • Cellucci, F., MD . (2017, July). Oral Rehydration - Pediatrics. Retrieved from https://www.merckmanuals.com/professional/pediatrics/dehydration-and-fluid-therapy-in-children/oral-rehydration
  • London, M. L., Ladewig, P. R., Davidson, M. R., Ball, J. W., McGillis-Bindler, R. C., & Cowen, K. J. (2017). Maternal & child nursing care (5th ed.). Columbus: Pearson.
  • McCaffery M, Herr K, Pasero C. (2011). Pain assessment and pharmacologic management. Mosby Elseveir.
  • Scales, K., & Pilsworth, J. (2008). The importance of fluid balance in clinical practice. Nurs Stand 22(47):50-57.
  • Signs of Dehydration in Infants & Children. (2015, November). Retrieved from https://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/dehydration.aspx
  • Ubbink, D. T., Brölmann, F. E., Go, P. M. N. Y. H., & Vermeulen, H. (2015). Evidence-Based Care of Acute Wounds: A Perspective. Advances in Wound Care, 4(5), 286–294.
  • VanRossem C.C., Schreinemacher M.H.F., VanGeloven A.A.W., Bemelman W.A. (2016). Antibiotic Duration After Laparoscopic Appendectomy for Acute Complicated Appendicitis. JAMA Surg. 151(4):323–329. doi:10.1001/jamasurg.2015.4236

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