Grand Rounds By Rebecca Berryman Focus The focus

Grand Rounds By: Rebecca Berryman

Focus • The focus of this presentation will be to introduce and discuss a patient I provided care for during clinical rotation at CHKD. • • Patient history and reason for admission Physical assessment Developmental Stage Nursing problems with expected outcomes Care interventions Teaching needs Application of current research

Patient Introduction • N. M. is an 11 year old, African American, Female • Birthday March 05, 2004 • This is her 2 nd admission related to burns • Diagnosis: Wounds not healing • Pt lives with her family in North Carolina • Siblings include 3 older brothers

Patient History • First admission was on February 22, 2015 • Came in with 20% Body Surface Area (BSA) Burns • Partial and Full thickness burns • Parents reported that the pt “fell into the stove and a pot of boiling water fell on her” • While family were in the room they were yelling at each other while pt sat in her bed

Assessment • Partial and Full thickness burns • Face, neck, clavicles, shoulders, and back • Patient was withdrawn and very depressed • Did not allow me to physically assess her

Developmental Theories Erikson • Pt is a school age child struggling with industry vs inferiority • Needs to face the demands of social and academic demands so that she can either succeed or fail • Pt will gain competence if she succeeds and feel more inferior if she fails. • Important to give her small tasks she can complete to fuel her towards competence Piaget • Pt is an adolescent • Concrete Operational • • Struggles with abstract thinking Very rigid Should be less egocentric Should be thinking logically

Concept Map • Nursing diagnosis • Acute pain • Imbalanced nutrition: Less than body requirements • • • Fluid imbalance Constipation Dysfunctional family processes Ineffective coping (pt is depressed) Skin Integrity Infection

Interrelatedness Between Nursing Problems • Pt’s pain was increased by depression • Medications could be a cause of constipation • Pt is not eating would could also be contributing to her constipation • The mother’s and grandmothers actions caused pt’s infection • Pt is depressed causing her not to eat • Pt’s skin integrity was affected by improper care

Plan of Care • The nurse and I tried to get the pt to eat but she refused • MD did say if pt kept refusing to eat then they would have to place an NG tube • Pt was receiving medications such as: Versed, Ibuprofen, Lactulose, Miralax, and Senna • • Dressing changes every 12 hours Child life was working with her Had a teacher working with her to keep her on track with her education Pt refused to work with Physical Therapy

Teaching Needs Patient • Significant nutritional teaching • NG tube • Burns • Unreceptive Family • What isolation does to a child • How to care for pt’s burn wounds • Malnutrition • Significance of nutrition after being burned • Never came to the hospital

Discharge Planning Needs • Wound care • Social services • Nutritionist • Financial issues

Research • Peadiatric Nurses’ Identification of Violence Against Children • Sample size: 160 nurses • This study was done in Poland • Questionnaire form • Largely focuses on nurses’ assessments, diagnostic skills, and interventions with child maltreatment • 61. 25% of the nurses reported working with a child that was maltreated • 30% mentioned some form of child neglect • Nurses need more specialized training on how to care for a maltreated child Pabiś, M. , Wrońska, I. , Ślusarska, B. , & Cuber, T. (2011). Paediatric nurses' identification of violence against children. Journal Of Advanced Nursing, 67(2), 384 -393. doi: 10. 1111/j. 1365 -2648. 2010. 05473. x

Summary • Patient was introduced and discussed • Patient history and reason for admission • Physical assessment • Developmental Stage • Nursing problems with expected outcomes • Care interventions • Teaching needs • Application of current research